Figure 17 - uploaded by Jamal Rahaman
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Postirradiation fibrosis in a patient with cervical cancer who had undergone hysterectomy and radiation therapy. (a) CT scan shows an ill-defined soft-tissue mass in the presacral region (arrow), a finding that represents therapy-induced fibrosis. Two foci of urine activity (arrowheads) are seen in the posteriorly displaced urinary bladder immediately anterior to the presacral mass. Irregular fibrotic changes in the presacral space pose a significant challenge in differentiating recurrent tumor from therapy-induced change at CT. (b, c) On a PET scan (b) and fused PET/CT image (c), the mass (arrow) is nonhypermetabolic. Arrowheads indicate the foci of urine activity.
Source publication
The prognosis of invasive cervical cancer is based on the stage, size, and histologic grade of the primary tumor and the status of the lymph nodes. Assessment of disease stage is essential in determining proper management in individual cases. In the posttherapy setting, the timely detection of recurrence is essential for guiding management and may...
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Cervical cancer affects 570,000 women globally and is among the most common causes of cancer-related deaths. Cervical cancer is caused due to the Human Papilloma Virus (HPV) which leads to abnormal growth of cells in the cervix region. Regular testing for HPV in women has helped reduce the death rate in developed countries. However, developing nati...
Citations
... Due to the excellent feature of high sensitivity in PET and SPECT, the amount of contrast used can be reduced to pico-mole or nano-mole levels. In this regard, the radioactivity of radiolabeled probes should be obsessively determined by a dose calibrator depending on the type of procedure [99]. ...
A variety of imaging modalities include X-ray-based Computed Tomography (CT) scan, Ultrasound (US), Magnetic Resonance Imaging (MRI), Nuclear Medical Imaging (NMI), and Optical Imaging (OI) are used to help diagnose and treat diseases through anatomical, physiological, and functional representation. With the advent of molecular imaging using nanoparticles, detailed information about properties is provided and facilitates early detection of malignancies. Now, novel approaches in nanoparticle designing, the development of hybrid imaging modalities, and improvements in the sensitivity of instruments have raised the level of disease diagnosis.
Regarding the fact that the molecular imaging fundamentals and basis of materials as contrast agents are different from each other, we have updated the brief synopsis of basic principles of imaging technique containing important points in detail with a practical approach.
... Also parametrial invasion was seen in (15 /20,75%), And lymph nodes involvement was seen in (17/20,85%). Although pelvic lymph node metastasis is not considered in figo staging, it is one of the important prognostic factors and presence of a positive node indicates poor prognosis in each stage [20]. Risk of nodal metastasis increases with tumor size, depth of stromal invasion, lymphovascular invasion and parametrial disease [21]. ...
... While typical sites of recurrent disease such as pelvis and lymph nodes have been well characterized on imaging, atypical presentations of recurrent disease, involving the liver, adrenal glands, lungs, and osseous structures are known to a lesser degree [10,11]. In recent years, due to the extensive use of intensive pelvic radiation therapy, recurrent cervical cancer presents more and more commonly with atypical recurrences: it has been estimated that extrapelvic and extranodal disease represent 59.5% of recurrences of cervical cancer [10][11][12][13]. Given this shift in presentation of recurrent disease, it is crucial that atypical presentations of recurrent disease are promptly identified on imaging to ensure early diagnosis and appropriate treatment. ...
... Imaging modalities such as CT and MRI have been used to detect early recurrence; however, their detection rate is low, whereas 18F-FDG PET has higher accuracy in detecting recurrences of cervical cancer. Reasons for this include its ability to detect recurrent lesions when anatomy has been distorted after surgery or radiation treatment [12,18]. However, PET/CT is limited in detecting retrovesical lesions, owing to the clearance of radiotracer into the bladder which may obscure focal FDG uptake [12]. ...
... Reasons for this include its ability to detect recurrent lesions when anatomy has been distorted after surgery or radiation treatment [12,18]. However, PET/CT is limited in detecting retrovesical lesions, owing to the clearance of radiotracer into the bladder which may obscure focal FDG uptake [12]. ...
Imaging has a central role in surveillance of cervical cancer, guiding decision on when to initiate treatment for recurrent disease and to guide management in advanced cervical cancer. Due to the increased availability of pelvic radiation therapy, the rate of atypical presentation of recurrent disease has increased. Simultaneously, the array of systemic therapies now available for advanced cervical cancer has considerably expanded in the last few years, with therapies now available in mid and low-income countries. While pelvic recurrences are amenable of loco-regional treatment, recurrent disease may present with metastases to the thoracoabdominal organs, lymph nodes, bones, skin and brain, for which systemic treatment represent the standard of care. Besides combined chemotherapy regimens, alternative chemotherapies, biosimilars and immune checkpoint inhibitors are now available, each associated with a definite pattern of response and toxicity. In this review, after describing the typical and atypical presentations of recurrent and advanced cervical carcinoma on cross-sectional imaging, we will discuss systemic treatment for recurrent or advanced disease and their associated radiographic sequelae, in light of the newly available therapies.
... The results of our study have shown significant reliability of this method in the detection of local and distant secondary deposits of the cancer, with high diagnostic accuracy of this method, as well as very high values of sensitivity and positive predictive value. Our results are in line with a number of other studies that have dealt with the use of functional morphological imaging in this area (10,11). This suggests that FDG PET/CT has a significant advantage in detecting all lesions in the underlying disease compared with conventional imaging, with a particular significance in the visualization of distant metastases, since it is a "whole body" visualization method (12). ...
Introduction: the positron emission tomography with computerized tomography is a valuable machine in identifying tumors-it can determine the exact size and position of the cancer, as well as the effect of therapy. The duality of this technique provides information on the metabolic activities of the neoplasm and a precise anatomical location. Aim: the aim of this study was be to determine the diagnostic performance of FDG PET/CT in detection of recurrent disease and to determine the stage of the disease after the application of therapy in patients with cervical carcinoma. Material and methods: In this study, a total of 38 patients were included, in whom FDG PET/ CT was made from 2010 to 2017. The diagnostic contribution of FDG PET/CT in the detection and identification of the recurrence of cervical cancer was determined by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FDG PET/CT in the detection of local and distant relapses of cervical carcinoma were 90%, 75%, 93.1%, 66.7% and 86.8%, respectively. There were 27 true positive, 2 false positive, 6 true negative and 3 false negative findings. Conclusion: the FDG PET/CT has proven to be a very sensitive method in the detection of secondary deposits of cervical cancer. Of particular importance is in the evaluation of the patient with this diagnosis. The metabolic activity of lesions (SUV max) did not have an impact on the therapeutic response.
... In these patients, earlier intervention leads to a better outcome [29]. In this setting, the role of PET/CT is to localize the recurrence so that patients can be properly referred to surgery (in those with pelvic recurrence) or salvage radiotherapy (in those with extrapelvic recurrence) [30][31][32]. ...
Purpose:
To investigate the prognostic value of posttreatment 18F-FDG PET/CT in patients with locally advanced cervical cancer (LACC) treated with concomitant chemoradiation therapy (CCRT). The secondary aim was to assess the possible role of intensity-based and volume-based PET parameters including SUVmax, SUVmean, MTV and TLG, and clinical parameters including age, pathology, FIGO stage and nodal involvement as factors predicting response to treatment.
Methods:
This retrospective study included 82 patients affected by LACC treated with CCRT. All patients underwent 18F-FDG PET/CT both before and after treatment. The posttreatment PET/CT scans were used to classify patients as complete metabolic responders (CMR) or non-complete metabolic responders (N-CMR) according to the EORTC criteria. Kaplan-Meier analysis was used to evaluate differences in overall survival (OS) between the CMR and N-CMR groups. Student's t test, Pearson's chi-squared test and logistic regression were used to investigate the possible value of PET and clinical parameters as predictors of metabolic response to therapy.
Results:
Kaplan-Meier analysis showed a highly significant difference in OS between the CMR and N-CMR groups (log-rank test p < 0.0001). Significant independent predictors of response to therapy were MTV (p = 0.019, odds ratio = 1.015, 95% CI = 1.002-1.028, Nagelkerke R2 = 0.110), TLG (p = 0.045, odds ratio = 1.001, 95% CI = 1.000-1.002, Nagelkerke R2 = 0.081) and nodal involvement (p = 0.088, odds ratio = 2.361, 95% CI = 0.879-6.343, Nagelkerke R2 = 0.051).
Conclusion:
18F-FDG PET/CT-based response assessment using the EORTC criteria reliably predicts OS in LACC patients treated with CCRT. In our cohort of patients, pretreatment MTV and TLG and nodal involvement were predictors of response to therapy. MTV was the best predictor of response. However, its additional risk value seems to be low (MTV odds ratio = 1.015).
... F18-deoxyglucose may be injected into a patient, taken up preferentially by abnormal oncologic tissue, and measured using a PET scanner [4]. PET/CT with the advantages of molecular imaging techniques, anatomical and functional characteristics and confirmed diagnostic value in all kinds of solid tumors, PET/CT has been applied in the initial stages of cervical cancer patients, treatment planning, testing and follow-up after treatment and prognostic judgement [ 5]. In order to objectively evaluate a diagnostic value of PET/CT on lymph node metastasis of cervical cancer, we analyzed the quality of PET/CT in the diagnosis of cervical lymph node metastasis by using systematic review method. ...
Objective
The aim of this study was to assess the diagnostic value of PET/CT for metastatic lymph nodes in cervical cancer patients.
Methods
Searching in the databases including PubMed, Embase, Web of Science, Cochrane Library and Google Scholar about non-invasive modalities for detecting lymph nodes metastases during 2000~2017. Following further screening, the extracted effective data were calculated by Meta-Disc 1.4 software, such as sensitivity (SEN), specificity (SPE), positive likelihood (LR+), and negative likelihood ratio (LR-).
Results
we obtained 27 articles. The pooled estimates for sensitivity of PET/CT were 0.72 (95% CI, [0.69, 0.75]); for specificity were 0.96 (95% CI, [0.96, 0.97]). Its weighted AUC was 0.93.
Conclusion
PET/CT remains to be an effective method for diagnosis of metastatic lymph nodes from cervical cancer.
... It may yield false-negative results in such microscopic diseases. The problem is most striking in the evaluation of subcentimetric pulmonary nodules [50]. Recent advances in PET scanners such as time-of-flight technology and development of newer tracers and solid-state detectors can address and circumvent this issue. ...
The incidence of gynecological malignancies is on the rise partly because of the availability of screening programmes, awareness, higher technological advancements, and availability of better medical care. Early diagnosis of any malignancy leads to prompt treatment. Use of 18Fluorine-Fluorodeoxyglucose (F-FDG) PET/CT in the treatment and follow-up of patients with Ca cervix considerably improves patient management. The primary diagnosis of Ca cervix is made either by biopsy of a visible tumor on the cervix or by a cone biopsy of a nonvisible malignant cervical focus. The staging procedure is purely clinical (i.e. gynecologic examination under general anesthesia) according to the International Federation of Gynaecology and Obstetrics classification. Earlier, with the nonavailability of sophisticated medical equipment and imaging specialists, oncologists relied heavily on clinical examination. However, anatomical and functional imaging has been proven to be considerably superior in understanding parametrial involvement and nodal/distant metastases in the cancer cervix than clinical examination alone. Data are evolving on the usage of F-FDG PET/CT in initial staging, treatment planning, and monitoring therapy response for gynecological malignancies. Prognostic information derived from the primary lesion such as the maximum standardized uptake value, metabolic tumor volume, and extent of para-aortic nodal metastatic disease plays a critical role in tailoring therapy on the basis of patient tumor-specific factors rather than on International Federation of Gynaecology and Obstetrics stage alone. Thus, F-FDG PET/CT needs to be listed not only under the panel of pretherapy investigations for Ca cervix but also for recurrence and therapy response assessments. It allows a more confident approach to patient management at initial staging, especially in terms of the decision to choose surgical versus palliation measures.
... N-staging is one of the most important factors in predicting the prognosis and survival of CC patients (13). CC first spreads to the pelvic area along the external and internal iliac vascular system, as well as to the presacral space (14). The incidence of pelvic LNM in the early stages of CC ranges from 10.9-44.7% ...
The current study aimed to determine the optimum diagnostic imaging technique out of magnetic resonance imaging (MRI),¹⁸F-fludeoxyglucose positron emission tomography/computed tomography ([¹⁸F] FDG-PET/CT, otherwise known as PET/CT) and [¹⁸F] FDG-PET/MRI (otherwise known as PET/MRI) for the pelvic lymph node staging (N-staging) of untreated cervical carcinoma (CC). A total of 27 patients were included in the present study. All patients had undergone pre-treatment with PET/CT and MRI ≤45 days prior to undergoing a lymphadenectomy. The results from PET (separated from PET/CT), MRI and the statistically combined results of (virtual) PET/MRI were compared to those from histological analyses (the gold standard). A per-patient-based analysis of the detection of pelvic lymph node metastases indicated that PET/MRI had a sensitivity of 64%. The specificity of PET/CT and MRI were 69 and 62%, respectively. The positive predictive value (PPV) was 69 and 64% for PET/CT and MRI, respectively. The negative predictive value (NPV) was 64 and 62% for PET/CT and MRI, respectively. The sensitivity of the PET-guided PET/MRI and the MRI-guided PET/MRI was 64% for both. The specificity of the PET-guided PET/MRI and the MRI-guided PET/MRI was 77 and 62%, respectively. The PPV was 75% for PET-guided PET/MRI and 64% for MRI-guided PET/MRI, and the NPV was 67 and 62%, respectively. PET/CT and the virtual PET/MRI exhibited the same low sensitivity (64%). PET/MRI exhibited slightly better results than PET/CT regarding specificity (77 vs. 69%, respectively), PPV (75 vs. 69%, respectively) and NPV (67 vs. 64%, respectively). The results of the present study suggested that PET/CT and MRI are not optimal diagnostic modalities, and that PET/MRI does not necessarily lead to better results than PET/CT, in the pelvic N-staging of CC.
... Paracervical and parametrial lymph nodes are the first to be drained, followed by spread to external iliac lymph nodes by lateral route, internal iliac lymph nodes by hypogastric route, and lateral sacral and sacral promontory lymph nodes by presacral route. All three routes eventually drain into the common iliac lymph nodes, possibly leading to paraaortic lymph nodes involvement, representing distant metastatic disease (48). ...
Uterine cervical cancer is globally the third most common cancer among women, and shows high mortality with invasive cervical carcinoma. Early detection of the disease, its correct staging, and treatment are therefore of great importance. The staging system updated in 2009 by the International Federation of Gynecology and Obstetrics (FIGO), is commonly used for planning the treatment. However, there are significant inaccuracies in the FIGO staging system. Accurate tumor staging is very important to decide the treatment strategy. Although not included in the staging system, magnetic resonance (MR) imaging is a valuable tool for local staging of the disease, and is useful in assessing the spread of the tumor and metastatic lymph nodes, thereby becoming a more accurate substitute for clinical staging of cervical carcinoma. In addition, it is capable of assessing the disease response to surgery or chemoradiation. This review briefly describes the role of MR imaging and the basic MR scanning protocol in evaluating cervical carcinoma. The MR findings with staging, and MR evaluation of treatment response, are further addressed.
... Corpus luteum cysts can show increased ovarian FDG uptake on PET/CT as they are metabolically active (Fig. 8). Correlation of increased FDG uptake in the ovary with menstrual history and other imaging such as ultrasound and contrast-enhanced CT are critical to prevent misdiagnosis of ovarian malignancy [12][13][14][15][16]. ...
Purpose:
To review the radiological appearances of corpus luteum cysts and their imaging mimics.
Conclusion:
Corpus luteum cysts are normal post-ovulatory structures seen in the ovaries through the second half of the menstrual cycle and the first trimester of pregnancy. The typical appearance, across all modalities, is of a 1- to 3-cm cyst with a thick crenulated vascularized wall. Occasionally, similar imaging findings may be seen with endometrioma, ectopic pregnancy, tuboovarian abscess, red degeneration of a fibroid, and ovarian neoplasia. In most cases, imaging findings are distinctive and allow for a confident and accurate diagnosis that provides reassurance for patients and referring physicians and avoids costly unnecessary follow-up.
