Positron emission tomography in ovarian cancer: 18F-deoxy-glucose and 16alpha-18F-fluoro-17beta-estradiol PET

Yoshio Yoshida, Tetsuji Kurokawa, Tetuya Tsujikawa, Hidehiko Okazawa, Fumikazu Kotsuji, Yoshio Yoshida, Tetsuji Kurokawa, Tetuya Tsujikawa, Hidehiko Okazawa, Fumikazu Kotsuji

Abstract

The most frequently used molecular imaging technique is currently 18F-deoxy-glucose (FDG) positron emission tomography (PET). FDG-PET holds promise in the evaluation of recurrent or residual ovarian cancer when CA125 levels are rising and conventional imaging, such as ultrasound, CT, or MRI, is inconclusive or negative. Recently, integrated PET/CT, in which a full-ring-detector clinical PET scanner and a multidetector helical CT scanner are combined, has enabled the acquisition of both metabolic and anatomic imaging data using one device in a single diagnostic session. This can also provide precise anatomic localization of suspicious areas of increased FDG uptake and rule out false-positive PET findings. FDG-PET/CT is an accurate modality for assessing primary and recurrent ovarian cancer and may affect management. FDG-PET/CT may provide benefits for detection of recurrent of ovarian cancer and improve surgical planning. And FDG-PET has been shown to predict response to neoadjuvant chemotherapy and survival in advanced ovarian cancer. This review focuses on the role of FDG-PET and FDG-PET/CT in the management of patients with ovarian cancer. Recently, we have evaluated 16alpha-18F-fluoro-17beta-estradiol (FES)-PET, which detects estrogen receptors. In a preliminary study we reported that FES-PET provides information useful for assessing ER status in advanced ovarian cancer. This new information may expand treatment choice for such patients.

Figures

Figure 1
Figure 1
A flow chart for differentiation of increased FDG uptake found incidentally.
Figure 2
Figure 2
A 66-year-old woman with a diagnosis of ovarian cancer and huge uterine leiomyoma underwent PET. MRI demonstrated a huge uterine leiomyoma (large arrow) and left ovarian cancer (small arrow) with metastases in the abdomen (arrow head) (A). FDG-PET demonstrated ovarian cancer (small arrow) and multiple metastases in the abdomen and pelvis (arrow head), and a negative FDG-PET scan is shown for the leiomyoma (large arrow) (B). FES-PET demonstrated moderate uptake of FES in both the ovarian cancer (arrow head) and its metastases (arrow head) and leiomyoma (large arrow) (C).
Figure 3
Figure 3
Paraffin sections taken from the leiomyoma (A) and the ovarian cancer (B) demonstrate moderate ER-α expression. The pattern of expression of ER-α in the leiomyoma (large arrow) (C) and ovarian cancer (small arrow) (D) was similar.

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