Article

Pitfalls in radiation oncology. "Myocardial metastasis" in PET-CT after palliative radiation treatment of the left 5th rib.

Medical Faculty, Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany.
Strahlentherapie und Onkologie (impact factor: 3.56). 02/2012; 188(4):359-62. DOI:10.1007/s00066-011-0059-y pp.359-62
Source: PubMed

ABSTRACT Positron emission tomography-computed tomography (PET-CT) is a useful diagnostic tool to detect metastases in patients with malignancy. False positives have been reported in cases of inflammation and tissue regeneration.
Over a period of 2 years, a 32-year-old woman with hepatocellular carcinoma and multiple bone metastases received three treatments of radiation therapy to a bone metastasis in the 5th left rib. Restaging with [18F]fluorodeoxyglucose (FDG) PET-CT showed increased uptake within the cardiac apex highly suspicious for a myocardial metastasis. Because the patient was asymptomatic, additional magnetic resonance imaging (MRI) of the heart was performed demonstrating radiation-associated changes but no evidence for metastases.
PET-CT is a well-established diagnostic tool in metastatic diseases but its results should always be correlated with the clinical picture of the patient and previous treatments to rule out false positives.

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Keywords

32-year-old woman
 
[18F]fluorodeoxyglucose
 
additional magnetic resonance imaging
 
bone metastasis
 
cardiac apex
 
False positives
 
metastases
 
metastatic diseases
 
multiple bone metastases
 
patients
 
Positron emission tomography-computed tomography
 
previous treatments
 
radiation therapy
 
radiation-associated changes
 
tissue regeneration
 
useful diagnostic tool
 
well-established diagnostic tool