Ovarian Cancer Case 01


Clinical History
A 56-year-old woman with a history of ovarian cancer underwent resection of the tumor followed by chemotherapy. The patient presented with rising CA-125 levels. A recent CT scan was negative. The physician referred the patient for a PET/CT scan for further evaluation.

Imaging Findings
INITIAL NUCLEAR MEDICINE PET/CT
STATED REASON FOR REQUEST: Restaging suspected recurrent ovarian cancer
TECHNIQUE: Emission scanning was performed extending from the skull through the pelvis approximately one hour post radiotracer injection. Images were reconstructed with and without attenuation correction using the CT attenuation coefficients.

INITIAL PET/CT FINDINGS: There was a focal abnormal area of increased radiopharmaceutical uptake that was not visible on the CT portion of the exam.

FOLLOW-UP PET/CT FINDINGS: One year later the patient returned for a PET/CT scan and now has wide-spread disease throughout the abdomen.

Discussion
Following the initial PET/CT scan the patient was sent for a CT guided biopsy, and during the procedure, the physician who could not see the lesion, sent for the fused images. The patient got upset and tired of waiting and left the hospital. She sought a second opinion from another physician, who, based on the CT results, concluded that there was no abnormality, and that the positive PET/CT results were likely due to some sort of inflammatory process.

One year later, after her CA-125 levels continued to rise, the patient returned for a follow-up PET/CT scan, which demonstrated wide-spread abdominal disease.

The power of combined PET/CT imaging is in localizing disease before an abnormality is apparent on CT images. Physicians gain added confidence in their decision to treat a patient that has a negative CT scan, but has rising CA-125 levels and abnormal increased radiopharmaceutical uptake on the combined PET/CT scan.

Data courtesy of Dr. Todd Blodgett, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

* Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.