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. 2013 Jul 10;3(4):317-25.
Print 2013.

The normal variant (18)F FDG uptake in the lower thoracic spinal cord segments in cancer patients without CNS malignancy

Geetika Bhatt  1 , Xiao-Feng Li, Angita Jain, Vivek R Sharma, Jianmin Pan, Archana Rai, Shesh Nath Rai, A Cahid Civelek
Affiliations

The normal variant (18)F FDG uptake in the lower thoracic spinal cord segments in cancer patients without CNS malignancy

Geetika Bhatt et al. Am J Nucl Med Mol Imaging. .

Abstract

Focal increased lower thoracic spinal cord (18)F FDG uptake is not infrequently observed as a normal physiological finding and may be confused for spinal cord metastases. This study was conducted to evaluate a possible correlation between the lower thoracic (T11-T12) spinal uptake and lower limb movements/ambulatory status of the patients as a surrogate. The primary endpoint was to identify the possible cause(s) of the normal variant focal increased thoracic spinal cord (T11-T12) (18)F FDG activity and correlate it with the lower limb movements/ambulatory status of the patients. This was a retrospective analysis of PET-CT scans of 200 patients with solid and hematological malignancies. The focal relatively increased (18)F FDG activity in the lower thoracic spinal cord correlated strongly with the (18)F FDG intensity of the liver, bowel, C3-C5 cervical cord activity, weight of the patient and injected dose of (18)F FDG. With regard to the primary endpoint, no significant correlation was found between the ambulatory status of patients in any of the groups and thoracic spine SUVmax. This could be further assessed by performing dual studies in the same patient with and without moderate to excessive leg motion. Identifying this variant focal increased (18)F FDG activity can minimize errors of misdiagnosis and unnecessary further investigation.

Keywords: 18F FDG PET-CT; ambulatory status; metastases; spinal cord.

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Figures

Figure 1
Figure 1
Flow-Chart of the study.
Figure 2
Figure 2
A 33 year-old physically active female with ovarian cancer treated with surgery and chemotherapy underwent a repeat 18F FDG PET-CT scan after 83 minutes of 18F FDG injection as part of her follow up work-up. The Liver SUVmax was 2.7 and Liver SUVavg 2.1. Her C-spine SUVmax/avg were 3.0/2.6, T11-T12 spine SUVmax/avg were 3.5/2.9 PET-CT scan did not reveal any signs of malignancy. The enhanced 18F FDG activity along the cervical spinal cord is seen as depicted by arrow in fused transverse PET-CT image (B), and in sagittal view (D). Corresponding CT images are depicted in Figure 2A and 2C. The focal increased 18F FDG activity in T11-T12 segment thoracic spinal cord is depicted by the arrow in a sagittal PET image (E), and in a fused sagittal PET-CT image (F), which was classified as a normal variant in this asymptomatic patient.
See this image and copyright information in PMC

References

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