Physiologic uptake of 18 F-FDG in transposed ovaries may mimic metastasis on 18 F-FDG PET/CT imaging

Tima Davidson, Orna Komisar, Jacob Korach, Shira Felder, Sara Apter, Simona Ben-Haim, Tamar Perri

Research output: Contribution to journalArticlepeer-review

Abstract

Background Ovarian transposition is aimed at preserving ovarian function before irradiation in pelvic malignancies. The extrapelvic location of the ovaries and their physiologic fluorine-18-fluorodeoxyglucose (18 F-FDG)-uptake is a potential source of misdiagnosis as metastasis on 18 F-FDG PET/CT. We describe the 18 F-FDG PET/CT characteristics of transposed ovaries and their changes over time. Patients and methods We reviewed 18 F-FDG PET/CT studies of all consecutive women with pelvic malignancies who underwent ovarian transposition between 2007 and 2013. Studies were grouped according to the time period over which they were carried out. Findings were categorized by location, size, appearance (solid/mixed/cystic), presence of surgical clips, ovarian 18 F-FDG uptake (maximum standardized uptake value), and attenuation values on CT (Hounsfield units). Group time-period differences were assessed. Results Seventy-nine 18 F-FDG PET/CT studies were reviewed, 30 before and 49 after transposition. Time-period groups after transposition were up to 4 months (18 studies), 4.1-12 months (n=14), and more than 12 months (n=17). After transposition, ovaries were located mainly in the paracolic gutter (n=32) and subhepatic regions (n=18). Surgical clips were present in 67%. Both ovaries appeared more solid 1 year after surgery than preoperatively (13.7% before vs. 61.3% after surgery; P<0.001). Transient 18 F-FDG-avidity was observed in 11 ovaries. Hounsfield unit values were higher within 4 months after surgery than preoperatively, reverting thereafter to preoperative values. Conclusion After ovarian transposition, nonanatomic location, loss of cysts formation in favor of solid appearance over time, and intermittent 18 F-FDG uptake of functioning transposed ovaries might mimic metastatic lesions. Careful interpretation of 18 F-FDG PET/CT findings is mandatory in women with pelvic malignancies who have undergone ovarian transposition.

Original languageEnglish
Pages (from-to)171-178
Number of pages8
JournalNuclear Medicine Communications
Volume39
Issue number2
DOIs
StatePublished - 2018

Keywords

  • PET/CT
  • metastasis
  • ovarian transposition

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