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Role of 18F-FDG Dual-Head Gamma-Camera Coincidence Imaging in Recurrent or Metastatic Colorectal Carcinoma

Einat Even-Sapir, MD, DSc1, Hedva Lerman, MD1, Arie Figer, MD2, Micha Rabau, MD3, Gennady Livshitz, MD1, Moshe Inbar, MD2 and Mordechai Gutman, MD3

1 Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
2 Department of Oncology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
3 Department of Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel



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  		FIGURE 1. Unexpected extraabdominal disease in 64-y-old woman with known perirectal recurrent adenocarcinoma. DHC 18F-FDG study was assessed for staging before surgery. In addition to recurrent tumor (long arrow), sites of increased uptake were also detected in left breast (short arrow) and left axilla (arrowhead), suggesting second metastatic primary cancer. Left hydronephrosis and hydroureter were also detected. Removal of perirectal tumor and mastectomy with axillary dissection were performed during surgery.

 


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  		FIGURE 2. A 74-y-old man with elevated CEA levels and negative CT. DHC 18F-FDG study detected several sites of increased uptake, suggesting diffuse abdominal metastatic spread. Patient was referred for chemotherapy; however, rapid clinical deterioration followed and he died 4 mo after scan was obtained.

 


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  		FIGURE 3. A 54-y-old woman with elevated CEA levels and negative CT and colonoscopy. DHC 18F-FDG study detected increased sites of uptake in presacral region (arrow). Presence of tumor tissue at this location was confirmed on histologic examination.

 


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  		FIGURE 4. Unsuspected metastatic disease in 61-y-old woman with known recurrent colon carcinoma and negative CT for metastases. DHC 18F-FDG study was performed for staging before surgery. In addition to local recurrence in right abdomen (arrow), 2 other sites of uptake were detected, suggesting lymph node metastases (arrowhead). Latter diagnosis was confirmed on histologic examination.

 




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