Abstract
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Objectives Physiological FDG uptake in uterus and ovaries is related to metabolic changes during the menstrual cycle. Chemotherapy often suppresses the activity of reproductive organs, while variable degree of recovery after treatment may occur. Current study compares FDG uptake in the ovaries and uterus before and after chemotherapy and in relation to the menstrual cycle.
Methods FDG-PET/CT studies of 182 women of reproductive age (12-50y) referred for assessment of various malignancies (excluding gynecological cancers) were included. Foci of uptake in ovaries and/or uterus were recorded. SUVmax was measured for each site. Patterns and degree of FDG uptake were correlated to patient age (below and above 35), to administration of and time interval from end of chemotherapy (average 16.8 months) and to the phase of the menstrual cycle.
Results Physiologic FDG uptake in ovaries of women <35y who did not receive chemotherapy occurred with two peaks: at the beginning of menstrual cycle and at mid-cycle around ovulation. After chemotherapy women <35y showed 18F-FDG ovarian uptake during the whole menstrual cycle in a random fashion. In women >35y there was no difference in FDG ovarian uptake before and after chemotherapy. There was a negative relationship between the time elapsed from end of chemotherapy to the incidence of uptake in the ovary (p <0.001). Bilateral ovarian uptake was significantly more prevalent in women<35y after chemotherapy (p<0.01), with a significant negative dependence to time from the end of chemotherapy (p <0.05). There was no statistically significant difference in FDG uptake in the uterus before and after chemotherapy in both age groups, and in SUVmax measurements in the ovaries and uterus.
Conclusions Chemotherapy may affect physiological FDG uptake in reproductive organs of women of reproductive age. Knowledge of this variability may avoid pitfalls in interpretation of clinical studies. If confirmed by further studies, ovarian FDG uptake patterns may play a potential role in understanding and predicting fertility recovery after chemotherapy