1. FDG PET/CT case report early detection of ovarian cancer NM case conference, 2008-01-18 chairman: Nan-Jing Peng, MD

2. 46 y/o female SLE under regular medication uterine myoma S/P hysterectomy 7-8 years ago family history of lung cancer (father) Patient’s sister is a GYN doctor Tumor marker checked every year: normal Elevating CA-199 level in 2 months, CA-19-9: 209.6 U/ml on 2007-12-24 Contrast-enhanced abdominal CT: negative GYN echo: negative Colonscopy: negative FDG PET/CT on 2007-12-24

3. “Small” focal FDG uptake at left adnexa (SUVmax: early 3.7 and delayed 5.2) Highly suspicious malignany FDG PET/CT on 2007-12-24

4. left adnexa adjacent bowel adhesion Debulking surgery on 2008-01-14 Pathology: mucinous adenocarcinoma of left ovary, stage Ia

5. DDx: benign v.s. malignant ovarian lesion:DDx: benign v.s. malignant ovarian lesion: Increased ovarian 18 F-FDG uptake: (1) postmenopausal patients: indicated malignancy (2) premenopausal patients: could be either malignant or functional SUV 7.9 separated benign from malignant ovarian uptake Many malignant and functional ovarian lesions had overlapping SUVs Detecting a dominant functional ovarian cyst on CT and discussing the menstrual cycle phase with the patient may assist in differentiating physiologic from malignant 18F-FDG ovarian uptake. J Nucl Med 2004; 45:266–271 sensitivityspecificityaccuracyPPVNPV 57%95%85%80%86%

6. Physiologic Ovarian UptakePhysiologic Ovarian Uptake long diameters : 2.0±0.3 cm early SUVmax : 4.4±1.5 g/ml delayed SUVmax : 5.0±1.62 g/ml FDG can accumulate in the normal ovarian follicle or corpus luteum. The typical spherical or discoid FDG accumulation in the ovary during the early luteal phase or ovulatory phase represents normal physiological uptake. In premenopausal women it is preferable to schedule pelvic FDG PET scans within a few days after the start of menstruation. Eur J Nucl Med Mol Imaging (2005) 32:757–763