FDG PET GÖRÜNTÜLEMEDE PROSTATTA İNSİDENTAL FDG TUTULUMUNUN SIKLIĞI VE KLİNİK ÖNEMİ

Amaç: Bu çalışmada FDG PET görüntülemede prostat bezinde izlenen insidental tutulumların görülme sıklığınıve klinik önemini değerlendirmek amaçlanmıştır.Materyal ve Metot: Prostat ve mesane kanserleri dışı endikasyonlarla FDG PET/BT görüntüleme yapılan 1839erkek hastanın PET raporları retrospektif olarak prostatta insidental FDG tutulumu açısından tarandı. PET/BTgörüntülerinde prostatta FDG tutulum varlığı ve paterni (fokal-diffüz), prostat volümü ve kalsifikasyon varlığıdeğerlendirildi. Takipte prostata yönelik yapılmış ileri inceleme sonuçları FDG PET bulguları ile karşılaştırmalıolarak değerlendirildi.Bulgular: Takipte 1839 hastanın %2,22’sinde prostatta insidental artmış FDG tutulumu saptanmıştır. Takipte41 hastadan 14’üne biyopsi yapılmış (%34,14), biyopsi yapılan olguların 3’ünde(%7,31) histopatolojik olarakprostat adenokarsinomu konfirme edilmiştir. Ayrıca 2 hastada inflamasyon/prostatit, 4 hastada ise BPH ileuyumlu bulgular izlenmiştir. FDG tutulumu 12 hastada diffüz tutulum, 29 hastada fokal tutulum şeklindeizlenmiştir. Malign olan hastaların hepsinde FDG tutulumu periferal yerleşimli olup; fokal tutulum paternindeizlenmiştir. Benign ve malign grupların SUVmaks ve PSA düzeyleri arasında anlamlı fark izlenmemiş olup;SUVmaks değerinin iki grupta örtüştüğü gözlenmiştir.Sonuç: Prostatta izlenen insidental FDG tutulumları prostat kanseri ile uyumlu olabileceği gibi benignpatolojilerde ve normal prostat dokusunda da artmış FDG tutulumu izlenebilmektedir. Malign ve benignpatolojilerde izlenen SUVmaks değerlerinin örtüşmesi nedeniyle malignite ayırıcı tanısında tek başınaSUVmaks değerinin kullanımı uygun görünmemektedir. Prostatta fokal FDG tutulumu izlenen hastalarda olasımalignite açısından ileri klinik değerlendirme önerilir.

FREQUENCY AND CLINICAL SIGNIFICANCE OF INCIDENTAL PROSTATIC FDG UPTAKE IN FDG PET IMAGING

Objectives: This study aims to disclose the frequency and clinical significance of incidental prostatic uptake during FDG PET imaging. Materials and Methods: FDG PET images of 1839 male patients undergoing imaging for non-prostate and nonurinary bladder malignancy indications were retrospectively reviewed for the presence of incidental prostatic FDG uptake. Prostatic volume, calcification and the presence and pattern of FDG uptake were evaluated. Further follow-up prostatic evaluation results were comparatively assessed. Results: Incidental prostatic FDG uptake was detected in 41 out of 1839 patients (2.22%). Biopsy was done in 14 patients (34.14%) on follow-up and disclosed prostatic adenocarcinoma in 3 (7.31%), inflammation/prostatitis in 2 and findings compatible with BPH in 4 patients. The pattern of FDG uptake was diffuse in 12 and focal in 29 patients. Patients who were found to have adenocarcinoma on follow-up disclosed FDG uptake with a focal pattern at a peripheral location. No significant difference existed between patients with malignant or benign disease of the prostate with respect to either the SUVmax or the PSA levels; SUVmax levels were found to overlap in the two groups. Conclusion: Incidental prostatic FDG uptake may be associated with prostate cancer, benign pathologies and even a normal prostate gland. Overlapping SUVmax levels in the benign and malignant pathologies make SUVmax level alone an inappropriate tool in the diagnosis of cancer. Further clinical investigation is warranted to disclose a probable prostatic malignancy in patients who display incidental prostatic FDG uptake on PET imaging employed for various other indications.

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