Šedienė, Severina

PET/KT yra detalus ir pažangus branduolinės medicinos tyrimo metodas, turintis platų klinikinį panaudojimą šiuolaikinėje medicinoje. Jis gali būti naudojamas nustatant širdies ir kraujagyslių ligas, galvos smegenų pakitimus, taip pat vertinant onkologinėmis ligomis sergančių pacientų būklę. Pozitronų emisijos tomografijos tyrimas padeda anksčiau nustatyti patologinį metabolinį aktyvumą audiniuose, tuo pačiu metu kompiuterinė tomografija tiksliai parodo jų anatominę vietą. Kadangi PET/KT tyrimas apima beveik visą kūną, neretai aptinkama darinių, nesusijusių su pagrindinių susirgimu. Patologinis metabolinis aktyvumas PET/KT tyrimo metu gali būti stebimas įvairiuose nespecifiniuose procesuose, todėl šie dariniai gali būti įvairios kilmės. Ypač sunku atskirti pakitimų kilmę galvos ir kaklo srityje, kur yra daug anatominių struktūrų (kraujagyslių, fascijų, liaukų, nervinių skaidulų ir t.t.) ir pakitimai yra smulkūs. Todėl svarbu įvertinti klinikinę PET/KT tyrimo reikšmę nustatant atsitiktinius darinius galvos ir kaklo srityje bei jų pobūdį.

Study Aim: To analyse data on prevalence of thoracic and pelvic incidentalomas in whole body positron emission tomography with computed tomography (PET/CT) imaging and find out optimal diagnostic and therapeutic management tactics. Study Objectives: 1.To qualitatively assess the prevalence of various chest types of incidentalomas in PET/CT imaging. 2. To qualitatively assess the prevalence of various pelvic types of incidentalomas in PET/CT imaging. 3. To investigate the probable management guidelines available for chest incidentalomas while they found on the whole body PET/CT imaging, which was carried out for other reasons. 2. To investigate the probable management guidelines available for pelvic incidentalomas while they found on the whole body PET/CT imaging, which was carried out for other reasons. Research methodology or methods: Relevant literature that is dated within the last 10 years was sourced using databases such as Pubmed and Science Direct using key words “Thorax” “Pelvic” “Incidentaloma” and “PET/CT”. 293 open access articles were found, of which 274 were excluded as they did not fit the inclusion criteria. 17 more articles were sourced from the cited 19 articles and in total 36 articles were included in this study. Conclusions. Malignant focal uptake in PET/CT examination mostly was located in the breast and prostate area. Benign uptake on PET/CT examination is usually seen in the lungs, esophagus, heart, uterus and ovaries. Management depends on the rate of malignancy in each organ , patient clinical factors, and characteristics of incidentaloma on PET/CT. All breast incidentalomas require investigation with US and/or MMX and biopsy should be performed in lesions with BIRADS score ≥ 4. Lung incidentalomas with an associated mass on PET/CT should be followed up with a dedicated CT scan. Heart incidentalomas are usually physiological in non-oncologic patients and patients without a history of cardiovascular or inflammatory disease and should be evaluated with ECG, echocardiography and in some cases scintigraphy and coronary angiography. 18F-FDG uptake at the GOJ is a strong marker of malignancy and lesions with SUV max ≥ 3.5 should undergo endoscopy. In prostate incidentalomas, the localization of the incidentaloma on the prostate, history of PCa[u1] [AE2] , and race should first be considered. Mp[SŠ3] [AE4] MRI and then biopsy should be used for further intervention. Ovarian incidentalomas in patient older than 45, not on their menstrual cycle, postmenopausal and/ or with history of ovarian or breast cancer should be assessed with transvaginal ultrasound. 18F-FDG uptake in uterine incidentalomas tends to increase with malignancy. Immunohistochemistry and pelvic ultrasound/ MRI should be done for further evaluation. Large or suspicious testicular incidentalomas may require further evaluation with testicular ultrasound and/or biopsy

We take a look at the role of FDG PET/CT values like SUVmax, Positive predictive value, negative predictive value, Sensitivity and specificity; by these, we see how these values can be predictors of relapse in Melanoma patients who are undergoing treatment, with this we see the progression of the tumour and response to treatment.