SpringerLink
Log in

Incidence and characteristics of uterine leiomyomas with FDG uptake

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

Uterine leiomyomas sometimes show focal 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) images that may result in a false-positive diagnosis for malignant lesions. This study was conducted to investigate the incidence and characteristics of uterine leiomyomas that showed FDG uptake.

Methods

We reviewed FDG-PET and pelvic magnetic resonance (MR) images of 477 pre-menopausal (pre-MP, age 42.1 ± 7.3 years) and 880 post-MP (age 59.9 ± 6.8 years) healthy women who underwent these tests as parts of cancer screening. Of 1357, 323 underwent annual cancer screening four times, 97 did three times, 191 did twice, and the rest were screened once. Focal FDG uptake (maximal standardized uptake value > 3.0) in the pelvis was localized and characterized on co-registered PET/MR images.

Results

Uterine leiomyomas were found in 164 pre-MP and 338 post-MP women. FDG uptake was observed in 18 leiomyomas of 17 of the 164 (10.4%) pre-MP women and in 4 leiomyomas of 4 of the 338 (1.2%) post-MP women. The incidence was significantly higher in pre-MP women than in post-MP women (chi-square, P < 0.001). Of the 22, 13 showed signal intensity equal to or higher than that of the myometrium on T2-weighted MR images, which suggested abundant cellularity, whereas the majority of leiomyomas without FDG uptake showed low signal intensity. Of the 13 women, 12 examined more than twice showed substantial changes in the level of FDG uptake in leiomyomas each year with FDG uptake disappearing or newly appearing. These changes were observed frequently in relation with menopause or menstrual phases.

Conclusions

Leiomyomas with focal FDG uptake were seen in both pre-and post-MP women with a higher incidence in pre-MP women. Abundant cellularity and hormonal dependency may explain a part of the mechanisms of FDG uptake in leiomyomas. It is important to know that the level of FDG uptake in leiomyomas can change and newly appearing FDG uptake does not necessarily mean malignant transformation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (France)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med 1996;26:308–314.

    Article  PubMed  CAS  Google Scholar 

  2. Gordon BA, Flanagan FL, Dehdashti F. Whole-body positron emission tomography: normal variations, pitfalls, and technical considerations. AJR 1997;169:1675–1680.

    PubMed  CAS  Google Scholar 

  3. Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics 1999;19:61–77.

    PubMed  CAS  Google Scholar 

  4. Lerman H, Metser U, Grisaru D, Fishman A, Kievshitz G, Even-Sapir E. Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre-and post-menopausal patients: assessment by PET/CT. J Nucl Med 2004;45:266–271.

    PubMed  Google Scholar 

  5. Nishizawa S, Inubushi M, Okada H. Physiological 18F-FDG uptake in the ovaries and uterus of healthy female volunteers. Eur J Nucl Med Mol Imaging 2005;32:549–556.

    Article  PubMed  Google Scholar 

  6. Nishizawa S, Inubushi M, Ozawa F, Aki Kido, Okada H. Physiological FDG uptake in the ovaries after hysterectomy. Ann Nucl Med 2007;21:345–348.

    Article  PubMed  Google Scholar 

  7. Kao CH. FDG uptake in a huge uterine myoma. Clin Nucl Med 2003;28:249.

    Article  PubMed  Google Scholar 

  8. Ak I, Ozalp S, Yalcin OT, Zor E, Vardareli E. Uptake of 2-[18F]fluoro-2-deoxy-d-glucose in uterine leiomyoma: imaging of four patients by coincidence positron emission tomography. Nucl Med Commun 2004;25:941–945.

    Article  PubMed  Google Scholar 

  9. Chura JC, Truskinovsky AM, Judson PL, Johnson L, Geller MA, Downs LS Jr. Positron emission tomography and leiomyomas: clinicopathologic analysis of 3 cases of PET scanpositive leiomyomas and literature review. Gynecol Oncol 2007;104:247–252.

    Article  PubMed  Google Scholar 

  10. Shida M, Murakami M, Tsukada H, Ishiguro Y, Kikuchi K, Yamashita E, et al. F-18 fluorodeoxyglucose uptake in leiomyomatous uterus. Int J Gynecol Cancer 2007;17:285–290.

    Article  PubMed  CAS  Google Scholar 

  11. Watanabe M, Shimizu K, Omura T, Sato N, Takahashi M, Kosugi T, et al. A high-throughput whole-body PET scanner using flat panel PS-PMTs. IEEE Trans Nucl Sci 2004;51:796–800.

    Article  Google Scholar 

  12. Förster GJ, Laumann C, Nickel O, Kann P, Pieker O, Bartenstein P. SPET/CT image co-registration in the abdomen with a simple and cost-effective tool. Eur J Nucl Med Mol Imaging 2003;30:32–39.

    Article  PubMed  Google Scholar 

  13. Nakamoto Y, Sakamoto S, Okada T, Matsumoto K, Minota E, Kawashima H, et al. Accuracy of image fusion using a fixation device for whole-body cancer imaging. AJR Am J Roentgenol 2005;184:1960–1966.

    PubMed  Google Scholar 

  14. Tanaka E, Kudo H. Subset-dependent relaxation in block-iterative algorithms for image reconstruction in emission tomography. Phys Med Biol 2003;48:1405–1422.

    Article  PubMed  Google Scholar 

  15. Vollenhoven BJ, Lawrence AS, Healy DL. Uterine fibroids: a clinical review. Br J Obstet Gynecol 1990;97:285–298.

    CAS  Google Scholar 

  16. Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology and end results analysis of 2677 cases of uterine sarcoma 1989–1999. Gynecol Oncol 2004;93:204–208.

    Article  PubMed  Google Scholar 

  17. Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics 1999;19:1179–1197.

    PubMed  CAS  Google Scholar 

  18. Umesaki N, Tanaka T, Miyama M, Kawamura N, Ogita S, Kawabe J, et al. Positron emission tomography with 18F-fluorodeoxyglucose of uterine sarcoma: a comparison with magnetic resonance imaging and power Doppler imaging. Gynecol Oncol 2001;80:372–377.

    Article  PubMed  CAS  Google Scholar 

  19. Nishizawa S, Inubushi M, Okada H, Ozawa F, Kojima S, Teramukai S, et al. Cancer screening trial to evaluate the efficacy of FDG PET in healthy subjects: 2-year results of the Hamamatsu Medical Imaging Center study (abstract). J CLin Oncol 2006;24Suppl 18:1025.

    Google Scholar 

  20. Maruo T, Ohara N, Wang JW, Matuo H. Sex steroidal regulation of uterine leiomyoma growth and apoptosis. Human Reprod Update 2004;10:207–220.

    Article  CAS  Google Scholar 

  21. Maruo T, Matsuo H, Samoto T, Shimomura Y, Kurachi O, Gao Z, et al. Effects of progesterone on uterine leiomyoma growth and apoptosis. Steroid 2000;65:585–592.

    Article  CAS  Google Scholar 

  22. Pavlovich SV, Volkov NI, Burlev VA. Proliferative activity and level of steroid hormone receptors in the myometrium and myoma nodes in different phases of menstrual cycle. Bull Exp Biol Med 2003;136:396–398.

    Article  PubMed  CAS  Google Scholar 

  23. Kawaguchi K, Fujii S, Konishi I, Nanbu Y, Mori T. Mitotic activity in uterine leiomyoma during the menstrual cycle. Am J Obstet Gynecol 1989;160:637–641.

    PubMed  CAS  Google Scholar 

  24. Buck AK, Reske SN. Cellular origin and molecular mechanisms of 18F-FDG uptake: is there a contribution of the endothelium? J Nucl Med 2004;45:461–462.

    PubMed  CAS  Google Scholar 

  25. Bos R, von der Hoeven JJM, von der Wall E, von der Groep P, van Diest PJ, Comans EFI, et al. Biologic correlates of 18F-FDG uptake in human breast cancer measured by positron emission tomography. J Clin Oncol 2002;20:379–387.

    Article  PubMed  CAS  Google Scholar 

  26. Ito K, Kato T, Ohta T, Tadikoro M, Yamada T, Ikeda M, et al. Fluorine-18 fluoro-2-deoxyglucose positron emission tomography in recurrent rectal cancer: relation to tumour size and cellularity. Eur J Nucl Med 1996;23:1372–1377.

    Article  PubMed  CAS  Google Scholar 

  27. Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. Am J Roentgenol 2000;174:1005–1008.

    CAS  Google Scholar 

  28. Lippitz B, Cremerius U, Mayfrank L, Bertalanffy H, Raoofi R, Weis J, et al. PET-study of intracranial meningiomas: correlation with histopathology, cellularity and proliferation rate. Acta Neurochir Suppl 1996;65:108–111.

    PubMed  CAS  Google Scholar 

  29. Higashi T, Tamaki N, Torizuka T, Nakamoto Y, Sakahara H, Kimura T, et al. FDG uptake, GLUT-1 glucose transporter and cellularity in human pancreatic tumors. J Nucl Med 1998;39:1727–1735.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hamamatsu Medical Imaging Center, Hamamatsu Medical Photonics Foundation, 5000 Hirakuchi, Hamakita-ku, Hamamatsu, Shizuoka, 434-0041, Japan

    Sadahiko Nishizawa, Masayuki Inubushi, Aki Kido, Masao Miyagawa, Takeshi Inoue, Katsura Shinohara & Makoto Kajihara

Authors
  1. Sadahiko Nishizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masayuki Inubushi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aki Kido
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masao Miyagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takeshi Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsura Shinohara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Makoto Kajihara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sadahiko Nishizawa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nishizawa, S., Inubushi, M., Kido, A. et al. Incidence and characteristics of uterine leiomyomas with FDG uptake. Ann Nucl Med 22, 803–810 (2008). https://doi.org/10.1007/s12149-008-0184-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-008-0184-6

Keywords

Search

Navigation