T Davidson1,2, E Klang3, E Goshen4,5, J Goldstein6, M Khaikin7,5, B Chikman8, S Ben-Haim4,9. 1. Department of Nuclear Medicine, Chaim Sheba Medical Center, 5265601, Tel Hashomer, Israel. tima.davidson@sheba.health.gov.il. 2. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. tima.davidson@sheba.health.gov.il. 3. Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel. 4. Department of Nuclear Medicine, Chaim Sheba Medical Center, 5265601, Tel Hashomer, Israel. 5. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. 6. Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel. 7. Department of Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel. 8. Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel. 9. Institute of Nuclear Medicine, University College London and UCL Hospitals, London, UK.
Abstract
OBJECTIVE: A number of case reports have demonstrated FDG uptake around mesh prostheses after hernia repair surgery. This study characterizes FDG PET-CT findings after hernia repair with synthetic mesh in a series of cancer patients. MATERIALS AND METHODS: FDG PET-CT studies were reviewed for increased FDG uptake consistent with CT appearances of post-surgical hernia repair in cancer patients. The findings were correlated with clinical data and follow-up studies. RESULTS: 53 PET-CT studies in 22 patients (18 males, 31-79 years) were identified. Surgery for repair of inguinal (n = 14), ventral (n = 5) or umbilical (n = 3) hernia was performed, 4-204 months prior to PET-CT. FDG avidity was focal or linear in the region of the anterior abdominal or pelvic wall (mean SUV max 4.0 ± 2.3). Corresponding nonspecific CT findings included soft tissue thickening (n = 18), fat infiltration (n = 20) and fluid collection (n = 19) in the region of the omentum, adjacent to or in the inner abdominal or pelvic wall at the surgical site. Linear hyper-dense structures (n = 9) or metallic clips (n = 8) seen on CT suggested benign postoperative changes. In 10/12 (83.3%) patients with repeat PET-CT, FDG uptake remained unchanged, one showed more diffuse uptake and another showed reduced uptake on follow-up. There was neither significant change in CT appearance at the surgical site in these 12 patients, nor in 3 additional patients with only CT follow-up. Another 3 patients had previous CT demonstrating hernia at the same location. CONCLUSION: With increasing use of synthetic mesh, awareness of variations in FDG PET-CT appearance is important to avoid false interpretation in cancer patients.
OBJECTIVE: A number of case reports have demonstrated FDG uptake around mesh prostheses after hernia repair surgery. This study characterizes FDG PET-CT findings after hernia repair with synthetic mesh in a series of cancerpatients. MATERIALS AND METHODS:FDG PET-CT studies were reviewed for increased FDG uptake consistent with CT appearances of post-surgical hernia repair in cancerpatients. The findings were correlated with clinical data and follow-up studies. RESULTS: 53 PET-CT studies in 22 patients (18 males, 31-79 years) were identified. Surgery for repair of inguinal (n = 14), ventral (n = 5) or umbilical (n = 3) hernia was performed, 4-204 months prior to PET-CT. FDG avidity was focal or linear in the region of the anterior abdominal or pelvic wall (mean SUV max 4.0 ± 2.3). Corresponding nonspecific CT findings included soft tissue thickening (n = 18), fat infiltration (n = 20) and fluid collection (n = 19) in the region of the omentum, adjacent to or in the inner abdominal or pelvic wall at the surgical site. Linear hyper-dense structures (n = 9) or metallic clips (n = 8) seen on CT suggested benign postoperative changes. In 10/12 (83.3%) patients with repeat PET-CT, FDG uptake remained unchanged, one showed more diffuse uptake and another showed reduced uptake on follow-up. There was neither significant change in CT appearance at the surgical site in these 12 patients, nor in 3 additional patients with only CT follow-up. Another 3 patients had previous CT demonstrating hernia at the same location. CONCLUSION: With increasing use of synthetic mesh, awareness of variations in FDG PET-CT appearance is important to avoid false interpretation in cancerpatients.
Entities:
Keywords:
FDG PET CT; Foreign body reaction; Hernia; Mesh
Authors: H Balink; S S Tan; N J G M Veeger; F Holleman; B L F van Eck-Smit; R J Bennink; H J Verberne Journal: Eur J Nucl Med Mol Imaging Date: 2015-02-06 Impact factor: 9.236
Authors: C G Pereira-lucena; R Artigiani Neto; D T de Rezende; G de J Lopes-Filho; D Matos; M M Linhares Journal: Hernia Date: 2013-12-27 Impact factor: 4.739