Tima Davidson1,2, Eyal Lotan3,4, Eyal Klang3,4, Johnatan Nissan5, Jeffrey Goldstein6, Elinor Goshen7,3, Simona Ben-Haim7,8, Sara Apter3,4, Bar Chikman9. 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. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. 4. Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel. 5. Technion - Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel. johnatan.n@gmail.com. 6. Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel. 7. Department of Nuclear Medicine, Chaim Sheba Medical Center, 5265601, Tel Hashomer, Israel. 8. Institute of Nuclear Medicine, University College London and UCL Hospitals, NHS Trust, London, UK. 9. Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
Abstract
OBJECTIVE: We describe FDG-PET/CT findings of postoperative fat necrosis in patients following abdominal surgery, and evaluate their changes in size and FDG uptake over time. METHODS: FDG-PET/CT scans from January 2007-January 2016 containing the term 'fat necrosis' were reviewed. Lesions meeting radiological criteria of fat necrosis in patients with prior abdominal surgery were included. RESULTS: Forty-four patients, 30 males, mean age 68.4 ± 11.0 years. Surgeries: laparotomy (n=37; 84.1 %), laparoscopy (n=3; 6.8 %), unknown (n=4; 9.1 %). CTs of all lesions included hyperdense well-defined rims surrounding a heterogeneous fatty core. Sites: peritoneum (n=34; 77 %), omental fat (n=19; 43 %), subcutaneous fat (n=8; 18 %), retroperitoneum (n=2; 5 %). Mean lesion long axis: 33.6±24.9 mm (range: 13.0-140.0). Mean SUVmax: 2.6±1.1 (range: 0.6-5.1). On serial CTs (n=34), lesions decreased in size (p=0.022). Serial FDG-PET/CT (n=24) showed no significant change in FDG-avidity (p=0.110). Mean SUVmax did not correlate with time from surgery (p=0.558) or lesion size (p=0.259). CONCLUSION: Postsurgical fat necrosis demonstrated characteristic CT features and may demonstrate increased FDG uptake. However, follow-up of subsequent imaging scans showed no increases in size or FDG-avidity. Awareness of this entity is important to avoid misinterpretation of findings as recurrent cancer. KEY POINTS: • Postsurgical fat necrosis may mimic cancer in FDG-PET/CT. • Follow-up of fat necrosis showed no increase in FDG intensity. • CT follow-up showed a decrease in lesion size. • FDG uptake did not correlate with time lapsed from surgery.
OBJECTIVE: We describe FDG-PET/CT findings of postoperative fat necrosis in patients following abdominal surgery, and evaluate their changes in size and FDG uptake over time. METHODS:FDG-PET/CT scans from January 2007-January 2016 containing the term 'fat necrosis' were reviewed. Lesions meeting radiological criteria of fat necrosis in patients with prior abdominal surgery were included. RESULTS: Forty-four patients, 30 males, mean age 68.4 ± 11.0 years. Surgeries: laparotomy (n=37; 84.1 %), laparoscopy (n=3; 6.8 %), unknown (n=4; 9.1 %). CTs of all lesions included hyperdense well-defined rims surrounding a heterogeneous fatty core. Sites: peritoneum (n=34; 77 %), omental fat (n=19; 43 %), subcutaneous fat (n=8; 18 %), retroperitoneum (n=2; 5 %). Mean lesion long axis: 33.6±24.9 mm (range: 13.0-140.0). Mean SUVmax: 2.6±1.1 (range: 0.6-5.1). On serial CTs (n=34), lesions decreased in size (p=0.022). Serial FDG-PET/CT (n=24) showed no significant change in FDG-avidity (p=0.110). Mean SUVmax did not correlate with time from surgery (p=0.558) or lesion size (p=0.259). CONCLUSION: Postsurgical fat necrosis demonstrated characteristic CT features and may demonstrate increased FDG uptake. However, follow-up of subsequent imaging scans showed no increases in size or FDG-avidity. Awareness of this entity is important to avoid misinterpretation of findings as recurrent cancer. KEY POINTS: • Postsurgical fat necrosis may mimic cancer in FDG-PET/CT. • Follow-up of fat necrosis showed no increase in FDG intensity. • CT follow-up showed a decrease in lesion size. • FDG uptake did not correlate with time lapsed from surgery.
Authors: Raghava Kashyap; Eddie Lau; Anupkumar George; John F Seymour; Stephen Lade; Rodney J Hicks; Michael S Hofman Journal: Eur J Nucl Med Mol Imaging Date: 2013-05-08 Impact factor: 9.236
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: Hussein Mahajna; Keren Vaknin; Jennifer Ben Shimol; Abdulla Watad; Arsalan Abu-Much; Naim Mahroum; Ora Shovman; Yehuda Shoenfeld; Howard Amital; Tima Davidson Journal: Int J Environ Res Public Health Date: 2021-05-18 Impact factor: 3.390