Head Pancreatic Carcinoma and D Mellitus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

            Male patient 69 year old,  diabetic under insulin with a history of pancreatic tumor. MRI: mild splenomegaly, bilateral perirenal edema; simple cyst left kidney. Abdominal CT: ill-defined small image in pancreatic head. Myelogram: no evidence of malignant cell infiltration. Gastric endoscopy antrum erosive gastritis; hiatal hernia. Colonoscopy: no obvious lesions. CA 19-9: 7980 U / mL (N <39; CA 125 : 640 U / mL (N <35). CEA: 6.8 ng / mL (N <3.4). PET FDG Dose: 17 mCi, injected with glucose of 120 mg / dL post injection of 5 U of insulin (due to abnormal basaline glucose of 261 mg / dL). F18FDG-PET shows a focus of increased uptake of FDG moderate epigastric in projection site of the pancreatic head, 2.8 cm in diameter approx (arrow). Diffuse increased tracer  activity in muscles and the heart explained by use of insulin, which may eventually reduce the uptake in other malignant lesions. It might be better to control adequately the diabetes before doing the PET F18FDG scan not to affect the sensitivity of the study.
 

References:

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2  Lemke AJ, Niehues SM, Hosten N, Amthauer H, Boehmig M, Stroszczynski C, Rohlfing T, Rosewicz S, Felix R. Retrospective digital image fusion of multidetector CT and 18F-FDG PET: clinical value in pancreatic lesions--a prospective study with 104 patients. J Nucl Med. 2004 Aug;45(8):1279-86.

3   Saif MW, Cornfeld D, Modarresifar H, Ojha B. 18F-FDG positron emission tomography CT (FDG PET-CT) in the management of
pancreatic cancer: initial experience in 12 patients. J Gastrointestin Liver Dis. 2008 Jun;17(2):173-8.

4   Kitajima K, Murakami K, Yamasaki E, Kaji Y, Shimoda M, Kubota K, Suganuma N, Sugimura K. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent pancreatic cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Mol Imaging Biol. 2010 Aug;12(4):452-9.

5   Lin YF, Yu FC, Chiu JS. The twilight saga of insulin administration in hyperglycemic patients undergoing (18)F-FDG PET.J Nucl Med. 2010 Mar;51(3):497. 11.
 

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