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Inflammatory and Ischemic Post Liver Transplant Complications Mimic Malignancy on 18F-FDG PET/CT

10.4274/mirt.03371

  • William Makis
  • Anthony Ciarallo
  • Stephan Probst

Received Date: 31.12.2016 Accepted Date: 15.10.2017 Mol Imaging Radionucl Ther 2018;27(1):37-40 PMID: 29393053

A 65-year-old male patient with a one year history of liver transplantation was referred for an 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to rule out post transplant lymphoproliferative disease. Multiple foci of intense abnormal 18F-FDG uptake were seen in the transplanted liver which were concerning for malignancy. Explantation of the liver approximately 1 month following the PET/CT revealed multiple inflammatory and ischemic changes including large bile duct necrosis, acute cholangitis, bile duct obstruction changes and periportal fibrosis, with no evidence of malignancy. We present the 18F-FDG PET/CT image findings of this case.

Keywords: Liver transplant,complications,pitfall,artifact,18F-fluorodeoxyglucose,positron emission tomography

Ethics

Informed Consent: All subjects in the study gave written informed consent or the institutional review board waived the need to obtain informed consent.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: W.M., A.C., S.P., Concept: W.M., Design: W.M., Data Collection or Processing: W.M., A.C., S.P., Analysis or Interpretation: W.M., A.C., S.P., Literature Search: W.M., A.C., S.P., Writing: W.M.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.


1. Patkowski W, Nyckowski P, Zieniewicz K, Pawlak J, Michalowicz B, Kotulski M, Smoter P, Grodzicki M, Skwarek A, Ziolkowski J, Oldakowska-Jedynak U, Niewczas M, Paczek L, Krawczyk M. Biliary tract complications following liver transplantation. Transplant Proc 2003;35:2316-2317.
2. Welling TH, Heidt DG, Englesbe MJ, Magee JC, Sung RS, Campbell DA, Punch JD, Pelletier SJ. Biliary complications following liver transplantation in the model for end-stage liver disease era: effect of donor, recipient, and technical factors. Liver Transpl 2008;14:73-80.
3. Foley DP, Fernandez LA, Leverson G, Anderson M, Mezrich J, Sollinger HW, D’Alessandro A. Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long term outcomes from a single center. Ann Surg 2011;253:817-825.
4. McCormack L, Hany TI, Hubner M, Petrowsky H, Mullhaupt B, Knuth A, Stenner F, Clavien PA. How useful is PET/CT imaging in the management of post-transplant lymphoproliferative disease after liver transplantation? Am J Transplant 2006;6:1731-1736.
5. Takehana CS, Twist CJ, Mosci C, Quon A, Mittra E, Iagaru A. 18F-FDG PET/CT in the management of patients with post-transplant lymphoproliferative disorder. Nuc Med Comm 2014;35:276-281.
6. Mocherla B, Kim J, Roayaie S, Kim S, Machac C, Kostakoglu L. FDG PET/CT imaging to rule out extrahepatic metastases before liver transplantation. Clin Nucl Med 2007;32:947-948.
7. Lee SD, Kim SH, Kim YK, Kim C, Kim SK, Han SS, Park SJ. 18F-FDG PET/CT predicts early tumor recurrence in living donor liver transplantation for hepatocellular carcinoma. Transplant Int 2013;26:50-60.
8. Frohlich A, Diederichs CG, Staib L, Vogel J, Beger HG, Reske SN. Detection of liver metastases from pancreatic cancer using FDG PET. J Nucl Med 1999;40:250-255.
9. Bleeker-Rovers CP, Vos FJ, Wanten GJ, van der Meer JW, Corstens FH, Kullberg BJ, Oyen WJ. 18F-FDG PET in detecting metastatic infectious disease. J Nucl Med 2005;46:2014-2019.
10. Kitajima K, Murakami K, Yamasaki E, Domeki Y, Kaji Y, Morita S, Suganuma N, Sugimura K. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent uterine cancer: comparison with PET and enhanced CT. Eur J Nucl Med Mol Imaging 2009;36:362-372.
11. Kawamura E, Habu D, Higashiyama S, Tsushima H, Shimonishi Y, Nakayama Y, Enomoto M, Kawabe J, Tamori A, Kawada N, Shiomi S. A case of sclerosing cholangitis with autoimmune pancreatitis evaluated by FDG-PET. Ann Nucl Med 2007;21:223-228.
12. Keidar Z, Gurman-Balbir A, Gaitini D, Israel O. Fever of unknown origin: the role of 18F-FDG PET/CT. J Nucl Med 2008;49:1980-1985.
13. Delbeke D, Martin WH, Sandler MP, Chapman WC, Wright JK Jr, Pinson CW. Evaluation of benign vs malignant hepatic lesions with positron emission tomography. Arch Surg 1998;133:510-516.
14. Kawamura E, Habu D, Tsushima H, Torii K, Kawabe J, Ohsawa M, Shiomi S. A case of hepatic inflammatory pseudotumor identified by FDG-PET. Ann Nucl Med 2006;20:321-323.
15. Guglielmi AN, Kim BY, Bybel B, Slifkin N. False-positive uptake of FDG in hepatic sarcoidosis. Clin Nucl Med 2006;31:175.