Al-Nabhani Khalsa, Syed Rizwan, Haroon Athar, Almukhailed Omar, Bomanji Jamshed
Institute of Nuclear Medicine, University College London Hospitals, London, UK.
J Radiol Case Rep. 2012 Nov;6(11):34-42. doi: 10.3941/jrcr.v6i11.1109. Epub 2012 Nov 1.
We present a case report of a patient with metastatic non-small cell lung cancer (NSCLC) who had a series of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans for assessment of response to treatment. A restaging 18F-FDG PET/CT scan after six cycles showed increased FDG activity in the bone lesions with reduced activity in the lung and liver lesions. The increased bone activity was considered to be due to flare phenomenon rather than metastasis. A short interval follow up scan after 1 month was advised to confirm this interpretation but this repeat scan showed disease relapse. Although the flare phenomenon does exist, caution should be exercised in attributing increased tracer uptake in the lesions in patients with adenocarcinoma of lung and especially those who have received erlotinib during the course of their treatment. Distinguishing the 'flare phenomenon' and 'disease progression' is at times difficult but is important since misdiagnosis may result in an unnecessary delay in patient management.
我们报告了一例转移性非小细胞肺癌（NSCLC）患者的病例，该患者接受了一系列氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）以评估治疗反应。六个周期后的重新分期18F-FDG PET/CT扫描显示，骨病变中的FDG活性增加，而肺和肝病变中的活性降低。骨活性增加被认为是由于炎症现象而非转移。建议在1个月后进行短期随访扫描以证实这一解释，但这次重复扫描显示疾病复发。尽管确实存在炎症现象，但对于肺癌腺癌患者，尤其是在治疗过程中接受过厄洛替尼治疗的患者，在将病变中示踪剂摄取增加归因于此现象时应谨慎。区分“炎症现象”和“疾病进展”有时很困难，但很重要，因为误诊可能导致患者管理的不必要延迟。
