title: Postoperative changes after surgical mesh hernia repair: a pitfall in interpretation of 18F-FDG PET-CT.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  With increasing use of synthetic mesh, awareness of variations in FDG PET-CT appearance is important to avoid false interpretation in cancer patients.
authors.affiliation: Department of Nuclear Medicine, Chaim Sheba Medical Center, 5265601, Tel Hashomer, Israel. tima.davidson@sheba.health.gov.il.|Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. tima.davidson@sheba.health.gov.il.
authors.forename: T
authors.initials: T
authors.lastname: Davidson
authors.affiliation: Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Klang
authors.affiliation: Department of Nuclear Medicine, Chaim Sheba Medical Center, 5265601, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Goshen
authors.affiliation: Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Goldstein
authors.affiliation: Department of Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Khaikin
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: B
authors.initials: B
authors.lastname: Chikman
authors.affiliation: Department of Nuclear Medicine, Chaim Sheba Medical Center, 5265601, Tel Hashomer, Israel.|Institute of Nuclear Medicine, University College London and UCL Hospitals, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ben-Haim
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D059685:Herniorrhaphy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009852:Omentum; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography; D011184:Postoperative Period; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013526:Surgical Mesh
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG PET CT; Foreign body reaction; Hernia; Mesh