IntroductionFluorine-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is used for non-invasive staging and restaging of solid malignant tumors. PET-CT based criteria have been developed to evaluate the response to targeted therapy. These include the European Organization for Research and Treatment of Cancer (EORTC) and the PET Response Criteria in Solid Tumors (PERCIST). The aim of this study was to determine the agreement between EORTC and PERCIST criteria for treatment response evaluation in patients with solid malignant tumors.Materials and methodsThis was a retrospective study conducted from February 2017 till July 2017. Electronic medical records of patients diagnosed with solid malignant tumors were searched. Experienced radiologists evaluated the PET-CT images based on EORTC and PERCIST criteria. The Kappa (κ) test was used for evaluation of agreement between treatment response according to EORTC and PERCIST criteria.ResultsOut of 54 patients, 41 (75.9%) were male and 13 (24.1%) were female with a mean age of 57.09 ± 10.65 years. According to EORTC criteria, complete metabolic response (CMR) was seen in five (9.3%) of patients, partial metabolic response (PMR) was seen in 36 (66.7%) of patients, progressive metabolic disease (PMD) was seen in nine (16.7%) of patients and stable metabolic disease (SMD) was seen in four (7.4%) of patients. According to PERCIST criteria, CMR was seen in five (9.3%) of patients, PMR was seen in 33 (61.1%) of patients, PMD was seen in nine (16.7%) of patients and SMD was seen in seven (13.0%) of patients. EORTC and PERCIST agreed on 43 (79.6%) of the patients with κ-coefficient of 0.62 indicating good agreement (p-value of <0.001).ConclusionEORTC and PERCIST criteria have a good agreement in evaluating treatment response in solid malignant tumors. Therefore, adoption of EORTC or PERCIST in PET-CT reporting can standardize the evaluation of oncological treatment results.

18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been established as the indisputable tool in the oncological arena to diagnose, stage/restage, and report treatment response for various tumor malignancies. FDG uptake mostly identifies pathological uptake in oncological scans with the tracer on PET studies; however, benign uptakes are also commonly seen. Reported here is a benign case of increased uptake of the FDG on a PET with computed tomography scan in the gallbladder (GB) of a patient being screened for a known carcinoma breast. The benign accumulation of the tracer is seen in the GB to various degrees and this phenomenon may occur as a result of FDG excretion into the bile. When interpreting clinical PET images, recognition of this phenomenon is important to avoid misdiagnosing physiological GB FDG uptake as pathological so as to avoid misinterpretations of the findings.

In the twenty first century, the idea of democracy has transcended its original conception of domestic governance to actively influence international relations. The nature of state—democratic or nondemocratic—has come to determine hierarchy, alliances, and status in international relations. It tends to bestow a degree of moral superiority to democratic states in dealings of international relations. This moral superiority in its most aggressive form, in the past two decades, has led to wars in the name of democracy. It has been used to justify military intervention in nondemocratic states by democratic nations. The use of force to bring about desired consequences has become the norm in inter-state relations. The focus is not on the action, but on its intent. This article studies the use of force and war by Western democratic countries to establish democracies through military intervention in other parts of the world. The article analyzes the widespread impact of foreign policies of the stronger nation-states and seeks to understand if the desired results are achieved or not. Beginning with the democratic peace theory that is held in high opinion by democracies of today, the article moves toward Immanuel Kant and his idea of perpetual peace. The democratic peace theory finds its base in Kant’s perpetual peace and finds an echo in Western democracies’ foreign policies. The article then sees how this theory is used to justify war, through the case study of Afghanistan, and what is the intention behind the wars. The article concludes that the desired aim of “positive peace” cannot be achieved via violent means. In the process of establishing peaceful and healthy democracy, Kant’s categorical imperatives are crucial.

Background: Accurate evaluation of ovarian carcinoma is utmost important for effective management. PET/CT is reported to be effective in evaluation of suspected recurrence of ovarian carcinoma. This study aims to assess the accuracy of PET/CT in evaluation of recurrent ovarian cancer among clinically suspected cases with rising tumor marker or suspicious clinic-radiological findings. Patients and methods: This prospective cross-sectional study was conducted at Radiology department of Jinnah Postgraduate Medical Centre Karachi from 22nd April 2019 to 21st April 2020. Patients having age of 40 to 60 years and referred for PET scan with suspected recurrence of ovarian carcinoma were consecutively enrolled. Patients were suspected due to relevant history, clinical findings and initial imaging investigations with elevated CA-125 level. Results of 18FDG PET/CT scan was correlated with the raised tumor findings. The PET/CT scan showing abnormally elevated FDG take-up and higher SUV values than the background activity considered recurrence. Diagnostic accuracy of PET/CT was calculated taking raised tumor level as reference category. Results: Of 65 patients, median age was 50 (43-56) years. The findings showed positive cases in 57 (87.7%) while negative in 8 (12.3%) patients, whereas the findings of tumor marker showed raised tumor marker in 61 (93.8%) patients. Diagnostic accuracy of PET/CT showed sensitivity, specificity, positive predicted value, negative predated value, and overall diagnostic accuracy as 93.44%, 100%, 100%, 50%, and 93.85% respectively. Conclusion: A higher accuracy of PET/CT was observed in the diagnosis of recurrent ovarian cancer among clinically suspected cases, thus helping in devising an appropriate management plan by the treating physician.

Although Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) is routinely used in oncological imaging, the F-18 fluorodeoxyglucose (18F-FDG) avidity is not tumor-specific. Numerous benign infective and inflammatory processes may also show increased radiotracer activity. Similarly, abnormal 18F-FDG uptake in an inflamed appendix can pose a diagnostic challenge for the interpreter of oncologic 18F-FDG PET/CT. We present the case of an 18-year-old female with classic Hodgkin's lymphoma who had 18F-FDG PET/CT while undergoing chemoradiotherapy. The scan demonstrated a complete metabolic response to treatment. However, there was increased 18F-FDG uptake in the right iliac region, projecting over the appendix, which, if interpreted as a lymphomatous involvement, would have upscaled the treatment response to progressive disease. The patient was called for additional workup, which included an ultrasound abdomen.The scan revealed classic features of acute appendicitis. However, there was no appendicolith or luminal obstruction. Upon additional questioning, the patient mentioned mild intermittent abdominal pain and anorexia eased by pain relievers for the preceding few days. On deep palpation of her abdomen, there was rebound tenderness in the right iliac region. According to the Alvarado score, it was graded 7 points suggesting probable/likely appendicitis. After collective evaluation of the clinical, laboratory, and imaging findings, the appendicular 18F-FDG uptake was deemed secondary to uncomplicated acute appendicitis rather than a lymphomatous lesion. Our patient refused surgery as she did not have severe abdominal pain. She was hemodynamically stable without signs of luminal obstruction. She was non-operatively managed with broad-spectrum antibiotics for six days. The results of the follow-up complete blood counts and ultrasound examination were negative. Our patient was symptom-free and recovering normally at a twoweek follow-up appointment.We present a follow-up case of classic Hodgkin's lymphoma with incidental uptake in the appendix, which resembled submucosal lymphomatous cell infiltration of the appendix. Careful scrutiny, clinical correlation, physical examination, blood tests, and additional imaging offered helpful insight and led to the correct, benign diagnosis of the 18F-FDG avid appendix.