51
|
Abstract
Breast cancer is a major disease with high morbidity and mortality in women. As a highly heterogeneous tumor, it contains different molecular subtypes: luminal A, luminal B, human epidermal growth factor 2-positive, and triple-negative subtypes. As each subtype has unique features, it may not be universal to the optimal treatment and expected response for individual patients. Therefore, it is critical to identify different breast cancer subtypes. Targeting subcellular levels, molecular imaging, especially PET and single photon emission computed tomography, has become a promising means to identify breast cancer subtypes and monitor treatment. Different biological processes between various subtypes, including changes correlated with receptor expression, cell proliferation, or glucose metabolism, have the potential for imaging with PET and single photon emission computed tomography radiopharmaceuticals. Receptor imaging, with radiopharmaceuticals targeting estrogen receptor, progesterone receptor, or human epidermal growth factor 2, is available to distinguish receptor-positive tumors from receptor-negative ones. Cell proliferation imaging with fluorine-18 fluorothymidine PET aids identification of luminal A and B subtypes on the basis of the correlation with the immunohistochemical biomarker Ki-67. Glucose metabolism imaging with fluorine-18 fluorodeoxyglucose PET may have potential to discriminate triple-negative subtypes from others. With increasing numbers of novel radiopharmaceuticals, noninvasive molecular imaging will be applied widely for the identification of different subtypes and provide more in-vivo information on individualized management of breast cancer patients.
Collapse
|
52
|
Nakajo M, Kajiya Y, Jinguji M, Nakabeppu Y, Nakajo M, Nihara T, Yoshiura T. Current clinical status of 18F-FLT PET or PET/CT in digestive and abdominal organ oncology. Abdom Radiol (NY) 2017; 42:951-961. [PMID: 27770160 DOI: 10.1007/s00261-016-0947-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Positron emission tomography (PET) or PET/computed tomography (CT) using 18F-3'-fluoro-3'-deoxythymidine (18F-FLT) offers noninvasive assessment of cell proliferation in human cancers in vivo. The present review discusses the current status on clinical applications of 18F-FLT-PET (or PET/CT) in digestive and abdominal oncology by comparing with 18F-fluorodeoxyglucose (18F-FDG)-PET (or PET/CT). The results of this review show that although 18F-FLT uptake is lower in most cases of digestive and abdominal malignancies compared with 18F-FDG uptake, 18F-FLT-PET can be used to detect primary tumors. 18F-FLT-PET has shown greater specificity for N staging than 18F-FDG-PET which can show false-positive uptake in areas of inflammation. However, because of the high background uptake in the liver and bone marrow, it has a limited role of assessing liver and bone metastases. Instead, 18F-FLT-PET will be a powerful tool for monitoring response to treatment and provide prognostic information in digestive and abdominal oncology.
Collapse
Affiliation(s)
- Masatoyo Nakajo
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
- Department of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan.
| | - Yoriko Kajiya
- Department of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Megumi Jinguji
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yoshiaki Nakabeppu
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Masayuki Nakajo
- Department of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Tohru Nihara
- Department of Gastroentenology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| |
Collapse
|
53
|
Kanchustambham V, Schenone A, Reichardt BA, Saladi S, Mehta K, Poddar N, Stoeckel D. All That Glitters Is Not Gold" - A Case of an Occult Foreign Body in the Lung with Elevated 2-[18F]-Fluoro-2-deoxy-D-glucose (FDG) Uptake Mimicking Bronchogenic Carcinoma. Cureus 2017; 9:e990. [PMID: 28265526 PMCID: PMC5323024 DOI: 10.7759/cureus.990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Combined positron emission tomography/computed tomography (PET/CT) using the glucose analogue 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) has become the standard of care in oncological patients. However, due to the non-specific nature of FDG uptake, there are many physiological variants and benign pathological entities that also demonstrate augmented glucose metabolism, such as inflammatory and infective processes. Undiagnosed and retained foreign bodies (occult foreign bodies) in the lung can induce inflammatory reaction consisting of polymorphonuclear neutrophils, macrophages, and granulation tissue resulting in intense FDG uptake because of high metabolic activity and cell turnover. Here, we present a case of an occult foreign body imitating a tumor on PET/CT.
Collapse
Affiliation(s)
| | - Aaron Schenone
- Internal Medicine, Saint Louis University School of Medicine
| | - Brian A Reichardt
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine
| | - Swetha Saladi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine
| | - Kris Mehta
- Internal Medicine, Saint Louis University School of Medicine
| | - Nishant Poddar
- Division of Hematology and Oncology, Saint Louis University School of Medicine
| | - David Stoeckel
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine
| |
Collapse
|
54
|
Yalin GY, Dogansen SC, Canbaz B, Gul N, Bilgic B, Uzum AK. INCIDENTAL PAGET'S DISEASE DISGUISED AS BONE METASTASIS IN A PATIENT WITH ENDOMETRIUM CARCINOMA. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:111-114. [PMID: 31149157 DOI: 10.4183/aeb.2017.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Paget's disease is a disorder of aging bone which occurs in the setting of accelarated bone remodelling. In the presented case we discuss the difficulties in the diagnosis of Paget's disease in a 77 year old patient with coexisting endometrium carcinoma. The patient was initially diagnosed with metastatic bone disease due to endometrium adenocarcinoma when she was admitted to oncology clinic with pelvic pain. Bone scintigraphy with Tc99 and (18)F fluorodeoxyglucose positron emission tomography/CT revealed an increased uptake on the bone lesions which were reported as metastatic bone involvement. Although the (18)F-FDG uptake was much higher than the levels that would generally be anticipated in a case with Paget's disease, high levels of bone turnover markers indicated further evaluation in the differential diagnosis and the definitive diagnosis of Paget's disease was established with the pathological evaluation of bone biopsy.
Collapse
Affiliation(s)
- G Y Yalin
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
| | - S C Dogansen
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
| | - B Canbaz
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
| | - N Gul
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
| | - B Bilgic
- Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Turkey
| | - A K Uzum
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
| |
Collapse
|
55
|
Bikkina P, Kotha S, Ali Z. Abnormal Fluorodeoxyglucose Uptake in Lung without Structural Abnormality on Computed Tomography. Indian J Nucl Med 2017; 32:359-360. [PMID: 29142360 PMCID: PMC5672764 DOI: 10.4103/ijnm.ijnm_68_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is a useful proven imaging modality in the management of many types of cancers. It is being used at various stages of treatment of cancer. Knowledge regarding the physiological biodistribution and false-positive findings should be kept in mind for correct interpretation. Pulmonary FDG uptake can be due to different causes such as infection, inflammation, and metastases which are invariably associated with structural abnormality on CT. In rare circumstances, there can be a focus of FDG uptake in the lung with no corresponding structural abnormality which might be due to an inflammatory vascular microthrombus or due to iatrogenic microembolism caused during the injection of radiotracer. It is important to be aware of this as it can cause difficulty in interpreting the scan and can lead to false-positive findings. It also highlights the importance of hybrid imaging in the form of PET-CT as there is a definite possibility of misinterpreting this as a site of metastasis in a known carcinoma patient if there was no corresponding CT image.
Collapse
Affiliation(s)
- Prathyusha Bikkina
- Department of Nuclear Medicine and PET-CT, Basavatarakam Indo American Cancer Hospital, Hyderabad, Telangana, India
| | - Swapna Kotha
- Department of Radiology, Basavatarakam Indo American Cancer Hospital, Hyderabad, Telangana, India
| | - Zakir Ali
- Department of Nuclear Medicine and PET-CT, Basavatarakam Indo American Cancer Hospital, Hyderabad, Telangana, India
| |
Collapse
|
56
|
|
57
|
Wright CL, Maly JJ, Zhang J, Knopp MV. Advancing Precision Nuclear Medicine and Molecular Imaging for Lymphoma. PET Clin 2016; 12:63-82. [PMID: 27863567 DOI: 10.1016/j.cpet.2016.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PET with fluorodeoxyglucose F 18 (18F FDG-PET) is a meaningful biomarker for the detection, targeted biopsy, and treatment of lymphoma. This article reviews the evolution of 18F FDG-PET as a putative biomarker for lymphoma and addresses the current capabilities, challenges, and opportunities to enable precision medicine practices for lymphoma. Precision nuclear medicine is driven by new imaging technologies and methodologies to more accurately detect malignant disease. Although quantitative assessment of response is limited, such technologies will enable a more precise metabolic mapping with much higher definition image detail and thus may make it a robust and valid quantitative response assessment methodology.
Collapse
Affiliation(s)
- Chadwick L Wright
- Wright Center of Innovation in Biomedical Imaging, Division of Imaging Science, Department of Radiology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Room 430, Columbus, OH 43210, USA
| | - Joseph J Maly
- Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Starling Loving Hall 406C, 320 West 10th Avenue, Columbus, OH 43210, USA
| | - Jun Zhang
- Wright Center of Innovation in Biomedical Imaging, Division of Imaging Science, Department of Radiology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Room 430, Columbus, OH 43210, USA
| | - Michael V Knopp
- Wright Center of Innovation in Biomedical Imaging, Division of Imaging Science, Department of Radiology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Room 430, Columbus, OH 43210, USA.
| |
Collapse
|
58
|
Matthews R, Choi M. Clinical Utility of Positron Emission Tomography Magnetic Resonance Imaging (PET-MRI) in Gastrointestinal Cancers. Diagnostics (Basel) 2016; 6:diagnostics6030035. [PMID: 27618106 PMCID: PMC5039569 DOI: 10.3390/diagnostics6030035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 12/17/2022] Open
Abstract
Anatomic imaging utilizing both CT (computed tomography) and MRI (magnetic resonance imaging) limits the assessment of cancer metastases in lymph nodes and distant organs while functional imaging like PET (positron emission tomography) scan has its limitation in spatial resolution capacity. Hybrid imaging utilizing PET-CT and PET-MRI are novel imaging modalities that are changing the current landscape in cancer diagnosis, staging, and treatment response. MRI has shown to have higher sensitivity in soft tissue, head and neck pathology, and pelvic disease, as well as, detecting small metastases in the liver and bone compared to CT. Combining MRI with PET allows for detection of metastases that may have been missed with current imaging modalities. In this review, we will examine the clinical utility of FDG PET-MRI in the diagnosis and staging of gastrointestinal cancers with focus on esophageal, stomach, colorectal, and pancreatic cancers. We will also explore its role in treatment response and future directions associated with it.
Collapse
Affiliation(s)
- Robert Matthews
- Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
| | - Minsig Choi
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
| |
Collapse
|
59
|
Eberhardt SC, Strickland CD, Epstein KN. Radiology of epiploic appendages: acute appendagitis, post-infarcted appendages, and imaging natural history. Abdom Radiol (NY) 2016; 41:1653-65. [PMID: 27142382 DOI: 10.1007/s00261-016-0757-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Our aim was to demonstrate the imaging characteristics of epiploic appendages in native, acute inflamed/ischemic and post-infarcted states through retrospective imaging analysis, with clinical and pathologic correlation, and to discuss clinical implications. Cases were gathered mostly retrospectively and reviewed for inclusion based on established diagnostic criteria. Radiology report text search was used to find cases, using terms "epiploic," "appendage," "appendagitis," and "peritoneal body." Data records included patient demographics, relevant clinical data, lesion size, location and apparent imaging composition, and the presence of change or stability in features over multiple studies. Pathologic and clinical data were sought and assessed for correlation. Imaging studies of 198 individuals were included (mean age 50, range 9-95), with a total of 228 lesions: 63 acute and 165 non-acute presentations. All included subjects had CT imaging and some had lesions visible on radiographs, MRI, PET/CT, and sonography. 23 subjects had more than one studied lesion. In addition to classic acute appendagitis, more frequently encountered are post-infarcted appendages either in situ along the colon, adhered to peritoneal or serosal surfaces, or freely mobile in the peritoneum as loose bodies. The majority of the non-acute varieties are recognizable due to peripheral calcification that develops over time following ischemic insult. Multiple cases demonstrated the imaging natural history and confirmed pathologic basis for imaging findings. In summary, acute and post-infarcted epiploic appendages have characteristic imaging appearances and natural history which should provide correct diagnosis in most cases. Incidental post-infarcted epiploica are more commonly encountered than acute presentations.
Collapse
|
60
|
Amraoui S, Tlili G, Hindié E, Perez P, Peuchant O, Bordenave L, Bordachar P. Accuracy of Positron Emission Tomography as a Diagnostic Tool for Lead Endocarditis: Design of the Prospective Multicentre ENDOTEP Study. Eur Cardiol 2016; 11:25-28. [PMID: 30310444 DOI: 10.15420/ecr.2016:6:2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Rates of pacemaker implantation are steadily increasing and as patients are living longer, endovenous leads remain implanted for an extended period of time thereby increasing the risk of cardiac implantable electronic device (CIED) infection. Investigating fever of unknown origin in patients with implanted pacemakers can be challenging. Recently, 18F-fluorodeoxyglucose positron emission tomography/computerised tomography (18F-FDG-PET/CT) scanning has been used as a diagnostic tool for lead endocarditis in small studies. Objectives: ENDOTEP is a prospective and multicentre study designed to evaluate the accuracy of 18F-FDG-PET/CT scanning in the diagnosis of lead endocarditis. Methods: A total of 250 patients referred for pacemaker extraction due to suspicion of an infected device will be prospectively enrolled in six French regional centres for investigation and treatment of CIED infection. 18F-FDG-PET/CT scanning (index test) will be performed in each patient in the 48 hours preceding lead extraction. Bacteriological cultures (reference standard) will assess the presence of lead endocarditis, blind to 18F-FDG-PET/CT results. Enrolment started in June 2015 and is expected to end by June 2017. The primary objective will be to establish the sensitivity of the 18F-FDG-PET/CT scan for lead endocarditis. Secondary objectives will include other accuracy parameters, inter-observer agreement in the interpretation of 18F-FDG-PET/CT scanning, the influence of previous antibiotic therapy on 18F-FDG-PET/CT diagnostic accuracy and assessment of septic emboli associated to lead endocarditis. Conclusion: The ENDOTEP study will examine the ability of 18F-FDG-PET/CT scanning to avoid possible false-positive results, as is common using the current usual diagnostic strategy and may lead to unnecessary extraction of implants in patients with suspected lead infection.
Collapse
Affiliation(s)
- Sana Amraoui
- Cardiologic Haut-Lévêque hospital, Bordeaux university, INSERM U1045, LIRYC institute, Bordeaux, France
| | - Ghoufrane Tlili
- Nuclear medicine center, Bordeaux university, Bordeaux, France
| | - Elif Hindié
- Nuclear medicine center, Bordeaux university, Bordeaux, France
| | - Paul Perez
- ISPED center, Bordeaux university, Bordeaux, France
| | - Olivia Peuchant
- Cardiologic Haut-Lévêque hospital, Bordeaux university, INSERM U1045, LIRYC institute, Bordeaux, France.,Nuclear medicine center, Bordeaux university, Bordeaux, France.,ISPED center, Bordeaux university, Bordeaux, France
| | | | - Pierre Bordachar
- Cardiologic Haut-Lévêque hospital, Bordeaux university, INSERM U1045, LIRYC institute, Bordeaux, France
| |
Collapse
|
61
|
Jo K, Kim S, Cha J, Hwang SH, Lee N, Yun M, Kang WJ. A Comparison Study of Esophageal Findings on (18)F-FDG PET/CT and Esophagogastroduodenoscopy. Nucl Med Mol Imaging 2016; 50:123-9. [PMID: 27275360 DOI: 10.1007/s13139-015-0376-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The aim of this study was to compare the esophageal findings of 2-deoxy-2-[(18)F]fluoro-d-glucose positron emission tomography-computed tomography ((18)F-FDG PET/CT) and esophagogastroduodenoscopy (EGD). METHODS We retrospectively reviewed (18)F-FDG PET/CT and EGD findings of 369 subjects who underwent medical examination between January 2014 and December 2014. The range and intensity of esophageal (18)F-FDG uptake were visually analyzed. The maximum standardized uptake value (SUVmax) of the esophagus and around the esophagogastric (EG) junction was measured. EGD results were provided by the gastroenterologist. We compared the esophageal findings obtained using (18)F-FDG PET/CT and EGD. RESULTS There were typical linear FDG uptakes in (18)F-FDG PET/CT patients who underwent EGD the same day. In visual analysis of the range and intensity of the (18)F-FDG uptake, the patients who underwent (18)F-FDG PET/CT and EGD on the same day showed relatively diffuse and discernible (18)F-FDG uptake in the esophagus. Reflux esophagitis was diagnosed in 59 subjects, and 27 of these were classified as higher than Los Angeles classification A. With an increasing degree of reflux esophagitis observed on EGD, the SUVmax in the esophagus and around the EG junction was also increased. CONCLUSION Our study showed that FDG uptake at the esophagus or the EG junction might be clinically significantly related to esophagitis. However, EGD performed before (18)F-FDG PET/CT on the same day may affect the esophageal (18)F-FDG uptake.
Collapse
Affiliation(s)
- KwanHyeong Jo
- Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752 Korea
| | - Soyoung Kim
- Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752 Korea
| | - Jongtae Cha
- Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752 Korea
| | - Sang Hyun Hwang
- Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752 Korea
| | - Narae Lee
- Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752 Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752 Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752 Korea
| |
Collapse
|
62
|
van Es SC, Venema CM, Glaudemans AWJM, Lub-de Hooge MN, Elias SG, Boellaard R, Hospers GAP, Schröder CP, de Vries EGE. Translation of New Molecular Imaging Approaches to the Clinical Setting: Bridging the Gap to Implementation. J Nucl Med 2016; 57 Suppl 1:96S-104S. [PMID: 26834109 DOI: 10.2967/jnumed.115.157974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Molecular imaging with PET is a rapidly emerging technique. In breast cancer patients, more than 45 different PET tracers have been or are presently being tested. With a good rationale, after development of the tracer and proven feasibility, it is of interest to evaluate whether there is a potential meaningful role for the tracer in the clinical setting-such as in staging, in the (early) prediction of a treatment response, or in supporting drug choices. So far, only (18)F-FDG PET has been incorporated into breast cancer guidelines. For proof of the clinical relevance of tracers, especially for analysis in a multicenter setting, standardization of the technology and access to the novel PET tracer are required. However, resources for PET implementation research are limited. Therefore, next to randomized studies, novel approaches are required for proving the clinical value of PET tracers with the smallest possible number of patients. The aim of this review is to describe the process of the development of PET tracers and the level of evidence needed for the use of these tracers in breast cancer. Several breast cancer trials have been performed with the PET tracers (18)F-FDG, 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT), and (18)F-fluoroestradiol ((18)F-FES). We studied them to learn lessons for the implementation of novel tracers. After defining the gap between a good rationale for a tracer and implementation in the clinical setting, we propose solutions to fill the gap to try to bring more PET tracers to daily clinical practice.
Collapse
Affiliation(s)
- Suzanne C van Es
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clasina M Venema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carolina P Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
| |
Collapse
|
63
|
FLT PET/CT Is Better Than FDG PET/CT in Differentiating Benign From Malignant Pancreatobiliary Lesions. Clin Nucl Med 2016; 41:e244-50. [PMID: 26914562 DOI: 10.1097/rlu.0000000000001163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
64
|
Amraoui S, Tlili G, Sohal M, Berte B, Hindié E, Ritter P, Ploux S, Denis A, Derval N, Rinaldi CA, Cazanave C, Jais P, Haissaguerre M, Bordenave L, Bordachar P. Contribution of PET Imaging to the Diagnosis of Septic Embolism in Patients With Pacing Lead Endocarditis. JACC Cardiovasc Imaging 2016; 9:283-90. [DOI: 10.1016/j.jcmg.2015.09.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/07/2015] [Accepted: 09/10/2015] [Indexed: 01/27/2023]
|
65
|
Ye M, Huang J, Wang J, Ren J, Tu J, You W, Zhu T. Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report. BMC Infect Dis 2016; 16:34. [PMID: 26823075 PMCID: PMC4731994 DOI: 10.1186/s12879-016-1376-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background The occurrence of non-contiguous, multiple, and remote involvement tuberculous spondylitis is rare. The clinical presentation in patients with multifocal musculoskeletal tuberculosis may closely mimic that in patients with multiple bone metastases, which makes the accurate clinical diagnosis challenging. Herein, we report a multifocal musculoskeletal tuberculosis case that was misdiagnosed for 8 months as multiple bone metastases. Case presentation A 63-year-old male farmer of Chinese Han ethnicity presented to us with pain in left side of the neck, right side of the chest and the back for 10 months without typical tuberculosis symptoms. His past medical history, the CT and fluoroscopy-guided biopsy were negative for tuberculosis. Interferon gamma by T-SPOT was also negative. Radiological findings including CT, MRI and PET-CT suggested that the patient had multiple metastases. Accordingly, the patient was misdiagnosed as having musculoskeletal tumors until a swelling under the right nipple ulcerated. The smear test for acid-fast bacilli and the PCR test for TB-DNA of the pus from the swollen area were both positive, leading to the final correct diagnosis of musculoskeletal tuberculosis. Conclusion The proper diagnosis of musculoskeletal tuberculosis is clinically challenging due to Mycobacterium tuberculosis variants involved and atypical presentations, especially when the lesions are multiple. Our findings indicate that multiple tuberculous spondylitis must be considered in the differential diagnosis of multiple musculoskeletal lesions.
Collapse
Affiliation(s)
- Meiping Ye
- Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China. .,Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
| | - Jinwei Huang
- Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
| | - Jie Wang
- Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
| | - Jianmin Ren
- Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
| | - Jianfei Tu
- Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
| | - Weibo You
- Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
| | - Taohui Zhu
- Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
| |
Collapse
|
66
|
Radiotherapy volume delineation using dynamic [ 18F]-FDG PET/CT imaging in patients with oropharyngeal cancer: a pilot study. Int J Comput Assist Radiol Surg 2016; 11:2059-2069. [PMID: 26811083 DOI: 10.1007/s11548-016-1351-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Delineation of gross tumour volume in 3D is a critical step in the radiotherapy (RT) treatment planning for oropharyngeal cancer (OPC). Static [18F]-FDG PET/CT imaging has been suggested as a method to improve the reproducibility of tumour delineation, but it suffers from low specificity. We undertook this pilot study in which dynamic features in time-activity curves (TACs) of [18F]-FDG PET/CT images were applied to help the discrimination of tumour from inflammation and adjacent normal tissue. METHODS Five patients with OPC underwent dynamic [18F]-FDG PET/CT imaging in treatment position. Voxel-by-voxel analysis was performed to evaluate seven dynamic features developed with the knowledge of differences in glucose metabolism in different tissue types and visual inspection of TACs. The Gaussian mixture model and K-means algorithms were used to evaluate the performance of the dynamic features in discriminating tumour voxels compared to the performance of standardized uptake values obtained from static imaging. RESULTS Some dynamic features showed a trend towards discrimination of different metabolic areas but lack of consistency means that clinical application is not recommended based on these results alone. CONCLUSIONS Impact of inflammatory tissue remains a problem for volume delineation in RT of OPC, but a simple dynamic imaging protocol proved practicable and enabled simple data analysis techniques that show promise for complementing the information in static uptake values.
Collapse
|
67
|
Iyer K, Karkhanis V, Basu S, Joshi JM. Fluro-deoxygenase-positron emission tomography/computed tomography in hard metal lung disease. Lung India 2015; 32:480-2. [PMID: 26628763 PMCID: PMC4587003 DOI: 10.4103/0970-2113.164160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of a diamond polisher where FDG-PET/CT was helpful in identifying active inflammation in hard metal lung disease (HMLD) caused by cobalt exposure.
Collapse
Affiliation(s)
- Kapil Iyer
- Department of Pulmonary Medicine, Topiwala National Medical College, BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Vinaya Karkhanis
- Department of Pulmonary Medicine, Topiwala National Medical College, BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Sandip Basu
- Department of Nuclear Medicine, Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jyotsna M Joshi
- Department of Pulmonary Medicine, Topiwala National Medical College, BYL Nair Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
68
|
Troum OM, Pimienta OL, Olech E, Østergaard M, Thiele R, Seraphine JL, Bruyn GAW, Peterfy C. Proceedings from The 8th Annual International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) Conference. Semin Arthritis Rheum 2015; 45:e17-23. [PMID: 26614546 DOI: 10.1016/j.semarthrit.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
The International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) was founded in 2005 with the goal of discussing matters related to imaging in rheumatology, particularly, validation, education, and use in both clinical practice and research. The field of musculoskeletal (MSK) imaging is continuously evolving; therefore, education for healthcare providers in this field is of paramount importance. ISEMIR's international faculty and world-renowned experts presented the newest information as it relates to the use of magnetic resonance imaging (MRI) and ultrasound (US) at the 8th annual ISEMIR meeting that took place on April 17-18 in Santa Monica, California. Presentations from the meeting can be viewed at www.isemir.org.
Collapse
Affiliation(s)
- Orrin M Troum
- The Doctors of Saint John׳s, Providence Saint John׳s Health center, Santa Monica, CA
| | - Olga L Pimienta
- The Doctors of Saint John׳s, Providence Saint John׳s Health center, Santa Monica, CA
| | - Ewa Olech
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Judy L Seraphine
- International Society for Musculoskeletal Imaging in Rheumatology, 342 N. Main St, West Hartford, CT 06117.
| | - George A W Bruyn
- Department of Rheumatology, MC groep Hospitals, Lelystad, The Netherlands
| | | |
Collapse
|
69
|
Bae JM, Lee HY, Choi JY. False-positive Uptake on Positron Emission Tomography/Computed Tomography Immediately After Lung Biopsy: A Case Report. Medicine (Baltimore) 2015; 94:e1896. [PMID: 26554786 PMCID: PMC4915887 DOI: 10.1097/md.0000000000001896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is an evolving tool in the field of oncology. 18F-fluorodeoxyglucose, however, is not a specific tool for malignant tumor that it may also accumulate in benign processes. To avoid false-positive interpretation of 18F-FDG-PET/computed tomography (CT), having knowledge of the potential pitfalls is important.The authors present a case of a patient with a lung mass who underwent fluoroscopy-guided transthoracic lung biopsy followed by 18F-FDG-PET/CT scan with a 4-hour interval between biopsy and scanning. Abnormally increased FDG uptake in the mass and pleural effusion was detected. Pathologic examination of the specimen, however, revealed only fibrous tissues with chronic inflammatory cells. On performing CT imaging, 1 month later, the mass and effusion had spontaneously resolved without treatment.Our findings suggest that PET/CT performed immediately following invasive procedures can result in false-positive results and thus mislead diagnosis. Therefore, the interval and order, in which PET/CT and invasive procedures are performed, should be carefully considered in oncologic work-up.
Collapse
Affiliation(s)
- Jung Min Bae
- From the Department of Radiology and Center for Imaging Science (JMB, HYL.); and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (JYC)
| | | | | |
Collapse
|
70
|
A pilot study of the value of 18F-fluoro-deoxy-thymidine PET/CT in predicting viable lymphoma in residual 18F-FDG avid masses after completion of therapy. Clin Nucl Med 2015; 39:874-81. [PMID: 25144214 DOI: 10.1097/rlu.0000000000000539] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite its success in diagnosing and staging lymphoma, F-FDG PET/CT can be falsely positive in areas of posttreatment inflammation. 3'-F-fluoro-3'-deoxy-l-thymidine (F-FLT) is a structural analog of the DNA constituent thymidine; its uptake correlates with cellular proliferation. This pilot study evaluates the ability of F-FLT PET/CT to distinguish viable lymphoma from posttreatment inflammatory changes in F-FDG avid residual masses. METHODS Twenty-one patients with lymphoma with at least 1 F-FDG avid residual mass after therapy underwent F-FLT PET/CT imaging. F-FDG and F-FLT uptake values were compared, including quantitative pharmacokinetic parameters extracted from the F-FLT time activity curves generated from dynamic data using graphical and nonlinear compartmental modeling. RESULTS The true nature of the residual mass was confirmed by biopsy in 12 patients (8 positive and 4 negative for viable lymphoma and by follow-up CT and/or repeat F-FDG PET/CT imaging over 1 year); among the remaining 9 patients, 7 lesions resolved or decreased and 2 showed growth indicative of lymphoma. F-FLT PET SUVest.max was significantly higher in tumors than in benign lesions (5.5 [2.2] vs 1.7 [0.6]; P < 0.0001), whereas the difference in F-FDG SUVs was not significant (malignant, 7.8 [3.8] vs benign, 5.4 [2.4]; P = 0.11). All of the benign lesions had an F-FLT SUVest.max of less than 3.0. CONCLUSIONS F-FLT shows improved specificity over F-FDG in distinguishing residual lymphoma from posttreatment inflammation and may be useful in the evaluation of patients with residual F-FDG-positive masses after completing therapy.
Collapse
|
71
|
Nakajo M, Nakajo M, Jinguji M, Fukukura Y, Nakabeppu Y, Tani A, Yoshiura T. The value of intratumoral heterogeneity of (18)F-FDG uptake to differentiate between primary benign and malignant musculoskeletal tumours on PET/CT. Br J Radiol 2015; 88:20150552. [PMID: 26337605 DOI: 10.1259/bjr.20150552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The cumulative standardized uptake value (SUV)-volume histogram (CSH) was reported to be a novel way to characterize heterogeneity in intratumoral tracer uptake. This study investigated the value of fluorine-18 fludeoxyglucose ((18)F-FDG) intratumoral heterogeneity in comparison with SUV to discriminate between primary benign and malignant musculoskeletal (MS) tumours. METHODS The subjects comprised 85 pathologically proven MS tumours. The area under the curve of CSH (AUC-CSH) was used as a heterogeneity index, with lower values corresponding with increased heterogeneity. As 22 tumours were indiscernible on (18)F-FDG positron emission tomography, maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and AUC-CSH were obtained in 63 positive tumours. The Mann-Whitney U test and receiver operating characteristic (ROC) analysis were used for analyses. RESULTS The difference between benign (n = 35) and malignant tumours (n = 28) was significant in AUC-CSH (p = 0.004), but not in SUVmax (p = 0.168) and SUVmean (p = 0.879). The sensitivity, specificity and accuracy for diagnosing malignancy were 61%, 66% and 64% for SUVmax (optical threshold value, >6.9), 54%, 60% and 57% for SUVmean (optical threshold value, >3) and 61%, 86% and 75% for AUC-CSH (optical threshold value, ≤0.42), respectively. The area under the ROC curve was significantly higher in AUC-CSH (0.71) than SUVmax (0.60) (p = 0.018) and SUVmean (0.51) (p = 0.005). CONCLUSION The heterogeneity index, AUC-CSH, has a higher diagnostic accuracy than SUV analysis in differentiating between primary benign and malignant MS tumours, although it is not sufficiently high enough to obviate histological analysis. ADVANCES IN KNOWLEDGE AUC-CSH can assess the heterogeneity of (18)F-FDG uptake in primary benign and malignant MS tumours, with significantly greater heterogeneity associated with malignant MS tumours. AUC-CSH is more diagnostically accurate than SUV analysis in differentiating between benign and malignant MS tumours.
Collapse
Affiliation(s)
- Masatoyo Nakajo
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.,2 Department of Radiology, Nanpuh Hospital, Kagoshima, Japan
| | - Masayuki Nakajo
- 2 Department of Radiology, Nanpuh Hospital, Kagoshima, Japan
| | - Megumi Jinguji
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoshihiko Fukukura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoshiaki Nakabeppu
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Atsushi Tani
- 2 Department of Radiology, Nanpuh Hospital, Kagoshima, Japan
| | - Takashi Yoshiura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| |
Collapse
|
72
|
van Gómez López O, García Vicente AM, Honguero Martínez AF, Jiménez Londoño GA, Vega Caicedo CH, León Atance P, Soriano Castrejón ÁM. (18)F-FDG-PET/CT in the assessment of pulmonary solitary nodules: comparison of different analysis methods and risk variables in the prediction of malignancy. Transl Lung Cancer Res 2015. [PMID: 26207210 DOI: 10.3978/j.issn.2218-6751.2015.05.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of different metabolical, morphological and clinical criteria for correct presurgical classification of the solitary pulmonary nodule (SPN). METHODS Fifty-five patients, with SPN were retrospectively analyzed. All patients underwent preoperative (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT). Maximum diameter in CT, maximum standard uptake value (SUVmax), histopathologic result, age, smoking history and gender were obtained. Different criteria were established to classify a SPN as malignant: (I) visually detectable metabolism, (II) SUVmax >2.5 regardless of SPN diameter, (III) SUVmax threshold depending of SPN diameter, and (IV) ratio SUVmax/diameter greater than 1. For each criterion, statistical diagnostic parameters were obtained. Receiver operating characteristic (ROC) analysis was performed to select the best diagnostic SUVmax and SUVmax/diameter cutoff. Additionally, a predictive model of malignancy of the SPN was derived by multivariate logistic regression. RESULTS Fifteen SPN (27.3%) were benign and 40 (72.7%) malignant. The mean values ± standard deviation (SD) of SPN diameter and SUVmax were 1.93±0.57 cm and 3.93±2.67 respectively. Sensitivity (Se) and specificity (Sp) of the different diagnostic criteria were (I): 97.5% and 13.1%; (II) 67.5% and 53.3%; (III) 70% and 53.3%; and (IV) 85% and 33.3%, respectively. The SUVmax cut-off value with the best diagnostic performance was 1.95 (Se: 80%; Sp: 53.3%). The predictive model had a Se of 87.5% and Sp of 46.7%. The SUVmax was independent variables to predict malignancy. CONCLUSIONS The assessment by semiquantitative methods did not improve the Se of visual analysis. The limited Sp was independent on the method used. However, the predictive model combining SUVmax and age was the best diagnostic approach.
Collapse
Affiliation(s)
- Ober van Gómez López
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Ana María García Vicente
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Antonio Francisco Honguero Martínez
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Germán Andrés Jiménez Londoño
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Carlos Hugo Vega Caicedo
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Pablo León Atance
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Ángel María Soriano Castrejón
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| |
Collapse
|
73
|
Role of 2-Fluoro-2-Deoxyglucose PET/Computed Tomography in Carcinoma of Unknown Primary. PET Clin 2015; 10:297-310. [DOI: 10.1016/j.cpet.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
74
|
Sogge SM, Fotos JS, Tulchinsky M. Bacillus Calmette-Guerin injections for melanoma immunotherapy: potential for a false-positive PET/CT. Clin Nucl Med 2015; 40:368-9. [PMID: 25674877 DOI: 10.1097/rlu.0000000000000718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An 82-year-old woman presented for routine follow-up PET/CT after undergoing local melanoma resection in the left lower leg, isolated limb infusion chemotherapy, and immunomodulation therapy with Bacillus Calmette-Guérin (BCG) vaccine. Symmetric, bilateral, moderately intense FDG avid axillary and inguinal cutaneous nodules were observed that were new from the prior PET-CT. The patient had developed skin lesions at the BCG injection sites several months before the study. The case raises awareness to PET/CT appearance of local inflammatory response to BCG injection, which could be mistaken by an unaware reader for recurrent melanoma.
Collapse
Affiliation(s)
- Steven M Sogge
- From the Section of Nuclear Medicine, Department of Radiology, Milton S. Hershey Medical Center, Penn State University, Hershey, PA
| | | | | |
Collapse
|
75
|
Kamaleshwaran KK, Natarajan S, Shibu D, Malaikkal A, Shinto AS. Paget's disease of pelvis mimicking metastasis in a patient with lung cancer evaluated using staging and follow-up imaging with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography. Indian J Nucl Med 2015; 30:151-3. [PMID: 25829736 PMCID: PMC4379677 DOI: 10.4103/0972-3919.152980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paget's disease of bone is a benign disease, of uncertain etiology, characterized by an accelerated turnover, that is, bone resorption and formation. Paget's disease may be present in up to 5% of the population, and the majority of cases are asymptomatic. We report the imaging findings of Paget's disease of pelvis discovered incidentally in patient with lung cancer evaluated by fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for staging. FDG PET-CT scan showed intense uptake in the right lung lower lobe primary and mediastinal lymph nodes. Furthermore, increased uptake noted in left hemipelvis suggestive of Paget's disease. He underwent follow-up FDG PET-CT after chemotherapy showed decrease in lung mass and mediastinal nodes. However, the uptake in left hemipelvis remains same confirming Paget's disease.
Collapse
Affiliation(s)
- Koramadai Karuppusamy Kamaleshwaran
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Sudhakar Natarajan
- Department of Medical Oncology, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Deepu Shibu
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Anjali Malaikkal
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| |
Collapse
|
76
|
The Evolving Role of Molecular Imaging in Non–Small Cell Lung Cancer Radiotherapy. Semin Radiat Oncol 2015; 25:133-42. [DOI: 10.1016/j.semradonc.2014.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
77
|
Brain: normal variations and benign findings in fluorodeoxyglucose-PET/computed tomography imaging. PET Clin 2015; 9:129-40. [PMID: 24772054 DOI: 10.1016/j.cpet.2013.10.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Brain 18F-fluorodeoxyglucose (18F-FDG) PET allows the in vivo study of cerebral glucose metabolism, reflecting neuronal and synaptic activity. 18F-FDG-PET has been extensively used to detect metabolic alterations in several neurologic diseases compared with normal aging. However, healthy subjects have variants of 18F-FDG distribution, especially as associated with aging. This article focuses on 18F-FDG-PET findings in so-called normal brain aging, and in particular on metabolic differences occurring with aging and as a function of people’s gender. The effect of different substances, medications, and therapy procedures are discussed, as well as common artifacts.
Collapse
|
78
|
Erhamamci S, Reyhan M, Nursal GN, Torun N, Yapar AF, Findikcioglu A, Canpolat T. Elastofibroma dorsi incidentally detected by 18F-FDG PET/CT imaging. Ann Nucl Med 2015; 29:420-5. [DOI: 10.1007/s12149-015-0959-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
|
79
|
|
80
|
Liu Y. Postoperative reactive lymphadenitis: A potential cause of false-positive FDG PET/CT. World J Radiol 2014; 6:890-894. [PMID: 25550993 PMCID: PMC4278149 DOI: 10.4329/wjr.v6.i12.890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/01/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
A wide variety of surgical related uptake has been reported on F18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET/CT) scan, most of which can be differentiated from neoplastic process based on the pattern of FDG uptake and/or anatomic appearance on the integrated CT in image interpretation. A more potential problem we may be aware is postoperative reactive lymphadenitis, which may mimic regional nodal metastases on FDG PET/CT. This review presents five case examples demonstrating that postoperative reactive lymphadenitis could be a false-positive source for regional nodal metastasis on FDG PET/CT. Surgical oncologists and radiologists should be aware of reactive lymphadenitis in interpreting postoperative restaging FDG PET/CT scan when FDG avid lymphadenopathy is only seen in the lymphatic draining location from surgical site.
Collapse
|
81
|
Karantanis D, Kalkanis D, Czernin J, Herrmann K, Pomykala KL, Bogsrud TV, Subramaniam RM, Lowe VJ, Allen-Auerbach MS. Perceived misinterpretation rates in oncologic 18F-FDG PET/CT studies: a survey of referring physicians. J Nucl Med 2014; 55:1925-9. [PMID: 25453041 DOI: 10.2967/jnumed.114.145607] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Because only pathologic examination can confirm the presence or absence of malignant disease in cancer patients, a certain rate of misinterpretation in any kind of imaging study is inevitable. For the accuracy of interpretation to be improved, determination of the nature, causes, and magnitude of this problem is needed. This study was designed to collect pertinent information from physicians referring patients for oncologic (18)F-FDG PET/CT. METHODS A total of 662 referring physicians completed an 11-question survey focused on their experience with the interpretation of oncologic (18)F-FDG PET/CT studies. The participants were oncologists (36.1%; n = 239), hematologists (14.5%; n = 96), radiation oncologists (7.4%; n = 49), surgeons (33.8%; n = 224), and other physicians (8.2%; n = 54). Questions were aimed at determining the frequency, nature, and causes of scan misinterpretations as well as potential solutions to reduce the frequency of misinterpretations. RESULTS Perceived misinterpretation rates ranged from 5% to 20%, according to most (59.3%) of the participants; 20.8% of respondents reported rates of less than 5%. Overinterpretation rather than underinterpretation was more frequently encountered (68.9% vs. 8.7%, respectively). Limited availability of a patient's history and limited experience of interpreters were the major contributors to this phenomenon, according to 46.8% and 26.7% of the participants, respectively. The actions most commonly suggested to reduce misinterpretation rates (multiple suggestions were possible) were the institution of multidisciplinary meetings (59.8%), the provision of adequate history when ordering an examination (37.4%), and a discussion with imaging specialists when receiving the results of the examination (38.4%). CONCLUSION Overinterpretation rather than underinterpretation of oncologic (18)F-FDG PET/CT studies prevails in clinical practice, according to referring physicians. Closer collaboration of imaging specialists with referring physicians through more multidisciplinary meetings, improved communication, and targeted training of interpreting physicians are actions suggested to reduce the rates of misinterpretation of oncologic (18)F-FDG PET/CT studies.
Collapse
Affiliation(s)
- Dimitrios Karantanis
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California Department of Nuclear Medicine, Greek Air Force Hospital, Athens, Greece
| | - Dimitrios Kalkanis
- Department of Nuclear Medicine, Greek Air Force Hospital, Athens, Greece
| | - Johannes Czernin
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Ken Herrmann
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Kelsey L Pomykala
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Trond V Bogsrud
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway Department of Nuclear Medicine and PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Rathan M Subramaniam
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland; and
| | - Val J Lowe
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Martin S Allen-Auerbach
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
| |
Collapse
|
82
|
FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging 2014; 5:585-602. [PMID: 25154759 PMCID: PMC4195840 DOI: 10.1007/s13244-014-0349-x] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/08/2014] [Accepted: 07/21/2014] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Positron emission tomography-computed tomography (PET/CT) with fluorine-18-fluorodeoxy-D-glucose (FDG) has evolved from a research modality to an invaluable tool in head and neck cancer imaging. However, interpretation of FDG PET/CT studies may be difficult due to the inherently complex anatomical landmarks, certain physiological variants and unusual patterns of high FDG uptake in the head and neck. The purpose of this article is to provide a comprehensive approach to key imaging features and interpretation pitfalls of FDG-PET/CT of the head and neck and how to avoid them. METHODS We review the pathophysiological mechanisms leading to potentially false-positive and false-negative assessments, and we discuss the complementary use of high-resolution contrast-enhanced head and neck PET/CT (HR HN PET/CT) and additional cross-sectional imaging techniques, including ultrasound (US) and magnetic resonance imaging (MRI). RESULTS The commonly encountered false-positive PET/CT interpretation pitfalls are due to high FDG uptake by physiological causes, benign thyroid nodules, unilateral cranial nerve palsy and increased FDG uptake due to inflammation, recent chemoradiotherapy and surgery. False-negative findings are caused by lesion vicinity to structures with high glucose metabolism, obscuration of FDG uptake by dental hardware, inadequate PET scanner resolution and inherent low FDG-avidity of some tumours. CONCLUSIONS The interpreting physician must be aware of these unusual patterns of FDG uptake, as well as limitations of PET/CT as a modality, in order to avoid overdiagnosis of benign conditions as malignancy, as well as missing out on actual pathology. TEACHING POINTS • Knowledge of key imaging features of physiological and non-physiological FDG uptake is essential for the interpretation of head and neck PET/CT studies. • Precise anatomical evaluation and correlation with contrast-enhanced CT, US or MRI avoid PET/CT misinterpretation. • Awareness of unusual FDG uptake patterns avoids overdiagnosis of benign conditions as malignancy.
Collapse
|
83
|
Domachevsky L, Jacene HA, Sakellis CG, Kim CK. Postradiation changes in tissues: evaluation by imaging studies with emphasis on fluorodeoxyglucose-PET/computed tomography and correlation with histopathologic findings. PET Clin 2014; 9:217-35. [PMID: 25030284 DOI: 10.1016/j.cpet.2013.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Efforts have been made to minimize the damage to adjacent normal tissues during radiotherapy, primarily by shifting from the use of conventional radiotherapy to more advanced techniques. Reviewing the overall pattern on combined anatomic and functional imaging can enhance diagnostic accuracy. Several radiotracers can be used; [(18)F]fluorodeoxyglucose is the most common. Familiarity with the type and timing of previous radiation therapy, the spectrum of imaging findings after radiation injury, and the appropriate use of the different radiotracers can be crucial. This article summarizes postradiation histologic findings and multimodality imaging findings, with emphasis on PET/computed tomography.
Collapse
Affiliation(s)
- Liran Domachevsky
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Christopher G Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Chun K Kim
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| |
Collapse
|
84
|
Wu YW, Tseng PH, Lee YC, Wang SY, Chiu HM, Tu CH, Wang HP, Lin JT, Wu MS, Yang WS. Association of esophageal inflammation, obesity and gastroesophageal reflux disease: from FDG PET/CT perspective. PLoS One 2014; 9:e92001. [PMID: 24642729 PMCID: PMC3958434 DOI: 10.1371/journal.pone.0092001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/15/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Gastroesophageal reflux disease (GERD) is associated with bothersome symptoms and neoplastic progression into Barrett's esophagus and esophageal adenocarcinoma. We aim to determine the correlation between GERD, esophageal inflammation and obesity with 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). METHODS We studied 458 subjects who underwent a comprehensive health check-up, which included an upper gastrointestinal endoscopy, FDG PET/CT and complete anthropometric measures. GERD symptoms were evaluated with Reflux Disease Questionnaire. Endoscopically erosive esophagitis was scored using the Los Angeles classification system. Inflammatory activity, represented by standardized uptake values (SUVmax) of FDG at pre-determined locations of esophagus, stomach and duodenum, were compared. Association between erosive esophagitis, FDG activity and anthropometric evaluation, including body mass index (BMI), waist circumference, visceral and subcutaneous adipose tissue volumes were analyzed. RESULTS Subjects with erosive esophagitis (n = 178, 38.9%) had significantly higher SUVmax at middle esophagus (2.69±0.74 vs. 2.41±0.57, P<.001) and esophagogastric junction (3.10±0.89 vs. 2.38±0.57, P<.001), marginally higher at upper esophageal sphincter (2.29±0.42 vs. 2.21±0.48, P = .062), but not in stomach or duodenum. The severity of erosive esophagitis correlated with SUVmax and subjects with Barrett's esophagus had the highest SUVmax at middle esophagus and esophagogastric junction. Heartburn positively correlated with higher SUVmax at middle oesophagus (r = .262, P = .003). Using multivariate regression analyses, age (P = .027), total cholesterol level (P = .003), alcohol drinking (P = .03), subcutaneous adipose tissue (P<.001), BMI (P<.001) and waist circumference (P<.001) were independently associated with higher SUVmax at respective esophageal locations. CONCLUSIONS Esophageal inflammation demonstrated by FDG PET/CT correlates with endoscopic findings and symptomatology of GERD. Obesity markers, both visceral and general, are independent determinants of esophageal inflammation.
Collapse
Affiliation(s)
- Yen-Wen Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hung Tu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jaw-Town Lin
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Shiung Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
85
|
Takemoto K, Hatano E, Nishii R, Kagawa S, Kishibe Y, Takahashi M, Yamauchi H, Matsumura K, Zaima M, Toriguchi K, Tanabe K, Kitamura K, Seo S, Taura K, Endo K, Uemoto S, Higashi T. Assessment of [(18)F]-fluoroacetate PET/CT as a tumor-imaging modality: preclinical study in healthy volunteers and clinical evaluation in patients with liver tumor. Ann Nucl Med 2014; 28:371-80. [PMID: 24599824 DOI: 10.1007/s12149-014-0823-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/05/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although [(18)F]-FDG is a useful oncologic PET tracer, FDG uptake is known to be low in a certain type of hepatocellular carcinoma (HCC). [(18)F]-fluoroacetate ((18)F-FACE) is an [(18)F] fluorinated acetate, which is known to be converted into fatty acids, incorporated in membrane and is expected to be a promising oncologic PET tracer. The aim of this study was to evaluate the usefulness of (18)F-FACE as an oncologic PET tracer in preclinical study in healthy volunteers and in patients with liver tumors. METHODS Twenty-four healthy volunteers (age 48.2 ± 12.9 years old; 15 male and 9 female) and ten patients with liver tumor (age 72.1 ± 7.0 years old; 6 male and 4 female) were included. We performed whole-body static PET/CT scan using (18)F-FACE (n = 34) and (18)F-FDG (n = 5 for volunteers, n = 8 for patients) on each day, respectively. Qualitative analysis and quantitative analysis of tumors (5 HCCs, 1 cholangiocellular carcinoma, 4 metastatic tumors from colon cancer and P-NET) were performed using SUVmax and tumor-to-normal liver ratio (TNR). RESULTS In healthy volunteers, (18)F-FACE was metabolically stable in vivo and its biodistribution was almost similar to blood pool, basically uniformly independent of age and gender during PET scan time (up to 3 h). Normal physiological uptake of (18)F-FACE at each organ including liver (SUVmean 1.8 ± 0.2) was lower than that of blood pool (SUVmean 2.3 ± 0.3) at 1 h after injection. Chronic inflammatory uptake around femur of post-operative state of femoral osteotomy and faint uptake of benign hemangioma were observed in a case of healthy volunteer. (18)F-FACE (SUVmax 2.7 ± 0.6, TNR 1.5 ± 0.4) of liver tumors was significantly lower than those of (18)F-FDG uptake (6.5 ± 4.2, 2.6 ± 1.7, respectively). In qualitative analysis, (18)F-FDG was positive in 4 tumors (3 HCCs, 1 CCC) and negative in the other 6 tumors, while (18)F-FACE was also positive in 4 tumors which were the same tumors with positive (18)F-FDG uptake. CONCLUSIONS Biodistribution of (18)F-FACE was appropriate for oncologic imaging. Tumor (18)F-FACE uptake was positive in four patients with HCC and CCC, but the uptake pattern was similar to (18)F-FDG. Further evaluation was needed.
Collapse
Affiliation(s)
- Kenji Takemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
86
|
Weiler-Sagie M, Kagna O, Dann EJ, Ben-Barak A, Israel O. Characterizing bone marrow involvement in Hodgkin’s lymphoma by FDG-PET/CT. Eur J Nucl Med Mol Imaging 2014; 41:1133-40. [DOI: 10.1007/s00259-014-2706-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
|
87
|
Randall E, Loeber S, Kraft S. PHYSIOLOGIC VARIANTS, BENIGN PROCESSES, AND ARTIFACTS FROM 106 CANINE AND FELINE FDG-PET/COMPUTED TOMOGRAPHY SCANS. Vet Radiol Ultrasound 2014; 55:213-26. [DOI: 10.1111/vru.12138] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/20/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Elissa Randall
- Department of Environmental and Radiological Health Sciences (ERHS); Colorado State University; CO 80523
| | - Samantha Loeber
- Department of Environmental and Radiological Health Sciences (ERHS); Colorado State University; CO 80523
| | - Susan Kraft
- Department of Environmental and Radiological Health Sciences (ERHS); Colorado State University; CO 80523
| |
Collapse
|
88
|
The value of 18F-FLT PET for detecting second primary cancers and distant metastases in head and neck cancer patients. Clin Nucl Med 2014; 38:e318-23. [PMID: 23455521 DOI: 10.1097/rlu.0b013e3182815fe1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Diagnostic efficacy of (18)F-FLT PET was compared with that of (18)F-FDG PET regarding second primary cancers and distant metastases of head and neck squamous cell cancers (HNSCCs). METHODS A total of 88 patients with HNSCCs were qualitatively examined with FLT PET and FDG PET for regions of focally increased metabolism. Final diagnoses of second primary cancer and distant metastasis were established on the basis of histological findings or clinical follow-up. RESULTS FDG PET had 1 false-negative finding with lung metastasis, and FLT PET had 4 false-negative findings with 1 liver metastasis, 1 bone metastasis, and 2 lung metastases. There were no false-positive findings with FLT PET in contrast to 9 with FDG PET (1 in lung, 4 in mediastinum, 1 in rectum, and 3 in stomach). Overall accuracy of FDG PET and FLT PET for pretreatment metastasis staging was 92% and 98%, respectively. Five distant metastases in 3 patients occurred after the initiation of chemoradiotherapy. FLT PET missed 2 metastatic lesions (1 in liver and 1 in lung), whereas FDG PET could not discriminate intracranial metastasis because of FDG uptake in the brain. CONCLUSIONS FLT PET does not appear to be recommendable to replace FDG PET for pretreatment metastasis staging in HNSCC cases because of its lower sensitivity and higher background activity in the liver and bone marrow. However, it might provide additional diagnostic specificity and biological information.
Collapse
|
89
|
|
90
|
Secondary syphilis presenting as a generalized lymphadenopathy: clinical mimicry of malignant lymphoma. Sex Transm Dis 2013; 40:490-2. [PMID: 23680905 DOI: 10.1097/olq.0b013e3182897eb0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The diagnosis of syphilis remains challenging. The absence of classical features of the disease, such as the rash of secondary syphilis or genital lesion, may pose diagnostic difficulties. In this article, we report a case of secondary syphilis in which the clinical syndrome and pattern of fluorodeoxyglucose uptake mimicked malignant lymphoma. This case highlights the importance of thorough history taking including sexual contact. Clinicians should be alert for syphilis-underlying unexplained lymphadenopathy, even in the absence of typical rash or genital lesion.
Collapse
|
91
|
Lartizien C, Rogez M, Niaf E, Ricard F. Computer-aided staging of lymphoma patients with FDG PET/CT imaging based on textural information. IEEE J Biomed Health Inform 2013; 18:946-55. [PMID: 24081876 DOI: 10.1109/jbhi.2013.2283658] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We have designed a computer-aided diagnosis system to discriminate between hypermetabolic cancer lesions and hypermetabolic inflammatory or physiological but noncancerous processes in FDG PET/CT exams of lymphoma patients. Detection performance of the support vector machine (SVM) classifier was assessed based on feature sets including 105 positron emission tomography (PET) and Computed tomography (CT) characteristics derived from the clinical practice and from more sophisticated texture analysis. An original feature selection method based on combining different filter methods was proposed. The evaluation database consisted of 156 lymphomatous and 32 suspicious but nonlymphomatous regions of interest. Different types of training databases including either the PET and CT features or the PET features only, with or without feature selection, were evaluated to assess the added value of multimodality and texture information on classification performance. An optimization study was conducted for each classifier separately to select the best combination of parameters. Promising classification performance was achieved by the SVM classifier combined with the 12 most discriminant PET and CT features with a value of the area under the receiver operating curve of 0.91.
Collapse
|
92
|
Role of (18)F-FDG PET Scan in Rheumatoid Lung Nodule: Case Report and Review of the Literature. Case Rep Rheumatol 2013; 2013:621340. [PMID: 23984160 PMCID: PMC3741933 DOI: 10.1155/2013/621340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/02/2013] [Indexed: 12/04/2022] Open
Abstract
Flourine-18 fluoro-2-deoxy-glucose (18F-FDG) positron emission tomography combined with computed tomography (PET/CT) is a useful test for the management of malignant conditions. Inflammatory and infectious processes, however, can cause increased uptake on PET scanning, often causing diagnostic dilemmas. This knowledge is important to the rheumatologist not only because of the inflammatory conditions we treat but also because certain rheumatic diseases impose an increased risk of malignancy either due to the disease itself or as a consequence of medications used to treat the rheumatic diseases. There is an increasing body of evidence investigating the role of PET scans in inflammatory conditions. This paper describes a patient with rheumatoid arthritis who developed pulmonary nodules that showed increased uptake on PET/CT scan and reviews the use of PET scanning in the diagnosis and management of rheumatoid arthritis.
Collapse
|
93
|
Abstract
Transient visualization of a FDG avid abnormality in the lungs without any structural lesion is reported in a case of iatrogenic pulmonary microembolism.
Collapse
Affiliation(s)
- H Tokmak
- Department of Nuclear Medicine, American Hospital, Güzelbahce Sok. No: 20 Nişantaşı, 34365, Istanbul, Turkey
| |
Collapse
|
94
|
Diagnostic usefulness of an amino acid tracer, α-[N-methyl-(11)C]-methylaminoisobutyric acid ( (11)C-MeAIB), in the PET diagnosis of chest malignancies. Ann Nucl Med 2013; 27:808-21. [PMID: 23824782 PMCID: PMC3830191 DOI: 10.1007/s12149-013-0750-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/17/2013] [Indexed: 12/03/2022]
Abstract
Objectives Although positron emission tomography (PET) using [18F]-fluoro-2-deoxy-d-glucose (18F-FDG) is established as one of the first-choice imaging modalities in the diagnosis of chest malignancies, there are several problems to solve in clinical practice, such as false positive uptake in inflammatory diseases. The aim of this study was to evaluate the clinical usefulness of an amino acid tracer, α-[N-methyl-11C]-methylaminoisobutyric acid (11C-MeAIB), in the diagnosis of chest malignancies, in combination with 18F-FDG. Setting Fifty-nine cases (57 patients, 66 ± 12 years old) who consulted to our institution for the wish to receive differential diagnosis of chest diseases were included. Purpose of the studies were as follows: differential diagnosis of newly developed lung nodules, n = 22; newly developed mediastinal lesions, n = 20; and both, n = 17 (including lung cancer: n = 19, lymphoma: n = 1, other cancers: n = 2, sarcoidosis: n = 15, non-specific inflammation: n = 18, other inflammatory: n = 4, respectively). Whole-body static PET or PET/CT scan was performed 20 and 50 min after the IV injection of 11C-MeAIB and 18F-FDG, respectively. Results 11C-MeAIB uptake of malignant and benign lesions was statistically different both in pulmonary nodules (p < 0.005) and in mediastinal lesions (p < 0.0005). In visual differential diagnosis, 11C-MeAIB showed higher results (specificity: 73 %, accuracy: 81 %), compared to those in 18F-FDG (60, 73 %, respectively). In cases of sarcoidosis, 11C-MeAIB showed higher specificity (80 %) with lower uptake (1.8 ± 0.7) in contrast to the lower specificity (60 %) with higher uptake of 18F-FDG (7.3 ± 4.5). Conclusions 11C-MeAIB PET/CT was useful in the differential diagnosis of pulmonary and mediastinal mass lesions found on CT. 11C-MeAIB PET or PET/CT showed higher specificity than that of 18F-FDG PET/CT in differentiating between benign and malignant disease. Our data suggest that the combination of 18F-FDG and 11C-MeAIB may improve the evaluation of chest lesions, when CT and 18F-FDG PET/CT are equivocal.
Collapse
|
95
|
|
96
|
Nodular lymphoid hyperplasia in endoscopic and FDG-PET/CT ((18)F-fluoro-2-deoxyglucose positron emission tomography/computerized tomography) imaging. Kaohsiung J Med Sci 2013; 29:396-9. [PMID: 23768704 DOI: 10.1016/j.kjms.2012.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/22/2012] [Indexed: 11/22/2022] Open
Abstract
Gastrointestinal nodular lymphoid hyperplasia is a rare lymphoproliferative state. In children, it is associated with familial immunodeficiency disease but most cases have no obvious etiology. In adults, nodular lymphoid hyperplasia is associated with immunocompromised status, including chemotherapy, acquired immunodeficiency viral infection, organ transplantation, and multiple polypoid lesions are noted in endoscopic findings and sometimes may be confused with family polypoid syndrome. We present a child with histological proof of focal intestinal nodular lymphoid hyperplasia that had a complete image study including negative results of (18)F-fluoro-2-deoxyglucose positron emission tomography/computerized tomography analysis.
Collapse
|
97
|
Simultaneous splenic and colonic metastases from gastric cancer: different FDG avidities according to the density of cancer cells imaged on FDG PET/CT. Clin Nucl Med 2013; 38:60-2. [PMID: 23242052 DOI: 10.1097/rlu.0b013e31827085b6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe the ¹⁸F-FDG PET/CT findings of 2 simultaneous metastatic gastric cancers to the colon and spleen with quite different FDG avidities. Longitudinal and weak FDG uptake was observed in the descending colon; therefore, it could not be distinguished from nonpathological functional uptake of normal colon. Meanwhile, the splenic mass showed intense uptake. Contrast-enhanced CT revealed a segmental wall thickening of the descending colon as well as a hypoattenuating splenic mass suggesting metastases. Splenectomy and left hemicolectomy were performed. Histological diagnosis disclosed metastatic gastric cancer. The differential diagnoses and review of the literature are presented.
Collapse
|
98
|
¹⁸F-FDG PET/CT diagnosis of unexpected extracardiac septic embolisms in patients with suspected cardiac endocarditis. Eur J Nucl Med Mol Imaging 2013; 40:1190-6. [PMID: 23653242 DOI: 10.1007/s00259-013-2426-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Acute infective endocarditis is a potentially life-threatening disease. Its outcome strongly depends on systemic embolization and extracardiac infections. When present, these conditions usually lead to a more aggressive therapeutic approach. However, the diagnosis of peripheral septic embolism is very challenging. (18)F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT has proven to be accurate for the detection of inflammatory diseases and occult infections. The aim of this study was to assess the added value of (18)F-FDG PET/CT in the detection of extracardiac embolisms in the evaluation of patients with suspected valvular endocarditis (VE). METHODS Seventy-one patients with suspected infective endocarditis, enrolled between June 2010 and December 2012, underwent (18)F-FDG PET/CT with the standard procedure on a dedicated PET/CT scanner. Extracardiac findings were subsequently evaluated with other imaging procedures. RESULTS Of the 71 patients with suspicion of infective endocarditis, we found unexpected extracardiac findings in 17 patients (24%) without any clinical suspicion. Extracardiac findings were subsequently evaluated with other imaging procedures. CONCLUSION PET/CT detected unexpected extra sites of infection in 24% of cases, leading to changes in therapeutic management in a very relevant percentage of patients. These findings may have important therapeutic implications.
Collapse
|
99
|
Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: Peristaltic segment sign. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
100
|
Mena L, Hernández A, Gallego M, Martínez T, Contreras J. Incidental detection of Paget disease on 18F-FDG PET/CT scan in a patient with rectal cancer. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|