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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.
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102
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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]
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103
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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]
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104
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Fu L, Liu M, Song Z, Xu B, Tian J. 18F-fluoro-deoxyglucose positron emission tomography/computed tomography scan findings in Rosai-Dorfman disease with IgG4-positive plasma cell infiltration mimicking breast malignancy: a case report and literature review. J Med Case Rep 2012. [PMID: 23198743 PMCID: PMC3533857 DOI: 10.1186/1752-1947-6-411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED INTRODUCTION Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, is a rare benign disorder characterized histologically by lymphatic sinus dilatation due to histiocyte proliferation. Rosai-Dorfman disease accompanied by IgG4+ plasma cell infiltration is an even rarer situation. To the best of our knowledge, no imaging report of fluoro-deoxyglucose positron emission tomography/computed tomography findings of Rosai-Dorfman disease with IgG4+ plasma cell infiltration has been published, although a series of pathological research has focused on this phenomenon. CASE PRESENTATION We reviewed the 18F-fluoro-deoxyglucose positron emission tomography/computed tomography scan of a 78-year-old Chinese woman with a solid mass that was found in her right breast during a health checkup. 18F-fluoro-deoxyglucose positron emission tomography/computed tomography showed a hypermetabolic nodule in her right breast and slightly heterogeneous increased fluoro-deoxyglucose uptake of the pulmonary nodules, which were histologically proven to be mammary Rosai-Dorfman disease with IgG4+ plasma cell infiltration and pulmonary amyloidosis, respectively. A literature review was performed to gather information on this rare disease process. CONCLUSIONS Although distinguishing benign lymphoplasmacytic proliferation from malignancy may be difficult with 18F-fluoro-deoxyglucose positron emission tomography/computed tomography in light of the pattern and intensity of fluoro-deoxyglucose uptake, our case highlights that whole-body positron emission tomography/computed tomography imaging not only can display the extent of the disease to help complete staging but also can provide functional information about disease activity to guide biopsy.
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Affiliation(s)
- Liping Fu
- Department of Nuclear Medicine, the Chinese PLA General Hospital and PLA Medical School, Fuxing Road 28, Beijing, 100853, China.
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105
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Reactive tonsillar enlargement showing strong 18F-FDG uptake during the follow-up of follicular lymphoma. Head Neck Pathol 2012; 7:258-62. [PMID: 23011892 PMCID: PMC3738754 DOI: 10.1007/s12105-012-0400-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
The 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a standard procedure for the diagnosis, staging, and restaging in lymphoma patients. However, a relative high rate of false-positive results has been reported. We report a case of a 40-year-old man with a previous history of a nodal follicular lymphoma, stage IVA, treated with R-CHOP, which showed strong 18F-FDG uptake in the Waldeyer's tonsillar ring during his follow-up, being considered highly suspicious of relapsed lymphoma. A surgical removal of the palatine tonsils and adenoids was performed, which showed reactive follicular hyperplasia. Furthermore, bone marrow biopsy revealed absence of neoplasia. The patient is still in follow-up with no signs of recurrent lymphoma. This case illustrates that, despite the high sensitivity for the detection of recurrent lymphoma, 18F-FDG uptake should be interpreted with great caution and confirmatory studies should be performed before any therapy.
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106
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Kim SK, Shin JE, Lee JH. Peripheral Tuberculous Lymphadenitis Masquerading as Metastatic Gastric Carcinoma on F-18 FDG Dual Time Point PET/CT. Nucl Med Mol Imaging 2012; 46:316-7. [PMID: 24900083 DOI: 10.1007/s13139-012-0169-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 08/24/2012] [Accepted: 08/26/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- Su Kon Kim
- Department of Obstetrics and gynecology, Dankook University College of Medicine, Cheonan, Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jai Hyuen Lee
- Department of Nuclear medicine, Dankook University College of Medicine, Dongnam-ku, Anseo-dong, Cheonan, 330-715 Republic of Korea
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Schillaci O. Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity. Semin Nucl Med 2012; 42:267-80. [DOI: 10.1053/j.semnuclmed.2012.02.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Yildirim D, Tamam MO, Sahin M, Ekci B, Gurses B. Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: peristaltic segment sign. Rev Esp Med Nucl Imagen Mol 2012; 32:86-91. [PMID: 22743109 DOI: 10.1016/j.remn.2012.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/03/2012] [Accepted: 05/07/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to present the effect of the peristaltic segment sign for the differential diagnosis between malignant, physiological and gastrointestinal focal fluorodeoxyglucose (FDG) uptakes as an alternative method to maximum standardized uptake value (SUVmax). MATERIALS AND METHODS Gastrointestinal tract (GIT) sections of 823 FDG positron emission tomography/computed tomography (FDG-PET/CT) performed in our center were reviewed retrospectively. Images of these cases that have been reported for positive intestinal focal FDG uptake areas were included. Through the sectional images, any accompanying short segment expanded with air just after or before the uptake area was marked as "positive peristaltism sign". The cases were confirmed with endoscopy plus biopsy (n:42), endoscopy (n:5), laparotomy (n:1), transabdominal biopsy (n:1), enteroclysis (n:1), CT-colonoscopy (n:5), rectal contrast enhanced CT (n:4). Distinguishing features of the sign were analyzed statistically compared to the conventional method for differentiation of malignity. RESULTS Localized FDG uptake was reported in 59 of 823 cases. A SUVmax greater than 2.5 with intestinal wall thickening allowed the diagnosis of malignity with sensitivity 33%, specificity 65%, positive predictive value 69% and negative predictive value 46%. The peristaltic segment sign, considered as a benign finding, increased the statistical values to 68%, 80%, 82% and 65%, respectively. CONCLUSION In case of gastrointestinal increased focal FDG uptake, the new parameter of peristaltic segment sign may differentiate the physiologic uptakes from the malignant ones more accurately than the conventional SUVmax.
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Affiliation(s)
- Duzgun Yildirim
- Kasimpasa Military Hospital, Department of Radiology, Istanbul, Turkey
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109
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Mena LM, Hernández AC, Gallego M, Martínez T, Contreras JF. [Incidental detection of Paget disease on ¹⁸F-FDG PET/CT scan in a patient with rectal cancer]. Rev Esp Med Nucl Imagen Mol 2012. [PMID: 23177337 DOI: 10.1016/j.remn.2012.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- L M Mena
- Servicio de Medicina Nuclear, Hospital Universitario Santa Lucía, Cartagena, Murcia, España.
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110
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Povoski SP, Hall NC, Murrey DA, Sharp DS, Hitchcock CL, Mojzisik CM, Bahnson EE, Knopp MV, Martin EW, Bahnson RR. Multimodal imaging and detection strategy with 124 I-labeled chimeric monoclonal antibody cG250 for accurate localization and confirmation of extent of disease during laparoscopic and open surgical resection of clear cell renal cell carcinoma. Surg Innov 2012; 20:59-69. [PMID: 22455975 PMCID: PMC3758170 DOI: 10.1177/1553350612438416] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Renal cell carcinoma (RCC) accounts for approximately 85% to 90% of all primary kidney
malignancies, with clear cell RCC (ccRCC) constituting approximately 70% to 85% of all
RCCs. This study describes an innovative multimodal imaging and detection strategy that
uses 124I-labeled chimeric monoclonal antibody G250 (124I-cG250) for
accurate preoperative and intraoperative localization and confirmation of extent of
disease for both laparoscopic and open surgical resection of ccRCC. Two cases presented
herein highlight how this technology can potentially guide complete surgical resection and
confirm complete removal of all diseased tissues. This innovative 124I-cG250
(ie, 124I-girentuximab) multimodal imaging and detection approach, which would
be clinically very useful to urologic surgeons, urologic medical oncologists, nuclear
medicine physicians, radiologists, and pathologists who are involved in the care of ccRCC
patients, holds great potential for improving the diagnostic accuracy, operative planning
and approach, verification of disease resection, and monitoring for evidence of disease
recurrence in ccRCC patients.
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Affiliation(s)
- Stephen P Povoski
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH 43210, USA.
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Muzahir S, Mian M, Munir I, Nawaz MK, Faruqui ZS, Mufti KA, Bashir H, Uddin N, Siddiqui N, Maaz AUR, Mahmood MT. Clinical utility of ¹⁸F FDG-PET/CT in the detection of bone marrow disease in Hodgkin's lymphoma. Br J Radiol 2012; 85:e490-6. [PMID: 22215887 DOI: 10.1259/bjr/29583493] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of the study was to evaluate the potential role of fludeoxyglucose (FDG)-positron emission tomography (PET)/CT in the detection of bone/bone marrow disease in patients with Hodgkin's lymphoma (HL). METHODS We retrospectively reviewed ((18)F)-FDG-PET/CT scans of 122 newly diagnosed, biopsy-proven cases of HL performed between November 2009 and June 2010. All the patients were staged before treatment by both PET/CT and bone marrow biopsy (BMB). Patients were subdivided into three groups based on the findings of FDG-PET/CT. Group A consisted of patients showing diffuse FDG uptake, Group B consisted of patients showing unifocal FDG uptake and Group C patients showed multifocal FDG-avid foci on PET/CT scans. Bone marrow results were also reviewed and considered positive if lymphomatous involvement was detected on bone marrow trephine biopsy. BMB results were correlated with FDG-PET/CT findings. RESULTS There were 122 patients in total-81 (66.4%) were male and 41 (33.6%) were female. The age range was from 6 years to 78 years (mean 35.70 years). PET/CT was reported as negative for bone/bone marrow involvement in 85 (69.7%) patients, while the remaining 37 showed abnormal FDG uptake. The sensitivity of FDG-PET/CT was calculated to be 100%, the specificity was 76.57%, the negative predictive value was 76.57%, the positive predictive value was 29.72% and the diagnostic accuracy was 78.62%. CONCLUSION (18)F-FDG-PET/CT and BMB are complementary in the evaluation of bone marrow disease.
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Affiliation(s)
- S Muzahir
- Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan.
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Lin M, Ambati C. The management impact of clinically significant incidental lesions detected on staging FDG PET-CT in patients with non-small cell lung cancer (NSCLC): an analysis of 649 cases. Lung Cancer 2011; 76:344-9. [PMID: 22206598 DOI: 10.1016/j.lungcan.2011.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 10/31/2011] [Accepted: 11/20/2011] [Indexed: 12/25/2022]
Abstract
UNLABELLED To evaluate FDG PET-CT in the detection of unexpected pre-malignancy or second malignancy at the initial staging of patients with histologically proven non-small cell lung cancer (NSCLC) and its impact on management. METHODS Staging FDG PET-CT scans acquired between February 2006 and July 2010 in 649 patients (M=389; F=260) with NSCLC were reviewed for the presence of unexpected pre-malignancy or second primary. A "True-Positive" lesion represented a second primary or pre-malignant lesion. A "False-Positive" lesion was due to benign causes or an atypical site of metastasis from NSCLC. RESULTS 77 (12%) patients were identified on PET-CT as having a potential pre-malignancy or second primary. 39 out of 77 (51%) patients had diagnostic verification where histopathology served as reference standard in 33 patients (85%) and the rest had endoscopy and progress PET-CT scans. 20 patients (3.1%) had a second primary (n=11) or pre-malignant lesions comprising dysplastic colorectal polyps (n=9), and additional therapy and/or management change for the index tumour was instigated in 17 patients (85%). In patients with a second primary, 3 (27%) patients had a high impact change in management from an initial curative intent to palliative. CONCLUSION Staging FDG PET-CT is highly valuable in identifying second primary cancers or pre-malignant lesions in patients with NSCLC. When a second primary is detected on PET-CT, there is a high impact change in management in 27% of patients.
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Affiliation(s)
- Michael Lin
- University of New South Wales, 1 Elizabeth Drive, Liverpool Hospital, Liverpool, NSW 2170, Australia.
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113
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Lin M, Koo JH, Abi-Hanna D. Management of patients following detection of unsuspected colon lesions by PET imaging. Clin Gastroenterol Hepatol 2011; 9:1025-32. [PMID: 21723237 DOI: 10.1016/j.cgh.2011.06.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/29/2011] [Accepted: 06/14/2011] [Indexed: 12/11/2022]
Abstract
Positron emission tomography (PET) is a well-established and integral component of multimodality imaging in oncology. However, the expanded use of PET in oncological and also non-oncological imaging (such as in assessing inflammatory conditions) has identified more lesions or tumors at unsuspected locations, such as in the large bowel during examination of patients not known to have colorectal disease. We review the clinical significance of colon lesions that were discovered incidentally by PET imaging and management strategies for gastroenterologists.
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Affiliation(s)
- Michael Lin
- Department of Nuclear Medicine and PET, Liverpool Hospital, University of New South Wales, Liverpool, New SouthWales, Austrailia.
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114
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Monitoring Therapeutic Response in a Case of Extrapulmonary Tuberculosis by Serial F-18 FDG PET/CT. Nucl Med Mol Imaging 2011; 46:69-72. [PMID: 24900035 DOI: 10.1007/s13139-011-0114-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/25/2011] [Accepted: 09/28/2011] [Indexed: 10/15/2022] Open
Abstract
Due to the low yield of AFB smear and culture in extrapulmonary tuberculosis, therapeutic responses of patients with extrapulmonary tuberculosis are usually monitored clinically and/or radiographically. Such monitoring techniques, however, are not enough to provide effective diagnosis if a remnant lesion exists after treatment. Tuberculosis presents hypermetabolic activity on F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) scanning. Reported herein is a case of extrapulmonary tuberculosis where the therapeutic response was assessed via serial F-18 FDG PET/CT scanning, which was useful for detecting the extent of extrapulmonary tuberculosis and for estimating the patient's therapeutic response.
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115
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Peng J, He Y, Xu J, Sheng J, Cai S, Zhang Z. Detection of incidental colorectal tumours with 18F-labelled 2-fluoro-2-deoxyglucose positron emission tomography/computed tomography scans: results of a prospective study. Colorectal Dis 2011; 13:e374-8. [PMID: 21831098 DOI: 10.1111/j.1463-1318.2011.02727.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM This study assessed the clinical significance of incidental colorectal 2-fluoro-2-deoxyglucose (FDG) uptake using (18) F-FDG positron emission tomography/computed tomography (PET/CT) scans and evaluated the importance of colonoscopy when incidental colorectal FDG uptake was observed. METHOD A prospective study was designed and conducted at a single institution over a 2-year period. In patients undergoing PET/CT scans, all with FDG uptake in the colorectum were assigned to have colonoscopy and biopsy. The value of PET/CT scanning was studied by comparison with the colonoscopy and biopsy results. RESULTS Among 10,978 PET/CT scans, one or more focal uptakes of FDG in the colorectum were observed in 148 (1.35%) patients. In 136 valid patients, malignant colorectal tumours and polyps were found in 23.5% and 20.5%, respectively,, while the colon in the other 56% was normal. A higher false-positive rate was found in the right colon compared with the distal colorectum (66.2%vs 36.7%, P = 0.004). A significant increase of the maximum standardized uptake (SUVmax) value was found among normal, polyps and cancer groups. Multivariate analysis revealed that SUVmax was the risk factor for predicting colorectal cancer or polyps and FDG uptake in the right colon was a negative predictive factor for finding cancers or polyps. CONCLUSIONS Our study proves the necessity of colonoscopy when incidental FDG uptake is found on PET/CT imaging. The false-positive FDG uptake is more commonly observed in the right colon. Although the SUVmax value is higher in cancer patients, a high SUVmax value does not necessarily result in malignancies.
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Affiliation(s)
- J Peng
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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116
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Applications of molecular imaging. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2011; 95:237-98. [PMID: 21075334 DOI: 10.1016/b978-0-12-385071-3.00009-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Today molecular imaging technologies play a central role in clinical oncology. The use of imaging techniques in early cancer detection, treatment response, and new therapy development is steadily growing and has already significantly impacted on clinical management of cancer. In this chapter, we overview three different molecular imaging technologies used for the understanding of disease biomarkers, drug development, or monitoring therapeutic outcome. They are (1) optical imaging (bioluminescence and fluorescence imaging), (2) magnetic resonance imaging (MRI), and (3) nuclear imaging (e.g., single-photon emission computed tomography (SPECT) and positron emission tomography (PET)). We review the use of molecular reporters of biological processes (e.g., apoptosis and protein kinase activity) for high-throughput drug screening and new cancer therapies, diffusion MRI as a biomarker for early treatment response and PET and SPECT radioligands in oncology.
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117
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Venkatesan AM, Kadoury S, Abi-Jaoudeh N, Levy EB, Maass-Moreno R, Krücker J, Dalal S, Xu S, Glossop N, Wood BJ. Real-time FDG PET guidance during biopsies and radiofrequency ablation using multimodality fusion with electromagnetic navigation. Radiology 2011; 260:848-56. [PMID: 21734159 DOI: 10.1148/radiol.11101985] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess the feasibility of combined electromagnetic device tracking and computed tomography (CT)/ultrasonography (US)/fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) fusion for real-time feedback during percutaneous and intraoperative biopsies and hepatic radiofrequency (RF) ablation. MATERIALS AND METHODS In this HIPAA-compliant, institutional review board-approved prospective study with written informed consent, 25 patients (17 men, eight women) underwent 33 percutaneous and three intraoperative biopsies of 36 FDG-avid targets between November 2007 and August 2010. One patient underwent biopsy and RF ablation of an FDG-avid hepatic focus. Targets demonstrated heterogeneous FDG uptake or were not well seen or were totally inapparent at conventional imaging. Preprocedural FDG PET scans were rigidly registered through a semiautomatic method to intraprocedural CT scans. Coaxial biopsy needle introducer tips and RF ablation electrode guider needle tips containing electromagnetic sensor coils were spatially tracked through an electromagnetic field generator. Real-time US scans were registered through a fiducial-based method, allowing US scans to be fused with intraprocedural CT and preacquired FDG PET scans. A visual display of US/CT image fusion with overlaid coregistered FDG PET targets was used for guidance; navigation software enabled real-time biopsy needle and needle electrode navigation and feedback. RESULTS Successful fusion of real-time US to coregistered CT and FDG PET scans was achieved in all patients. Thirty-one of 36 biopsies were diagnostic (malignancy in 18 cases, benign processes in 13 cases). RF ablation resulted in resolution of targeted FDG avidity, with no local treatment failure during short follow-up (56 days). CONCLUSION Combined electromagnetic device tracking and image fusion with real-time feedback may facilitate biopsies and ablations of focal FDG PET abnormalities that would be challenging with conventional image guidance.
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Affiliation(s)
- Aradhana M Venkatesan
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health, 10 Center Dr, Bldg 10, Room 1C369, MSC 1182, Bethesda, MD 20892, USA.
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118
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Lindskog DM, Nikkhou K, Talusan P. False-positive positron emission tomography in patients with history of malignancy. J Clin Oncol 2011; 29:e582-5. [PMID: 21502554 DOI: 10.1200/jco.2011.34.9761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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119
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Aragon-Ching JB, Akin EA. Positron emission tomography findings in clinical mimics of lymphoma. Ann N Y Acad Sci 2011; 1228:19-28. [DOI: 10.1111/j.1749-6632.2011.06019.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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120
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Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M. PET/CT imaging in systemic lupus erythematosus. Ann N Y Acad Sci 2011; 1228:71-80. [DOI: 10.1111/j.1749-6632.2011.06076.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Carcinoma of unknown primary (CUP) is defined as histologically proven metastatic disease that, after a complete diagnostic work-up, yields no primary detectable tumor. CUP is one of the ten most frequent cancers, with overall poor outcome. Detection of the unknown primary tumor is of crucial importance in this scenario, since it might help to select and offer definitive treatment, which, in turn, may improve patient prognosis. Additional diagnostic work-up, usually consisting of a combination of several radiological and endoscopic investigations and serum tumor marker studies, can be time consuming, expensive, and pose a significant burden to the patient. The final diagnostic yield of these tests is often limited. Combined positron emission tomography/computed tomography (PET/CT), using the radiotracer (18)F-fluoro-2-deoxyglucose (FDG), may be of great value in the management of patients with CUP for the detection of primary tumors. This chapter gives a brief introduction to the syndrome of CUP, followed by an outline of the rationale, use, and utility of FDG-PET/CT in CUP, and concludes with a discussion on the challenges and future directions in the diagnostic management of patients with CUP.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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122
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D'souza MM, D'souza PV, Jaimini A, Sharma R, Tripathi M, Singh D, Mondal A. A rare case of pemphigus vegetans mimicking malignancy on F-18 FDG PET/CT. Clin Nucl Med 2011; 36:248-51. [PMID: 21285693 DOI: 10.1097/rlu.0b013e318208f746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 42-year-old man with a history of chronic smoking and alcoholism was suspected to harbor a malignancy involving the perioral region and the scalp. He underwent an F-18 FDG PET/CT scan which revealed abnormal F-18 FDG accumulation in the oral mucosa and lips, extending to the nose, scalp, and bilateral cervical lymph nodes. Further work-up ultimately revealed the lesions to be secondary to pemphigus vegetans. Pemphigus vegetans is a rare variant of pemphigus vulgaris, an autoimmune bullous cutaneous disorder and involves mainly the flexural regions of the body. Unlike pemphigus vulgaris, lesions of pemphigus vegetans present as heaped up, eroded, and ulcerative plaques in the intertriginous regions of the body. Occasional lesions may be present on scalp and elsewhere in the Hallopeau variant of the disease. The use of F-18 FDG PET in the field of oncology is rapidly evolving; however, it is not tumor specific. The integration of CT into PET has increased the specificity of this modality. Nevertheless, there are many physiologic and benign conditions that may result in high accumulation of FDG, and may mimic malignancy. Familiarity with F-18 FDG-avid nonmalignant lesions may extend the use of F-18 FDG PET imaging beyond the field of oncology. To the best of our knowledge, this is the first description of PET/CT findings in pemphigus vegetans.
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Affiliation(s)
- Maria M D'souza
- Department of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
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Visualization of Amyloid Arthropathy in Light-Chain Systemic Amyloidosis on F-18 FDG PET/CT Scan. Clin Nucl Med 2011; 36:52-3. [DOI: 10.1097/rlu.0b013e3181feefd4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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An intense F-FDG pulmonary microfocus on PET without detectable abnormality on CT: A manifestation of an iatrogenic FDG pulmonary embolus. Biomed Imaging Interv J 2010; 6:e37. [PMID: 21611073 PMCID: PMC3097806 DOI: 10.2349/biij.6.4.e37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 02/09/2010] [Accepted: 02/23/2010] [Indexed: 11/17/2022] Open
Abstract
An incidental finding of an intense focus of (18)F-Fluorodeoxyglucose (FDG) pulmonary uptake on positron emission tomography (PET) without detectable lesions on computed tomography (CT) is highly suggestive of FDG microembolus. Its microscopic nature means it is undetectable on CT. It is an artefact attributable to (18)F-FDG-tracer contamination at the injection site. This paper reports a case of a 61 year-old lady with a past history of breast carcinoma, in whom follow-up PET/CT images demonstrated an incidental intense FDG pulmonary abnormality. A follow-up PET/CT seven months later demonstrated complete resolution of the abnormality.
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Even-Sapir E, Keidar Z, Bar-Shalom R. Hybrid imaging (SPECT/CT and PET/CT)--improving the diagnostic accuracy of functional/metabolic and anatomic imaging. Semin Nucl Med 2010; 39:264-75. [PMID: 19497403 DOI: 10.1053/j.semnuclmed.2009.03.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In-line combined systems, single-photon emission computed tomography (SPECT)/computed tomography (CT) and positron emission tomography (PET)/CT, allow an instant generation of fused images of scintigraphy and CT data. The accumulated clinical data on the use of these systems in various clinical scenarios indicate that this hybrid technology improves the diagnostic accuracy as compared to scintigraphy and CT alone and even to side-by-side interpretation of scintigraphy and CT, which were acquired separately. The improved diagnostic accuracy is reflected by improving image quality of SPECT and PET, detection of more clinically relevant lesions, better localization of disease and differentiation between physiologic and pathologic uptake, characterization of disease by its functional and morphologic appearance before and after therapy and accurate delineation of disease, optimizing biopsy and therapy planning.
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Affiliation(s)
- Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Extra-articular inflammatory sites detected by F-18 FDG PET/CT in a patient with rheumatoid arthritis. Clin Nucl Med 2010; 35:540-1. [PMID: 20548154 DOI: 10.1097/rlu.0b013e3181e05eb9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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128
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Measuring the "unmeasurable": assessment of bone marrow response to therapy using FDG-PET in patients with lymphoma. Acad Radiol 2010; 17:1175-85. [PMID: 20634105 DOI: 10.1016/j.acra.2010.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/29/2010] [Accepted: 05/01/2010] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES To determine if anatomically "nonmeasurable" disease in bone marrow (BM) is assessable for response to therapy by [(18)F]-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT). MATERIALS AND METHODS FDG PET/CT images of 27 patients with lymphoma, FDG-avid bone marrow (BM) lesions, and >or=1 FDG-avid, tumor-involved lymph node (LN) at baseline were retrospectively reviewed. FDG uptake in target LNs and BM foci was determined pre- and posttherapy using the standardized uptake value corrected for lean body mass (SUL(mean)). Size of the same target LNs was measured pre- and posttherapy on CT. Percentage decreases of LN size and LN and BM SUL were calculated. Response was classified according to revised International Workshop Criteria (IWC) with and without modification for metabolic evaluation of BM and correlated to overall survival. Statistical analyses were performed using paired t-tests, Pearson correlation coefficients, and z-tests. RESULTS LN size, LN SUL(mean), and BM SUL(mean) were significantly higher pre- versus posttherapy (2337 mm(2) +/- 1810 vs. 309 mm(2) +/- 323; 6.94 +/- 4.96 vs. 1.02 +/- 1.00; and 6.81 +/- 4.58 to 1.84 +/- 1.58, all P < .001, respectively). After therapy, significant correlation was found between percentage declines of LN size and SUL(mean) of LNs (r = 0.84, P < .001) or BM (r = 0.56, P = .002) and SUL(mean) of LN and BM (r = 0.76, P < .001). Including a metabolic assessment of BM correctly altered overall response assessment in 5/27 (19%) patients and better predicted overall survival than revised IWC. CONCLUSION Anatomically "unmeasurable" BM infiltration with lymphoma behaves similarly to LN disease after therapy and is "measurable" by FDG PET/CT. FDG PET/CT is valuable for monitoring tumor response in "measurable" disease and BM, which was previously considered "unmeasurable" by anatomical imaging.
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Zou P, Povoski SP, Hall NC, Carlton MM, Hinkle GH, Xu RX, Mojzisik CM, Johnson MA, Knopp MV, Martin EW, Sun D. 124I-HuCC49deltaCH2 for TAG-72 antigen-directed positron emission tomography (PET) imaging of LS174T colon adenocarcinoma tumor implants in xenograft mice: preliminary results. World J Surg Oncol 2010; 8:65. [PMID: 20691066 PMCID: PMC2924340 DOI: 10.1186/1477-7819-8-65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 08/06/2010] [Indexed: 01/29/2023] Open
Abstract
Background 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is widely used in diagnostic cancer imaging. However, the use of 18F-FDG in PET-based imaging is limited by its specificity and sensitivity. In contrast, anti-TAG (tumor associated glycoprotein)-72 monoclonal antibodies are highly specific for binding to a variety of adenocarcinomas, including colorectal cancer. The aim of this preliminary study was to evaluate a complimentary determining region (CDR)-grafted humanized CH2-domain-deleted anti-TAG-72 monoclonal antibody (HuCC49deltaCH2), radiolabeled with iodine-124 (124I), as an antigen-directed and cancer-specific targeting agent for PET-based imaging. Methods HuCC49deltaCH2 was radiolabeled with 124I. Subcutaneous tumor implants of LS174T colon adenocarcinoma cells, which express TAG-72 antigen, were grown on athymic Nu/Nu nude mice as the xenograft model. Intravascular (i.v.) and intraperitoneal (i.p.) administration of 124I-HuCC49deltaCH2 was then evaluated in this xenograft mouse model at various time points from approximately 1 hour to 24 hours after injection using microPET imaging. This was compared to i.v. injection of 18F-FDG in the same xenograft mouse model using microPET imaging at 50 minutes after injection. Results At approximately 1 hour after i.v. injection, 124I-HuCC49deltaCH2 was distributed within the systemic circulation, while at approximately 1 hour after i.p. injection, 124I-HuCC49deltaCH2 was distributed within the peritoneal cavity. At time points from 18 hours to 24 hours after i.v. and i.p. injection, 124I-HuCC49deltaCH2 demonstrated a significantly increased level of specific localization to LS174T tumor implants (p = 0.001) when compared to the 1 hour images. In contrast, approximately 50 minutes after i.v. injection, 18F-FDG failed to demonstrate any increased level of specific localization to a LS174T tumor implant, but showed the propensity toward more nonspecific uptake within the heart, Harderian glands of the bony orbits of the eyes, brown fat of the posterior neck, kidneys, and bladder. Conclusions On microPET imaging, 124I-HuCC49deltaCH2 demonstrates an increased level of specific localization to tumor implants of LS174T colon adenocarcinoma cells in the xenograft mouse model on delayed imaging, while 18F-FDG failed to demonstrate this. The antigen-directed and cancer-specific 124I-radiolabled anti-TAG-72 monoclonal antibody conjugate, 124I-HuCC49deltaCH2, holds future potential for use in human clinical trials for preoperative, intraoperative, and postoperative PET-based imaging strategies, including fused-modality PET-based imaging platforms.
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Affiliation(s)
- Peng Zou
- Division of Pharmaceutics, College of Pharmacy, The Ohio State University,and Department of Surgery, Arthur G. James Cancer Hospital, Columbus, Ohio 43210, USA
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Muijs CT, Beukema JC, Pruim J, Mul VE, Groen H, Plukker JT, Langendijk JA. A systematic review on the role of FDG-PET/CT in tumour delineation and radiotherapy planning in patients with esophageal cancer. Radiother Oncol 2010; 97:165-71. [PMID: 20541273 DOI: 10.1016/j.radonc.2010.04.024] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 04/14/2010] [Accepted: 04/29/2010] [Indexed: 12/16/2022]
Abstract
PURPOSE FDG-PET/CT has proven to be useful in the staging process of esophageal tumours. This review analysed the role of FDG-PET/CT in tumour delineation and radiotherapy planning in comparison with CT alone among patients with esophageal cancer. Thereby we focused on the detection of the primary tumour and lymph nodes by FDG-PET/CT, changes in target volume (TV) delineation based on FDG-PET/CT and its validity, changes in inter- and intra-observer variability in TV delineation, consequences for radiotherapy treatment planning with regard to either target volumes or organs at risk and finally on the validation of FDG-PET/CT-based TVs in terms of treatment outcome. METHODS A literature search was performed in MEDLINE and Cochrane library databases for studies concerning the current value of FDG-PET/CT in tumour detection and delineation and radiotherapy-planning procedures among patients with esophageal cancer. Both prospective and retrospective studies were included. RESULTS Fifty publications met the eligibility criteria, of which 19 were review papers and one was a case report. The remaining 30 publications reported on the results of original studies. FDG-PET was able to identify most primary tumours, with a sensitivity and specificity for the detection of metastatic lymph nodes of 30-93% and 79-100%. The use of FDG-PET/CT resulted in changes of target volumes, and consequently in changes in treatment planning. However, evidence supporting the validity of the use of FDG-PET/CT in the tumour delineation process is very limited. Only three studies reported a significant positive correlation between FDG-PET-based tumour lengths and pathological findings. There were two studies that tested the influence of FDG-PET/CT to the inter- and intra-observer variability. One of them found a significant decrease in inter- and intra-observer variability, while the others did not. Furthermore, there are no studies demonstrating the use of PET/CT in terms of improved locoregional control or survival. CONCLUSION Since the literature is very limited standard implementation of FDG-PET/CT into the tumour delineation process for radiation treatment seems unjustified and needs further clinical validation first.
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Affiliation(s)
- Christina T Muijs
- Department of Radiation Oncology, University of Groningen, Groningen, The Netherlands.
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Ahmadi A, Li Q, Muller K, Collins D, Valentine JF, Drane W, Polyak S. Diagnostic value of noninvasive combined fluorine-18 labeled fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography enterography in active Crohn's disease. Inflamm Bowel Dis 2010; 16:974-81. [PMID: 19885907 DOI: 10.1002/ibd.21153] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The role of combined localized positron emission tomography (lPET) and computed tomography enterography (CTe) in Crohn's disease is unclear. We examined if this imaging modality using fluorine-18 labeled-fluoro-2-deoxy-D-glucose (FDG) could more effectively identify disease activity. METHODS 52 lPET-CTe scans were analyzed in this retrospective study. CTe scores and FDG uptake were quantified. Correlations of CTe scores and standard uptake value (SUV) with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), short Inflammatory Bowel Disease Questionnaire (sIBDq), and Harvey-Bradshaw index (HBI) were estimated using Pearson analysis. Imaging scores were compared to medical outcome by logistics regression model. RESULTS CTe scores correlated with SUV, but additional abnormal segments of small bowel were not identified. In all, 38 (79%) abnormal CTe segments demonstrated increased FDG uptake with mean SUVmax 4.77; 10 (21%) abnormal CTe segments lacked FDG accumulation, with mean SUVmax 1.27. There was no correlation between SUVmax and CRP, ESR, sIBDq, or HBI. There were no significant differences in clinical indices, biochemical parameters, and presence of multiple abnormal segments between medical responders and uptake were associated with failed medical therapy (P = 0.001). CONCLUSIONS PET scanning added to CTe did not identify additional abnormal segments when compared to CTe alone. Abnormal segments with mucosal enhancement on CTe that did not accumulate FDG were significantly associated with failure of medical therapy. A larger trial is warranted to confirm if combined lPET-CTe has an important role in the clinical management of stricturing Crohn's disease.
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Affiliation(s)
- Anis Ahmadi
- Department of Medicine, Division of Gastroenterology, University of Florida College of Medicine, Gainesville, FL 32610, USA
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Jansen I, Hendriksz TR, Han SH, Huiskes AWLC, van Bommel EFH. (18)F-fluorodeoxyglucose position emission tomography (FDG-PET) for monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis. Eur J Intern Med 2010; 21:216-21. [PMID: 20493425 DOI: 10.1016/j.ejim.2010.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/05/2010] [Accepted: 02/22/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the value of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in monitoring disease activity and predicting treatment response in idiopathic retroperitoneal fibrosis (iRPF). PATIENTS AND METHODS This prospective study was approved by the institutional review board. Informed consent was obtained from all patients. Twenty-six patients with iRPF receiving tamoxifen monotherapy underwent repeated FDG-PET (baseline and, if positive, at 3 months) and computed tomographic (CT) scanning (baseline, 4 and 8 months). Maximal RPF mass thickness in 3 different view directions was measured on each CT scan; FDG-uptake was semi-quantified using a visual 4-point scale. Initial and follow-up PET scan results were correlated with clinical, laboratory and CT scan follow-up data. Treatment outcome was the aggregate measure of clinical, laboratory and CT-documented response to tamoxifen. RESULTS FDG-PET was positive in 20 patients. Patients with positive PET scan result had higher C-reactive protein level (P=0.02) and larger mass size (P=0.01) compared with patients with negative PET scan result. Visual PET score correlated with C-reactive protein level (P=0.002) and CT-documented mass thickness (P=0.04). Visual PET score decreased following treatment (P<0.01). This decrease correlated with decrease in ESR (P<0.001) but not with CT-documented mass regression. Positive predicting value (PPV) of initial positive PET scan result was 0.63; PPV of negative follow-up PET scan result in patients with initial positive PET scan result was 0.66. CONCLUSION FDG-PET is valuable in detecting (recurrent) disease activity. Short-term follow-up with FDG-PET cannot be routinely recommended for the therapeutic evaluation of RPF disease in tamoxifen-treated patients.
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Affiliation(s)
- I Jansen
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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133
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Validation of automatic target volume definition as demonstrated for 11C-choline PET/CT of human prostate cancer using multi-modality fusion techniques. Acad Radiol 2010; 17:614-23. [PMID: 20188602 DOI: 10.1016/j.acra.2010.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 01/05/2010] [Accepted: 01/06/2010] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES Positron emission tomography (PET) is actively investigated to aid in target volume definition for radiation therapy. The objectives of this study were to apply an automatic computer algorithm to compute target volumes and to validate the algorithm using histologic data from real human prostate cancer. MATERIALS AND METHODS Various modalities for prostate imaging were performed. In vivo imaging included T2 3-T magnetic resonance imaging and (11)C-choline PET. Ex vivo imaging included 3-T magnetic resonance imaging, histology, and block face photos of the prostate specimen. A novel registration method based on mutual information and thin-plate splines was applied to all modalities. Once PET is registered with histology, a voxel-by-voxel comparison between PET and histology is possible. A thresholding technique based on various fractions of the maximum standardized uptake value in the tumor was applied, and the respective computed threshold volume on PET was compared with histologic truth. RESULTS Sixteen patients whose primary tumor volumes ranged from 1.2 to 12.6 cm(3) were tested. PET has low spatial resolution, so only tumors > 4 cm(3) were considered. Four cases met this criterion. A threshold value of 60% of the (11)C-choline maximum standardized uptake value resulted in the highest volume overlap between threshold volume on PET and histology. Medial axis distances between threshold volume on PET and histology showed a mean error of 7.7 +/- 5.2 mm. CONCLUSIONS This is a proof-of-concept study demonstrating for the first time that histology-guided thresholding on PET can delineate tumor volumes in real human prostate cancer.
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18F-FDG PET/CT for early detection of embolism and metastatic infection in patients with infective endocarditis. Eur J Nucl Med Mol Imaging 2010; 37:1189-97. [DOI: 10.1007/s00259-010-1380-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
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Yue HY, Liu WT, Deng BR, Chang YX, Fang WL. Diagnosis of patients with peritoneal diseases: an analysis of 42 cases. Shijie Huaren Xiaohua Zazhi 2010; 18:199-203. [DOI: 10.11569/wcjd.v18.i2.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical value of different methods for diagnosis of peritoneal diseases.
METHODS: A total of 42 patients with peritoneal diseases were included in the study. Measurement of serum tumor markers and computed tomography (CT) were performed in all patients, peritoneocentesis in 40 patients, positron emission tomography (PET)/CT in 9 patients, and ultrasound-guided percutaneous peritoneal biopsy in 13 patients. The sensitivity, specificity and accuracy of each method and the causes of peritoneal diseases were analyzed.
RESULTS: The sensitivity of measurement of serum tumor markers (CEA, CA153, CA19-9, CA242 and CA125) in the diagnosis of metastatic peritoneal tumors was 14.8%, 18.5%, 29.6%, 22.2% and 100%, and the specificity was 80.0%, 93.3%, 93.3%, 93.3% and 0%, respectively. The sensitivity and specificity of exfoliative cytologic examination in the diagnosis of carcinous ascites were 36% and 100%, respectively. The sensitivity and specificity of ascites adenosine deaminase (ADA) in the diagnosis of tuberculous ascites were 92.3% and 92.5%, respectively. The accuracy of CT, PET/CE and percutaneous peritoneal biopsy was 19%, 78% and 85%, respectively.
CONCLUSION: Serum tumor marker measurement, exfoliative cytologic examination and ascites ADA can help differentiate between carcinous and inflammatory peritoneal diseases. The accuracy of PET/CT and percutaneous peritoneal biopsy is higher than that of CT.
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Delbeke D, Schöder H, Martin WH, Wahl RL. Hybrid imaging (SPECT/CT and PET/CT): improving therapeutic decisions. Semin Nucl Med 2009; 39:308-40. [PMID: 19646557 DOI: 10.1053/j.semnuclmed.2009.03.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The incremental diagnostic value of integrated positron emission tomography-computed tomography (PET/CT) or single-photon emission computed tomography (SPECT)/CT images compared with PET or SPECT alone, or PET or SPECT correlated with a CT obtained at a different time includes the following: (1) improvement in lesion detection on both CT and PET or SPECT images, (2) improvement in the localization of foci of uptake resulting in better differentiation of physiological from pathologic uptake, (3) precise localization of the malignant foci, for example, in the skeleton vs soft tissue or liver vs adjacent bowel or node (4) characterization of serendipitous lesions, and (5) confirmation of small, subtle, or unusual lesions. The use of these techniques can occur at the time of initial diagnosis, in assessing the early response of disease to treatment, at the conclusion of treatment, and in continuing follow-up of patients. PET/CT and SPECT/CT fusion images affect the clinical management in a significant proportion of patients with a wide range of diseases by (1) guiding further procedures, (2) excluding the need of further procedures, (3) changing both inter- and intramodality therapy, including soon after treatment has been initiated, and (4) by providing prognostic information. PET/CT fusion images have the potential to provide important information to guide the biopsy of a mass to active regions of the tumor and to provide better maps than CT alone to modulate field and dose of radiation therapy. It is expected that the role of PET/CT and SPECT/CT in changing management will continue to evolve in the future and that these tools will be fundamental components of the truly "personalized medicine" we are striving to deliver.
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Affiliation(s)
- Dominique Delbeke
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232-2675, USA.
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Kobayashi E, Iwamiya T, Masaki H, Yamagata A, Isobe M, Miyake T, Shiki Y, Nakashima R, Yamasaki M. Postoperative abdominal aspergilloma mimicking cervical cancer recurrence and diagnostic imaging, including F-fluorodeoxyglucose positron emission tomography, with false-positive findings. J Obstet Gynaecol Res 2009; 35:808-11. [PMID: 19751349 DOI: 10.1111/j.1447-0756.2009.01019.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present the case of a 39-year-old woman with a subfascial abscess. The patient had undergone radical hysterectomy for stage Ib1 cervical cancer. Six months after the surgery, she was found to have an elevated concentration of the serum squamous cell carcinoma antigen. Thereafter, she underwent magnetic resonance imaging and positron emission tomography-computed tomography. Magnetic resonance imaging revealed an irregular mass (diameter: 2 cm) in the abdominal wall. Increased (18)F-fluorodeoxyglucose uptake into the mass was observed on positron emission tomography. Therefore, we could not rule out the possibility of the peritoneal dissemination of cervical cancer, and we resected the mass. The mass was pathologically and microbiologically diagnosed as a subfascial aspergilloma. The lesion was located in the subfascial area where a drain was inserted at the time of the primary laparotomy.
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Affiliation(s)
- Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai City, Osaka, Japan.
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Kwee TC, Basu S, Cheng G, Alavi A. FDG PET/CT in carcinoma of unknown primary. Eur J Nucl Med Mol Imaging 2009; 37:635-44. [PMID: 19882152 PMCID: PMC2822231 DOI: 10.1007/s00259-009-1295-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 09/23/2009] [Indexed: 01/26/2023]
Abstract
Carcinoma of unknown primary (CUP) is a heterogeneous group of metastatic malignancies in which a primary tumor could not be detected despite thorough diagnostic evaluation. Because of its high sensitivity for the detection of lesions, combined 18F-fluoro-2-deoxyglucose positron emission tomography (FDG PET)/computed tomography (CT) may be an excellent alternative to CT alone and conventional magnetic resonance imaging in detecting the unknown primary tumor. This article will review the use, diagnostic performance, and utility of FDG PET/CT in CUP and will discuss challenges and future considerations in the diagnostic management of CUP.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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139
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FDG Uptake in a Rheumatoid Nodule With Imaging Appearance Similar to a Malignant Soft Tissue Tumor. Clin Nucl Med 2009; 34:691-2. [DOI: 10.1097/rlu.0b013e3181b53814] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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140
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141
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Liu Y. Orthopedic surgery-related benign uptake on FDG-PET: case examples and pitfalls. Ann Nucl Med 2009; 23:701-8. [PMID: 19728016 DOI: 10.1007/s12149-009-0296-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
Abstract
Orthopedic surgical procedures often create some special postoperative complications, which may demonstrate abnormally increased or focal uptake for an extended period of time on FDG PET-CT images. The distinction of normal from pathologic, benign from malignant uptake is very important to minimize the number of false positive results. To date, very little data have been published regarding surgical-related benign musculoskeletal uptake on PET-CT imaging. In this paper, we present to the readers some case examples of FDG PET-CT imaging for postoperative fracture, infection or osteomyelitis, metallic implants, aggressive bone edge, heterotopic ossification, granuloma and neuroma. We also discuss potential pitfalls to recognize these orthopedic surgery-related complications and identify benign nature of increased FDG uptake. In all cases, the patient's medical and surgical history would be of paramount importance to the radiologists/nuclear medicine physicians who interprets the scan. It is also crucial to carefully correlate FDG uptake with the anatomy on the co-registered CT images in all transaxial, coronal and sagittal views in order to identify the location and pattern of uptake.
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Affiliation(s)
- Yiyan Liu
- Nuclear Medicine Section, Department of Radiology, The University Hospital, UMDNJ, Newark, NJ 07103, USA.
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Gastrointestinal 18F-FDG accumulation on PET without a corresponding CT abnormality is not an early indicator of cancer development. Eur Radiol 2009; 19:2171-9. [PMID: 19415294 DOI: 10.1007/s00330-009-1405-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 02/21/2009] [Indexed: 12/22/2022]
Abstract
Focal gastrointestinal 2-deoxy-2-[(18)F]-fluoro-D: -glucose (FDG) uptake can frequently be found on FDG-PET/CT even in patients without known gastrointestinal malignancy. The aim of this study was to evaluate whether increased gastrointestinal FDG uptake without CT correlate is an early indicator of patients developing gastrointestinal malignancies. A total of 1,006 patients without esophagogastric or anorectal malignancies underwent FDG-PET/CT. The esophagogastric junction, the stomach and the anorectum were evaluated for increased FDG uptake. Patients without elevated uptake were assigned to group A, patients with elevated uptake were allocated to group B. The SUVmax values of both groups were tested for significant differences using the U test. A follow-up of longer than 1 year (mean 853 +/- 414 days) served as gold standard. A total of 460 patients had to be excluded based on insufficient follow-up data. For the remaining 546 patients the mean SUVmax was as follows: (a) esophagogastric junction, group A 3.1 +/- 0.66, group B 4.0 +/- 1.11, p < 0.01; (b) stomach, group A 2.8 +/- 0.77, group B 4.1 +/- 1.33, p < 0.01; (c) rectal ampulla, group A 2.8 +/- 0.83, group B 3.9 +/- 1.49, p < 0.01; (d) anal canal, group A 2.7 +/- 0.55, group B 3.9 +/- 1.59, p < 0.01. Only one patient developed gastric cancer. In the case of an unremarkable CT, elevated esophagogastric or anorectal FDG uptake does not predict cancer development and does not have to be investigated further.
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143
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PET-CT-guided interventions in the management of FDG-positive lesions in patients suffering from solid malignancies: initial experiences. Eur Radiol 2009; 19:1780-5. [DOI: 10.1007/s00330-009-1338-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 12/16/2008] [Accepted: 12/22/2008] [Indexed: 10/21/2022]
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144
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Rotger A, Trifirò G, L. Travaini L, de Cicco C, Paganelli G. Carcinoma, tuberculosis and elastofibroma in one patient: is [18F]FDG-PET/CT helpful? ACTA ACUST UNITED AC 2009; 28:22-5. [DOI: 10.1016/s0212-6982(09)70212-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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145
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Suga K, Yasuhiko K, Hiyama A, Sumiyoshi Y. Radiation Therapy-Induced Complicated Pelvic Bone and Soft-Tissue Disorders Showing Abnormal FDG Uptake. Clin Nucl Med 2009; 34:89-93. [DOI: 10.1097/rlu.0b013e318192c41d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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146
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Abstract
We present the PET/CT findings of hemostatic absorbable gelatin (Gelfoam) in a 41-year-old woman who had hysterectomy and bilateral oophorectomy. CT showed a very low attenuation lesion (−232 HU) in the surgical bed, but PET showed no significant activity.
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147
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Morii T, Mochizuki K, Sano H, Fujino T, Harasawa A, Satomi K. Occult myofibroblastic sarcoma detected on FDG-PET performed for cancer screening. Ann Nucl Med 2008; 22:811-5. [PMID: 19039560 DOI: 10.1007/s12149-008-0194-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 07/21/2008] [Indexed: 12/15/2022]
Abstract
We present a rare case of occult low-grade myofibroblastic sarcoma (LGMFS) detected by marked 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) uptake on positron emission tomography (PET). A 46-year-old woman presented with abnormal FDG uptake in her back when FDG-PET was performed for cancer screening. The maximum standard uptake values (SUVmax) were 9.8. Physical examination and laboratory investigations revealed no abnormalities. Magnetic resonance images demonstrated an ill-defined 2 x 3 cm mass in the multifidus muscle. Excisional biopsy led to a pathological diagnosis of LGMFS. Additional wide resection was performed for local control. No local recurrence or distant metastasis was observed 12 months after the initial operation. This is the first report describing FDG-PET findings of LGMFS, suggesting a discrepancy between histological grade and SUV intensity in this low-grade entity.
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Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
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148
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Role of fluorodeoxyglucose-PET versus fluorodeoxyglucose-PET/computed tomography in detection of unknown primary tumor: a meta-analysis of the literature. Nucl Med Commun 2008; 29:666-73. [PMID: 18677207 DOI: 10.1097/mnm.0b013e328302cd26] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objectives of this study were to evaluate the diagnostic accuracy of fluorodeoxyglucose (FDG)-PET and FDG-PET/computed tomography (CT) in the detection of primary tumors in patients presenting with carcinoma of unknown primary (CUP) unidentified by conventional workup, and to compare the statistical difference between the FDG-PET and FDG-PET/CT. Twenty-eight studies (involving a total of 910 patients) published between 1990 and 2007 were reviewed. These studies evaluated the role of FDG-PET and FDG-PET/CT in the detection of unknown primary tumors after physical examination and conventional workup failed to detect a primary tumor. Systematic methods were used to identify, select, and evaluate the methodological quality of the studies as well as to summarize the overall findings of sensitivity, specificity, and detection capacity of the primary tumor. The overall sensitivity and specificity of FDG-PET in detecting unknown primary tumors were 0.78 [95% confidence interval (CI): 0.72-0.84)] and 0.79 (95% CI: 0.74-0.83), respectively. Furthermore, FDG-PET detected 28.54% of tumors that were not apparent after CUP failed to be detected by conventional workup. Data were collected on the locations of primary tumors detected by FDG-PET in 17 studies and detected by FDG-PET/CT in seven studies. Tumors from the base of the tongue accounted for 20.7% (six of 29) of all false-positive FDG-PET scans, corresponding to a false-positive rate of 28.6% (six of 29), much higher than tumors from the others. FDG-PET exhibited a lower sensitivity with respect to the tumors at the base of the tongue and tonsils, which was 68.2 and 76.7%, respectively. In the eight studies with 430 patients diagnosed with CUP by FDG-PET/CT, 31.4% (n=135) of primary tumors were detected. The pooled sensitivity and specificity were 0.81 (95% CI: 0.74-0.87) and 0.83 (95% CI: 0.78-0.87), respectively. FDG-PET and FDG-PET/CT can detect primary tumors that went undetected by physical examination and conventional workup. FDG-PET exhibited lower sensitivity with respect to the tumors at the base of the tongue and the tonsils.
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149
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Paget disease of the humerus mimicking metastatic disease in a patient with metastatic malignant mesothelioma on whole body F-18 FDG PET/CT. Clin Nucl Med 2008; 33:510-2. [PMID: 18580246 DOI: 10.1097/rlu.0b013e318177928a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 71-year-old man with newly diagnosed malignant mesothelioma was referred for an F-18 FDG PET/CT study to evaluate the extent of disease. PET showed mild FDG uptake in the right chest, corresponding to a lobulated, mass-like right pleural effusion versus thickening involving the entire right pleural space, and some mediastinal involvement, on the accompanying CT scan. In addition, marked FDG uptake was seen in the proximal left humerus, suspicious for an osseous metastasis. The corresponding CT scan findings of cortical thickening and a "Swiss cheese" appearance were most consistent with Paget disease. The intense FDG uptake in an osseous lesion on FDG-PET in our case reminds us of the variable nature of FDG uptake in Paget disease, the possibility of false-positive findings on FDG-PET in patients with cancer, and the usefulness of the fusion techniques in the evaluation of skeletal lesions, with the potential for discriminating between benign Paget disease and other pathologic bone findings.
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150
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Shin DS, Shon OJ, Han DS, Choi JH, Chun KA, Cho IH. The clinical efficacy of 18F-FDG-PET/CT in benign and malignant musculoskeletal tumors. Ann Nucl Med 2008; 22:603-9. [DOI: 10.1007/s12149-008-0151-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 04/07/2008] [Indexed: 11/28/2022]
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