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Does Routine Triple-Time-Point FDG PET/CT Imaging Improve the Detection of Liver Metastases? Diagnostics (Basel) 2020; 10:diagnostics10090609. [PMID: 32825064 PMCID: PMC7554868 DOI: 10.3390/diagnostics10090609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 12/23/2022] Open
Abstract
Prior reports have demonstrated the improved ability of delayed fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging (dual-time-point imaging) in detecting more patients with liver metastases. To evaluate whether routine triple-time-point FDG PET/CT imaging improves the detection of liver metastasis not visualized on initial imaging. To our knowledge, no triple-time-point imaging has been reported. This retrospective study included total 310 patients with various malignancies who underwent PET/CT scans. Triple-time-point imaging including the liver was obtained. The comparison between negative and positive liver lesions on delayed imaging for patients with initial negative imaging were analyzed. Of the 310 patients, 286 did not exhibit liver lesions on initial imaging, but six of the 286 patients exhibited lesions on delayed imaging. No additional liver lesions were detected on further delayed imaging in the 286 patients. The other 24 patients with liver lesions identified on initial imaging still showed lesions on delayed and further delayed imaging. The analysis showed a significant difference in the percentage of colorectal cancer (66.7%) and liver lesions before the PET scan (50.0%) compared with unchanged results (22.1% and 3.9%, respectively). Routine triple-time-point imaging did not improve the detection of liver metastases; however, it may be recommended in patients with colorectal cancer and liver lesions before the PET scan.
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The added value of dual-time-point 18F-FDG PET/CT imaging in the diagnosis of colorectal cancer liver metastases. Abdom Radiol (NY) 2020; 45:1075-1081. [PMID: 31927618 DOI: 10.1007/s00261-019-02396-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the added value of dual-time-point 18F-FDG PET/CT imaging in the diagnosis of colorectal cancer liver metastases (CRLM). METHODS One hundred and eight patients with CRLM preoperatively underwent a dual-time-point 18F-FDG PET/CT scan. All hepatic lesions were diagnosed by histopathology. The diagnostic sensitivity of 18F-FDG PET/CT for CRLM was calculated on early scan and delayed scan, respectively. The McNemar test was used to test the differences of the sensitivity and the specificity between early scan and delayed scan. RESULTS On a per-patient basis, no significant difference in sensitivity was found between early scan and delayed scan (92.93% vs. 96.97%, P = 0.125). The per-patient specificity of early and delayed scans was 77.78%. On a per-lesion basis, overall sensitivity of delayed scan was significantly higher than that of early scan (83.49% vs. 76.61%, P < 0.001). The per-lesion specificity of early and delayed scans was 69.23%. For the lesion size of CRLM ≤ 10 mm, delayed imaging had significantly higher sensitivity than early imaging (47.17% vs. 26.42%, P < 0.001). However, for CRLM > 10 mm, there was no significant difference in sensitivity between early and delayed scans (92.73% vs. 95.15%, P = 0.125). Of the detected 182 liver metastatic lesions on delayed scan, the SUVmax on delayed scan was significantly higher than that on early scan (12.13 ± 7.13 vs. 9.16 ± 4.74, P < 0.001). The SUVmean of the normal liver on delayed scan was significantly lower than that on early scan (1.91 ± 0.29 vs. 2.33 ± 0.31, P < 0.001). The tumor to normal background ratio on delayed scan was significantly higher than that on early scan (6.59 ± 4.43 vs. 4.02 ± 2.23, P < 0.001). CONCLUSION The dual-time-point 18F-FDG PET/CT imaging might detect more CRLM lesions compared with single-time-point imaging, especially for small (< 10 mm) lesions.
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AKBULUT A, ESEN B, GÖKÇORA N, İLGİN N, KİTAPÇI M. The value of late phase imaging with FDG-PET/CT in liver metastases of colorectal carcinoma. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.686957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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The Evolving Role of PET-Based Novel Quantitative Techniques in the Interventional Radiology Procedures of the Liver. PET Clin 2019; 14:419-425. [PMID: 31472739 DOI: 10.1016/j.cpet.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Interventional radiology procedures have revolutionized the treatment of cancer and interventional oncology is now the fourth pillar of cancer care. The article discusses the importance of fluorodeoxyglucose (FDG)-PET imaging, and dual time-point imaging in the context of PET/computed tomography as applied to treatments of liver malignancy. The necessary paradigm shift in the adoption of novel segmentation methodologies to express global disease burden is explored.
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Oksuzoglu K, Ones T, Ozguven S, Inanir S, Turoglu HT, Bozkurtlar E, Celikel CA, Erdil TY. Change in standardized uptake values in delayed 18F-FDG positron emission tomography images in hepatocellular carcinoma. Medicine (Baltimore) 2018; 97:e12817. [PMID: 30334977 PMCID: PMC6211921 DOI: 10.1097/md.0000000000012817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Delayed 18F-2-fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography (PET) imaging has been associated with improved diagnostic yield in several malignancies; however, data on the use of delayed imaging in patients with hepatocellular carcinoma (HCC) is scarce. This study aimed to examine tumoral and background standardized uptake value (SUV) alterations in dual-phase F-FDG PET/computed tomography (CT) imaging.Fifty-two HCC cases underwent dual-time-point F-FDG PET/CT examination where early and delayed images were obtained. The maximum and mean SUVs (SUVmax and SUVmean) of the tumor were determined for both time points. Similarly, the average SUVmean were also determined for background (liver, soft tissue, and spleen). Changes in tumoral and background SUV between early and delayed images were examined.The mean age was 62.0 ± 12.9 years (range, 20-88 years) and the majority of the patients were men (86.5%). Tumor SUVs, both tumor SUVmean and tumor SUVmax, significantly increased at delayed images when compared to early images. In contrast, the average SUVmean for the liver, soft tissue, and spleen significantly decreased at delayed images.A significant increase in tumor SUV in delayed images in contrast to a significant decrease in background SUVs suggests that delayed images in HCC may contribute to diagnostic performance through a potential increase in the contrast between the tumor and background. However, further studies with larger sample sizes including patients with benign lesions and different grades of the disease are warranted to better elucidate the diagnostic contribution as well as the association of delayed imaging values with prognosis.
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Affiliation(s)
| | | | | | | | | | - Emine Bozkurtlar
- Department of Pathology, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Cigdem Ataizi Celikel
- Department of Pathology, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
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Ushio A, Takauchi K, Kobayashi M, Abe N, Sumida H, Nagata Y, Awai K. [Differentiation between Hepatic Focal Lesions and Heterogenous Physiological Accumulations by Early Delayed Scanning in 18F-FDG PET/CT Examination]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:556-562. [PMID: 29925750 DOI: 10.6009/jjrt.2018_jsrt_74.6.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE We examined whether early delayed scanning is useful for differentiation of liver lesion and heterogenous physiological accumulation in positron emission tomography (PET) examination. METHODS The subjects of the study were 33 patients with colorectal cancer who underwent PET examination and were added early delayed scanning to distinguish between liver lesions and heterogenous physiological accumulation to conventional early images. We placed same regions of interest (ROI) in the tumor and hepatic parenchyma for early delayed and conventional early images. Then, we measured SUVmax of the ROIs and calculated tumor to liver parenchyma uptake ratio (TLR). In addition, change rates between early and early delayed images were calculated for the SUVmax and TLR. RESULTS The receiver operating characterstic (ROC) analysis result of SUVmax showed the highest SUVmax change rate, and the ROC analysis result of TLR showed the highest early delayed scanning. The SUVmax of the lesions did not change between early scan and early delayed scanning (p=0.98), but it decreased significantly in the normal group (p<0.001). TLR of the lesion group was significantly increased (p<0.001) in early delayed images compared to early scan and TLR significantly decreased in the normal group (p<0.001). The AUC of the ROC curve showed the highest SUVmax change rate (0.99). CONCLUSION Early delayed scanning could distinguish between liver lesions and heterogenous physiological accumulation in colon cancer patients.
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Affiliation(s)
- Ayaka Ushio
- Department of Radiology, Hiroshima University Hospital
| | | | | | - Nobukazu Abe
- Department of Radiology, Hiroshima University Hospital
| | | | - Yasushi Nagata
- Department of Radiation Oncology, Hiroshima University Hospital
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital
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Chirindel A, Alluri KC, Tahari AK, Chaudhry M, Wahl RL, Lodge MA, Subramaniam RM. Liver standardized uptake value corrected for lean body mass at FDG PET/CT: effect of FDG uptake time. Clin Nucl Med 2015; 40:e17-22. [PMID: 24873794 PMCID: PMC5413863 DOI: 10.1097/rlu.0000000000000446] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of this study is to establish the magnitude change and interreader reliability of the liver standardized uptake value corrected for lean body mass (SULmean) in dual-time-point imaging at 1 and 2 hours and 1 and 4 hours. PATIENTS AND METHODS Early and delayed FDG PET/CT scans were included for 28 patients (13 men and 15 women) who had normal liver by CT or ultrasound. The average uptake time between the early and delayed scans were 55 minutes (range, 44-69 minutes) for pancreatic adenocarcinoma patients (n = 19) and 184 minutes (range, 140-197 minutes) for neurofibromatosis patients (n = 9). A 30-mm-diameter spherical volume of interest was placed within the right lobe of the liver above, below, and at the level of the main portal vein by 2 independent readers. Correlation coefficients, analysis of variance, intraclass correlation coefficient, and Bland-Altman analysis were performed. RESULTS The mean liver SULmean was between 1.39 and 1.42 and between 1.28 and 1.3 in early and delayed images, respectively (P = 0.001). There is time-dependent reduction in the mean liver SULmean at 2-hour (7%-8%) and 4-hour uptake time (15%-21%) compared with 1-hour uptake time. The correlation coefficient between delayed uptake time and liver SULmean reduction is 0.39 to 0.41 at the upper aspect of the liver. The intraclass correlation coefficient for 2 readers varied between 0.997 and 0.998 and between 0.995 and 0.999 in early and delayed images, respectively (P = 0.001). CONCLUSIONS There is time-dependent reduction of mean liver SULmean, about 7% to 8% within the clinically relevant FDG uptake time, in the same patient with excellent interreader agreement in early and delayed images within the right lobe of the liver. Therefore, liver SULmean could represent a useful reference parameter in quantitative analysis of dual-phase FDG PET/CT in malignancy or atypical infection/inflammatory disease. Furthermore, it may be suitable as a normalization factor in currently available formulae quantifying therapy response on PET imaging.
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Affiliation(s)
- Alin Chirindel
- From the Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
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Nielsen K, Scheffer HJ, Pieters IC, van Tilborg AAJM, van Waesberghe JHTM, Oprea-Lager DE, Meijerink MR, Kazemier G, Hoekstra OS, Schreurs HWH, Sietses C, Meijer S, Comans EFI, van den Tol PMP. The use of PET-MRI in the follow-up after radiofrequency- and microwave ablation of colorectal liver metastases. BMC Med Imaging 2014; 14:27. [PMID: 25103913 PMCID: PMC4141664 DOI: 10.1186/1471-2342-14-27] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 08/04/2014] [Indexed: 12/16/2022] Open
Abstract
Background Thermal ablation of colorectal liver metastases (CRLM) may result in local progression, which generally appear within a year of treatment. As the timely diagnosis of this progression allows potentially curative local treatment, an optimal follow-up imaging strategy is essential. PET-MRI is a one potential imaging modality, combining the advantages of PET and MRI. The aim of this study is evaluate fluorine-18 deoxyglucose positron emission tomography (FDG) PET-MRI as a modality for detection of local tumor progression during the first year following thermal ablation, as compared to the current standard, FDG PET-CT. The ability of FDG PET-MRI to detect new intrahepatic lesions, and the extent to which FDG PET-MRI alters clinical management, inter-observer variability and patient preference will also be included as secondary outcomes. Methods/Design Twenty patients undergoing treatment with radiofrequency or microwave ablation for (recurrent) CRLM will be included in this prospective trial. During the first year of follow-up, patients will be scanned at the VU University Medical Center at 3-monthly intervals using a 4-phase liver CT, FDG PET-CT and FDG PET-MRI. Patients treated with chemotherapy <6 weeks prior to scanning or with a contra-indication for MRI will be excluded. MRI will be performed using both whole body imaging (mDixon) and dedicated liver sequences, including diffusion-weighted imaging, T1 in-phase and opposed-phase, T2 and dynamic contrast-enhanced imaging. The results of all modalities will be scored by 4 individual reviewers and inter-observer agreement will be determined. The reference standard will be histology or clinical follow-up. A questionnaire regarding patients’ experience with both modalities will also be completed at the end of the follow-up year. Discussion Improved treatment options for local site recurrences following CRLM ablation mean that accurate post-ablation staging is becoming increasingly important. The combination of the sensitivity of MRI as a detection method for small intrahepatic lesions with the ability of FDG PET to visualize enhanced metabolism at the ablation site suggests that FDG PET-MRI could potentially improve the accuracy of (early) detection of progressive disease, and thus allow swifter and more effective decision-making regarding appropriate treatment. Trial registration Trial registration number:
NCT01895673
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Petrousjka M P van den Tol
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Comparing respiratory gated with delayed scans in the detection of colorectal carcinoma hepatic and pulmonary metastases with 18F-FDG PET-CT. Clin Nucl Med 2014; 39:e7-e13. [PMID: 23751828 DOI: 10.1097/rlu.0b013e31828e96dd] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE In patients experiencing colorectal carcinoma, exhaustive analysis of indicates extent of hepatic and pulmonary surgery that prolongs survival of patients. PATIENTS AND METHODS To localize metastasis, we compared 2 F-FDG PET-CT imaging protocols, early respiratory gated scan, and delayed scan, to standard PET imaging procedure. SUVmax and lesion-to-healthy tissue ratio were measured in 60 pulmonary and 21 hepatic lesions by each of the 2 imaging protocols. RESULTS In the liver, metastatic lesion-to-healthy tissue ratios significantly increased on delayed scans as compared with early scans (P < 0.001). Better ratios could not be obtained when using respiratory gated scans, whereas more lesions were detected on delayed scans. In the lungs, metastatic lesion- to-healthy tissue ratio increased significantly on delayed scans for largest lesions (P < 0.001). Ratios were not better when exploring smallest metastatic lesions or when using respiratory gated scans. Factors interfering with F-FDG PET-CT sensitivity are discussed, such as respiratory motion and high FDG physiological uptake in healthy liver parenchyma. CONCLUSIONS Our studies indicate that routine acquisitions should use delayed hepatic scans for all patients referred for evaluation, recurrence check, or monitoring of colorectal adenocarcinoma. Delayed pulmonary scans are useful for the largest metastatic lesions and should be used in addition to early scan. In our experience, respiratory gated scans seem to be less convenient because of a low sensitivity in detection, as compared with the delayed technique; in addition, this technique is currently complicated by some technical issues, although these might be overcome with new gated protocols.
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Povoski SP, Murrey DA, Smith SM, Martin EW, Hall NC. 18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals derived from a single-institution 18F-FDG-directed surgery experience: feasibility and quantification of 18F-FDG accumulation within 18F-FDG-avid lesions and background tissues. BMC Cancer 2014; 14:453. [PMID: 24942656 PMCID: PMC4075626 DOI: 10.1186/1471-2407-14-453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/13/2014] [Indexed: 12/31/2022] Open
Abstract
Background 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a well-established imaging modality for a wide variety of solid malignancies. Currently, only limited data exists regarding the utility of PET/CT imaging at very extended injection-to-scan acquisition times. The current retrospective data analysis assessed the feasibility and quantification of diagnostic 18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals. Methods 18F-FDG-avid lesions (not surgically manipulated or altered during 18F-FDG-directed surgery, and visualized both on preoperative and postoperative 18F-FDG PET/CT imaging) and corresponding background tissues were assessed for 18F-FDG accumulation on same-day preoperative and postoperative 18F-FDG PET/CT imaging. Multiple patient variables and 18F-FDG-avid lesion variables were examined. Results For the 32 18F-FDG-avid lesions making up the final 18F-FDG-avid lesion data set (from among 7 patients), the mean injection-to-scan times of the preoperative and postoperative 18F-FDG PET/CT scans were 73 (±3, 70-78) and 530 (±79, 413-739) minutes, respectively (P < 0.001). The preoperative and postoperative mean 18F-FDG-avid lesion SUVmax values were 7.7 (±4.0, 3.6-19.5) and 11.3 (±6.0, 4.1-29.2), respectively (P < 0.001). The preoperative and postoperative mean background SUVmax values were 2.3 (±0.6, 1.0-3.2) and 2.1 (±0.6, 1.0-3.3), respectively (P = 0.017). The preoperative and postoperative mean lesion-to-background SUVmax ratios were 3.7 (±2.3, 1.5-9.8) and 5.8 (±3.6, 1.6-16.2), respectively, (P < 0.001). Conclusions 18F-FDG PET/CT oncologic imaging can be successfully performed at extended injection-to-scan acquisition time intervals of up to approximately 5 half-lives for 18F-FDG while maintaining good/adequate diagnostic image quality. The resultant increase in the 18F-FDG-avid lesion SUVmax values, decreased background SUVmax values, and increased lesion-to-background SUVmax ratios seen from preoperative to postoperative 18F-FDG PET/CT imaging have great potential for allowing for the integrated, real-time use of 18F-FDG PET/CT imaging in conjunction with 18F-FDG-directed interventional radiology biopsy and ablation procedures and 18F-FDG-directed surgical procedures, as well as have far-reaching impact on potentially re-shaping future thinking regarding the “most optimal” injection-to-scan acquisition time interval for all routine diagnostic 18F-FDG PET/CT oncologic imaging.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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Caoduro C, Porot C, Vuitton DA, Bresson-Hadni S, Grenouillet F, Richou C, Boulahdour H, Blagosklonov O. The Role of Delayed 18F-FDG PET Imaging in the Follow-up of Patients with Alveolar Echinococcosis. J Nucl Med 2013; 54:358-63. [DOI: 10.2967/jnumed.112.109942] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Lee JW, Kim SK, Lee SM, Moon SH, Kim TS. Detection of Hepatic Metastases Using Dual-Time-Point FDG PET/CT Scans in Patients with Colorectal Cancer. Mol Imaging Biol 2010; 13:565-572. [DOI: 10.1007/s11307-010-0394-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Caprio MG, Cangiano A, Imbriaco M, Soscia F, Di Martino G, Farina A, Avitabile G, Pace L, Forestieri P, Salvatore M. Dual-time-point [18F]-FDG PET/CT in the diagnostic evaluation of suspicious breast lesions. Radiol Med 2009; 115:215-24. [PMID: 20017002 DOI: 10.1007/s11547-009-0491-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 05/04/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE The authors sought to evaluate whether the reacquisition of images 3 h after administration of radiotracer improves the sensitivity of fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography ([(18)F]-FDG PET/CT) in patients with suspicious breast lesions. MATERIALS AND METHODS Forty-eight patients with 59 breast lesions underwent an [(18)F]-FDG PET/CT study in the prone position with a dual-time-point acquisition performed in the early phase 1 h after FDG administration (PET-1) and in the delayed phase 3 h after FDG administration (PET-2). Both examinations were evaluated qualitatively and semiquantitatively with calculation of the mean percentage variation of the standard uptake values (Delta% SUV(max)) between PET-1 and PET-2. All lesions with an SUV(max) >or=2.5 at PET-1 or a reduction in SUV between PET-1 and PET-2 were considered benign. The definitive histopathological diagnosis was available for all patients included in the study. RESULTS The dual-time-point acquisition of [(18)F]-FDG PET/CT displayed an accuracy of 85% for lesions with an SUV(max) >or=2.5 and/or positive Delta% SUV(max), with sensitivity and specificity values of 81% and 100% compared with 69%, 63% (both p<0.001) and 100% (p=n.s.), respectively, for the single-time-point acquisition. Malignant lesions showed an increase in FDG uptake between PET-1 and PET-2, with a Delta% SUV(max) of 10+/-7 (p<0.04). In contrast, benign lesions showed a decrease in SUV between PET-1 and PET-2, with a Delta% SUV(max) of -21+/-7 (p<0.001). CONCLUSIONS The delayed repeat acquisition of PET images improves the accuracy of [(18)F]-FDG PET/CT in patients with suspicious breast lesions with respect to the single-time-point acquisition. In addition, malignant breast lesions displayed an increase in FDG uptake over time, whereas benign lesions showed a reduction. These variations in FDG uptake between PET-1 and PET-2 are a reliable parameter that can be used for differentiating between benign and malignant breast lesions.
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Affiliation(s)
- M G Caprio
- Fondazione S. D. N., Istituto di Ricerca Diagnostica e Nucleare, Via Pansini 5, 80131, Napoli, Italy
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A statistical clustering approach to visualizing the relationship between early and delayed images in whole-body FDG-PET. Radiol Phys Technol 2009; 2:145-50. [DOI: 10.1007/s12194-009-0058-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 03/26/2009] [Accepted: 03/29/2009] [Indexed: 10/20/2022]
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Dual-phase FDG-PET: delayed acquisition improves hepatic detectability of pathological uptake. Radiol Med 2008; 113:875-86. [DOI: 10.1007/s11547-008-0287-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 11/14/2007] [Indexed: 10/21/2022]
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Kuker RA, Mesoloras G, Gulec SA. Optimization of FDG-PET/CT imaging protocol for evaluation of patients with primary and metastatic liver disease. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY : ISSO 2007; 4:17. [PMID: 17623095 PMCID: PMC1939707 DOI: 10.1186/1477-7800-4-17] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 07/10/2007] [Indexed: 11/10/2022]
Abstract
BACKGROUND Accurate determination of the extrahepatic extent and intrahepatic distribution of disease is very important in patients with primary and metastatic liver disease for deciding whether a patient receives potentially curable surgery or palliative treatment. Our objective was to evaluate the efficacy of delayed phase FDG-PET/CT imaging in lesion detection and to define its clinical impact compared to triple-phase contrast enhanced CT (CECT). METHODS 30 patients underwent delayed phase FDG-PET/CT imaging (90 min whole body scan followed by a delayed abdominal scan at 120 min). Maximum standard uptake values (SUVs) and SUV ratios between tumor and normal liver parenchyma (T/N) were evaluated. In addition, comparison was made to CECT obtained within 10 days of the FDG-PET/CT to evaluate for lesion concordance within individual liver segments (Couinaud designation). RESULTS Sites of primary malignancies included: colorectal (19), breast (3), pancreas (2), lung (2), carcinoid (2), cholangiocarcinoma (1), and hepatocellular carcinoma (1). There was a significant increase in SUV value of liver lesions between early and delayed acquisition (P < 0.001). Although there was not a significant reduction in liver background activity between the two studies, there was a strong increase in T/N ratio (P < 0.001) allowing better lesion detection by visual inspection. New lesions were identified in 5 of the 30 patients, which were not appreciated on the early scan. Delayed phase FDG-PET/CT identified one lesion which was not present on the corresponding CECT. Delayed phase FDG-PET/CT revealed extrahepatic sites of metastases not appreciated on CECT in 6 patients. CONCLUSION Delayed phase FDG-PET/CT protocol improved lesion detectability in primary and metastatic liver disease, revealing new lesions in 17% of the patients. Moreover, FDG-PET/CT identified extrahepatic disease not seen on CECT in 20% of the patients.
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Affiliation(s)
- Russ A Kuker
- Department of Radiology, Jackson Memorial Hospital, Miami, FL, USA
| | | | - Seza A Gulec
- Department of Surgical Oncology, Goshen Cancer Institute, Goshen, IN, USA
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Liao AH, Li CH, Cheng WF, Li PC. Non-Invasive imaging of small-animal tumors: high-frequency ultrasound vs. MicroPET. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2005:5695-8. [PMID: 17281549 DOI: 10.1109/iembs.2005.1615779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tumor volume measurement on small animals is important but currently invasive. We employ ultrasonic micro-imaging (UMI) in this study and demonstrate its feasibility. In addition, we use small animal positron emission tomography (microPET) as a preliminary effort to develop multi-modality small animal imaging techniques. The tumor growth curve from UMI is also compared to radioactivity from microPET. Both UMI and [<sup>18</sup>F] FDG microPET imaging were performed on C57BL/6J black mice bearing WF-3 ovary cancer cells at various stages from the second week till up to the eighth week. Segmentation and 3D reconstruction were also done. The growth curve was obtained in vivo noninvasively by UMI. The cell doubling time was 7.46 days according to UMI. This result was compared with vernier caliper measurement and radioactivity counting by microPET. In microPET, we obtained the time-activity curves from the tumor and the tumor-surrounding tissue. The tumor-to-normal-tissues ratios reached maximum at the fifth week after tumor cell implantation.
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Affiliation(s)
- Ai-Ho Liao
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
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18
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Sanghera B, Wong WL, Lodge MA, Hain S, Stott D, Lowe J, Lemon C, Goodchild K, Saunders M. Potential novel application of dual time point SUV measurements as a predictor of survival in head and neck cancer. Nucl Med Commun 2006; 26:861-7. [PMID: 16160644 DOI: 10.1097/00006231-200510000-00003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the potential of pre-treatment dual time point [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a tool for improving the assessment of head and neck cancer. Two main areas were investigated: (a) optimum time to start FDG scanning post-injection and (b) potential of SUV obtained from dual time point scanning as a prognostic indicator of survival. METHODS Twelve patients with advanced head and neck cancer were prospectively studied. Each patient was scanned using a Siemen's Ecat Exact-47 PET scanner at 1 h and 2 h post-injection. Maximum tumour uptake (SUVt) and ratio of maximum tumour/normal tissue uptake (SUVt/n) were recorded. The optimal time to initiate scanning was investigated by comparing SUVt and SUVt/n with the decision made by two experienced observers as to which scan they preferred to report from, given the choice of the 1 h and 2 h scan in each patient. RESULTS A significant difference between 1 h and 2 h SUVt (P<0.004, paired t-test) and between 1 h and 2 h SUVt/n (P<0.0003, paired t-test) was observed. All 2 h SUVt and SUVt/n were greater in magnitude than their respective 1 h SUVt and SUVt/n counterparts. The two observers reported an identical number of lesions from the 1 h and 2 h scans but preferred the 2 h data. CONCLUSIONS Tumour stage and the percentage difference in 1 h and 2 h SUVt showed potential as prognostic indicators of long-term survival.
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Affiliation(s)
- Bal Sanghera
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK.
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19
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Lin WY, Tsai SC, Hung GU. Value of delayed 18F-FDG-PET imaging in the detection of hepatocellular carcinoma. Nucl Med Commun 2005; 26:315-21. [PMID: 15753790 DOI: 10.1097/00006231-200504000-00003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND 18F-Fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) is a very useful imaging technique and is the best modality for the evaluation of many kinds of tumour. However, in the evaluation of hepatocellular carcinoma (HCC), the diagnostic accuracy of routine 60 min static imaging is not satisfactory. Some authors have suggested that delayed 2 h imaging is a better 18F-FDG-PET protocol for tumour detection. However, the value of delayed 3 h imaging has not been clarified. In this study, we performed delayed 2 h and 3 h imaging on patients with HCC and compared their diagnostic accuracy with standard 60 min imaging. METHODS Twelve patients with HCC were enrolled in this study. Of these 12 patients, four had not been treated and eight had received transcatheter arterial embolization (TAE) therapy for more than 4 months before the PET study. One hour after injection of 18F-FDG, a whole-body scan was performed. In addition, delayed imaging focusing on the liver was also performed 2 h and 3 h after the injection. The standard uptake value (SUV) was calculated for the tumours in each image. RESULTS The twelve patients had 16 HCCs. Of the 16 HCCs, nine were detected by 18F-FDG-PET scans based on the 1 h images, whereas 10 HCCs were detected based on the 2 or 3 h images. The diagnostic sensitivity increased from 56.3% on the 1 h image to 62.5% on the 2 and 3 h images. In addition, the mean SUV increased from 3.63 at 1 h to 3.86 at 2 h and 3.99 at 3 h after the injection of 18F-FDG. On the other hand, the mean SUV in the normal liver tissue decreased slightly from 2.38 at 1 h to 2.33 at 2 h and 2.31 at 3 h. The tumour to normal liver tissue (T/N) ratio increased from 1.56 at 1 h to 1.68 at 2 h and 1.75 at 3 h. CONCLUSION In the evaluation of HCC, delayed 2 and 3 h imaging can detect more lesions than standard 1 h imaging. Imaging at 3 h has a better T/N ratio than imaging at 2 h, but does not increase the diagnostic sensitivity.
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Affiliation(s)
- Wan-Yu Lin
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
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20
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Kato H, Miyazaki T, Nakajima M, Takita J, Kimura H, Faried A, Sohda M, Fukai Y, Masuda N, Fukuchi M, Manda R, Ojima H, Tsukada K, Kuwano H, Oriuchi N, Endo K. The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma. Cancer 2005; 103:148-56. [PMID: 15558794 DOI: 10.1002/cncr.20724] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The purpose of the current study was to assess whether [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) provides incremental value (e.g., additional information on lymph node involvement or the presence of distant metastases) compared with computed tomography (CT) in patients with esophageal carcinoma. METHODS The authors examined 149 consecutive patients with thoracic esophageal carcinoma. Eighty-one patients underwent radical esophagectomy without pretreatment, 17 received chemoradiotherapy followed by surgery, 3 underwent endoscopic mucosal resection, and the remaining 48 patients received definitive radiotherapy and chemotherapy. The diagnostic accuracy of FDG-PET and CT was evaluated at the time of diagnosis. RESULTS The primary tumor was visualized using FDG-PET in 119 (80%) of 149 patients. Regarding lymph node metastases, FDG-PET had 32% sensitivity, 99% specificity, and 93% accuracy for individual lymph node group evaluation and 55% sensitivity, 90% specificity, and 72% accuracy for lymph node staging evaluation. PET exhibited incremental value over CT with regard to lymph node status in 14 of 98 patients who received surgery: 6 patients with negative CT findings were eventually shown to have lymph node metastases (i.e., they had positive PET findings and a positive reference standard [RS]); 6 patients with positive CT findings were shown not to have lymph node metastases (i.e., they had negative PET findings and a negative RS); and 2 patients were shown to have cervical lymph node metastases in addition to mediastinal or abdominal lymph node metastases. Among the remaining patients, PET showed incremental value over CT with regard to distant organ metastases in six patients. The overall incremental value of PET compared with CT with regard to staging accuracy was 14% (20 of 149 patients). CONCLUSIONS FDG-PET provided incremental value over CT in the initial staging of esophageal carcinoma. At present, combined PET-CT may be the most effective method available for the preoperative staging of esophageal tumors.
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Affiliation(s)
- Hiroyuki Kato
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, Maebashi, Japan.
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21
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Gil Martínez EM, Rabadán Bujalance F, Ponce Herrera C, Martínez Obrador D, Moya García F. [FDG-PET in hepatocellular carcinoma. Based on one case]. ACTA ACUST UNITED AC 2004; 23:352-3. [PMID: 15450142 DOI: 10.1016/s0212-6982(04)72316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of a 73 year old man, who lost 12 kg of weight in one month, had abdominal pain and progressive hepatic failure. A MRI and liver ultrasound were performed and, with the patient's symptoms, hepatocellular carcinoma Vs metastatic liver was suspected. A PET-FDG was performed and the images showed hepatomegaly and splenomegaly, without other findings of interest. FDG distribution in the liver was homogeneous. The patient was diagnosed of hepatocellular carcinoma after liver biopsy. FDG-PET detects only 50 % to 70 % of hepatocellular carcinomas due to varying degrees of activity of the enzyme glucose-6-phosphatase in these tumors. This paper reviews the literature on this type of situations.
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22
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Hain SF, Fogelman I. Recent advances in imaging hepatocellular carcinoma: diagnosis, staging and response assessment: functional imaging. Cancer J 2004; 10:121-7. [PMID: 15130271 DOI: 10.1097/00130404-200403000-00007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Historically, nuclear medicine has had an important role in the differential diagnosis of liver tumors but has been largely superseded by other forms of conventional imaging, in particular computed tomographic portography. It remains helpful in difficult cases because it has characteristic features in both hepatocellular carcinoma (HCC) and benign conditions. 131I is an important therapeutic tool. FDG-PET is useful in certain cases, especially for finding metastases and monitoring response to therapy.
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Affiliation(s)
- S F Hain
- Department of Nuclear Medicine, Guy's and St. Thomas Hospital and King's College, London, UK.
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23
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Kato H, Miyazaki T, Nakajima M, Fukuchi M, Manda R, Kuwano H. Value of positron emission tomography in the diagnosis of recurrent oesophageal carcinoma. Br J Surg 2004; 91:1004-9. [PMID: 15286962 DOI: 10.1002/bjs.4595] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) might be useful for staging oesophageal squamous cell carcinoma (SCC). FDG-PET may be more accurate than computed tomography (CT) in diagnosing lymph node metastasis. This retrospective study compared the ability of FDG-PET and CT to diagnose recurrent oesophageal carcinoma. METHODS Fifty-five patients with thoracic oesophageal SCC who had undergone radical oesophagectomy were studied. The accuracy of FDG-PET and CT in detecting recurrence during follow-up was calculated using data from the first images generated by either modality that suggested the presence of recurrent disease. Lesions deemed to be equivocal on these scans were considered as positive for recurrence. RESULTS Twenty-seven of the 55 patients had recurrent disease in a total of 37 organs. Locoregional recurrence was observed in 19 patients (35 per cent). Distant recurrent disease occurred in 15 patients (27 per cent) in 18 organs. Six patients had recurrence in the liver, four in the lung, six in bone and two in distant lymph nodes. FDG-PET showed 96 per cent sensitivity, 68 per cent specificity and 82 per cent accuracy in demonstrating recurrent disease. The corresponding values for CT were 89, 79 and 84 per cent. The sensitivity of FDG-PET was higher than that of CT in detecting locoregional recurrence, but its specificity was lower because of FDG uptake in the gastric tube and thoracic lymph nodes. In distant organs the sensitivity of PET in detecting lung metastasis was lower than that of CT, but its sensitivity for bone metastasis was higher. CONCLUSION FDG-PET has a larger field than CT. Combined PET-CT would appear to be an appropriate modality for the detection of recurrent oesophageal cancer.
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Affiliation(s)
- H Kato
- Department of Surgery I, Gunma University Faculty of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
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24
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Koga H, Sasaki M, Kuwabara Y, Nakagawa M, Hayashi K, Kaneko K, Chen T, Honda H. Lesion detectability of a gamma camera based coincidence system with FDG in patients with malignant tumors: A comparison with dedicated positron emission tomography. Ann Nucl Med 2004; 18:131-6. [PMID: 15195760 DOI: 10.1007/bf02985103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the lesion detectability of a gamma camera based coincidence detector system (c-PET system) in comparison to the dedicated PET system (d-PET system), and thereby clarify the feasibility of the clinical application of this system and also describe any factors influencing the lesion detectability of the c-PET system. METHODS We examined 74 patients including 19 with malignant lymphoma, 16 with lung cancer, 9 with primary malignant bone tumor, 7 with esophageal cancer, 6 with malignant melanoma, 3 with hepatocellular carcinoma, 3 with primary unknown cancer, 2 with breast cancer, 2 with colon cancer, and 7 with others. d-PET images were obtained using ECAT EXACT HR+ at 60 min, followed by c-PET imaging using ECAM at 120 min after the injection of 185 MBq of FDG. Each image was reconstructed without any attenuation correction. In the image interpretation, the whole body was classified into 16 regions (5 superficial regions and 11 deep regions). The FDG accumulation of the lesions was evaluated by visual grading based on the consensus of three nuclear medicine physicians, and the findings were classified into three grades; (++), (+), and (-). The lesions were also classified into 3 groups according to their size: large group (> or =2 cm), middle group (1 < or = <2 cm) and small group (<1 cm). RESULTS In 627 regions, the abnormal FDG uptake was detected in 109 regions by the d-PET system. Out of 109 regions, the c-PET system could detect the lesions in 91 regions and was false positive in 1 region. Therefore, the sensitivity, specificity, and accuracy of the c-PET system were 83.5%, 99.8% and 97.0%, respectively. Lesion detectability of the small group (54.5%) was significantly lower than that of the large group (97.9%) (p < 0.001) and that of the middle group (93.1%) (p < 0.001); however, the difference in lesion detectability between the large and middle groups was not significant. Neither the degree of FDG accumulation nor the location of the lesion markedly influenced the lesion detectability of the c-PET system. However, when we focused on the large and middle size lesions, the detectability of deep lesions tended to be lower than that of superficial lesions. CONCLUSION In conclusion, the lesion detectability of the c-PET system was inferior to that of the d-PET system, especially in the case of small lesions. Further examination is required to assess the clinical usefulness of the c-PET system.
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Affiliation(s)
- Hirofumi Koga
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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25
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Higashi T, Saga T, Nakamoto Y, Ishimori T, Fujimoto K, Doi R, Imamura M, Konishi J. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) --usefulness and limitations in "clinical reality". Ann Nucl Med 2003; 17:261-79. [PMID: 12932109 DOI: 10.1007/bf02988521] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The present review will provide an overview of the literature concerning the FDG PET diagnosis of pancreatic cancer and a summary from our experience of 231 cases of pancreatic lesions. FDG PET can effectively differentiate pancreatic cancer from benign lesion with high accuracy. Newly-developed PET scanners can detect small pancreatic cancers, up to 7 mm in diameter, by their high resolution, which could make a great contribution to the early detection of resectable and potentially curable pancreatic cancers. FDG PET is useful and cost-beneficial in the pre-operative staging of pancreatic cancer because an unexpected distant metastasis can be detected by whole-body PET in about 40% of the cases, which results in avoidance of unnecessary surgical procedures. FDG PET is also useful in evaluation of the treatment effect, monitoring after the operation and detection of recurrent pancreatic cancers. However, there are some drawbacks in PET diagnosis. A relatively wide overlap has been reported between semiquantitative uptake values obtained in cancers and those in inflammatory lesions. As for false-positive cases, active and chronic pancreatitis and autoimmune pancreatitis sometimes show high FDG accumulation and mimic pancreatic cancer with a shape of focal uptake. There were 8 false negative cases in the detection of pancreatic cancer by FDG PET, up to 33 mm in diameter, mainly because of their poor cellularity in cancer tissues. In addition, there are 19% of cancer cases with a decline in FDG uptake from 1 hr to 2 hr scan. FDG PET was recently applied to and was shown to be feasible in the differential diagnosis of cystic pancreatic lesions, such as intraductal papillary mucinous tumor of the pancreas. Further investigations are required to clarify the clinical value of FDG PET in predicting prognosis of the pancreatic patients.
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Affiliation(s)
- Tatsuya Higashi
- Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate School of Medicine, Sakyo, Japan.
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