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Parida GK, Muthu GS, Suman A, Kumar A, Mitra S. Physiologic Testicular Uptake of 18-F Fluorodeoxyglucose in the Indian Population. Indian J Nucl Med 2021; 36:261-266. [PMID: 34658549 PMCID: PMC8481841 DOI: 10.4103/ijnm.ijnm_4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of the study is to assess the physiologic uptake of testes in patients undergoing 18F-fluoro-2-deoxyglucose (FDG) position emission tomography/computed tomography (PET/CT) scans for various malignancies other than testicular malignancy. Materials and Methods The testicular uptake of 18F-FDG expressed as the standardized uptake value (T) was measured on PET/CT images in 320 men with no known testicular pathology from July 2019 to March 2020 at Tata Main Hospital, Jamshedpur. The ratio of maximum standardized uptake value (SUVmax) of the testis (T) to SUVmax of muscle (M) T/M ratio and to SUVmax of the liver (L) T/L ratio was calculated using SUVmax of right adductor muscle and liver, respectively. Testicular volume was calculated with the measurements taken from the axial, coronal, and sagittal slices of CT images. The correlation of testicular uptake with age, blood serum glucose level, and testicular volume was also analyzed. Results The mean age of 320 men was 57 ± 15 years (range: 10-94) and the mean blood glucose level was 107.7 ± 23.5 mg/dl (range: 64-175). Mean testicular SUVmax in 320 men was 2.48 ± 0.80 (range: 0.67-5.5). The mean testicular volume of 640 testes of 320 men was 18.80 ± 4.83 cm3 (range: 3.85-33.56 cm3). The mean values of (T/M) and (T/L) ratios in the studied population were 3.64 ± 1.21 (range: 1.08-5.58) and 0.97 ± 0.251 (range: 0.34-1.88), respectively. The laterality index (L - R/(L + R) ×2) in 320 men was 0.074 ± 0.050 (0.000-0.308). There was a minimal negative correlation between testicular SUVmax and age (r = -0.136, P = 0.15). Mild negative correlation was noted between T/M ratio and age (r = -0.291, P < 0.0001) and between T/L ratio and age (r = -0.182, P = 0.001) in the studied population. Conclusion The physiological testicular FDG uptake (SUVmax) of testes was 2.48 ± 0.80 (0.67-5.5) among the Indian population in this study, which has a mild negative correlation with age.
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Affiliation(s)
- Girish Kumar Parida
- Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Gopal Sonai Muthu
- Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Akchata Suman
- Department of Nuclear Medicine and PET-CT, Meherbai Tata Memorial Hospital, Jamshedpur, Jharkhand, India
| | - Abhishek Kumar
- Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Sujata Mitra
- Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
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Bochiński A, Sujenthiran A, Al-Hussini M, Fruhwirth GO, Shabbir M, Yap T. 18 F-FDG PET/CT use in functional assessment of the testes: A systematic review. Andrology 2021; 9:1410-1421. [PMID: 34019736 DOI: 10.1111/andr.13042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Our study analysed previous studies employing positron emission tomography with co-registered computer tomography (PET/CT) in andrological patient evaluation and assessed the differences in 2-[18 F]F-fluoro-2'-deoxyglucose (FDG) uptake between three groups: healthy testes, benign and malignant testicular pathology. METHODS Medline and Embase were systematically searched for studies involving FDG-PET/CT imaging of testes with results expressed as mean standardised uptake value (SUVmean ). A one-way ANOVA was used to compare SUVmean between three groups. All papers assessing andrological parameters were pooled to compare fertility data. RESULTS Seventeen studies, including three relating to fertility diagnosis, with a total of 830 patients, were included in the review. One-way ANOVA showed a statistical difference between mean values of tracer SUVmean in healthy and malignant testes (Dif. = -2.77, 95% CI = -4.32 to 1.21, p < 0.01) as well as benign and malignant (Dif. = -2.95, 95% CI = -4.33 to -1.21, p < 0.01) but no difference between healthy and benign (Dif. = 0.19, 95% CI = -0.96 to 1.33, p = 0.90). There is some evidence to suggest that FDG uptake and testicular volume are positively correlated to total sperm count, sperm concentration and sperm motility and that germ cells are likely to account for the majority of testicular FDG accumulation. CONCLUSION Our findings indicate that malignant testicular lesions demonstrate a significantly higher FDG uptake than benign testicular lesions or healthy testes. Some evidence also suggests that FDG-PET could visualise metabolic activity and thus spermatogenesis; however more studies are required to determine whether FDG-PET could also be used to diagnose infertility. Further studies should focus on correlating both sex hormone-serum levels and semen analysis results with imaging data.
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Affiliation(s)
- Antoni Bochiński
- School of Bioscience Education, Guy's Campus, King's College London, London, UK
| | | | | | - Gilbert O Fruhwirth
- Imaging Therapies and Cancer Group, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Majed Shabbir
- Department of Urology, Guy's and St Thomas' NHS Trust, London, UK
| | - Tet Yap
- Department of Urology, Guy's and St Thomas' NHS Trust, London, UK
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Abstract
OBJECTIVE. Knowledge of normal testicular 18F-FDG PET/CT (FDG PET/CT) SUVs is crucial for accurate examination interpretation. The objective of this study was to establish normal testicular SUV ranges among adult men receiving health care in North America. MATERIALS AND METHODS. A retrospective review of an institutional electronic database identified adult men undergoing pretreatment clinical FDG PET/CT examinations from March 15, 2013, through March 15, 2018. An FDG PET/CT image review of 700 testicles in 350 male patients was performed. Data collected included testicular SUVmax, SUVmean, and visual PET pattern of uptake. RESULTS. Testicular SUVmean and SUVmax values (mean ± SD) by age group were as follows: 3.1 ± 0.7 and 3.8 ± 0.9 for the age group of 18-30 years; 3.2 ± 0.6 and 4.0 ± 0.8, 31-40 years; 3.1 ± 0.4 and 3.8 ± 0.5, 41-50 years; 3.0 ± 0.5 and 3.7 ± 0.7, 51-60 years; 2.9 ± 0.5 and 3.5 ± 0.7, 61-70 years; 2.8 ± 0.5 and 3.5 ± 0.7, 71-80 years; and 2.6 ± 0.5 and 3.3 ± 0.6, more than 80 years. A statistically significant difference exists between age groups for testicular SUVmean (p ≤ .001) and SUVmax (p < .001), with SUVs peaking in the 4th decade of life and subsequently declining with age. A small but significant negative correlation exists between blood glucose level and testicular SUVmean (r = -0.12). CONCLUSION. This study reports the largest currently known cohort of SUVs in normal testicles and may guide clinical interpretation of testicular FDG activity. Discrepancies in normal SUVs may exist because of differences in patient demographics and PET technology.
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Functional Parameters of 18F-FDG PET/CT in Patients with Primary Testicular Diffuse Large B-Cell Lymphoma. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:8659826. [PMID: 30363729 PMCID: PMC6180978 DOI: 10.1155/2018/8659826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/21/2018] [Accepted: 09/03/2018] [Indexed: 02/05/2023]
Abstract
Fluorine-18 fluorodeoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT), a hybrid imaging technique that simultaneously provides functional and anatomical information, has been reported to be useful in lymphoma. The present study was to evaluate the functional parameters of 18F-FDG PET/CT in patients with testicular diffuse large B-cell lymphoma (DLBCL). We retrospectively reviewed medical records of 5095 patients with lymphoma who treated at West China Hospital between March 2003 and January 2017, and selected patients with 18F-FDG PET/CT findings and subsequently biopsy confirmed the invasion of testis with DLBCL. Maximum standardized uptake values (SUVmax), peak standardized uptake values (SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the patients were measured. We evaluated the characteristics of 18F-FDG PET/CT in this population. Six patients ranged in age from 37 to 73 years (median age, 58 years) were included in the analysis. The mean SUVmax was 11.09 and varied between 7.20 and 19.75; mean SUVpeak was 9.56 and ranged between 6.79 and 14.39. In addition, mean MTV 42% was 18.4 and varied between 1.3 and 61.6; mean MTV 2.5 was 34.7 and varied significantly between 1.6 and 141.9. With regard to TLG, mean TLG 42% was 168.906 and ranged from 7.514 to 687.004, while mean TLG 2.5 was 253.972 and ranged from 8.400 to 1127.802. In conclusion, 18F-FDG PET/CT scan is a useful tool in patients with testicular DLBCL. SUV, MTV, and TLG may vary a lot in different patients. SUVmax of testicular DLBCL lesion is relatively higher than that of normal testis. Also, we provided a set of MTV and TLG data and firstly showed their significant correlation with overall survival, which indicated a potential prognostic value of MTV and TLG. However, studies with larger population are needed to confirm these findings.
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Tripathy S, Mukherjee A, Bal C, Tripathi M, Mallick S, Shamim SA. Primary Germ Cell Tumor of Testes with Extensive Lymph Nodal and Splenic Metastases Masquerading Lymphoma on 18-F-FDG PET/CT. Indian J Nucl Med 2017; 32:153-154. [PMID: 28533651 PMCID: PMC5439192 DOI: 10.4103/0972-3919.202243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Germ cell tumors (GCT) account for the 95% of the malignancies associated with testes. They are the most common solid malignancies affecting the males in the age group of 15–35 years. It is known to be bilateral in 3% of cases. We herein present FDG PET-CT findings of a case with biopsy proven GCT with multiple lymph nodal and splenic metastases mimicking lymphomatous neoplasm.
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Affiliation(s)
- Sarthak Tripathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saumyaranjan Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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18F-FDG PET/CT Imaging of Epididymal Smooth Muscle Mass Mimicking Recurrent Lymphoma. Clin Nucl Med 2017; 42:e224-e226. [DOI: 10.1097/rlu.0000000000001571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Accurate reporting of combined PET/CT imaging requires a thorough understanding of the normal and variant physiological distribution of tracers as well as common incidental findings and technical artifacts. We describe these pitfalls and artifacts, what action may help to mitigate them in clinical practice, and what further action may be appropriate. This review presents these in a region-based approach, in order to closely mimic clinical practice, and focuses on technical artifacts followed by a description of two commonly used oncologic tracers: FDG and choline.
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Affiliation(s)
| | - Paul John Schleyer
- St Thomas' PET Imaging Centre, Guys and St Thomas NHS Trust and Kings College London, London, UK
| | - Gary John Cook
- St Thomas' PET Imaging Centre, Guys and St Thomas NHS Trust and Kings College London, London, UK
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FDG PET/CT images demonstrating epididymo-orchitis in a patient with HIV, acute kidney injury and known epididymo-orchitis on scrotal ultrasound. Clin Nucl Med 2015; 40:e171-2. [PMID: 25247269 DOI: 10.1097/rlu.0000000000000514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 52-year-old man with HIV was referred for an F-FDG PET/CT scan for the cause of kidney injury. FDG PET/CT scan revealed increased renal cortical FDG activity, which can be seen in HIV nephropathy or acute interstitial nephritis. Diffuse increased FDG uptake was demonstrated within the right testicle and epididymis, consistent with the patient's known right epididymo-orchitis, as diagnosed on ultrasound 1 week before admission. Multiple enlarged lymph nodes with increased FDG activity were also found within the right inguinal and external iliac nodal chains, which were presumed to be reactive. The patient was treated with ciprofloxacin with symptomatic improvement.
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Meij-de Vries A, Lazarenko SV, Knol RJJ, Meijer RW, van der Plas EM, Heij HA. The independent functioning of the orchidopexied congenital undescended testis as assessed by positron emission tomography/computed tomography. World J Nucl Med 2015; 14:31-5. [PMID: 25709542 PMCID: PMC4337005 DOI: 10.4103/1450-1147.150531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Fertility after orchidopexied undescended testes (UDT) is impaired. Although fertility parameters are known to be more favorable in unilateral cases than in bilateral cases, the exact contribution of the unilateral orchidopexied UDT to fertility is unknown. We used testicular 18F-fluoro-2-deoxyglucose (18F-FDG)-uptake assessed by positron emission tomography/computed tomography (PET/CT) to investigate the function of the orchidopexied unilateral congenital UDT, compared to its normally descended counterpart. We hypothesize that the contribution of the orchidopexied unilateral congenital UDT to fertility in adulthood is low. Eleven men who underwent orchidopexy for congenital UDT at the age of 1.9 ± 1.4 (range, 4.5 months -4.0) years were seen in follow-up at the age of 24.1 ± 2.3 (20.6-28.0) years. All underwent physical examination, testicular ultrasonography and PET/CT. Testicular 18F-FDG-uptake was expressed as the peak Standardized Uptake Value (SUVpeak). The mean SUVpeak of the orchidopexied UDT was 2.74 ± 0.48 (2.13-3.47), which was significantly lower than its counterpart (P = 0.021). Besides, there was no correlation between the testicular volume and the SUVpeak. The orchidopexied congenital UDT has been shown to be less metabolically active than its contralateral counterpart. Nevertheless, we suggest that the operated testes function to some degree.
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Affiliation(s)
- Annebeth Meij-de Vries
- Department of Surgery, Chirurgen Noordwest, Medical Center Alkmaar, Amsterdam, The Netherlands
| | - Sergiy V Lazarenko
- Department of Nuclear Medicine, Medical Center Alkmaar, Amsterdam, The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine, Medical Center Alkmaar, Amsterdam, The Netherlands
| | - Robert W Meijer
- Department of Surgery, Medical Center Alkmaar, Amsterdam, The Netherlands
| | | | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam, Amsterdam, The Netherlands
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Sidhu P, Lin P, Son H, Rosenfeld D, Lin M. Testicular fluorine-18 fludeoxyglucose uptake on positron emission tomography CT in patients with lymphoma: clinical significance and management impact. Br J Radiol 2014; 87:20140472. [PMID: 25333503 DOI: 10.1259/bjr.20140472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This is the first case series examining the role of fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography-CT (PET-CT) in the diagnosis of lymphoma, and its impact on the clinical management of patients with secondary testicular involvement. This study explores the clinical significance of abnormal testicular uptake, maximum standardized uptake values and the diagnostic value of the CT component in PET-CT scans of these patients. METHODS The case notes and PET scans of 12 patients with diagnosis of lymphoma that were reported to have abnormal (18)F-FDG uptake in the testes were examined. Case notes were reviewed for the underlying diagnosis, indication for the scan and its effect on the management decision. RESULTS 12 patients demonstrated abnormal (18)F-FDG uptake on the PET-CT scans (mean age, 63 years; range, 37-82 years). Seven patients were diagnosed with testicular lymphoma. Six out of the seven (86%) patients received additional intrathecal chemotherapy in addition to their systemic chemotherapy, and one patient had testicular radiotherapy. CONCLUSION This study establishes the importance of identifying and reporting abnormal (18)F-FDG uptake in the testes on PET-CT in patients with lymphoma. (18)F-FDG PET-CT is superior to conventional imaging in identifying testicular lymphoma and has significant management impact. It also emphasizes the importance of incorporating the testes as part of the scan coverage. ADVANCES IN KNOWLEDGE The appearances of testicular lymphoma on (18)F-FDG PET-CT can be variable and abnormal testicular uptake warrants further investigations and confirmation. FDG PET-CT is an important tool and can be used in addition to conventional imaging in the identification of testicular lymphoma.
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Affiliation(s)
- P Sidhu
- 1 Department of Radiology, Royal Prince Alfred Hospital, NSW, Australia
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Meij-de Vries A, Knol RJJ, Lazarenko SV, Meijer RW, van der Plas EM, Heij HA. Uptake of (18)F-fluoro-2-deoxyglucose in the Healthy Testes of Young Men as Assessed by Positron Emission Tomography/Computed Tomography; Including the Inter- and Intra-observer Variation. World J Nucl Med 2014; 13:88-93. [PMID: 25191122 PMCID: PMC4150165 DOI: 10.4103/1450-1147.139137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Knowledge of the physiological testicular accumulation of 18F-fluoro-2-deoxyglucose (FDG) is essential in order to discriminate between normal and pathological findings. In this study, the 18F-FDG-uptake in healthy testes of young men was assessed using positron emission tomography/computed tomography (PET/CT)-scans. A total of 40 testes of 20 men with a mean age of 26.5 ± 3.9 years were evaluated. 18F-FDG-uptake was expressed as the standardized uptake value (SUV). Testicular volume was measured on CT and PET. All scans were assessed by three researchers, one of whom assessed every scan twice. Laterality indices and inter- and intra-observer variation were evaluated. Correlation between the SUVmax and SUVpeak, between SUVmean and SUVpeak and between age and SUVpeak were assessed. Testes showed an average SUVmax of 3.42 ± 0.61, SUVpeak of 3.06 ± 0.54 and SUVmean of 2.44 ± 0.44. The average testicular volume on CT was 23.0 ± 6.4 ml, whereas on PET it was 18.0 ± 5.1 ml. Laterality indices were calculated of 0.077 ± 0.065 (SUVmax), 0.074 ± 0.066 (SUVpeak), 0.072 ± 0.063 (SUVmean), 0.245 ± 0.259 (CT), and 0.200 ± 0.188 (PET), respectively. Inter- and intra-observer reliability were found to be perfect for the SUVs (intraclass correlation coefficient [ICC] 0.992-1.0), but poor for testicular volumes (ICC 0.854-0.902). Testicular 18F-FDG uptake in young men can be measured accurately on PET/CT and shows high symmetry. Consequently, 18F-FDG PET/CT has the potential to become a useful instrument in the evaluation of the functioning of the individual testis.
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Affiliation(s)
- A Meij-de Vries
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
| | - R J J Knol
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
| | - S V Lazarenko
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
| | - R W Meijer
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
| | | | - H A Heij
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
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HAMEEDUDDIN A, SINGH NK, COOK GJR, CHUA SC. Assessment of incidental and clinically unsuspected fluorodeoxyglucose-avid foci detected on oncological positron emission tomography/CT. IMAGING 2013. [DOI: 10.1259/imaging.20110088] [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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Burger IA, Vargas HA, Goldman DA, Gonen M, Kumar A, Zelenetz AD, Schöder H, Hricak H. The impact of systemic chemotherapy on testicular FDG activity in young men with Hodgkin's lymphoma. Eur J Nucl Med Mol Imaging 2013; 40:701-7. [PMID: 23389428 DOI: 10.1007/s00259-012-2335-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 12/25/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Based on prior reports suggesting a positive correlation between fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/CT and total sperm count and concentration, we sought to identify changes in testicular FDG uptake over the course of chemotherapy in young men with Hodgkin's lymphoma. METHODS Fifty-two patients with a mean age of 24.2 years (range 15.5-44.4) at diagnosis monitored with FDG PET/CT to assess treatment response for Hodgkin's lymphoma were selected for this retrospective analysis under an Institutional Review Board waiver. Of the patients, 26 were treated with a chemotherapy regimen known to cause prolonged and sometimes permanent azoospermia (BEACOPP--bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) and 26 with a regimen known to have a much milder effect on gonadal function (ABVD--doxorubicin, bleomycin, vincristine, and dacarbazine). Each patient underwent one FDG PET/CT before treatment and at least one FDG PET/CT after start of chemotherapy. In all examinations, FDG activity was measured in the testes with different quantification metrics: maximum standardized uptake value (SUVmax), SUVmean, functional volume (FV) and total testicular glycolysis (TTG), and blood pool activity determined (SUVmean). RESULTS Testicular FDG uptake (SUVmax) was significantly associated with blood pool activity (p < 0.001). Furthermore, testicular FDG uptake metrics incorporating volume (e.g., FV and TTG) were associated with age. There was no significant change in SUVmax, SUVmean, FV, and TTG from the PET/CT at baseline to the PET/CTs over the course of chemotherapy either for patients treated with BEACOPP or for patients treated with ABVD. CONCLUSION For patients undergoing chemotherapy for Hodgkin's lymphoma, there is a significant association between testicular FDG uptake and blood pool activity, but no significant changes in FDG uptake over the course of chemotherapy. Therefore, FDG uptake may not be a feasible surrogate marker for fertility monitoring in patients with Hodgkin's lymphoma undergoing chemotherapy.
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Affiliation(s)
- Irene A Burger
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
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(18)F-FDG Uptake of Human Testis on PET/CT: Correlation with Age, Sex Hormones, and Vasectomy. Nucl Med Mol Imaging 2011; 45:291-8. [PMID: 24900020 DOI: 10.1007/s13139-011-0108-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 08/17/2011] [Accepted: 08/26/2011] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate glucose metabolism of normal human testis on (18)F-FDG PET/CT and to assess possible correlations among age, the serum levels of sex hormones, and vasectomy. METHODS (18)F-FDG PET/CT was performed in 66 normal healthy men (50.8 ± 13.6 years, range 22-81), and mean standard uptake values (SUV) of (18)F-FDG in testis and adductor muscle were measured. Testis-muscle SUV ratios (T/M ratios) were calculated. Serum levels of total testosterone, free testosterone, estradiol, and of sex-hormone binding globulin (SHBG) were measured. We searched for correlations between T/M ratios and age and the serum concentrations of sex hormones. (18)F-FDG PET/CT was also performed in 32 vasectomized men (55.7 ± 7.8 years, range 38-71) and 52 nonvasectomized men (55.4 ± 11.6 years, range 37-72). Mean SUVs of testis and adductor muscle were measured, and T/M ratios were calculated. RESULTS A significant age-related decline was found in T/M ratio (r = -0.509, p < 0.0001). Serum levels of total testosterone and free testosterone were also found to be positively correlated with T/M ratio (r = 0.427, p = 0.0003; r = 0.435, p = 0.0003, respectively). The mean SUV and T/M ratio of vasectomized men were significantly lower than those of nonvasectomized men (p < 0.0378 and p = 0.0001, respectively). CONCLUSIONS Glucose metabolism in the testis in an adult population was found to be correlated with age, serum sex hormone level, and vasectomy history. These results indicate that testicular (18)F-FDG uptake may have attributed to testicular function and testicular histology. Our findings may have important implications for the interpretation of testicular (18)F-FDG uptake in the normal adult population.
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Functional testicular evaluation using PET/CT with 18F-fluorodeoxyglucose. Eur J Nucl Med Mol Imaging 2011; 39:129-37. [DOI: 10.1007/s00259-011-1929-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
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Liu Y, Ghesani NV, Zuckier LS. Physiology and pathophysiology of incidental findings detected on FDG-PET scintigraphy. Semin Nucl Med 2010; 40:294-315. [PMID: 20513451 DOI: 10.1053/j.semnuclmed.2010.02.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A routine feature of positron emission tomography/computed tomography (PET/CT) imaging is whole-body acquisition that results in many unexpected findings identified outside of the primary region of abnormality. Furthermore, (18)F-fluorodeoxyglucose (FDG) is a marker of glycolysis and does not specifically accumulate in malignancy. Understanding the physiology and pathophysiology of normal FDG distribution and common incidental findings is therefore essential to the physician interpreting whole-body FDG-PET/CT studies. Whereas many incidental findings are benign and of limited clinical significance, others represent uncommon manifestations of the primary malignancy, second malignancies, or various clinically significant pathologic processes. Patients with a single malignancy are at greater risk of developing synchronous or metachronous second malignancies, possibly related to exposure to shared carcinogenic agents or presence of prooncogenic mutations. The decision of how to pursue an intervention on the basis of an incidental finding is generally left to clinical judgment.
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Affiliation(s)
- Yiyan Liu
- Nuclear Medicine Section, Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
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The Effects of Aging on Testicular Volume and Glucose Metabolism: an Investigation with Ultrasonography and FDG-PET. Mol Imaging Biol 2010; 13:391-8. [DOI: 10.1007/s11307-010-0341-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goethals I, De Vriendt C, Hoste P, Smeets P, Ham H. Normal uptake of F-18 FDG in the testis as assessed by PET/CT in a pediatric study population. Ann Nucl Med 2009; 23:817-20. [DOI: 10.1007/s12149-009-0308-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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Singh NK, Cook GJR, Lewington VJ, Chua SC. PET/CT assessment of clinically unsuspected, incidental FDG-avid lesions in oncological patients. IMAGING 2008. [DOI: 10.1259/imaging/30631072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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20
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Kitajima K, Nakamoto Y, Senda M, Onishi Y, Okizuka H, Sugimura K. Normal uptake of 18F-FDG in the testis: an assessment by PET/CT. Ann Nucl Med 2007; 21:405-10. [PMID: 17876554 DOI: 10.1007/s12149-007-0041-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 05/02/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to assess the physiological uptake of 18F-fluoro-2-deoxyglucose (FDG) by an apparently normal testis with combined positron emission tomography-computed tomography (PET/CT) and its correlation with age, blood glucose level, and testicular volume. METHODS The testicular uptake of 18F-FDG, expressed as the standardized uptake value (SUV), was measured on PET/CT images in 203 men. The correlation between SUV and age, blood glucose level, and testicular volume was assessed. RESULTS The SUV in the total of 406 testes was 2.44 +/- 0.45 (range 1.23-3.85). The SUV was 2.81 +/- 0.43 (2.28-3.85) for 30-39 years (n = 12), 2.63 +/- 0.45 (1.77-3.75) for 40-49 years (n = 64), 2.46 +/- 0.35 (1.44-3.15) for 50-59 years (n = 82), 2.51 +/- 0.41 (1.50-3.46) for 60-69 years (n = 86), 2.43 +/- 0.47 (1.42-3.29) for 70-79 years (n = 86), and 2.18 +/- 0.45 (1.23-3.03) for 80-89 years (n = 76). When we calculated the mean SUV of bilateral testes in each patient, there were significant statistical differences between those in the age group of 30-39 years and 80-89 years, 40-49 years and 80-89 years, and 50-60 years and 80-89 years, when using an unpaired test with Bonferroni correction. The laterality index (|L - R|/(L + R) x 2) in 203 men was 0.066 +/- 0.067 (0-0.522). There was a mild correlation between the mean SUV and age (r = -0.284, P < 0.001) as well as between the mean SUV and mean volume (r = +0.368, P < 0.001). There was no correlation between the mean SUV and glucose blood level (r = -0.065, P = 0.358). CONCLUSIONS Some uptake of FDG is observed in the normal testis and declines slightly with age. Physiological FDG uptake in the testis should not be confused with pathological accumulation.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
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Well D, Yang H, Houseni M, Iruvuri S, Alzeair S, Sansovini M, Wintering N, Alavi A, Torigian DA. Age-Related Structural and Metabolic Changes in the Pelvic Reproductive End Organs. Semin Nucl Med 2007; 37:173-84. [PMID: 17418150 DOI: 10.1053/j.semnuclmed.2007.01.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this work, we provide preliminary data and a review of the literature regarding normal structural and functional changes that occur in the aging uterus, ovary, testicle, and prostate gland. It is expected that such knowledge will help physicians to distinguish physiologic changes from pathologic changes at an early stage. We retrospectively reviewed pelvic magnetic resonance imaging (MRI) scans of 131 female and 79 male subjects ages 13 to 86 years to determine changes in volume of the uterus, ovary, and prostate gland with age. Scrotal ultrasound examinations of 150 male subjects ages 0 to 96 years also were analyzed retrospectively to determine changes in testicular volume with age. In addition, (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) scans of 145 male subjects ages 11 to 90 years were analyzed retrospectively to assess for changes in maximum standardized uptake value (SUV(max)) of the testicles with age. The uterus had a mean volume of 38.55 +/- 3.68 cm(3) at 17 to 19 years of age, increased to a peak volume of 71.76 +/- 19.81 cm(3) between 35 to 40 years, and then declined to 24.02 +/- 8.11 cm(3) by the eighth decade of life. The maximal ovarian volume per subject maintained a relatively stable size in early life, measuring 9.46 +/- 3.25 cm(3) during the second decade of life, 8.46 +/- 3.32 cm(3) in the mid-fourth decade of life, and 7.46 +/- 3.33 cm(3) at 45 years of age, after which it declined to 4.44 +/- 2.02 cm(3) by the late fifth decade of life. The ovaries were not identifiable on MRI in subjects beyond the sixth decade of life. The volume of the prostate increased from 23.45 +/- 6.20 cm(3) during the second decade of life to 47.5 +/- 41.59 cm(3) by the late eighth decade of life; the central gland of the prostate increased from 9.96 +/- 3.99 cm(3) to 29.49 +/- 28.88 cm(3) during the same age range. Mean testicular volume was 11.2 +/- 5.9 cm(3). Testicular volume increased with age from birth to 25 years. After age 25, there was a significant decline in the testicular volume. The mean SUV(max) for the testicles was 1.9 +/- 0.5. Testicular metabolic activity demonstrated an increasing trend until the age of 35 years. A plateau in SUV(max) was observed after the age of 35 years until the age of 65 years. A slight decrease in SUV(max) was observed after the age of 65 years. The pelvic structures of men and women change both structurally and functionally over the lifespan, and such changes can be quantified using ultrasound, MRI, and (18)F-FDG-PET.
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Affiliation(s)
- David Well
- Department of Radiology, Division of Nuclear Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4283, USA
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Gorospe Sarasúa L, Echeveste Aizpurúa J, Raman S. Tomografía por emisión de positrones/tomografía computarizada: artefactos y pitfalls en pacientes con cáncer. RADIOLOGIA 2006; 48:189-204. [PMID: 17058646 DOI: 10.1016/s0033-8338(06)73156-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnostic accuracy and correct initial staging (or restaging) are fundamental in the management of oncological patients and can directly influence therapeutic decisions. The combination of positron-emission tomography (PET) and computed tomography (CT) in a single scanner (PET/TC) represents an important achievement in the fields of oncology, nuclear medicine, and radiology. These scanners allow morphologic images (obtained by CT) to be fused and correlated with metabolic images (obtained by PET) to a high degree of accuracy. In addition to an understanding of the physiopathology of cancer and the behavior of the different types of neoplasms, the correct interpretation of PET/CT images requires in-depth knowledge of the physiological distribution of the F-18 fluorodeoxyglucose molecule (FDG, currently the most widely used marker in oncology), of the frequent physiological variations in its distribution, and of the possible causes of non-malignant pathological FDG uptake. Furthermore, the use of CT data to correct attenuation and reconstruct PET images in PET/CT scanners can generate some characteristic artifacts specific to this new diagnostic tool, and these can lead to misinterpretation with potential therapeutic implications. This article reviews and illustrates some of the most common artifacts and pitfalls that can appear in PET/CT studies. The detection and correct interpretation of these findings are essential for the appropriate management of oncologic patients.
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Basu S, Nair N. Unilateral testicular relapse of abdominal non-Hodgkin lymphoma detected by FDG-PET. Pediatr Radiol 2006; 36:274-5. [PMID: 16328321 DOI: 10.1007/s00247-005-0040-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 09/07/2005] [Accepted: 09/10/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Bombay, Maharashtra 400012, India.
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Kuo PH, Cooper DL, Cheng DW. Recurrence of lymphoma presenting as asymmetrically increased testicular activity on FDG-PET/CT. Semin Nucl Med 2006; 36:105-7. [PMID: 16356799 DOI: 10.1053/j.semnuclmed.2005.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Phillip H Kuo
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520-8042, USA.
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25
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Rosenbaum SJ, Lind T, Antoch G, Bockisch A. False-positive FDG PET uptake--the role of PET/CT. Eur Radiol 2005; 16:1054-65. [PMID: 16365730 DOI: 10.1007/s00330-005-0088-y] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 10/27/2005] [Accepted: 11/18/2005] [Indexed: 01/11/2023]
Abstract
Positron emission tomography (PET) is a powerful molecular imaging technique for the human body-imaging applications currently available. As altered glucose metabolism is characteristic for many malignancies, FDG-PET is mostly used in oncology for staging and therapy control. Although PET is a sensitive tool for detecting malignancy, FDG uptake is not tumor specific. It can also be seen in healthy tissue or in benign disease as inflammation or posttraumatic repair and could be mistaken for cancer. The experienced nuclear medicine physician mostly manages to differentiate malignant from non-malignant FDG uptake, but some findings may remain ambiguous. In these cases, the difficulties in differentiating physiologic variants or benign causes of FDG uptake from tumor tissue can often be overcome by combined PET and CT (PET/CT) as anatomic information is added to the metabolic data. Thus, PET/CT improves the diagnostic accuracy compared to PET alone and helps to avoid unnecessary surgery/therapy. However, PET/CT involves other sources of artifacts that may occur when using CT for attenuation correction of PET or by patient motion caused by respiration or bowel movements.
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Affiliation(s)
- Sandra J Rosenbaum
- Department of Nuclear Medicine, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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El-Haddad G, Alavi A, Mavi A, Bural G, Zhuang H. Normal variants in [18F]-fluorodeoxyglucose PET imaging. Radiol Clin North Am 2004; 42:1063-81, viii. [PMID: 15488558 DOI: 10.1016/j.rcl.2004.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The number of fluorodeoxyglucose PET applications is increasing. In the process of reading fluorodeoxyglucose-PET scans, nuclear medicine physicians encounter a wide variety of normal findings, which must be recognized to determine the best management for patients. It is important to recognize and understand normal variants to avoid misinterpretation of more serious pathology. This article reviews different patterns of physiologic fluorodeoxyglucose uptake including changes with age.
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Affiliation(s)
- Ghassan El-Haddad
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 110 Donner Building, Philadelphia, PA 19104, USA
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27
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Abstract
It is estimated that in excess of one million positron emission tomography (PET) scans are performed each year and PET can now truly be regarded as a routine imaging procedure in clinical management. Many potential pitfalls and artifacts have previously been described with (18)F-fluorodeoxyglucose PET imaging, but more continue to become apparent as worldwide experience increases. In addition, the advent of combined PET/CT scanners in clinical imaging practice has brought their own specific pitfalls and artifacts. It is essential that we learn these potential pitfalls so that patients can be optimally prepared for their scans and that accurate interpretation can be made.
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Affiliation(s)
- Gary J R Cook
- Department of Nuclear Medicine and PET, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK
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Tamgac F, Tofighi M, Baillet G, Weinmann P, Moretti JL. Apport de l’imagerie au 18FDG dans la prise en charge du cancer du testicule. Presse Med 2004; 33:270-6. [PMID: 15029020 DOI: 10.1016/s0755-4982(04)98554-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The key to prognosis. Initial staging and early recurrence diagnosis are key parameters in the treatment and outcome of testicular cancer. Initial staging. It is difficult using conventional modalities, which can miss node involvement and are non-specific since enlargement does not rhyme with involvement. 18FDG PET improves the accuracy of initial staging. Residual mass and recurrences. Existence of residual mass or enhancement of its Volume in the presence of an otherwise beneficial chemotherapy is difficult to manage. Several studies have demonstrated the value of 18FDG imaging in such cases. As for follow-up whole body 18FDG can prevent multiple diagnostic imaging and can diagnose recurrences with greater diagnostic accuracy than with other imaging modalities.
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Affiliation(s)
- Feyzi Tamgac
- Upres 2360, CHU Avicenne, Université Paris XIII (75).
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Fujii H, Yasuda S, Ide M, Takahashi W, Shohtsu A, Kubo A. Fluorine-18 fluorodeoxyglucose uptake in the retractile testis. Clin Nucl Med 1999; 24:323-5. [PMID: 10232469 DOI: 10.1097/00003072-199905000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 51-year-old man with a palpable mass in his right inguinal region had fluorine-18 fluorodeoxyglucose (F-18 FDG) whole-body positron emission tomography (PET) in our cancer screening program. FDG accumulated in the mass, suggesting a metabolically active lesion that was likely malignant. A pelvic MRI and a urologist's palpation revealed that his inguinal mass was a retractile testis. Because a retractile testis is a benign process with no need for interventional therapy, it would be considered a false-positive finding on the cancer screening program using F-18 FDG PET.
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Affiliation(s)
- H Fujii
- HIMEDIC Imaging Center at Lake Yamanaka, Yamanashi, Japan
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Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics 1999; 19:61-77; quiz 150-1. [PMID: 9925392 DOI: 10.1148/radiographics.19.1.g99ja0761] [Citation(s) in RCA: 558] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A rapidly emerging clinical application of positron emission tomography (PET) is the detection and staging of cancer with the glucose analogue tracer 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG). Proper interpretation of FDG PET images requires knowledge of the normal physiologic distribution of the tracer, frequently encountered physiologic variants, and benign pathologic causes of FDG uptake that can be confused with a malignant neoplasm. One hour after intravenous administration, high FDG activity is present in the brain, the myocardium, and--due to the excretory route--the urinary tract. Elsewhere, tracer activity is typically low, a fact that allows sensitive demonstration of tracer accumulation in many malignant neoplasms. Interpretive pitfalls commonly encountered on FDG PET images of the body obtained 1 hour after tracer administration can be mistaken for cancer. Such pitfalls include variable physiologic FDG uptake in the digestive tract, thyroid gland, skeletal muscle, myocardium, bone marrow, and genitourinary tract and benign pathologic FDG uptake in healing bone, lymph nodes, joints, sites of infection, and cases of regional response to infection and aseptic inflammatory response. In many instances, these physiologic variants and benign pathologic causes of FDG uptake can be specifically recognized and properly categorized; in other instances, such as the lymph node response to inflammation or infection, focal FDG uptake is nonspecific.
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Affiliation(s)
- P D Shreve
- Department of Internal Medicine, Division of Nuclear Medicine, University Hospital, University of Michigan Medical Center, Ann Arbor 48109, USA
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