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Focal Uptake in the Sternum on 18F-FDG-PET/CT Caused by G-CSF Therapy after Chemotherapy Mimicking Bone Metastasis of Breast Cancer. Diagnostics (Basel) 2022; 12:diagnostics12102308. [PMID: 36291997 PMCID: PMC9600177 DOI: 10.3390/diagnostics12102308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
A woman in her 70s was diagnosed with left breast cancer and left axillary lymph node metastasis by an ultrasound-guided biopsy. 18F-FDG-PET/CT showed strong FDG accumulation in the tumor in the left breast and a left axillary lymph node. Neoadjuvant chemotherapy (NAC) was administered in combination with a G-CSF injection to prevent febrile neutropenia. The post-treatment 18F-FDG-PET/CT showed the disappearance of the left breast tumor and left axillary lymph node and revealed a solitary new area of strong FDG accumulation in the sternum. To rule out the possibility of sternal metastasis, a sternal biopsy was performed at the same time as surgery, which revealed no malignant findings. Although very rare, focal uptake on 18F-FDG-PET/CT performed after anticancer drug therapy with G-CSF may mimic a solitary bone metastasis. A bone biopsy may be a useful technique to avoid an immediate misdiagnosis of bone metastasis.
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Association Between Time Since Administration of Pegylated G-CSF (Pegfilgrastim) and Bone Marrow Uptake on FDG PET/CT: Determination of a Minimum Interval. AJR Am J Roentgenol 2021; 218:351-358. [PMID: 34467784 DOI: 10.2214/ajr.21.26480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Pegfilgrastim administration after chemotherapy increases bone marrow and spleen FDG uptake. Consensus is lacking regarding the optimal interval between pegfilgrastim administration and FDG PET/CT. OBJECTIVE. The purpose of this study was to assess the association between bone marrow and spleen uptake and the interval between pegfilgrastim administration and FDG PET/CT. METHODS. This retrospective study included 70 oncology patients (mean age, 64 ± 12 [SD] years; 48 men, 22 women) receiving chemotherapy who underwent FDG PET/CT (study scan) within 35 days after pegfilgrastim administration and who underwent additional FDG PET/CT at least 4 months before pegfilgrastim initiation or at least 3 months after last pegfilgrastim administration (reference scan). A nuclear medicine physician recorded the SUVmean for normal osseous structures and spleen and assessed bone marrow uptake using a 4-point visual scale (1, no abnormal uptake; 2, clinically insignificant uptake; 3, clinically significant uptake possibly interfering with interpretation; 4, clinically significant uptake expected to interfere with interpretation). RESULTS. Percentage change in SUVmean between reference and study scans significantly increased (p < .05) as the interval increased for five sites (i.e., for patients with interval of 7-13 vs 29-35 days, mean percentage change was 32.3% ± 18.2% vs 11.5% ± 17.3% for cervical vertebra, 42.2% ± 18.3% vs 21.3% ± 14.2% for thoracic vertebra, 47.2% ± 19.8% vs 19.1% ± 13.9% for lumbar vertebra, 51.1% ± 25.8% vs 12.7% ± 11.3% for pelvis, and 53.0% ± 25.6% vs 4.4% ± 14.1% for lower extremity); percentage change was not associated with the interval for upper extremity or spleen (p > .05). Visual uptake scores of 4, 3, 2, and 1 were observed in days 7-21, 12-22, 12-28, and 14-35, respectively. Percentage of patients with a score of 3 or 4 was 94.4% for days 7-13, 58.1% for days 14-21, 6.7% for days 22-28, and 0% for days 29-35. A total of 71.4% of patients had a score of 3 or 4 on day 7-21, whereas 4.8% had a score of 3 and 0% had a score of 4 on days 22-35. CONCLUSION. A visual uptake score of 3 or 4 was consistently observed throughout an approximately 3-week interval following pegfilgrastim administration, without any such case beyond 22 days. CLINICAL IMPACT. We recommend a preferred interval of at least 3 weeks after pegfilgrastim administration before PET/CT.
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Takahashi MES, Mosci C, Duarte GO, Pericole FV, Metze K, Lorand-Metze IGH, Ramos CD. Intensity of bone involvement: a quantitative 18F-FDG PET/CT evaluation for monitoring outcome of multiple myeloma. Nucl Med Commun 2021; 42:1375-1381. [PMID: 34347655 DOI: 10.1097/mnm.0000000000001470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The parameter intensity of bone involvement (IBI) was recently proposed to quantitatively assess patients with multiple myeloma using 18F-fluorodeoxyglucose-PET combined with computed tomography (18F-FDG PET/CT) images. Here, we aimed to calculate IBI variation (ΔIBI) between two consecutive PET/CT of the same patient and verified its relationship with a subjective visual analysis of the images and with clinical outcome. METHODS Consecutive whole-body 18F-FDG PET/CT performed to assess the outcomes of 29 patients diagnosed with multiple myeloma were retrospectively evaluated. ΔIBI was calculated after bone segmentation, using liver standardized uptake value as a threshold to determine metabolically active volumes in the skeleton. For each pair of consecutive PET/CTs, two nuclear medicine physicians classified visually the most recent image as PET-remission, PET-progression or PET-stable when compared to the previous examination. RESULTS The lowest ΔIBI was -1.27 and the highest was 0.29. PET-remission was related to ΔIBI <0 (median = -0.10; -1.27 to +0.03), while PET-progression was related to ΔIBI >0 (median = 0.02; -0.07 to +0.29). ΔIBI around zero was found in images classified as PET-stable (median = 0.00; -0.08 to +0.06). Significant difference in ΔIBI was found between the three groups. Multivariate stepwise analysis showed that IBI value at diagnostic PET/CT, serum calcium and percentage of plasma cells in the bone marrow are independent prognostic factors. CONCLUSION Delta IBI provides quantitative data for variations of 18F-FDG uptake in the bone marrow during the follow-up of the patients. In addition, higher IBI values at diagnosis are associated with a higher risk of patient's death.
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Affiliation(s)
| | - Camila Mosci
- Division of Nuclear Medicine, School of Medical Sciences
| | | | | | | | | | - Celso D Ramos
- Division of Nuclear Medicine, School of Medical Sciences
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Kawabata K, Hosono M, Tanaka H, Hyuga M, Kanagaki M. Granulocyte Colony-Stimulating Factor Administration at 1 Hour Before 18F-FDG PET Does Not Increase Bone Marrow FDG Accumulation. Clin Nucl Med 2021; 46:770-771. [PMID: 33883491 DOI: 10.1097/rlu.0000000000003649] [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: 11/27/2022]
Abstract
ABSTRACT A 74-year-old man with diffuse large B-cell lymphoma underwent 18F-FDG PET/CT to evaluate the response to chemotherapy. Although granulocyte colony-stimulating factor was incidentally administered 1 hour before FDG administration, bone marrow FDG accumulation did not increase compared with the previous 18F-FDG PET/CT examination without granulocyte colony-stimulating factor administration. The mean SUVmax of 12 thoracic and 5 lumbar vertebrae was 2.55 (range, 2.14-3.36) and 3.19 (range, 2.49-4.28) in the present and previous examinations, respectively.
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Affiliation(s)
- Kazuna Kawabata
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka
| | - Hiroki Tanaka
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Mizuki Hyuga
- Department of Hematology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Mitsunori Kanagaki
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
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Myocardial Metabolic Response Predicts Chemotherapy Curative Potential on Hodgkin Lymphoma: A Proof-of-Concept Study. Biomedicines 2021; 9:biomedicines9080971. [PMID: 34440175 PMCID: PMC8393404 DOI: 10.3390/biomedicines9080971] [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: 07/02/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
Genome sharing between cancer and normal tissues might imply a similar susceptibility to chemotherapy toxicity. The present study aimed to investigate whether curative potential of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) is predicted by the metabolic response of normal tissues in patients with Hodgkin lymphoma (HL). METHODS According to current guidelines, 86 patients with advanced-stage (IIB-IVB) HL, prospectively enrolled in the HD0607 trial (NCT00795613), underwent 18 F-fluorodeoyglucose PET/CT imaging at diagnosis and, at interim, after two ABVD courses, to decide regimen maintenance or its escalation. In both scans, myocardial FDG uptake was binarized according to its median value. Death and disease relapse were recorded to estimate progression-free survival (PFS) during a follow-up with median duration of 43.8 months (range 6.97-60). RESULTS Four patients (4.6%) died, while six experienced disease relapse (7%). Complete switch-off of cancer lesions and cardiac lighting predicted a favorable outcome at Kaplan-Mayer analyses. The independent nature and additive predictive value of their risk prediction were confirmed by the multivariate Cox regression analysis. CONCLUSION Susceptibility of HL lesions to chemotherapy is at least partially determined by factors featuring the host who developed it.
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Evaluation of Computed Tomography Attenuation Value of Proximal Femoral Marrow to Diagnose and Differentiate Hematologic Malignancies, Myelofibrosis, and Aplastic Anemia. J Comput Assist Tomogr 2021; 45:912-918. [PMID: 34347713 DOI: 10.1097/rct.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to diagnose hematologic diseases using computed tomography (CT) number of proximal femoral marrow. METHODS The average CT number of marrow in hematologic diseases was measured on the caudal side of the greater trochanter. RESULTS The CT numbers were -60.3 ± 16.8 in 12 patients with aplastic anemia, -53.2 ± 19.4 in 11 patients with monoclonal gammopathy of undetermined significance, -44.2 ± 21.1 in 10 normal controls, -30.9 ± 42.3 in 9 patients with chronic lymphatic leukemia, -29.8 ± 29.9 in 17 patients with benign anemia, -13.7 ± 40.9 in 33 patients with multiple myeloma, 0.32 ± 44.6 in 17 patients with myelodysplastic syndrome (MDS), 18.7 ± 40.0 in 44 patients with acute myeloid leukemia, 50.3 ± 27.4 in 13 patients with acute lymphatic leukemia, 51.5 ± 16.8 in 8 patients with myelofibrosis, and 56.4 ± 15.6 in 9 patients with chronic myeloid leukemia. Significant differences were observed between acute myeloid leukemia and MDS, between MDS and aplastic anemia, and between multiple myeloma and monoclonal gammopathy of undetermined significance (P < 0.01). CONCLUSION The marrow CT numbers may be indicators of hematologic diseases and can be used as a diagnostic tool.
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Seban RD, Assié JB, Giroux-Leprieur E, Massiani MA, Bonardel G, Chouaid C, Deleval N, Richard C, Mezquita L, Girard N, Champion L. Prognostic value of inflammatory response biomarkers using peripheral blood and [18F]-FDG PET/CT in advanced NSCLC patients treated with first-line chemo- or immunotherapy. Lung Cancer 2021; 159:45-55. [PMID: 34311344 DOI: 10.1016/j.lungcan.2021.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We aimed to compare the prognostic value of inflammatory biomarkers extracted from pretreatment peripheral blood and [18F]-FDG PET for estimating outcomes in non-small cell lung cancer (NSCLC) patients treated with first-line immunotherapy (IT) or chemotherapy (CT). MATERIALS AND METHODS In this retrospective multicenter study, we evaluated 111 patients with advanced NSCLC who underwent baseline [18F]-FDG PET/CT before IT or CT between 2016 and 2019. Several blood inflammatory indices were evaluated: derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP) and systemic immune-inflammation index (SII). FDG-PET inflammatory parameters were extracted from lymphoid tissues (BLR and SLR: bone marrow or spleen-to-Liver SUVmax ratios). Association with survival and relationships between parameters were evaluated using Cox prediction models and Spearman's correlation respectively. RESULTS Overall, 90 patients were included (IT:CT) (51:39pts). Median PFS was 8.6:6.6 months and median OS was not reached:21.2 months. In the IT cohort, high dNLR (>3), high SII (≥1,270) and high SLR (0.77) were independent statistically significant prognostic factors for one-year progression-free survival (1y-PFS) and two-year overall survival (2y-OS) on multivariable analysis. In the CT cohort, high BLR (≥0.80) and high dNLR (>3) were associated with shorter 1y-PFS (HR 2.2, 95% CI 1.0-4.9) and 2y-OS (HR 3.4, 95CI 1.1-10.3) respectively, on multivariable analysis. Finally, BLR significantly but moderately correlated with most blood-based inflammatory indices (CRP, PLR and SII) while SLR was only associated with CRP (p < 0.01 for all). CONCLUSION In advanced NSCLC patients undergoing first-line IT or CT, pretreatment blood and inflammatory factors evaluating the spleen or bone marrow on [18F]-FDG PET/CT provided prognostic information for 1y-PFS and 2y-OS. These biomarkers should be further evaluated for potential clinical application.
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Affiliation(s)
- Romain-David Seban
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France; Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401, Orsay, France.
| | - Jean-Baptiste Assié
- Department of Pneumology, Paris-Est University, Centre Hospitalier Inter-Communal de Créteil, Inserm U955, UPEC, IMRB, équipe CEpiA, 94010 Créteil, France; Inserm, Centre de Recherche des Cordeliers, Sorbonne University, Université de Paris, Functionnal Genomics of Solid Tumors Laboratory, F-75006 Paris, France
| | - Etienne Giroux-Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP, Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
| | | | - Gérald Bonardel
- Department of Nuclear Medicine, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Christos Chouaid
- Department of Pneumology, Paris-Est University, Centre Hospitalier Inter-Communal de Créteil, Inserm U955, UPEC, IMRB, équipe CEpiA, 94010 Créteil, France
| | - Nicolas Deleval
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France
| | - Capucine Richard
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France
| | - Laura Mezquita
- Department of Medical Oncology, Hospital Clínic, Laboratory of Translational Genomics and Target Therapeutics in Solid Tumors, IDIBAPS, 08036 Barcelona, Spain
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, F-75006 Paris, France
| | - Laurence Champion
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France; Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401, Orsay, France
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Sollini M, Morbelli S, Ciccarelli M, Cecconi M, Aghemo A, Morelli P, Chiola S, Gelardi F, Chiti A. Long COVID hallmarks on [18F]FDG-PET/CT: a case-control study. Eur J Nucl Med Mol Imaging 2021; 48:3187-3197. [PMID: 33677642 PMCID: PMC7937050 DOI: 10.1007/s00259-021-05294-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
Purpose The present study hypothesised that whole-body [18F]FDG-PET/CT might provide insight into the pathophysiology of long COVID. Methods We prospectively enrolled 13 adult long COVID patients who complained for at least one persistent symptom for >30 days after infection recovery. A group of 26 melanoma patients with negative PET/CT matched for sex/age was used as controls (2:1 control to case ratio). Qualitative and semi-quantitative analysis of whole-body images was performed. Fisher exact and Mann-Whitney tests were applied to test differences between the two groups. Voxel-based analysis was performed to compare brain metabolism in cases and controls. Cases were further grouped according to prevalent symptoms and analysed accordingly. Results In 4/13 long COVID patients, CT images showed lung abnormalities presenting mild [18F]FDG uptake. Many healthy organs/parenchyma SUVs and SUV ratios significantly differed between the two groups (p ≤ 0.05). Long COVID patients exhibited brain hypometabolism in the right parahippocampal gyrus and thalamus (uncorrected p < 0.001 at voxel level). Specific area(s) of hypometabolism characterised patients with persistent anosmia/ageusia, fatigue, and vascular uptake (uncorrected p < 0.005 at voxel level). Conclusion [18F]FDG PET/CT acknowledged the multi-organ nature of long COVID, supporting the hypothesis of underlying systemic inflammation. Whole-body images showed increased [18F]FDG uptake in several “target” and “non-target” tissues. We found a typical pattern of brain hypometabolism associated with persistent complaints at the PET time, suggesting a different temporal sequence for brain and whole-body inflammatory changes. This evidence underlined the potential value of whole-body [18F]FDG PET in disclosing the pathophysiology of long COVID. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05294-3.
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Affiliation(s)
- Martina Sollini
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Michele Ciccarelli
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
| | - Maurizio Cecconi
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Alessio Aghemo
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Paola Morelli
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Silvia Chiola
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Fabrizia Gelardi
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy.
| | - Arturo Chiti
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
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Diagnostic performance of 18F-2-fluoro-2-deoxy-D-glucose PET/computerized tomography in identifying bone marrow infiltration in new patients with diffuse large B-cell lymphoma and Hodgkin lymphoma. Nucl Med Commun 2020; 41:269-279. [PMID: 31895758 DOI: 10.1097/mnm.0000000000001139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare between F-2-fluoro-2-deoxy-D-glucose PET/computerized tomography (F-FDG PET/CT) and routine iliac bone marrow biopsy (BMB) in assessment of bone marrow infiltration (BMI) in Hodgkin lymphoma and diffuse large B-cell lymphoma (DLBCL) patients at initial presentation. PATIENTS AND METHODS A retrospective analysis of 138 patients (50 Hodgkin lymphomas, 88 DLBCLs). The study included 70 males and 68 females with median age of 43 years. All patients underwent F-FDG PET/CT and iliac crest BMB before treatment. Any focal or patchy FDG uptake in the bone marrow, superior-to hepatic uptake was interpreted as abnormal with or without corresponding CT changes. Treatment response was evaluated clinically with each cycle of chemotherapy, radiologically after three cycles and at the end of treatment. RESULTS The overall diagnostic performance showed significant higher sensitivity of F-FDG PET/CT than that of BMB (73.9 versus 62.5%, P = 0.046), while the specificity was higher in BMB than in F-FDG PET/CT (100% in BMB versus 93.5% in F-FDG PET/CT). In Hodgkin lymphoma, sensitivity, negative predictive value (NPV) and accuracy were significantly higher in F-FDG PET/CT compared with BMB, being 87.5, 94.4 and 96% versus 50, 81 and 84% (P = 0.02, 0.03, 0.04, respectively). However, for DLBCL patients, almost comparable results were found between both tests in terms of sensitivity, NPV and accuracy (66.7, 83.9 and 81.8% versus 68.8, 84.9 and 88.6%, respectively). After PET/CT scan, 12 patients (8.6%) were upstaged to stage IV, eight of them were negative by BMB. CONCLUSION F-FDG PET/CT seemed to be an excellent diagnostic test in assessment of BMI at initial assessment and staging of Hodgkin lymphoma and DLBCL patients.
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Kusumahstuti KP, Watabe T, Kitamura N, Yamamoto T. Diffuse bone marrow uptake related to granulocyte colony-stimulating factor-producing maxillary sinus carcinoma on 4-borono-2- 18F-fluoro-L-phenylalanine positron emission tomography/computed tomography. World J Nucl Med 2020; 20:188-191. [PMID: 34321973 PMCID: PMC8286009 DOI: 10.4103/wjnm.wjnm_80_20] [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: 06/08/2020] [Revised: 07/21/2020] [Accepted: 08/13/2020] [Indexed: 01/12/2023] Open
Abstract
Granulocyte colony-stimulating factor (G-CSF) can be produced by tumor cells and is known to promote tumor growth, thereby potentially accelerating disease progression. Squamous cell carcinoma (SCC) at maxillary sinus is aggressive growth with poor prognosis. Maxillary sinus carcinomas are rare and can be clinically silent in the early stages or manifest with the same signs and symptoms of more common illnesses, leading to their delayed diagnosis of disease. Hypermetabolic uptake of 18F-fluorodeoxyglucose (18F-FDG) but not of 4-borono-2-18F-fluoro- L-phenylalanine (18F-FBPA), in the bone marrow of patients with G-CSF-producing tumors without bone marrow involvement during positron emission tomography (PET), has been reported. The present case report describes our first experience of bone marrow uptake in PET/computed tomography examination using18F-FBPA, high uptake seen in the bone marrow of a patient with a G-CSF-secreting SCC of the maxillary sinus that it relapsed following chemoradiation therapy and surgical resection of the tumor.
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Affiliation(s)
- Kharisma Perdani Kusumahstuti
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Nuclear Medicine and Molecular Imaging, Universitas Padjadjaran, General Hasan Sadikin Hospital, Bandung, Indonesia, Japan
| | - Tadashi Watabe
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan.,Institute for Radiation Sciences, Osaka University, Suita, Osaka, Japan
| | - Naoya Kitamura
- Department of Oral and Maxillofacial Surgery, Kochi Medical School, Kochi University, Nangoku, Kochi, Japan
| | - Tetsuya Yamamoto
- Department of Oral and Maxillofacial Surgery, Kochi Medical School, Kochi University, Nangoku, Kochi, Japan
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Abstract
A girl diagnosed with neuroblastoma at 33 months underwent I-MIBG scan after surgery and chemoradiotherapy. Although MIBG scan showed complete response, the bone marrow biopsy showed refractory disease. Therefore, she underwent Ga-DOTATATE PET/CT, which revealed bone marrow involvement and Ga-DOTATATE-avid brain metastasis. Rare physiological pineal gland uptake was also depicted. Ga-DOTATATE PET/CT showed active progressive disease earlier, before it was detectable with MIBG scan. For patients with MIBG-negative relapsed/refractory disease, Ga-DOTATATE may have an important role in restaging, detecting unsuspected metastasis, therapy planning.
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Abstract
Hybrid imaging using the tracer [18F]FDG (2‑deoxy-2-fluoro-D-glucose) is regarded as the backbone of the diagnostic workup of lymphomas. All international guidelines, and especially the Lugano and RECIL (Response Evaluation Criteria in Lymphoma) guidelines, currently recommend [18F]FDG-PET/CT (positron emission tomography/computed tomography) for staging and treatment response assessment. With the exception of pediatric lymphomas, neither PET/MRI (magnetic resonance imaging) nor whole-body MRI are currently endorsed by international guidelines, despite the fact that both techniques have clear advantages over [18F]FDG-PET/CT in the assessment of lymphomas with variable FDG avidity. Of the new, more specific PET tracers that are being evaluated for the use in lymphomas, the CXCR4 (CXC motif chemokine receptor 4) tracer [68Ga]Pentixafor is of particular interest, as initial studies have shown that it may be used to visualize frequently non-FDG-avid lymphomas such as small-cell lymphocytic lymphoma, mucosa-associated lymphoid tissue (MALT) lymphoma and lymphomplasmacytic lymphoma.
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Affiliation(s)
- Marius E Mayerhöfer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10065, New York, USA.
- Univ.-Klinik für Radiologie und Nuklearmedizin, Abteilung für Allgemeine und Kinderradiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, Wien, 1090, Österreich.
| | - Alexander Haug
- Univ.-Klinik für Radiologie und Nuklearmedizin, Abteilung für Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, Wien, 1090, Österreich
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Okuyama C, Higashi T, Nakamoto R, Ishizu K, Takahashi M, Kusano K, Kagawa S, Saga T, Yamauchi H. Predominance and homogeneity patterns of physiological FDG accumulation in thoracic and lumbar vertebrae: suspected mechanism of “bone pseudometastasis” on FDG-PET in Japanese patients with esophageal cancer. Ann Nucl Med 2019; 34:182-191. [DOI: 10.1007/s12149-019-01430-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
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Clark MS, Packard AT, Johnson DR, Johnson GB. Pitfalls of a Mixed Metabolic Response at PET/CT. Radiographics 2019; 39:1461-1475. [PMID: 31398089 DOI: 10.1148/rg.2019180093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Although the term mixed metabolic response is commonly used in PET/CT reports, it should be a red flag to reconsider the assumptions made by the PET scan reader. Fluorine 18 fluorodeoxyglucose (FDG) PET/CT is recognized as an accurate imaging method for detecting response to cancer therapies. Critical clinical decisions regarding therapy are dependent on accurate interpretation of findings. The use of standardized terminology for response assessment, such as that in the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST), is highly recommended. With PERCIST, treatment response is categorized as complete metabolic response, partial metabolic response, stable metabolic disease, or progressive metabolic disease. Mixed metabolic response is not included in PERCIST. Rather, it is used colloquially to describe a scenario in which scanning performed after systemic cancer therapy reveals divergent findings, with some tumor foci responding and others not responding or even seen progressing. In PERCIST, mixed metabolic response should be described as stable metabolic disease or progressive metabolic disease. However, the PET/CT reader may also wish to suggest that individual tumors have heterogeneous genetic and/or other characteristics and consequently a mixed response to therapy. The concept of tumor heterogeneity is gaining momentum in cancer research and thus possibly leading to options for therapy targeted to oligometastases that are not responding. However, the authors suggest exercising extreme caution when PET/CT findings appear at first to reflect what some might call a mixed response. In addition, they have found that FDG PET/CT findings are often confounding owing to the simultaneous presence of two or more unrelated disease processes. Common examples include synchronous neoplasms, inflammatory processes, and treatment-related effects. Thus, an apparent mixed response is a red flag to reconsider whether all of the FDG-avid findings are actually metastases of the same cancer. Common mimics of a mixed metabolic response that do not represent true tumor heterogeneity are highlighted to improve the FDG PET/CT reader's recognition of these lesions.©RSNA, 2019.
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Affiliation(s)
- Michael S Clark
- From the Division of Nuclear Radiology, Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902
| | - Ann T Packard
- From the Division of Nuclear Radiology, Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902
| | - Derek R Johnson
- From the Division of Nuclear Radiology, Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902
| | - Geoff B Johnson
- From the Division of Nuclear Radiology, Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902
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15
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do Vale RHB, Ferraro DA, Duarte PS, Carvalho G, Lima MS, Coura Filho GB, Sapienza MT, Buchpiguel CA. Bone marrow uptake of 18F-fluorodeoxyglucose in Hodgkin lymphoma without bone involvement: comparison between patients with and without B symptoms. Radiol Bras 2018; 51:76-80. [PMID: 29743733 PMCID: PMC5935399 DOI: 10.1590/0100-3984.2016.0201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective To compare the degree of benign bone marrow uptake of
18F-fluorodeoxyglucose (18F-FDG) between Hodgkin
lymphoma patients with and without B symptoms. Materials and Methods We analyzed the medical charts of 74 Hodgkin lymphoma patients who underwent
18F-FDG positron emission tomography/computed tomography
(PET/CT) prior to the initiation of therapy between October 2010 and
September 2013. In all of the patients, the bone marrow biopsy was negative
and the 18F-FDG PET/CT images did not suggest bone marrow
involvement. Of the 74 patients evaluated, 54 presented inflammatory (B)
symptoms and 20 did not. Regions of interest (ROIs) were drawn on the
sternum, the proximal thirds of the humeri, the proximal thirds of the
femora, and both iliac wings (totaling seven ROIs per patient). To compare
the patients with and without B symptoms, in terms of standardized uptake
values (SUVs) for the seven ROIs, we used the Mann-Whitney U test. Results For six of the ROIs, the SUVs were higher in the patients with B symptoms
than in those without, and the difference was statistically significant
(p < 0.05). There was also a tendency toward a
statistically significant difference between the two groups in terms of the
SUV for the right iliac wing ROI (p = 0.06). Conclusion In our sample, the presence of B symptoms was associated with increased
18F-FDG uptake in bone marrow.
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Affiliation(s)
| | - Daniela Andrade Ferraro
- MD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Paulo Schiavom Duarte
- MD, PhD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Giovana Carvalho
- MD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Marcos Santos Lima
- MD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - George Barbério Coura Filho
- MD, PhD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Marcelo Tatit Sapienza
- MD, PhD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- MD, PhD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
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16
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Makino T, Hata Y, Otsuka H, Koezuka S, Kikuchi N, Isobe K, Tochigi N, Shibuya K, Homma S, Iyoda A. Diffuse fluorodeoxyglucose-positron uptake in the bone marrow of a patient with granulocyte colony-stimulating factor-producing pleomorphic carcinoma of the lung: A case report. Mol Clin Oncol 2017; 7:103-106. [PMID: 28685085 DOI: 10.3892/mco.2017.1271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 02/16/2017] [Indexed: 11/05/2022] Open
Abstract
The current study presents the case of a 66-year-old male presenting with fever and chest pain. Chest enhanced computed tomography scanning revealed a mass shadow in the right upper lobe with chest wall invasion. 18-Fluorodeoxyglucose-positron emission tomography (FDG-PET) identified the localized uptake of the mass lesion in the right upper lobe, in addition to diffuse uptake by the bone marrow. The laboratory data on admission revealed marked leukocytosis and an elevated C-reactive protein level (CRP). Serum concentrations of granulocyte colony-stimulating factor (G-CSF) and interleukin 6 were increased. Based on a clinical diagnosis of non-small cell lung cancer (c-T3N0M0 stage IIB), the patient underwent right upper lobectomy with chest wall resection. The histological examination showed a pulmonary pleomorphic carcinoma. Immunohistochemical analysis of the resected tumor tissues revealed positive staining for G-CSF. The patient's high-grade fever, leukocytosis, and elevated CRP level rapidly subsided following the resection. This confirmed that the tumor was a G-CSF-producing pulmonary pleomorphic carcinoma. Five months after the resection, the diffuse FDG uptake in the bone marrow was absent, even with the presence of a small pulmonary metastasis and marginal serum G-CSF elevation. Diffuse FDG uptake in bone marrow induced by G-CSF producing pleomorphic carcinoma must be taken into consideration, in order for it not to be misinterpreted as diffuse bone marrow metastases or hematologic malignancy.
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Affiliation(s)
- Takashi Makino
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Yoshinobu Hata
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Nao Kikuchi
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Kazutoshi Isobe
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Sakae Homma
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
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17
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Pham AQ, Broski SM, Habermann TM, Jevremovic D, Wiseman GA, Feldman AL, Maurer MJ, Ristow KM, Witzig TE. Accuracy of 18-F FDG PET/CT to detect bone marrow clearance in patients with peripheral T-cell lymphoma - tissue remains the issue. Leuk Lymphoma 2017; 58:2342-2348. [PMID: 28290723 DOI: 10.1080/10428194.2017.1300891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Staging of peripheral T-cell non-Hodgkin lymphoma (PTCL) is determined by 18-F FDG PET scan and bone marrow biopsy. This study addressed the accuracy of PET at detecting bone marrow (BM) involvement at restaging in patients with known involvement pretreatment. We identified patients with biopsy proven BM PTCL at diagnosis and concomitant BM and PET at the end of therapy. Pre-treatment PET demonstrated 50% (8/16) had a false-negative PET scan of the BM. After induction, repeat biopsy revealed 62.5% (10/16) with BM involvement. Of these 10, two had a positive PET; eight were false negative by PET. Of the six patients with a negative posttherapy BM biopsy, four were PET negative and two false positive. The sensitivity of PET at end of treatment was 20% (2/10) with a specificity of 66.7% (4/6). PET/CT is not an accurate predictor of BM involvement in patients with known PTCL in the marrow.
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Affiliation(s)
- Anthony Q Pham
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | | | - Dragan Jevremovic
- c Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
| | | | - Andrew L Feldman
- c Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
| | - Matthew J Maurer
- d Department of Health Science Research, Health Sciences Research , Mayo Clinic , Rochester , MN , USA
| | - Kay M Ristow
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Thomas E Witzig
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
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18
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Agarwal KK, Seth R, Behra A, Jana M, Kumar R. 18F-Fluorodeoxyglucose PET/CT in Langerhans cell histiocytosis: spectrum of manifestations. Jpn J Radiol 2016; 34:267-76. [DOI: 10.1007/s11604-016-0517-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/28/2015] [Indexed: 12/29/2022]
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19
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Optimizing the interval between G-CSF therapy and F-18 FDG PET imaging in children and young adults receiving chemotherapy for sarcoma. Pediatr Radiol 2015; 45:1001-6. [PMID: 25646737 DOI: 10.1007/s00247-014-3273-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/07/2014] [Accepted: 12/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Granulocyte colony-stimulating factors (G-CSF) speed recovery from chemotherapy-induced myelosuppression but the marrow stimulation they cause can interfere with interpretation of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) exams. OBJECTIVE To assess the frequency of interfering G-CSF-induced bone marrow activity on FDG PET imaging in children and young adults with Ewing sarcoma and rhabdomyosarcoma and to define an interval between G-CSF administration and FDG PET imaging that limits marrow interference. MATERIALS AND METHODS Blinded, retrospective review of FDG PET exams performed in patients treated with long-acting G-CSF as part of their chemotherapeutic regimen. Exams were subjectively scored by two reviewers (R1 and R2) who assessed the level of marrow uptake of FDG and measured standardized uptake values in the marrow, liver, spleen and blood pool. FDG PET findings were correlated with time since G-CSF administration and with blood cell counts. RESULTS Thirty-eight FDG PET exams performed in 17 patients were reviewed with 47.4% (18/38) of exams having marrow uptake of FDG sufficient to interfere with image interpretation. Primary predictors of marrow uptake of FDG were patient age (P=0.0037) and time since G-CSF exposure (P=0.0028 for subjective marrow uptake of FDG, P=0.008 [R1] and P=0.004 [R2] for measured maximum standardized uptake value (SUVmax)). The median interval between G-CSF administration and PET imaging in cases with marrow activity considered normal or not likely to interfere was 19.5 days (range: 7-55 days). CONCLUSION In pediatric and young adult patients with Ewing sarcoma and rhabdomyosarcoma, an interval of 20 days between administration of the long-acting form of G-CSF and FDG PET imaging should limit interference by stimulated marrow.
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22
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Aras M, Dede F, Ones T, Inanır S, Erdıl TY, Turoglu HT. Evaluation of physiological FDG uptake in the skeleton in adults: Is it uniformly distributed? Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Aras M, Dede F, Ones T, Inanır S, Erdıl TY, Turoglu HT. Evaluation of physiological FDG uptake in the skeleton in adults: Is it uniformly distributed? Rev Esp Med Nucl Imagen Mol 2014; 33:286-9. [DOI: 10.1016/j.remn.2014.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/07/2014] [Accepted: 03/24/2014] [Indexed: 11/16/2022]
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Abstract
Positron emission tomography combined with computed tomography (PET/CT) has emerged in the last decade as a dominant imaging modality used for staging, monitoring response and surveillance of various cancers, including melanoma. Using 2-deoxy-2-((18)F)fluoro-D-glucose ((18)F-FDG) as the radiopharmaceutical, PET/CT has demonstrated its efficacy and its utility in the management of patients with advanced melanoma. Nonetheless, challenges remain in the early stage evaluation of melanoma and in the development of novel radiotracers to better characterize lesions found on PET/CT. This chapter focuses on the advantages and limitations of this imaging modality in melanoma. We also detail and describe the approach to perform (18)F-FDG PET/CT, the methods to accurately quantify lesions, as well as the pearls/pitfalls of image interpretation. Finally, an overview of preclinical and investigational clinical radiopharmaceuticals is presented.
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Affiliation(s)
- Khun Visith Keu
- Département de Radiobiologie et de Médecine Nucléaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
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25
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Combined 18F-fluoride and 18F-FDG PET/CT: a response based on actual data from prospective studies. Eur J Nucl Med Mol Imaging 2013; 40:1922-4. [DOI: 10.1007/s00259-013-2556-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 08/21/2013] [Indexed: 01/18/2023]
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26
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Jamar F, Buscombe J, Chiti A, Christian PE, Delbeke D, Donohoe KJ, Israel O, Martin-Comin J, Signore A. EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med 2013; 54:647-58. [PMID: 23359660 DOI: 10.2967/jnumed.112.112524] [Citation(s) in RCA: 383] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Francois Jamar
- Department of Nuclear Medicine, Université Catholique de Louvain, Brussels, Belgium
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27
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Varoglu E, Kaya B, Sari O. Chronic myeloid leukemia detected on FDG PET/CT imaging in a patient with renal cell carcinoma. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2012.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Iagaru A, Mittra E, Mosci C, Dick DW, Sathekge M, Prakash V, Iyer V, Lapa P, Isidoro J, de Lima JM, Gambhir SS. Combined 18F-fluoride and 18F-FDG PET/CT scanning for evaluation of malignancy: results of an international multicenter trial. J Nucl Med 2012; 54:176-83. [PMID: 23243299 DOI: 10.2967/jnumed.112.108803] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
UNLABELLED (18)F-FDG PET/CT is used in a variety of cancers, but because of variable rates of glucose metabolism, not all cancers are reliably identified. (18)F(-) PET/CT allows for the acquisition of highly sensitive and specific images of the skeleton. We prospectively evaluated combined (18)F(-)/(18)F-FDG as a single PET/CT examination for evaluation of cancer patients and compared it with separate (18)F(-) PET/CT and (18)F-FDG PET/CT scans. METHODS One hundred fifteen participants with cancer were prospectively enrolled in an international multicenter trial evaluating (18)F(-) PET/CT, (18)F-FDG PET/CT, and combined (18)F(-)/(18)F-FDG PET/CT. The 3 PET/CT scans were performed sequentially within 4 wk of one another for each patient. RESULTS (18)F(-)/(18)F-FDG PET/CT allowed for accurate interpretation of radiotracer uptake outside the skeleton, with findings similar to those of (18)F-FDG PET/CT. In 19 participants, skeletal disease was more extensive on (18)F(-) PET/CT and (18)F(-)/(18)F-FDG PET/CT than on (18)F-FDG PET/CT. In another 29 participants, (18)F(-) PET/CT and (18)F(-)/(18)F-FDG PET/CT showed osseous metastases where (18)F-FDG PET/CT was negative. The extent of skeletal lesions was similar in 18 participants on all 3 scans. CONCLUSION This trial demonstrated that combined (18)F(-)/(18)F-FDG PET/CT shows promising results when compared with separate (18)F(-) PET/CT and (18)F-FDG PET/CT for evaluation of cancer patients. This result opens the possibility for improved patient care and reduction in health-care costs, as will be further evaluated in future trials.
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Affiliation(s)
- Andrei Iagaru
- Division of Nuclear Medicine, Stanford University Medical Center, Stanford, California 94305, USA.
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Gámez Cenzano C, Sabaté Llobera A, Narváez García JA, Rodríguez Bel L, García del Muro FJ. [Positron emission tomography-computed tomography in tumors of the locomotor apparatus]. RADIOLOGIA 2012; 54 Suppl 1:3-13. [PMID: 22959330 DOI: 10.1016/j.rx.2012.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/26/2012] [Accepted: 07/09/2012] [Indexed: 12/23/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) is a hybrid imaging technique that combines the anatomic information from CT with the metabolic information acquired from PET after the administration of specific radiotracers, the most commonly used of which is F18-fluorodeoxyglucose (FDG). In oncology, this technique is based on the increased uptake of FDG by malignant lesions. In the locomotor apparatus, some uptake by bones and soft tissues is physiological or benign and this uptake must be differentiated from uptake by malignancies, whether primary or secondary. The most important limitations are active inflammatory or infectious processes, which are positive on PET images, and malignant lesions that are smaller than 1cm, cystic, necrotic, or low-grade, which are negative on PET images. PET/CT in the locomotor apparatus is especially useful for the detection of metastases from the most common tumors. It is also used for staging and monitoring the response to treatment of some hematological tumors like lymphoma, where it is fundamental to determine whether the bone marrow has been infiltrated, or myeloma. Lastly, although it is not yet an established indication, PET/CT is being increasingly used to study sarcomas, because it can provide additional information that can be useful for the characterization and grading of tumors, for guiding biopsies, for staging and re-staging, and for evaluating the response to neoadjuvant therapy as well as for evaluating new drugs in clinical trials.
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Affiliation(s)
- C Gámez Cenzano
- Unidad PET-IDI, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
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30
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Early bone marrow metastasis detection: The additional value of FDG-PET/CT vs. CT imaging. Biomed Pharmacother 2012; 66:448-53. [DOI: 10.1016/j.biopha.2012.06.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 06/10/2012] [Indexed: 11/22/2022] Open
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Chronic myeloid leukemia detected on FDG PET/CT imaging in a patient with renal cell carcinoma. Rev Esp Med Nucl Imagen Mol 2012. [PMID: 23177344 DOI: 10.1016/j.remn.2012.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It is well known that hematopoietic cytokine stimulation can cause increased fluorodeoxyglucose (FDG) accumulation in bone marrow on PET/CT imaging, which simulates that seen in patients with bone marrow metastases. However, increased bone marrow FDG uptake can be caused by other etiologies. We report a patient with operated renal cell carcinoma had no history of hematopoietic cytokine stimulation. The FDG PET/CT images showed increased bone marrow FDG uptake, and the patient was diagnosed as chronic myeloid leukemia. This case revealed that increased FDG uptake on bone marrow may be related to neoplastic disease of the hematopoietic tissues.
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32
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Grenader T, Shavit L. PET scan in a patient with pneumococcal sepsis. Intern Emerg Med 2012; 7 Suppl 1:S47-9. [PMID: 21660491 DOI: 10.1007/s11739-011-0645-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 05/24/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Tal Grenader
- Department of Oncology, Sha'are Zedek Medical Center, PO Box 3235, 91031 Jerusalem, Israel.
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33
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Sharp SE, Gelfand MJ, Absalon MJ. Altered FDG uptake patterns in pediatric lymphoblastic lymphoma patients receiving induction chemotherapy that includes very high dose corticosteroids. Pediatr Radiol 2012; 42:331-6. [PMID: 21881935 DOI: 10.1007/s00247-011-2228-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 07/14/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Altered FDG uptake patterns were noted in certain lymphoblastic lymphoma patients during therapy. OBJECTIVE To describe these altered FDG uptake patterns and their relationship to chemotherapy. MATERIALS AND METHODS Thirty-five FDG PET or PET/CT scans obtained in 11 children with lymphoblastic lymphoma were retrospectively reviewed. FDG uptake patterns were recorded. SUV measurements were performed in liver and facial soft tissues. Results were correlated with induction chemotherapy regimens. RESULTS Six of the children had transiently altered FDG uptake with increased uptake in the superficial soft tissues, most notably involving the face. Altered uptake was noted approximately 1 month after initiation of chemotherapy and subsequently resolved. Hepatic uptake was transiently reduced on the 1-month scan in all six children with increased facial uptake. No significant FDG uptake in lymphoma was seen on five of six scans with altered uptake; however, two of these five affected children had FDG uptake in lymphoma on the next follow-up examination. Blood glucose levels in the affected children were in the normal range. All six children with altered FDG uptake received the same induction chemotherapy regimen, which included very high doses of corticosteroids. CONCLUSIONS Children with lymphoblastic lymphoma on induction chemotherapy protocols including very high doses of corticosteroids transiently demonstrated altered FDG uptake patterns, including increased superficial facial uptake and reduced hepatic uptake. The facial uptake is probably the FDG PET equivalent of Cushingoid facies. Caution in interpreting scans with this altered FDG uptake pattern is suggested, as uptake at sites of lymphomatous involvement may potentially be affected.
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Affiliation(s)
- Susan E Sharp
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
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34
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Long NM, Smith CS. Causes and imaging features of false positives and false negatives on F-PET/CT in oncologic imaging. Insights Imaging 2011; 2:679-698. [PMID: 22347986 PMCID: PMC3259390 DOI: 10.1007/s13244-010-0062-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 12/09/2010] [Accepted: 12/17/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND: 18F-FDG is a glucose analogue that is taken up by a wide range of malignancies. 18F-FDG PET-CT is now firmly established as an accurate method for the staging and restaging of various cancers. However, 18F-FDG also accumulates in normal tissue and other non-malignant conditions, and some malignancies do not take up F18-FDG or have a low affinity for the tracer, leading to false-positive and false-negative interpretations. METHODS: PET-CT allows for the correlation of two separate imaging modalities, combining both morphological and metabolic information. We should use the CT to help interpret the PET findings. In this article we will highlight specific false-negative and false-positive findings that one should be aware of when interpreting oncology scans. RESULTS: We aim to highlight post-treatment conditions that are encountered routinely on restaging scans that can lead to false-positive interpretations. We will emphasise the importance of using the CT component to help recognise these entities to allow improved diagnostic accuracy. CONCLUSION: In light of the increased use of PET-CT, it is important that nuclear medicine physicians and radiologists be aware of these conditions and correlate the PET and CT components to avoid misdiagnosis, over staging of disease and unnecessary biopsies.
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Affiliation(s)
- Niamh M. Long
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| | - Clare S. Smith
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
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Multiple myeloma: a review of imaging features and radiological techniques. BONE MARROW RESEARCH 2011; 2011:583439. [PMID: 22046568 PMCID: PMC3200072 DOI: 10.1155/2011/583439] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 04/06/2011] [Accepted: 05/30/2011] [Indexed: 11/17/2022]
Abstract
The recently updated Durie/Salmon PLUS staging system published in 2006 highlights the many advances that have been made in the imaging of multiple myeloma, a common malignancy of plasma cells. In this article, we shall focus primarily on the more sensitive and specific whole-body imaging techniques, including whole-body computed tomography, whole-body magnetic resonance imaging, and positron emission computed tomography. We shall also discuss new and emerging imaging techniques and future developments in the radiological assessment of multiple myeloma.
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Hara R. A Retroperitoneal Dedifferentiated Liposarcoma Producing Granulocyte Colony-Stimulating Factor Accompanied by Spontaneous Rupture: PET/CT Imaging of a G-CSF-Producing Tumor. Case Rep Oncol 2011; 4:236-41. [PMID: 21537374 PMCID: PMC3085038 DOI: 10.1159/000327847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The patient was a 63-year-old man who was referred to our hospital as an emergency case with the chief complaint of abdominal pain. An abdominal CT revealed a right retroperitoneal tumor of 15 cm and retroperitoneal bleeding. After a transcatheter arterial embolization was performed, the patient was transferred to our department. There was no infective focus. The white blood cell (WBC) count (37,820/μl, normal range <8 pg/ml) and the serum granulocyte colony-stimulating factor (G-CSF) level (2,670 pg/ml, normal range <8 pg/ml) were high. Bone marrow biopsy revealed little fat, significant hyperplasia, and predominantly increased neutrophils, but no findings of bone metastasis or bone marrow involvement. A G-CSF-producing tumor was diagnosed and right nephrectomy and retroperitoneal tumorectomy were performed. However, the tumor had infiltrated into the inferior vena cava, diaphragm and abdominal wall, and only part of the tumor could be removed. In histopathological tests, hematoxylin-eosin staining showed malignant fibrous histiocytoma-like findings mixed with those for well-differentiated liposarcoma, and the case was diagnosed as dedifferentiated liposarcoma. Preoperative (18)F-FDG-PET computed tomography showed diffuse (18)F-FDG uptake throughout the bone marrow and elevated uptake at the tumor site. However, since bone biopsy and bone scintigraphy indicated no bone metastasis or bone marrow involvement, we concluded that PET/CT imaging gave false-positive results in the bone marrow. This is the first report of PET/CT imaging of a G-CSF-producing tumor in a urological disease. The imaging results may be useful for differential diagnosis for this tumor in patients with high WBC counts without infection.
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Affiliation(s)
- Ryoei Hara
- Department of Urology, Kawasaki Medical School, Kurashiki City, Japan
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Koga T, Umeda M, Migita K, Yamasaki S, Nakamura H, Kawakami A. A Japanese case of familial Mediterranean fever presenting diffuse bone marrow uptake of FDG-PET and high levels of neutrophil membrane CD64 expression. Rheumatology (Oxford) 2011; 50:1171-3. [PMID: 21296849 DOI: 10.1093/rheumatology/ker012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18F-FDG PET-TAC en mononucleosis por citomegalovirus. ACTA ACUST UNITED AC 2010; 29:304-7. [DOI: 10.1016/j.remn.2010.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 03/10/2010] [Accepted: 03/11/2010] [Indexed: 01/28/2023]
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Abstract
(18)F-fluorodeoxyglucose (FDG) is the radiotracer used in the vast majority of positron emission tomography (PET) cancer studies. FDG is a powerful radiotracer that provides valuable data in many cancer types. Normal FDG biodistribution is easily identified. In the PET-only era, physiological uptake provided important anatomical landmarks. However, the normal biodistribution of FDG is often variable and can be altered by intrinsic or iatrogenic factors. Recognizing these patterns of altered biodistribution is important for optimal FDG-PET interpretation. Altered FDG uptake in muscles, brown adipose tissue, bone marrow, the urinary tract, and the bowel is demonstrated in a significant proportion of patients, which can hide underlying malignant foci or mimic malignant lesions. The introduction of PET/computed tomography revolutionized PET imaging, bringing much-needed anatomical information. This modality allowed better characterization of some types of uptake, particularly brown adipose tissue FDG uptake. Different approaches to minimize interference from altered FDG biodistribution should be considered when performing PET scans. Otherwise, careful review and correlation of metabolic (FDG-PET) and anatomical (computed tomography) data should be performed to accurately characterize the foci of increased FDG uptake.
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Affiliation(s)
- Christian Cohade
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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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: 83] [Impact Index Per Article: 5.9] [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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Measuring the "unmeasurable": assessment of bone marrow response to therapy using FDG-PET in patients with lymphoma. Acad Radiol 2010; 17:1175-85. [PMID: 20634105 DOI: 10.1016/j.acra.2010.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/29/2010] [Accepted: 05/01/2010] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES To determine if anatomically "nonmeasurable" disease in bone marrow (BM) is assessable for response to therapy by [(18)F]-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT). MATERIALS AND METHODS FDG PET/CT images of 27 patients with lymphoma, FDG-avid bone marrow (BM) lesions, and >or=1 FDG-avid, tumor-involved lymph node (LN) at baseline were retrospectively reviewed. FDG uptake in target LNs and BM foci was determined pre- and posttherapy using the standardized uptake value corrected for lean body mass (SUL(mean)). Size of the same target LNs was measured pre- and posttherapy on CT. Percentage decreases of LN size and LN and BM SUL were calculated. Response was classified according to revised International Workshop Criteria (IWC) with and without modification for metabolic evaluation of BM and correlated to overall survival. Statistical analyses were performed using paired t-tests, Pearson correlation coefficients, and z-tests. RESULTS LN size, LN SUL(mean), and BM SUL(mean) were significantly higher pre- versus posttherapy (2337 mm(2) +/- 1810 vs. 309 mm(2) +/- 323; 6.94 +/- 4.96 vs. 1.02 +/- 1.00; and 6.81 +/- 4.58 to 1.84 +/- 1.58, all P < .001, respectively). After therapy, significant correlation was found between percentage declines of LN size and SUL(mean) of LNs (r = 0.84, P < .001) or BM (r = 0.56, P = .002) and SUL(mean) of LN and BM (r = 0.76, P < .001). Including a metabolic assessment of BM correctly altered overall response assessment in 5/27 (19%) patients and better predicted overall survival than revised IWC. CONCLUSION Anatomically "unmeasurable" BM infiltration with lymphoma behaves similarly to LN disease after therapy and is "measurable" by FDG PET/CT. FDG PET/CT is valuable for monitoring tumor response in "measurable" disease and BM, which was previously considered "unmeasurable" by anatomical imaging.
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Costelloe CM, Chuang HH, Madewell JE. FDG PET for the Detection of Bone Metastases: Sensitivity, Specificity and Comparison with Other Imaging Modalities. PET Clin 2010; 5:281-95. [PMID: 27157834 DOI: 10.1016/j.cpet.2010.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A literature review was performed of studies reporting sensitivity and specificity of [18F]fluorodeoxyglucose (FDG) PET from January 1, 2000 to January 1, 2010. PET was found to have higher sensitivity for the detection of osseous metastases when compared to CT, skeletal scintigraphy, whole body MRI and combined conventional imaging modalities. A potential exception is when comparing PET with bone scan in the setting of blastic metastases. PET may be a better indicator of active bony metastases. The efficacy of PET can be increased with fused anatomic imaging.
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Affiliation(s)
- Colleen M Costelloe
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Hubert H Chuang
- Division of Diagnostic Imaging, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - John E Madewell
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Abstract
Advances in the imaging and treatment of multiple myeloma have occurred over the past decade. This article summarises the current status and highlights how an understanding of both is necessary for optimum management.
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Affiliation(s)
- Conor D Collins
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Inhomogeneous Bone Marrow Uptake Caused by G-CSF Mimics Multiple Bone Metastases on FDG-PET. Clin Nucl Med 2010; 35:74-6. [DOI: 10.1097/rlu.0b013e3181c7bf4e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Diffusely increased uptake is more commonly observed than focal uptake in the spleen on a whole-body [F] fluorodeoxyglucose-positron emission tomography/computed tomography. The significance of diffusely increased splenic uptake varies in different clinical settings. On a pre-therapeutic scan for lymphoma, splenic uptake, greater than hepatic uptake, is a relative reliable indication of lymphomatous involvement of the spleen, unless the patient has a history of recent cytokine administration. In HIV infection, increased splenic uptake is usually noted in the early stage of the disease, which could reflect massive stimulation of B-cells in the spleen by nonreplicating antigenic material. Diffusely increased splenic uptake may also be present in sarcoidosis, malaria, and many inflammatory or hematopoietic diseases. Therapeutic-related reactive splenic uptake concurrent with bone marrow uptake is often secondary to administration of granulocyte colony-stimulating factor for myelosuppression or high-dose interferon-alpha-2b adjuvant therapy for melanoma.
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Shammas A, Lim R, Charron M. Pediatric FDG PET/CT: physiologic uptake, normal variants, and benign conditions. Radiographics 2009; 29:1467-86. [PMID: 19755606 DOI: 10.1148/rg.295085247] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) is increasingly being used in the evaluation of pediatric oncology patients. However, the normal distribution of (18)F FDG uptake in children is unique and may differ from that in adults. A number of physiologic variants are commonly encountered, including normal physiologic uptake in the head and neck, heart, breast, thymus, liver, spleen, gastrointestinal tract, genital system, urinary collecting system, bone marrow, muscles, and brown adipose tissue. Benign lesions with increased (18)F FDG uptake are also frequently seen and can be misinterpreted as malignancies. In addition, the use of combined PET/computed tomographic (CT) scanners is associated with pitfalls and artifacts such as attenuation correction and misregistration. Proper interpretation of pediatric (18)F FDG PET/CT studies requires knowledge of the normal distribution of (18)F FDG uptake in children, as well as of the aforementioned physiologic variants, benign lesions, and PET/CT-related artifacts. Knowing these potential causes of misinterpretation can increase accuracy in PET image interpretation, decrease the number of unnecessary follow-up studies or procedures, and improve patient treatment.
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Affiliation(s)
- Amer Shammas
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada.
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Time-dependent changes in 18F-FDG activity in the thymus and bone marrow following combination chemotherapy in paediatric patients with lymphoma. Eur J Nucl Med Mol Imaging 2009; 37:462-7. [PMID: 19820931 DOI: 10.1007/s00259-009-1280-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 09/13/2009] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the time-dependent changes in (18)F-FDG uptake by the thymus and marrow following combination chemotherapy for lymphoma in a paediatric study population. METHODS Included in the study were 27 paediatric patients who were in complete metabolic remission after chemotherapy and who underwent off-therapy follow-up with serial whole-body PET-CT scans. A total of 142 PET-CT scans were recorded. (18)F-FDG uptake by the thymus and marrow was assessed both visually and semiquantitatively. Visual uptake was scored on the three-dimensional maximum intensity projection of the whole-body PET image according to a three-point scale. For the semiquantitative assessment, standard uptake values were measured. To find a pattern in the (18)F-FDG uptake by the thymus and marrow a moving average technique was applied. RESULTS Our time series analysis indicated that the marrow activity was highest at cessation of chemotherapy and declined thereafter. During an off-chemotherapy period of on average 6 months, marrow activity decreased quickly. From 6 months onward, the activity declined more slowly. The posttherapy changes in (18)F-FDG uptake by the thymus were quite different from the changes in uptake by the marrow. The lowest thymic FDG uptake was found at cessation of chemotherapy. Thereafter, thymic activity steadily increased, reached a peak on average 10 months after therapy, and then slowly decreased. CONCLUSION Knowledge of the time-dependent changes in metabolic activity in the thymus and marrow is important to avoid misinterpretation of increased (18)F-FDG uptake as disease in the off-therapy setting.
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Kaibara H, Kaida H, Ishibashi M, Kurata S, Otsubo K, Fujimoto K, Uchida M, Abe T, Kobayashi M, Doi R, Kunou Y, Okamura T, Oshima K, Hayabuchi N. 18F-FDG-PET findings of rare case of nonsecretory plasmablastic myeloma. Ann Nucl Med 2009; 23:807-11. [DOI: 10.1007/s12149-009-0300-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 07/28/2009] [Indexed: 02/06/2023]
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50
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Sharp SE, Shulkin BL, Gelfand MJ, Salisbury S, Furman WL. 123I-MIBG scintigraphy and 18F-FDG PET in neuroblastoma. J Nucl Med 2009; 50:1237-43. [PMID: 19617326 DOI: 10.2967/jnumed.108.060467] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED The purpose of this study was to compare the diagnostic utility of (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy and (18)F-FDG PET in neuroblastoma. METHODS A total of 113 paired (123)I-MIBG and (18)F-FDG PET scans in 60 patients with neuroblastoma were retrospectively reviewed. Paired scans were acquired within 14 days of each other. RESULTS For stage 1 and 2 neuroblastoma (13 scans, 10 patients), (18)F-FDG depicted more extensive primary or residual neuroblastoma in 9 of 13 scans. (123)I-MIBG and (18)F-FDG showed equal numbers of lesions in 1 of 13 scans, and 3 of 13 scan results were normal. For stage 3 neuroblastoma (15 scans, 10 patients), (123)I-MIBG depicted more extensive primary neuroblastoma or local or regional metastases in 5 of 15 scans. (18)F-FDG depicted more extensive primary neuroblastoma or local or regional metastases in 4 of 15 scans. (123)I-MIBG and (18)F-FDG were equal in 2 of 15 scans, and 4 of 15 scan results were normal. For stage 4 neuroblastoma (85 scans, 40 patients), (123)I-MIBG depicted more neuroblastoma sites in 44 of 85 scans. (18)F-FDG depicted more neuroblastoma sites in 11 of 85 scans. (123)I-MIBG and (18)F-FDG were equivalent or complementary in 13 of 85 scans, and 17 of 85 scan results were normal. CONCLUSION (18)F-FDG is superior in depicting stage 1 and 2 neuroblastoma, although (123)I-MIBG may be needed to exclude higher-stage disease. (18)F-FDG also provides important information for patients with tumors that weakly accumulate (123)I-MIBG and at major decision points during therapy (i.e., before stem cell transplantation or before surgery). (18)F-FDG can also better delineate disease extent in the chest, abdomen, and pelvis. (123)I-MIBG is overall superior in the evaluation of stage 4 neuroblastoma, especially during initial chemotherapy, primarily because of the better detection of bone or marrow metastases.
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Affiliation(s)
- Susan E Sharp
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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