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Sammartino AM, Bonfioli GB, Dondi F, Riccardi M, Bertagna F, Metra M, Vizzardi E. Contemporary Role of Positron Emission Tomography (PET) in Endocarditis: A Narrative Review. J Clin Med 2024; 13:4124. [PMID: 39064164 PMCID: PMC11277723 DOI: 10.3390/jcm13144124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/20/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Endocarditis, a serious infectious disease, remains a diagnostic challenge in contemporary clinical practice. The advent of advanced imaging modalities has contributed significantly to the improved understanding and management of this complex disease. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging has shown remarkable potential in improving the diagnostic accuracy of endocarditis. In the update of the Modified Duke Criteria, in 2023, The International Society for Cardiovascular Infectious Diseases (ISCVID) Working Group recognized specific 18F-FDG PET/CT findings as a major diagnostic criterion, particularly in patient with prosthetic valve endocarditis. The ability of PET to visualize metabolic activity allows for the identification of infective foci and could differentiate between infective and non-infective processes. This review examines the clinical utility of PET in differentiating infective endocarditis from other cardiovascular pathologies, highlighting its sensitivity and specificity in detecting native and prosthetic valve infections, including patients with transcatheter aortic valve implantation (TAVI), cardiac implantable devices (CIEDs), and left ventricular assistance devices (LVAD). Also, practical aspects and indications are illustrated to optimize the quality of imaging and reduce potential false positive results. In conclusion, the current use of PET in endocarditis has become a valuable diagnostic tool; as technological advances continue, PET will play an increasingly important role in the multidisciplinary approach to the management of endocarditis.
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Affiliation(s)
- Antonio Maria Sammartino
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (G.B.B.)
| | - Giovanni Battista Bonfioli
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (G.B.B.)
| | - Francesco Dondi
- Nuclear Medicine, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
| | - Mauro Riccardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (G.B.B.)
| | - Francesco Bertagna
- Nuclear Medicine, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (G.B.B.)
| | - Enrico Vizzardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (G.B.B.)
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Pilkington P, Lopci E, Adam JA, Kobe C, Goffin K, Herrmann K. FDG-PET/CT Variants and Pitfalls in Haematological Malignancies. Semin Nucl Med 2021; 51:554-571. [PMID: 34272037 DOI: 10.1053/j.semnuclmed.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hematologic malignancies represent a vast group of hematopoietic and lymphoid cancers that typically involve the blood, the bone marrow, and the lymphatic organs. Due to extensive research and well defined and standardized response criteria, the role of [18F]FDG-PET/CT is well defined in these malignancies. Never the less, the reliability of visual and quantitative interpretation of PET/CT may be impaired by several factors including inconsistent scanning protocols and image reconstruction methods. Furthermore, the uptake of [18F]FDG not only reflects tissue glucose consumption by malignant lesions, but also in other situations such as in inflammatory lesions, local and systemic infections, benign tumors, reactive thymic hyperplasia, histiocytic infiltration, among others; or following granulocyte colony stimulating factors therapy, radiation therapy, chemotherapy or surgical interventions, all of which are a potential source of false-positive or negative interpretations. Therefore it is of paramount importance for the Nuclear Medicine Physician to be familiar with, not only the normal distribution of [18F]FDG in the body, but also with the most frequent findings that may hamper a correct interpretation of the scan, which could ultimately alter the patients management. In this review, we describe these myriad of situations so the interpreting physician can be familiar with them, providing tools for their correct identification and interpretation when possible.
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Affiliation(s)
- Patrick Pilkington
- Department of Nuclear Medicine, University Hospital 12 de Octubre, Madrid, Spain.
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Rozzano (Milano), Italy
| | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karolien Goffin
- Department of Nuclear Medicine, University Hospital Leuven, Division of Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen Germany; West German Cancer Center
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A secondary analysis of FDG spatio-temporal consistency in the randomized phase II PET-boost trial in stage II–III NSCLC. Radiother Oncol 2018; 127:259-266. [DOI: 10.1016/j.radonc.2018.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 12/25/2022]
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Bissonnette JP, Yap ML, Clarke K, Shessel A, Higgins J, Vines D, Atenafu EG, Becker N, Leavens C, Bezjak A, Jaffray DA, Sun A. Serial 4DCT/4DPET imaging to predict and monitor response for locally-advanced non-small cell lung cancer chemo-radiotherapy. Radiother Oncol 2018; 126:347-354. [DOI: 10.1016/j.radonc.2017.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/07/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022]
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Paediatric and adolescent Hodgkin lymphoma: information derived from diffuse organ uptake of 18 F-fluorodeoxyglucose on pre-treatment and on interim PET/CT. Eur J Nucl Med Mol Imaging 2015; 43:1220-30. [DOI: 10.1007/s00259-015-3280-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/01/2015] [Indexed: 12/31/2022]
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Chalaye J, Luciani A, Enache C, Beaussart P, Lhermite C, Evangelista E, Sasanelli M, Safar V, Meignan M, Haioun C, Rahmouni A, Itti E. Clinical impact of contrast-enhanced computed tomography combined with low-dose (18)F-fluorodeoxyglucose positron emission tomography/computed tomography on routine lymphoma patient management. Leuk Lymphoma 2014; 55:2887-92. [PMID: 24597987 DOI: 10.3109/10428194.2014.900761] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study evaluated the clinical impact of contrast-enhanced computed tomography (CECT) on routine management of patients with lymphoma. Over a 1-year period, 237 CECT scans were performed prospectively in 163 patients after low-dose (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT). Scans were performed at staging (n = 41), interim (n = 73), post-therapy (n = 115) and follow-up (n = 8). Clinical impact was determined from the multidisciplinary committee reports. CECT had no clinical impact in 219 cases (92%). A clear impact was noted in only 3%, i.e. up-staging of lymphoma (n = 2) and diagnosis of deep vein thrombosis (n = 5). A debatable impact was noted in the remaining 11 cases, consisting of additional investigations, either without therapeutic impact (n = 8), or resulting in delay of therapy onset (n = 2) or ablative surgery (n = 1). CECT delivered an average 33.5 ± 3.8 mSv vs. 17.7 ± 2.8 mSv for PET/CT. In conclusion, the clinical impact of CECT seems limited, although scarce, life-threatening conditions were diagnosed. Imaging of lymphoma needs optimization to reduce radiation exposure.
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Affiliation(s)
- Julia Chalaye
- Department of Nuclear Medicine, Henri Mondor Hospital and Paris-Est University , Créteil , France
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Vera P, Modzelewski R, Hapdey S, Gouel P, Tilly H, Jardin F, Ruan S, Gardin I. Does enhanced CT influence the biological GTV measurement on FDG-PET images? Radiother Oncol 2013; 108:86-90. [DOI: 10.1016/j.radonc.2013.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 03/10/2013] [Accepted: 03/17/2013] [Indexed: 10/26/2022]
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Boktor RR, Walker G, Stacey R, Gledhill S, Pitman AG. Reference range for intrapatient variability in blood-pool and liver SUV for 18F-FDG PET. J Nucl Med 2013; 54:677-82. [PMID: 23512357 DOI: 10.2967/jnumed.112.108530] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED (18)F-FDG PET qualitative tumor response assessment or tumor-to-background ratios compare targets against blood-pool or liver activity; standardized uptake value (SUV) semiquantitation has artifacts and is validated by a stable normal-tissue baseline. The aim of this study was to document the normal intrapatient range of scan-to-scan variation in blood-pool SUV and liver SUV and to identify factors that may adversely affect it (increase its spread). METHODS Between July 2009 and June 2010, 132 oncology patients had 2 PET/CT scans. Patient preparation, acquisition, and reconstruction protocols were held stable, uniform, and reproducible. Mean SUV (body weight) values were obtained from 2-dimensional regions of interest in the aortic arch blood pool and in the right lobe of the liver. RESULTS Of the 132 patients, 65 had lymphoma. Their mean age was 62.5 y. The group's mean serum glucose level was 6.0 mmol/L at the first visit and 5.9 mmol/L at the second visit. The mean (18)F-FDG dose was 4.1 MBq/kg at the first visit and 4.0 at the second. At the first visit, the group's mean blood-pool SUV was 1.55 (SD, 0.38); at the second, 1.58 (SD, 0.37)-not statistically different. The group's mean liver SUV was 2.17 (SD, 0.44) at the first visit and 2.29 (SD, 0.44) at the second (P = 0.005). Visit-to-visit intrapatient variation in blood-pool and liver SUVs had gaussian distributions. The variation in blood-pool SUV had a mean of 0.03 and SD of 0.42. The variation in liver SUV had a mean of 0.12 and SD of 0.50. Using 95th percentiles, the reference range in our patient population for intrapatient variation was -0.8 to 0.9 for blood pool SUV and -0.9 to 1.1 for liver SUV. Subanalysis by cancer type and chemotherapy suggested that the rise in liver SUV between the 2 visits was largely due to the commencement of chemotherapy, but no factors were identified as systematically affecting intrapatient variation, and no factors were identified as increasing its spread. CONCLUSION In our patient cohort, the reference range for intrapatient variation in blood-pool and liver SUVs is -0.8 to 0.9 and -0.9 to 1.1, respectively.
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Affiliation(s)
- Raef R Boktor
- Lake Imaging Department of Positron Emission Tomography and Nuclear Medicine at St. John of God Hospital, Ballarat, Victoria, Australia.
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Meignan M, Gallamini A, Haioun C, Polliack A. Report on the Second International Workshop on interim positron emission tomography in lymphoma held in Menton, France, 8–9 April 2010. Leuk Lymphoma 2010; 51:2171-80. [DOI: 10.3109/10428194.2010.529208] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Papajík T, Mysliveček M, Sedová Z, Buriánková E, Procházka V, Koranda P, Raida L, Kubová Z, Palová M, Kučerová L, Flodr P, Jarkovský J, Dušek L, Indrák K. Standardised uptake value of 18F-FDG on staging PET/CT in newly diagnosed patients with different subtypes of non-Hodgkin's lymphoma. Eur J Haematol 2010; 86:32-7. [PMID: 20874822 DOI: 10.1111/j.1600-0609.2010.01532.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Positron emission tomography using 2-[fluorine-18]-fluoro-2-deoxy-D-glucose ((18) F-FDG) is considered to be the most beneficial imaging method for staging patients with non-Hodgkin's lymphoma (NHL). The intensity of (18) F-FDG accumulation may be determined by calculating the so-called standardised uptake value (SUV). The study aimed at assessing the benefit of SUV(max) determination in staging (18) F-FDG PET/CT in untreated patients with NHL. METHODS One hundred and forty-nine initial staging (18) F-FDG PET/CT scans performed in patients with NHL between January 2007 and August 2009 were assessed, and the SUV(max) was determined. RESULTS The highest mean and median values of SUV(max) were observed in patients with diffuse large B-cell lymphoma (DLBCL), the lowest mean and median values were found in small lymphocytic lymphoma. The overlap in SUV(max) < 10 between DLBCL and the other subgroups of NHL was very significant. Statistically, no correlation was found between the lactate dehydrogenase and SUV(max) values. On the other hand, a correlation of the Ki-67 proliferative index of tumour cells and SUV(max) was revealed (r = 0.409, P < 0.001). The geometric mean of SUV(max) in patients with Ki-67 ≤ 60 and those with Ki-67 > 60 was 8.8 and 14.3, respectively (P < 0.001). CONCLUSIONS The results confirm that SUV(max) is not beneficial for making a more precise diagnosis in most patients with NHL. Correlation of SUV(max) with the Ki-67 values suggests that SUV(max) might have a prognostic values in NHL.
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Affiliation(s)
- Tomáš Papajík
- Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.
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Is contrast material needed after treatment of malignant lymphoma in positron emission tomography/computed tomography? Ann Nucl Med 2010; 25:93-9. [PMID: 20957527 DOI: 10.1007/s12149-010-0429-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 09/15/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE Positron emission tomography (PET)/computed tomography (CT) with (18)F-fluorodeoxyglucose is widely used for post-therapeutic surveillance of malignant lymphoma. Debate still exists as to whether intravenous contrast media during the CT stage of a PET/CT scan should be used. The purpose of this study was to investigate the clinical value of contrast agent in PET/CT in patients with lymphoma following treatment. PATIENTS AND METHODS One hundred and twenty-two consecutive patients with malignant lymphoma underwent 146 PET/CT scans to monitor therapeutic response (n = 57) or surveillance during follow-up (n = 89). All patients had a conventional PET/CT scan with low-dose CT without contrast (ldCT), and then a full-dose CT scan with contrast (ceCT). Two datasets were interpreted separately and prevalence of discrepant results between the two methods was evaluated. In addition, differences of diagnostic performance were investigated for restaging. RESULTS Both PET + ldCT and PET + ceCT were positive in 22 cases and negative in 35 cases when monitoring response to therapy. There were no cases in which these techniques demonstrated inconsistent findings. For restaging, the patient-based sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of PET + ldCT were 70, 91, 76, 87, and 84%, respectively, and those of PET + ceCT were 74, 92, 81, 89, and 87%, respectively. Discrepant results between the two methods occurred in only 2 of 89 cases (2%). CONCLUSION PET/ceCT yielded more accurate findings than PET/ldCT in a limited number of cases. PET/ldCT may, therefore, be sufficient for routine PET/CT scanning for post-therapeutic assessment or restaging of lymphoma patients.
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Vriens D, Visser EP, de Geus-Oei LF, Oyen WJG. Methodological considerations in quantification of oncological FDG PET studies. Eur J Nucl Med Mol Imaging 2009; 37:1408-25. [PMID: 19936745 PMCID: PMC2886126 DOI: 10.1007/s00259-009-1306-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 10/15/2009] [Indexed: 11/26/2022]
Abstract
Purpose This review aims to provide insight into the factors that influence quantification of glucose metabolism by FDG PET images in oncology as well as their influence on repeated measures studies (i.e. treatment response assessment), offering improved understanding both for clinical practice and research. Methods Structural PubMed searches have been performed for the many factors affecting quantification of glucose metabolism by FDG PET. Review articles and references lists have been used to supplement the search findings. Results Biological factors such as fasting blood glucose level, FDG uptake period, FDG distribution and clearance, patient motion (breathing) and patient discomfort (stress) all influence quantification. Acquisition parameters should be adjusted to maximize the signal to noise ratio without exposing the patient to a higher than strictly necessary radiation dose. This is especially challenging in pharmacokinetic analysis, where the temporal resolution is of significant importance. The literature is reviewed on the influence of attenuation correction on parameters for glucose metabolism, the effect of motion, metal artefacts and contrast agents on quantification of CT attenuation-corrected images. Reconstruction settings (analytical versus iterative reconstruction, post-reconstruction filtering and image matrix size) all potentially influence quantification due to artefacts, noise levels and lesion size dependency. Many region of interest definitions are available, but increased complexity does not necessarily result in improved performance. Different methods for the quantification of the tissue of interest can introduce systematic and random inaccuracy. Conclusions This review provides an up-to-date overview of the many factors that influence quantification of glucose metabolism by FDG PET.
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Affiliation(s)
- Dennis Vriens
- Department of Nuclear Medicine (internal postal code 444), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
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Evaluation of low-density neutral oral contrast material in PET/CT for tumor imaging: results of a randomized clinical trial. AJR Am J Roentgenol 2009; 193:326-32. [PMID: 19620427 DOI: 10.2214/ajr.08.1565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to determine the impact on image quality and risks in terms of artifacts and side effects of a low-density barium-based suspension as oral contrast material for CT during PET/CT examinations of an oncologic patient population. SUBJECTS AND METHODS Eighty-five patients (51 men and 34 women; mean age, 53 years; age range, 21-87 years) were prospectively randomized to receive either 0.1% barium sulfate oral suspension or no oral contrast material during PET/CT. Patients in the oral contrast group were given 1,350 mL over 60-75 minutes. The (18)F-FDG PET component of each examination was reviewed for the presence of artifacts by two nuclear medicine physicians and was classified as adequate (no presence of artifactual focal FDG uptake attributed to attenuation-correction errors) or inadequate (focal uptake in attenuation-correction PET images with no corresponding uptake in non-attenuation-corrected PET images). Two radiologists reviewed the CT studies and scored the degree of bowel opacification using a 5-point scale, ranging from 0 for no opacification (i.e., not possible to delineate the bowel structures from the surrounding tissues) to 4 for excellent opacification (i.e., bowel structure identifiable and bowel wall clearly visible). The attenuation values (in Hounsfield units) were recorded in the stomach, duodenum, mid jejunum, and terminal ileum for quantitative analysis. Interobserver variability was assessed using kappa coefficients. RESULTS None of the patients who received oral contrast material experienced side effects. All 85 PET examinations were considered adequate with no observable artifacts. The mean bowel opacification scores of the oral contrast group (2.59 and 2.93) as evaluated by radiologists 1 and 2, respectively, were significantly higher (p < 0.01) than those of the control group (1.55 and 1.59). The level of attenuation achieved in the contrast group was significantly higher than in the control group. The interobserver variability was moderate (kappa = 0.32). CONCLUSION The use of low-density neutral oral contrast material for CT during combined FDG PET/CT studies significantly improves visualization of the bowel structures compared with no contrast material without causing side effects or clinically detectable errors in the attenuation correction of the FDG PET study.
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Dutour A, Decouvelaere AV, Monteil J, Duclos ME, Roualdes O, Rousseau R, Marec-Bérard P. 18F-FDG PET SUVmax Correlates with Osteosarcoma Histologic Response to Neoadjuvant Chemotherapy: Preclinical Evaluation in an Orthotopic Rat Model. J Nucl Med 2009; 50:1533-40. [DOI: 10.2967/jnumed.109.062356] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Nodal status of malignant lymphoma in pelvic and retroperitoneal lymphatic pathways: PET/CT. ACTA ACUST UNITED AC 2009; 35:232-40. [PMID: 19370298 DOI: 10.1007/s00261-009-9516-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
Nodal involvement of abdominal lymphatic pathways occurs in a number of histologic subtypes of malignant lymphoma. The histologic diagnosis of abnormal uptake in abdominal lymphatic pathways includes mainly non-Hodgkin lymphoma with B-cell lineage and Hodgkin lymphoma. Initial involvement of pelvic and retroperitoneal lymphatic pathways can result from a variety of underlying non-Hodgkin's lymphoma: follicular lymphoma, diffuse large B-cell lymphoma, marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type, and mantle cell lymphoma. The diagnosis of these clinical entities requires various imaging techniques, including fluorine-18-fluorodeoxyglucose ((18)FDG) positron emission tomography/computed tomography (PET/CT), computed tomography, (67)Gallium scintigraphy, and magnetic resonance imaging (MRI). Specific symptoms of these diseases are often lacking, but intense (18)FDG accumulation on PET/CT may be a marker of disease activity. Interpretation of the presence of and the specific pattern of (18)FDG uptake may obviate the need for invasive biopsy. However, distinction of abnormal uptake is often difficult to determine because focal accumulation of (18)FDG in the urinary tract or intestine mimics nodal involvement in the pelvic and retroperitoneal lymphatic pathways. In this review, specific conditions causing nodal involvement of pelvic and retroperitoneal lymphatic pathways in patients with malignant lymphoma that may impact diagnostic and treatment decisions are highlighted.
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Groves AM, Win T, Screaton NJ, Berovic M, Endozo R, Booth H, Kayani I, Menezes LJ, Dickson JC, Ell PJ. Idiopathic pulmonary fibrosis and diffuse parenchymal lung disease: implications from initial experience with 18F-FDG PET/CT. J Nucl Med 2009; 50:538-45. [PMID: 19289428 DOI: 10.2967/jnumed.108.057901] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED The purpose of this study was to evaluate integrated (18)F-FDG PET/CT in patients with idiopathic pulmonary fibrosis (IPF) and diffuse parenchymal lung disease (DPLD). METHODS Thirty-six consecutive patients (31 men and 5 women; mean age +/- SD, 68.7 +/- 9.4 y) with IPF (n = 18) or other forms of DPLD (n = 18) were recruited for PET/CT and high-resolution CT (HRCT), acquired on the same instrument. The maximal pulmonary (18)F-FDG metabolism was measured as a standardized uptake value (SUV(max)). At this site, the predominant lung parenchyma HRCT pattern was defined for each patient: ground-glass or reticulation/honeycombing. Patients underwent a global health assessment and pulmonary function tests. RESULTS Raised pulmonary (18)F-FDG metabolism in 36 of 36 patients was observed. The parenchymal pattern on HRCT at the site of maximal (18)F-FDG metabolism was predominantly ground-glass (7/36), reticulation/honeycombing (26/36), and mixed (3/36). The mean SUV(max) in patients with ground-glass and mixed patterns was 2.0 +/- 0.4, and in reticulation/honeycombing it was 3.0 +/- 1.0 (Mann-Whitney U test, P = 0.007). The mean SUV(max) in patients with IPF was 2.9 +/- 1.1, and in other DPLD it was 2.7 +/- 0.9 (Mann-Whitney U test, P = 0.862). The mean mediastinal lymph node SUV(max) (2.7 +/- 1.3) correlated with pulmonary SUV(max) (r = 0.63, P < 0.001). Pulmonary (18)F-FDG uptake correlated with the global health score (r = 0.50, P = 0.004), forced vital capacity (r = 0.41, P = 0.014), and transfer factor (r = 0.37, P = 0.042). CONCLUSION Increased pulmonary (18)F-FDG metabolism in all patients with IPF and other forms of DPLD was observed. Pulmonary (18)F-FDG uptake predicts measurements of health and lung physiology in these patients. (18)F-FDG metabolism was higher when the site of maximal uptake corresponded to areas of reticulation/honeycomb on HRCT than to those with ground-glass patterns.
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Affiliation(s)
- Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, United Kingdom
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Diagnostic value of PET/CT for the staging and restaging of pediatric tumors. Eur J Nucl Med Mol Imaging 2008; 36:23-36. [DOI: 10.1007/s00259-008-0911-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 07/16/2008] [Indexed: 10/21/2022]
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The Netherlands protocol for standardisation and quantification of FDG whole body PET studies in multi-centre trials. Eur J Nucl Med Mol Imaging 2008; 35:2320-33. [PMID: 18704407 DOI: 10.1007/s00259-008-0874-2] [Citation(s) in RCA: 304] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 06/11/2008] [Indexed: 01/17/2023]
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Lammertsma AA, Boellaard R, Hoekstra OS. Quantitative Issues in Response Measurement by PET. PET Clin 2008; 3:5-11. [DOI: 10.1016/j.cpet.2008.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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