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Mingels C, Nalbant H, Sari H, Godinez F, Sen F, Spencer B, Esteghamat NS, Tuscano JM, Nardo L. Long-Axial Field-of-View PET Imaging in Patients with Lymphoma: Challenges and Opportunities. PET Clin 2024; 19:495-504. [PMID: 38969563 DOI: 10.1016/j.cpet.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
[18F]fluoro-2-deoxy-d-glucose PET/computed tomography has been implemented in the management of patients with lymphoma, offering real-time metabolic information on lymphoma with the promise of more accurate staging, treatment response assessment, prognostication, and early detection of disease recurrence. The clinical management of lymphoproliferative disease has recently, rapidly evolved from initial chemotherapeutic to the use of immunotherapy, targeted agents, and to the use of chimeric antigen receptor T-cell therapies. The implementation of these new systems and imaging protocols together with new tracer development creates, in the field of lymphoproliferative disease, both opportunities and challenges that will be detailed in this comprehensive literature review.
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Affiliation(s)
- Clemens Mingels
- Department of Radiology, University of California Davis, Sacramento, CA, USA; Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Hande Nalbant
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - Hasan Sari
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Siemens Healthineers International AG, Zurich, Switzerland
| | - Felipe Godinez
- Department of Radiology, University of California Davis, Sacramento, CA, USA; UC Cavis Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA
| | - Fatma Sen
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - Benjamin Spencer
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - Naseem S Esteghamat
- Division of Malignant Hematology, Cellular Therapy & Transplantation, Department of Internal Medicine, University of California Davis, Sacramento, CA, USA
| | - Joseph M Tuscano
- Division of Malignant Hematology, Cellular Therapy & Transplantation, Department of Internal Medicine, University of California Davis, Sacramento, CA, USA
| | - Lorenzo Nardo
- Department of Radiology, University of California Davis, Sacramento, CA, USA
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Mingels C, Spencer BA, Nalbant H, Omidvari N, Rokni M, Rominger A, Sen F, Cherry SR, Badawi RD, Abdelhafez YG, Nardo L. Dose Reduction in Pediatric Oncology Patients with Delayed Total-Body [ 18F]FDG PET/CT. J Nucl Med 2024; 65:1101-1106. [PMID: 38664017 PMCID: PMC11218730 DOI: 10.2967/jnumed.124.267521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/25/2024] [Indexed: 07/03/2024] Open
Abstract
Our aim was to define a lower limit of reduced injected activity in delayed [18F]FDG total-body (TB) PET/CT in pediatric oncology patients. Methods: In this single-center prospective study, children were scanned for 20 min with TB PET/CT, 120 min after intravenous administration of a 4.07 ± 0.49 MBq/kg dose of [18F]FDG. Five randomly subsampled low-count reconstructions were generated using ¼, ⅛, [Formula: see text], and [Formula: see text] of the counts in the full-dose list-mode reference standard acquisition (20 min), to simulate dose reduction. For the 2 lowest-count reconstructions, smoothing was applied. Background uptake was measured with volumes of interest placed on the ascending aorta, right liver lobe, and third lumbar vertebra body (L3). Tumor lesions were segmented using a 40% isocontour volume-of-interest approach. Signal-to-noise ratio, tumor-to-background ratio, and contrast-to-noise ratio were calculated. Three physicians identified malignant lesions independently and assessed the image quality using a 5-point Likert scale. Results: In total, 113 malignant lesions were identified in 18 patients, who met the inclusion criteria. Of these lesions, 87.6% were quantifiable. Liver SUVmean did not change significantly, whereas a lower signal-to-noise ratio was observed in all low-count reconstructions compared with the reference standard (P < 0.0001) because of higher noise rates. Tumor uptake (SUVmax), tumor-to-background ratio, and total lesion count were significantly lower in the reconstructions with [Formula: see text] and [Formula: see text] of the counts of the reference standard (P < 0.001). Contrast-to-noise ratio and clinical image quality were significantly lower in all low-count reconstructions than with the reference standard. Conclusion: Dose reduction for delayed [18F]FDG TB PET/CT imaging in children is possible without loss of image quality or lesion conspicuity. However, our results indicate that to maintain comparable tumor uptake and lesion conspicuity, PET centers should not reduce the injected [18F]FDG activity below 0.5 MBq/kg when using TB PET/CT in pediatric imaging at 120 min after injection.
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Affiliation(s)
- Clemens Mingels
- Department of Radiology, University of California Davis, Sacramento, California;
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin A Spencer
- Department of Radiology, University of California Davis, Sacramento, California
| | - Hande Nalbant
- Department of Radiology, University of California Davis, Sacramento, California
| | - Negar Omidvari
- Department of Biomedical Engineering, University of California Davis, Davis, California; and
| | - Mehrad Rokni
- Department of Radiology, University of California Davis, Sacramento, California
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fatma Sen
- Department of Radiology, University of California Davis, Sacramento, California
| | - Simon R Cherry
- Department of Radiology, University of California Davis, Sacramento, California
- Department of Biomedical Engineering, University of California Davis, Davis, California; and
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis, Sacramento, California
- Department of Biomedical Engineering, University of California Davis, Davis, California; and
| | - Yasser G Abdelhafez
- Department of Radiology, University of California Davis, Sacramento, California
- Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Lorenzo Nardo
- Department of Radiology, University of California Davis, Sacramento, California
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Ji X, Dong A, Zhu Y. Intraureteral Metastasis From Colon Cancer Mimicking Primary Ureteral Carcinoma on FDG PET/CT. Clin Nucl Med 2024:00003072-990000000-01160. [PMID: 38861423 DOI: 10.1097/rlu.0000000000005314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
ABSTRACT Hematogenous or lymphatic intraureteral metastasis from distant primary cancer is very rare. We present contrast-enhanced CT and FDG PET/CT findings in a case of intraureteral metastasis from colonic adenocarcinoma 3 years after colectomy. The intraureteral showed moderate enhancement on contrast-enhanced CT and increased FDG uptake on PET/CT mimicking a primary ureteral carcinoma. This case suggests that metastatic tumor of the ureter should be considered in the differential diagnosis in patients with hypermetabolic ureteral lesion and known malignancy.
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Affiliation(s)
- Xia Ji
- From the Department of Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Aisheng Dong
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University, and
| | - Yan Zhu
- Department of Pathology, No. 905 Hospital of People's Liberation Army Navy and The First Affiliated Hospital of Naval Medical University, Shanghai, China
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Ji X, Dong A, Wang Y. FDG PET/CT in a Case of Isolated Gastric Metastasis From Pancreatic Ductal Adenocarcinoma. Clin Nucl Med 2024; 49:377-378. [PMID: 38377374 DOI: 10.1097/rlu.0000000000005099] [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: 02/22/2024]
Abstract
ABSTRACT Hematogenous gastric metastasis from pancreatic cancer is extremely rare. We describe FDG PET/CT findings in a case of isolated hematogenous gastric metastasis from pancreatic cancer with significantly elevated serum carbohydrate antigen 19-9 level. The gastric metastasis showed intense focal FDG uptake mimicking a primary tumor. The elevation of serum carbohydrate antigen 19-9 level may be useful as an aid in the differential diagnosis.
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Affiliation(s)
- Xia Ji
- From the Department of Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Naval Medical University
| | - Yang Wang
- Department of Pathology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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Homburg S, Christensen CB, Pedersen M, Sørensen SG, Donia M, Svane IM, Hendel HW, Ellebaek E. Prospective Assessment of Fluorine-18-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography (FDG-PET/CT) for Early Identification of Checkpoint-Inhibitor-Induced Pseudoprogression. Cancers (Basel) 2024; 16:964. [PMID: 38473325 DOI: 10.3390/cancers16050964] [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: 02/03/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
The activity of immune checkpoint inhibitors (ICIs) in patients with metastatic melanoma is often monitored using fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scans. However, distinguishing disease progression (PD) from pseudoprogression (PsPD), where increased FDG uptake might reflect immune cell activity rather than tumor growth, remains a challenge. This prospective study compared the efficacy of dual-time point (DTP) FDG-PET/CT with modified response criteria (PERCIMT) in differentiating PsPD from PD. From July 2017-January 2021, 41 patients suspected to have PsPD on an evaluation scan were prospectively included (29 evaluable). A subsequent DTP FDG-PET/CT scan was conducted within 14 days, followed by a confirmatory FDG-PET/CT scan. Additionally, PERCIMT were applied. DTP FDG-PET/CT identified 24% with PsPD and 76% with PD. Applying PERCIMT criteria, 69% showed PsPD, while 31% had PD. On follow-up, 10 patients (34%) demonstrated confirmed PsPD, while 19 (66%) exhibited PD. The sensitivity and specificity of DTP FDG-PET/CT were 20% and 74%, respectively, and for PERCIMT this was 80% and 37%, respectively. Our findings suggest limited efficacy of DTP FDG-PET/CT in distinguishing PsPD from PD in ICI-treated patients with metastatic melanoma. The use of PERCIMT could complement clinical assessment and be incorporated in multidisciplinary team conferences for enhanced decision-making.
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Affiliation(s)
- Sif Homburg
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Charlotte Birk Christensen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Magnus Pedersen
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Simon Grund Sørensen
- Department of Molecular Medicine, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Marco Donia
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Inge Marie Svane
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Helle Westergren Hendel
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Eva Ellebaek
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
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Wu Y, Fu F, Meng N, Wang Z, Li X, Bai Y, Zhou Y, Liang D, Zheng H, Yang Y, Wang M, Sun T. The role of dynamic, static, and delayed total-body PET imaging in the detection and differential diagnosis of oncological lesions. Cancer Imaging 2024; 24:2. [PMID: 38167538 PMCID: PMC10759379 DOI: 10.1186/s40644-023-00649-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Commercialized total-body PET scanners can provide high-quality images due to its ultra-high sensitivity. We compared the dynamic, regular static, and delayed 18F-fluorodeoxyglucose (FDG) scans to detect lesions in oncologic patients on a total-body PET/CT scanner. MATERIALS & METHODS In all, 45 patients were scanned continuously for the first 60 min, followed by a delayed acquisition. FDG metabolic rate was calculated from dynamic data using full compartmental modeling, whereas regular static and delayed SUV images were obtained approximately 60- and 145-min post-injection, respectively. The retention index was computed from static and delayed measures for all lesions. Pearson's correlation and Kruskal-Wallis tests were used to compare parameters. RESULTS The number of lesions was largely identical between the three protocols, except MRFDG and delayed images on total-body PET only detected 4 and 2 more lesions, respectively (85 total). FDG metabolic rate (MRFDG) image-derived contrast-to-noise ratio and target-to-background ratio were significantly higher than those from static standardized uptake value (SUV) images (P < 0.01), but this is not the case for the delayed images (P > 0.05). Dynamic protocol did not significantly differentiate between benign and malignant lesions just like regular SUV, delayed SUV, and retention index. CONCLUSION The potential quantitative advantages of dynamic imaging may not improve lesion detection and differential diagnosis significantly on a total-body PET/CT scanner. The same conclusion applied to delayed imaging. This suggested the added benefits of complex imaging protocols must be weighed against the complex implementation in the future. CLINICAL RELEVANCE Total-body PET/CT was known to significantly improve the PET image quality due to its ultra-high sensitivity. However, whether the dynamic and delay imaging on total-body scanner could show additional clinical benefits is largely unknown. Head-to-head comparison between two protocols is relevant to oncological management.
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Affiliation(s)
- Yaping Wu
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Fangfang Fu
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Nan Meng
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Zhenguo Wang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Xiaochen Li
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Yan Bai
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Yun Zhou
- School of Biomedical Engineering, Shanghai Tech University, Shanghai, People's Republic of China
| | - Dong Liang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Yongfeng Yang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
- Laboratory of Brain Science and Brain-Like Intelligence TechnologyInstitute for Integrated Medical Science and Engineering, Henan Academy of Sciences, Zhengzhou, Henan, People's Republic of China
| | - Tao Sun
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China.
- Research Institute of Innovative Medical Equipment, United Imaging, Shenzhen, Guangdong, China.
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7
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Ji X, Dong A, Wang Y. FDG PET/CT in Pancreatic Ductal Adenocarcinoma Arising From a Heterotopic Pancreas of the Pylorus. Clin Nucl Med 2024; 49:e42-e44. [PMID: 37976432 DOI: 10.1097/rlu.0000000000004952] [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: 11/19/2023]
Abstract
ABSTRACT Malignant transformation of heterotopic pancreas is extremely rare. We describe FDG PET/CT findings in a case of pancreatic ductal adenocarcinoma arising from a heterotopic pancreas in the submucosa of the pylorus with peripyloric lymph node metastasis and elevated serum carbohydrate antigen 19-9 level. The heterotopic pancreatic adenocarcinoma showed intense FDG uptake, and the peripyloric lymph node metastasis showed mild FDG uptake. This case indicates that heterotopic pancreatic adenocarcinoma should be included in the differential diagnosis of FDG-avid gastric submucosal lesions, especially in patients with elevated serum carbohydrate antigen 19-9 level.
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Affiliation(s)
- Xia Ji
- From the Department of Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Naval Medical University
| | - Yang Wang
- Department of Pathology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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Boanova LG, Altmayer S, Watte G, Raupp AA, Francisco MZ, De Oliveira GS, Hochhegger B, Andrade RGF. Detection of Liver Lesions in Colorectal Cancer Patients Using 18F-FDG PET/CT Dual-Time-Point Scan Imaging. Cancers (Basel) 2023; 15:5403. [PMID: 38001662 PMCID: PMC10670707 DOI: 10.3390/cancers15225403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic performance of dual-time-point fluorine-18-fluorodeoxyglucose positron emission computed tomography/computed tomography (18F-FDG PET/CT) compared to conventional early imaging for detecting colorectal liver metastases (CRLM) in colorectal cancer (CRC) patients. METHODS One hundred twenty-four consecutive CRC patients underwent dual-time-point imaging scans on a retrospective basis. Histopathological confirmation and/or clinical follow-up were accepted as the gold standard. Standard uptake values (SUV), signal-to-noise ratio (SNR), retention index (RI), tumor-to-normal liver ratio (TNR), and lesion sizes were measured for early and delayed PET scans. The diagnostic performance of early and delayed images was calculated on a per-patient basis and compared using McNemar's test. RESULTS Among the 124 patients, 57 (46%) had CRLM, 6 (4.8%) had benign lesions, and 61 (49.2%) had no concerning lesions detected. Smaller CRLM lesions (<5 cm3) showed significantly higher uptake in the delayed scans relative to early imaging (p < 0.001). The SUV and TNR increased significantly in delayed imaging of all metastatic lesions (p < 0.001). The retention index of all CRLM was high (40.8%), especially for small lesions (54.8%). A total of 177 lesions in delayed images and 124 in standard early images were identified. In a per-patient analysis, delayed imaging had significantly higher sensitivity (100% vs. 87.7%) and specificity (91.0% vs. 94.0%) compared to early imaging (p-value = 0.04). CONCLUSIONS The detection of liver lesions using dual-time-point PET/CT scan improves the sensitivity and specificity for the detection of colorectal liver metastasis.
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Affiliation(s)
- Luciane G. Boanova
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
- Department of Nuclear Medicine, Hospital Mae de Deus, Av. Jose de Alencar 286, Porto Alegre 90880-481, Brazil;
| | - Stephan Altmayer
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
| | - Guilherme Watte
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite 245, Porto Alegre 90050-170, Brazil; (G.W.); (M.Z.F.)
| | - Ana Amelia Raupp
- Department of Nuclear Medicine, Hospital Mae de Deus, Av. Jose de Alencar 286, Porto Alegre 90880-481, Brazil;
| | - Martina Zaguini Francisco
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite 245, Porto Alegre 90050-170, Brazil; (G.W.); (M.Z.F.)
| | - Guilherme Strieder De Oliveira
- School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2400—Santa Cecília, Porto Alegre 90035-003, Brazil;
| | - Bruno Hochhegger
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
| | - Rubens G. F. Andrade
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
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Triumbari EKA, Rufini V, Mingels C, Rominger A, Alavi A, Fanfani F, Badawi RD, Nardo L. Long Axial Field-of-View PET/CT Could Answer Unmet Needs in Gynecological Cancers. Cancers (Basel) 2023; 15:2407. [PMID: 37173874 PMCID: PMC10177015 DOI: 10.3390/cancers15092407] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Gynecological malignancies currently affect about 3.5 million women all over the world. Imaging of uterine, cervical, vaginal, ovarian, and vulvar cancer still presents several unmet needs when using conventional modalities such as ultrasound, computed tomography (CT), magnetic resonance, and standard positron emission tomography (PET)/CT. Some of the current diagnostic limitations are represented by differential diagnosis between inflammatory and cancerous findings, detection of peritoneal carcinomatosis and metastases <1 cm, detection of cancer-associated vascular complications, effective assessment of post-therapy changes, as well as bone metabolism and osteoporosis assessment. As a result of recent advances in PET/CT instrumentation, new systems now offer a long-axial field-of-view (LAFOV) to image between 106 cm and 194 cm (i.e., total-body PET) of the patient's body simultaneously and feature higher physical sensitivity and spatial resolution compared to standard PET/CT systems. LAFOV PET could overcome the forementioned limitations of conventional imaging and provide valuable global disease assessment, allowing for improved patient-tailored care. This article provides a comprehensive overview of these and other potential applications of LAFOV PET/CT imaging for patients with gynecological malignancies.
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Affiliation(s)
- Elizabeth Katherine Anna Triumbari
- Nuclear Medicine Unit, G-STeP Radiopharmacy Research Core Facility, Department of Radiology, Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Department of Radiology, Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
- Section of Nuclear Medicine, Department of Radiological Sciences, Radiotherapy and Haematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Francesco Fanfani
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Section of Obstetrics and Gynaecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Ramsey D. Badawi
- Department of Radiology, University of California Davis, Sacramento, CA 95819, USA
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA
| | - Lorenzo Nardo
- Department of Radiology, University of California Davis, Sacramento, CA 95819, USA
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10
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Lu HH, Chiu NT. Dual-Time-Point 18 F-FDG PET/CT for Differentiating a Chest Wall Hemangioma From a Malignant Metastasis. Clin Nucl Med 2023; 48:332-334. [PMID: 36728134 DOI: 10.1097/rlu.0000000000004536] [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: 02/03/2023]
Abstract
ABSTRACT Dual-time-point 18 F-flluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) can be used to differentiate benign vascular tumors from other malignant growths. We present the case of a 70-year-old woman with a history of cervical carcinoma who was referred for PET/CT to examine a left chest wall tumor noted on CT, which involved the adjacent rib and pleura, thus raising the suspicion of metastasis. The chest wall tumor demonstrated moderate FDG uptake and further decreased uptake at the delayed-phase scanning, corresponding to biodistribution of FDG in the blood pool. These findings indicated a benign hemangioma rather than a metastasis.
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Affiliation(s)
- Hsi-Huei Lu
- From the Division of Nuclear Medicine, Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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11
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Ruan D, Sun L. Diagnostic Performance of PET/MRI in Breast Cancer: A Systematic Review and Bayesian Bivariate Meta-analysis. Clin Breast Cancer 2023; 23:108-124. [PMID: 36549970 DOI: 10.1016/j.clbc.2022.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/07/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION By performing a systematic review and meta-analysis, the diagnostic value of 18F-FDG PET/MRI in breast lesions, lymph nodes, and distant metastases was assessed, and the merits and demerits of PET/MRI in the application of breast cancer were comprehensively reviewed. METHODS Breast cancer-related studies using 18F-FDG PET/MRI as a diagnostic tool published before September 12, 2022 were included. The pooled sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under the curve (AUC) were calculated using Bayesian bivariate meta-analysis in a lesion-based and patient-based manner. RESULTS We ultimately included 24 studies (including 1723 patients). Whether on a lesion-based or patient-based analysis, PET/MRI showed superior overall pooled sensitivity (0.95 [95% CI: 0.92-0.98] & 0.93 [95% CI: 0.88-0.98]), specificity (0.94 [95% CI: 0.90-0.97] & 0.94 [95% CI: 0.92-0.97]), LDOR (5.79 [95% CI: 4.95-6.86] & 5.64 [95% CI: 4.58-7.03]) and AUC (0.98 [95% CI: 0.94-0.99] & 0.98[95% CI: 0.92-0.99]) for diagnostic applications in breast cancer. In the specific subgroup analysis, PET/MRI had high pooled sensitivity and specificity for the diagnosis of breast lesions and distant metastatic lesions and was especially excellent for bone lesions. PET/MRI performed poorly for diagnosing axillary lymph nodes but was better than for lymph nodes at other sites (pooled sensitivity, specificity, LDOR, AUC: 0.86 vs. 0.58, 0.90 vs. 0.82, 4.09 vs. 1.98, 0.89 vs. 0.84). CONCLUSION 18F-FDG PET/MRI performed excellently in diagnosing breast lesions and distant metastases. It can be applied to the initial diagnosis of suspicious breast lesions, accurate staging of breast cancer patients, and accurate restaging of patients with suspected recurrence.
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Affiliation(s)
- Dan Ruan
- Department of Nuclear Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Long Sun
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China.
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12
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Yu L, Huang S, Wu S, Yue J, Yin L, Lin Z. Comparison of 18F-FDG PET/CT imaging with different dual time 18F-FDG PET/CT with forced diuresis in clinical diagnosis of prostate cancer. Medicine (Baltimore) 2023; 102:e32331. [PMID: 36637950 PMCID: PMC9839298 DOI: 10.1097/md.0000000000032331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to compare the capability of different dual time (interval 1, 2, 3, or 4 hours) 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with forced diuresis to diagnose prostate cancer (PCa). A retrospective review of 273 male patients from March 2009 to June 2019, with any focal 18F-FDG uptake in the prostate gland during PET/CT imaging. Early PET/CT imaging was performed 60 minutes after FDG injection. Delayed imaging was performed 1 to 4 hours after diuretic injection. For prostate lesions with increased 18F-FDG uptake, a spheroid-shaped volume of interest was drawn, including the entire lesion, and the maximum standard uptake value (SUVmax) of the lesion was measured. The SUVmax > 2.5 after delayed imaging and the retention index > 15% were used as the diagnostic criteria for PET/CT in the diagnosis of PCa. Otherwise, it was diagnosed as the benign prostate disease. The final diagnosis was based on histological examination, associated imaging studies, or/and clinical follow-up. The results of inter-group comparison showed that the SUVmax of 1-, 2-, 3-, and 4-hour delayed imaging after diuresis in PCa group was significantly higher than that in control group (P < .05), but there was no statistical difference in SUVmax of early imaging between PCa and control group (P > .05). And the retention index of PCa group that delayed 1, 2, 3, and 4 hours after diuresis were significantly higher than those of control group, respectively (P < .05). The diagnostic sensitivity of imaging delayed 1, 2, 3, and 4 hours after diuresis was 68.8%, 81.2%, 85.7 %, and 71.4%, the specificity was 52.5%, 74.5%, 70.6%, and 65.0%, and the accuracy was respectively 58.2%, 77.4%, 76.4%, and 67.6%, the positive predictive values were 44.0%, 68.9%, 64.3%, and 58.8%, and the negative predictive value were 75.6%, 85.4%, 88.9%, and 76.5%, respectively. 18F-FDG PET/CT imaging as an imaging tool lacks certain specificity in the diagnosis of PCa, regardless of whether the imaging is delayed. The main advantage of delayed diuretic imaging in PCa is that it can significantly improve the sensitivity, especially the diagnostic effect delayed 2 hours after diuresis is better.
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Affiliation(s)
- Longhua Yu
- Department of Nuclear Medicine, Hospital 971 of The Navy of Chinese PLA, Qingdao, Shandong, China
| | - Shiming Huang
- Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
| | - Siyu Wu
- Department of obstetrics and gynecology, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
| | - Jianlan Yue
- Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
| | - Liang Yin
- Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
| | - Zhichun Lin
- Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
- * Correspondence: Zhichun Lin, Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, No.220 Chenglin Road, Hedong District, Tianjin 300162, China (e-mail: )
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13
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Calabro’ A, Abdelhafez YG, Triumbari EKA, Spencer BA, Chen MS, Albano D, Cassim CR, Bertagna F, Dondi F, Cherry SR, Badawi RD, Sen F, Nardo L. 18F-FDG gallbladder uptake: observation from a total-body PET/CT scanner. BMC Med Imaging 2023; 23:9. [PMID: 36627570 PMCID: PMC9832624 DOI: 10.1186/s12880-022-00957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Total-body positron emission tomography/computed tomography (PET/CT) scanners are characterized by higher signal collection efficiency and greater spatial resolution compared to conventional scanners, allowing for delayed imaging and improved image quality. These advantages may also lead to better detection of physiological processes that diagnostic imaging professionals should be aware of. The gallbladder (GB) is not usually visualized as an 18F-2-fluorodeoxyglucose (18F-FDG)-avid structure in routine clinical PET/CT studies; however, with the total-body PET/CT, we have been increasingly visualizing GB activity without it being involved in an inflammatory or neoplastic process. The aim of this study was to report visualization rates and characteristics of GB 18F-FDG uptake observed in both healthy and oncological subjects scanned on a total-body PET/CT system. MATERIALS AND METHODS Scans from 73 participants (48 healthy and 25 with newly diagnosed lymphoma) who underwent 18F-FDG total-body PET/CT were retrospectively reviewed. Subjects were scanned at multiple timepoints up to 3 h post-injection. Gallbladder 18F-FDG activity was graded using liver uptake as a reference, and the pattern was qualified as present in the wall, lumen, or both. Participants' characteristics, such as age, sex, body-mass index, blood glucose, and other clinical parameters, were collected to assess for any significant correlation with GB 18F-FDG uptake. RESULTS All 73 subjects showed GB uptake at one or more imaging timepoints. An increase in uptake intensity overtime was observed up until the 180-min scan, and the visualization rate of GB 18F-FDG uptake was 100% in the 120- and 180-min post-injection scans. GB wall uptake was detected in a significant number of patients (44/73, 60%), especially at early timepoint scans, whereas luminal activity was detected in 71/73 (97%) subjects, especially at later timepoint scans. No significant correlation was found between GB uptake intensity/pattern and subjects' characteristics. CONCLUSION The consistent observation of GB 18F-FDG uptake recorded in this study in healthy participants and subjects with a new oncological diagnosis indicates that this is a normal physiologic finding rather than representing an exception.
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Affiliation(s)
- Anna Calabro’
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA
| | - Yasser G. Abdelhafez
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA ,grid.252487.e0000 0000 8632 679XNuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Asyut, Egypt
| | - Elizabeth K. A. Triumbari
- grid.414603.4Nuclear Medicine Unit, TracerGLab, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Benjamin A. Spencer
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA ,grid.27860.3b0000 0004 1936 9684Department of Biomedical Engineering, University of California Davis, Davis, CA USA
| | - Moon S. Chen
- grid.27860.3b0000 0004 1936 9684Department of Internal Medicine, University of California Davis, Davis, CA USA
| | - Domenico Albano
- grid.7637.50000000417571846Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Christopher R. Cassim
- Department of Radiology, Sangre Grande Hospital, Eastern Regional Health Authority, Sangre Grande, Trinidad and Tobago
| | - Francesco Bertagna
- grid.7637.50000000417571846Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Dondi
- grid.7637.50000000417571846Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Simon R. Cherry
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA ,grid.27860.3b0000 0004 1936 9684Department of Biomedical Engineering, University of California Davis, Davis, CA USA
| | - Ramsey D. Badawi
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA ,grid.27860.3b0000 0004 1936 9684Department of Biomedical Engineering, University of California Davis, Davis, CA USA
| | - Fatma Sen
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA
| | - Lorenzo Nardo
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA
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14
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Value of dynamic metabolic curves and artificial neural network prediction models based on 18F-FDG PET/CT multiphase imaging in differentiating nonspecific solitary pulmonary lesions: a pilot study. Nucl Med Commun 2022; 43:1204-1216. [DOI: 10.1097/mnm.0000000000001627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Abstract
ABSTRACT Prostate metastasis from gastric cancer is rare. We report MRI and FDG PET/CT findings in a case with prostate metastasis from gastric cancer. In this case, the prostate metastasis was the first manifestation of the gastric cancer. This case demonstrates the usefulness of FDG PET/CT in identifying the primary gastric cancer and its contribution for an accurate staging. Familiarity with the FDG PET/CT findings of the prostate metastasis may be useful for the differential diagnosis of the hypermetabolic prostate lesions.
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Affiliation(s)
- Xia Ji
- From the Department of Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Navy Medical University, Shanghai, China
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16
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Sari H, Teimoorisichani M, Mingels C, Alberts I, Panin V, Bharkhada D, Xue S, Prenosil G, Shi K, Conti M, Rominger A. Quantitative evaluation of a deep learning-based framework to generate whole-body attenuation maps using LSO background radiation in long axial FOV PET scanners. Eur J Nucl Med Mol Imaging 2022; 49:4490-4502. [PMID: 35852557 PMCID: PMC9606046 DOI: 10.1007/s00259-022-05909-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/10/2022] [Indexed: 12/19/2022]
Abstract
Purpose Attenuation correction is a critically important step in data correction in positron emission tomography (PET) image formation. The current standard method involves conversion of Hounsfield units from a computed tomography (CT) image to construct attenuation maps (µ-maps) at 511 keV. In this work, the increased sensitivity of long axial field-of-view (LAFOV) PET scanners was exploited to develop and evaluate a deep learning (DL) and joint reconstruction-based method to generate µ-maps utilizing background radiation from lutetium-based (LSO) scintillators. Methods Data from 18 subjects were used to train convolutional neural networks to enhance initial µ-maps generated using joint activity and attenuation reconstruction algorithm (MLACF) with transmission data from LSO background radiation acquired before and after the administration of 18F-fluorodeoxyglucose (18F-FDG) (µ-mapMLACF-PRE and µ-mapMLACF-POST respectively). The deep learning-enhanced µ-maps (µ-mapDL-MLACF-PRE and µ-mapDL-MLACF-POST) were compared against MLACF-derived and CT-based maps (µ-mapCT). The performance of the method was also evaluated by assessing PET images reconstructed using each µ-map and computing volume-of-interest based standard uptake value measurements and percentage relative mean error (rME) and relative mean absolute error (rMAE) relative to CT-based method. Results No statistically significant difference was observed in rME values for µ-mapDL-MLACF-PRE and µ-mapDL-MLACF-POST both in fat-based and water-based soft tissue as well as bones, suggesting that presence of the radiopharmaceutical activity in the body had negligible effects on the resulting µ-maps. The rMAE values µ-mapDL-MLACF-POST were reduced by a factor of 3.3 in average compared to the rMAE of µ-mapMLACF-POST. Similarly, the average rMAE values of PET images reconstructed using µ-mapDL-MLACF-POST (PETDL-MLACF-POST) were 2.6 times smaller than the average rMAE values of PET images reconstructed using µ-mapMLACF-POST. The mean absolute errors in SUV values of PETDL-MLACF-POST compared to PETCT were less than 5% in healthy organs, less than 7% in brain grey matter and 4.3% for all tumours combined. Conclusion We describe a deep learning-based method to accurately generate µ-maps from PET emission data and LSO background radiation, enabling CT-free attenuation and scatter correction in LAFOV PET scanners. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05909-3.
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Affiliation(s)
- Hasan Sari
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
| | | | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | | | - Song Xue
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - George Prenosil
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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17
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Viswanath V, Sari H, Pantel AR, Conti M, Daube-Witherspoon ME, Mingels C, Alberts I, Eriksson L, Shi K, Rominger A, Karp JS. Abbreviated scan protocols to capture 18F-FDG kinetics for long axial FOV PET scanners. Eur J Nucl Med Mol Imaging 2022; 49:3215-3225. [PMID: 35278108 PMCID: PMC10695012 DOI: 10.1007/s00259-022-05747-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/25/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Kinetic parameters from dynamic 18F-fluorodeoxyglucose (FDG) imaging offer complementary insights to the study of disease compared to static clinical imaging. However, dynamic imaging protocols are cumbersome due to the long acquisition time. Long axial field-of-view (LAFOV) PET scanners (> 70 cm) have two advantages for dynamic imaging over clinical PET scanners with a standard axial field-of-view (SAFOV; 16-30 cm). The large axial coverage enables multi-organ dynamic imaging in a single bed position, and the high sensitivity may enable clinically routine abbreviated dynamic imaging protocols. METHODS In this work, we studied two abbreviated protocols using data from a 65-min dynamic 18F-FDG scan: (A) dynamic imaging immediately post-injection (p.i.) for variable durations, and (B) dynamic imaging immediately p.i. for variable durations plus a 1-h p.i. (5-min-long) datapoint. Nine cancer patients were imaged on the Biograph Vision Quadra (Siemens Healthineers). Time-activity curves over the lesions (N = 39) were fitted using the Patlak graphical analysis and a 2-tissue-compartment (2C, k4 = 0) model for variable scan durations (5-60 min). Kinetic parameters from the complete dataset served as the reference. Lesions from all cancers were grouped into low, medium, and high flux groups, and bias and precision of Ki (Patlak) and Ki, K1, k2, and k3 (2C) were calculated for each group. RESULTS Using only early dynamic data with the 2C (or Patlak) model, accurate quantification of Ki required at least 50 (or 55) min of dynamic data for low flux lesions, at least 30 (or 40) min for medium flux lesions, and at least 15 (or 20) min for high flux lesions to achieve both 10% bias and precision. The addition of the final (5-min) datapoint allowed for accurate quantification of Ki with a bias and precision of 10% using only 10-15 min of early dynamic data for either model. CONCLUSION Dynamic imaging for 10-15 min immediately p.i. followed by a 5-min scan at 1-h p.i can accurately and precisely quantify 18F-FDG on a long axial FOV scanner, potentially allowing for more widespread use of dynamic 18F-FDG imaging.
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Affiliation(s)
- Varsha Viswanath
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hasan Sari
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 18, 3010, Bern, Switzerland
| | - Austin R Pantel
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 18, 3010, Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 18, 3010, Bern, Switzerland
| | - Lars Eriksson
- Siemens Medical Solutions, USA Inc., Knoxville, TN, USA
- Department of Oncology and Pathology, Medical Radiation Physics, Karolinska Institutet, Stockholm, Sweden
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 18, 3010, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 18, 3010, Bern, Switzerland
| | - Joel S Karp
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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Soffers F, Helsen N, Van den Wyngaert T, Carp L, Hoekstra OS, Goethals L, Martens M, Deben K, Spaepen K, De Bree R, De Geeter F, Zwezerijnen GJC, Van Laer C, Maes A, Lenssen O, Stroobants S. Dual time point imaging in locally advanced head and neck cancer to assess residual nodal disease after chemoradiotherapy. EJNMMI Res 2022; 12:34. [PMID: 35695940 PMCID: PMC9192834 DOI: 10.1186/s13550-022-00905-y] [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: 03/17/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background FDG-PET/CT has a high negative predictive value to detect residual nodal disease in patients with locally advanced squamous cell head and neck cancer after completing concurrent chemoradiotherapy (CCRT). However, the positive predictive value remains suboptimal due to inflammation after radiotherapy, generating unnecessary further investigations and possibly even surgery. We report the results of a preplanned secondary end point of the ECLYPS study regarding the potential advantages of dual time point FDG-PET/CT imaging (DTPI) in this setting. Standardized dedicated head and neck FDG-PET/CT images were obtained 12 weeks after CCRT at 60 and 120 min after tracer administration. We performed a semiquantitative assessment of lymph nodes, and the retention index (RI) was explored to optimize diagnostic performance. The reference standard was histology, negative FDG-PET/CT at 1 year, or > 2 years of clinical follow-up. The time-dependent area under the receiver operator characteristics (AUROC) curves was calculated. Results In total, 102 subjects were eligible for analysis. SUV values increased in malignant nodes (median SUV1 = 2.6 vs. SUV2 = 2.7; P = 0.04) but not in benign nodes (median SUV1 = 1.8 vs. SUV2 = 1.7; P = 0.28). In benign nodes, RI was negative although highly variable (median RI = − 2.6; IQR 21.2), while in malignant nodes RI was positive (median RI = 12.3; IQR 37.2) and significantly higher (P = 0.018) compared to benign nodes. A combined threshold (SUV1 ≥ 2.2 + RI ≥ 3%) significantly reduced the amount of false-positive cases by 53% (P = 0.02) resulting in an increased specificity (90.8% vs. 80.5%) and PPV (52.9% vs. 37.0%), while sensitivity (60.0% vs. 66.7%) and NPV remained comparably high (92.9% vs. 93.3%). However, AUROC, as overall measure of benefit in diagnostic accuracy, did not significantly improve (P = 0.62). In HPV-related disease (n = 32), there was no significant difference between SUV1, SUV2, and RI in malignant and benign nodes, yet this subgroup was small. Conclusions DTPI did not improve the overall diagnostic accuracy of FDG-PET/CT to detect residual disease 12 weeks after chemoradiation. Due to differences in tracer kinetics between malignant and benign nodes, DTPI improved the specificity, but at the expense of a loss in sensitivity, albeit minimal. Since false negatives at the 12 weeks PET/CT are mainly due to minimal residual disease, DTPI is not able to significantly improve sensitivity, but repeat scanning at a later time (e.g. after 12 months) could possibly solve this problem. Further study is required in HPV-associated disease.
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Affiliation(s)
- Frederik Soffers
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.
| | - Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Otto S Hoekstra
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Michel Martens
- Department of Radiotherapy, AZ Turnhout, Turnhout, Belgium
| | - Kristof Deben
- Department of Otolaryngology, Jessa Hospital, Hasselt, Belgium
| | - Karoline Spaepen
- Department of Nuclear Medicine, Sint Augustinus, Wilrijk, Belgium
| | - Remco De Bree
- Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium.,Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank De Geeter
- Department of Nuclear Medicine, AZ Sint Jan, Brugge, Belgium
| | - G J C Zwezerijnen
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carl Van Laer
- Department Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Olivier Lenssen
- Department of Oral and Maxillofacial Surgery, ZNA Middelheim, Antwerp, Belgium
| | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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19
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Ng Q, Triumbari EKA, Omidvari N, Cherry SR, Badawi RD, Nardo L. Total-body PET/CT - First Clinical Experiences and Future Perspectives. Semin Nucl Med 2022; 52:330-339. [PMID: 35272853 PMCID: PMC9439875 DOI: 10.1053/j.semnuclmed.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 01/26/2023]
Abstract
Total-body PET has come a long way from its first conception to today, with both total-body and long axial field of view (> 1m) scanners now being commercially available world-wide. The conspicuous signal collection efficiency gain, coupled with high spatial resolution, allows for higher sensitivity and improved lesion detection, enhancing several clinical applications not readily available on current conventional PET/CT scanners. This technology can provide (a) reduction in acquisition times with preservation of diagnostic quality images, benefitting specific clinical situations (i.e. pediatric patients) and the use of several existing radiotracers that present transient uptake over time and where small differences in acquisition time can greatly impact interpretation of images; (b) reduction in administered activity with minimal impact on image noise, thus reducing effective dose to the patient, improving staff safety, and helping with logistical concerns for short-lived radionuclides or long-lived radionuclides with poor dosimetry profiles that have had limited use on conventional PET scanners until now; (c) delayed scanning, that has shown to increase the detection of even small and previously occult malignant lesions by improved clearance in regions of significant background activity and by reduced visibility of coexisting inflammatory processes; (d) improvement in image quality, as a consequence of higher spatial resolution and sensitivity of total-body scanners, implying better appreciation of small structures and clinical implications with downstream prognostic consequences for patients; (e) simultaneous total-body dynamic imaging, that allows the measurement of full spatiotemporal distribution of radiotracers, kinetic modeling, and creation of multiparametric images, providing physiologic and biologically relevant data of the entire body at the same time. On the other hand, the higher physical and clinical sensitivity of total-body scanners bring along some limitations and challenges. The strong impact on clinical sensitivity potentially increases the number of false positive findings if the radiologist does not recalibrate interpretation considering the new technique. Delayed scanning causes logistical issues and introduces new interpretation questions for radiologists. Data storage capacity, longer processing and reconstruction time issues are other limitations, but they may be overcome in the near future by advancements in reconstruction algorithms and computing hardware.
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Affiliation(s)
- Quinn Ng
- Department of Radiology, UC Davis, Sacramento, CA, USA
| | - Elizabeth Katherine Anna Triumbari
- Department of Radiology, UC Davis, Sacramento, CA, USA,Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Negar Omidvari
- Department of Biomedical Engineering California Davis, CA, USA
| | - Simon R. Cherry
- Department of Radiology, UC Davis, Sacramento, CA, USA,Department of Biomedical Engineering California Davis, CA, USA
| | - Ramsey D. Badawi
- Department of Radiology, UC Davis, Sacramento, CA, USA,Department of Biomedical Engineering California Davis, CA, USA
| | - Lorenzo Nardo
- Department of Radiology, UC Davis, Sacramento, CA, USA
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20
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Lee SW, Kim SJ. Is Delayed Image of 18F-FDG PET/CT Necessary for Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer Patients? Clin Nucl Med 2022; 47:414-421. [PMID: 35234195 DOI: 10.1097/rlu.0000000000004110] [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: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the diagnostic accuracies of dual-time-point (DTP) 18F-FDG PET/CT for detection of mediastinal lymph node (LN) metastasis in non-small cell lung cancer (NSCLC) patients through a systematic review and meta-analysis. PATIENTS AND METHODS The PubMed, Cochrane database, and EMBASE database, from the earliest available date of indexing through October 31, 2021, were searched for studies evaluating diagnostic performance of DTP 18F-FDG PET/CT for detection of metastatic mediastinal LN in NSCLC patients. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves. RESULTS Ten studies (758 patients) were included in the current study. In patient-based analysis, early image showed a sensitivity of 0.76 and a specificity of 0.75. Delayed image revealed a sensitivity of 0.84 and a specificity of 0.71. In LN-based analysis, early image showed a sensitivity of 0.80 and a specificity of 0.83. Delayed image revealed a sensitivity of 0.84 and a specificity of 0.87. Retention index or %ΔSUVmax is superior to early or delayed images of DTP 18F-FDG PET/CT for detection of mediastinal LN metastasis. CONCLUSIONS Dual-time-point 18F-FDG PET/CT showed a good diagnostic performances for detection of metastatic mediastinal LNs in NSCLC patients. Early and delayed images of DTP 18F-FDG PET/CT revealed similar diagnostic accuracies for LN metastasis. However, retention index or %ΔSUVmax is superior to early or delayed images of DTP 18F-FDG PET/CT for detection of mediastinal LN metastasis in NSCLC patients. Further large multicenter studies would be necessary to substantiate the diagnostic accuracy of DTP 18F-FDG PET/CT for mediastinal LN staging in NSCLC patients.
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Affiliation(s)
- Sang Woo Lee
- From the Department of Nuclear Medicine, Kyungpook National University, Chilgok Hospital and School of Medicine, Daegu
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21
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Zhang J, Li Z, Zhang L, Dong A, Zhu Y. FDG PET/CT in Cryptogenic Multifocal Ulcerating Stenosing Enteropathy. Clin Nucl Med 2022; 47:281-282. [PMID: 34653049 DOI: 10.1097/rlu.0000000000003931] [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: 11/25/2022]
Abstract
ABSTRACT Cryptogenic multifocal ulcerating stenosing enteropathy (CMUSE) is a rare and exclusive small intestine disease, characterized by repeated anemia or obstruction resulting from multiple shallow ulcers with strictures in the small intestine. We present a case of CMUSE showing multiple foci of activity in the small bowel on FDG PET/CT. This case indicates that CMUSE should be included in the differential diagnosis of multifocal FDG activity in the small bowel along with lymphoma, carcinoma, tuberculosis, Crohn disease, Behçet disease, and drug-induced enteropathy.
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Affiliation(s)
- Jian Zhang
- From the Shanghai University, Shanghai Universal Medical Imaging Diagnostic Center
| | - Zhi Li
- School of Medicine, Shanghai University
| | - Ling Zhang
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University
| | - Aisheng Dong
- Departments of Nuclear Medicine, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yuzhao Zhu
- From the Shanghai University, Shanghai Universal Medical Imaging Diagnostic Center
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22
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Duodenal Ulcer-Induced Gastric Outlet Obstruction Showing Pyloric Wall Thickening and Abnormal FDG Uptake Mimicking Malignancy. Clin Nucl Med 2022; 47:658-660. [DOI: 10.1097/rlu.0000000000004067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Dynamic whole-body FDG-PET imaging for oncology studies. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00479-8] [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
Abstract
Introduction
Recent PET/CT systems have improved sensitivity and spatial resolution by smaller PET detectors and improved reconstruction software. In addition, continuous-bed-motion mode is now available in some PET systems for whole-body PET imaging. In this review, we describe the advantages of dynamic whole-body FDG-PET in oncology studies.
Methods
PET–CT imaging was obtained at 60 min after FDG administration. Dynamic whole-body imaging with continuous bed motion in 3 min each with flow motion was obtained over 400 oncology cases. For routine image analysis, these dynamic phases (usually four phases) were summed as early FDG imaging. The image quality of each serial dynamic imaging was visually evaluated. In addition, changes in FDG uptake were analyzed in consecutive dynamic imaging and also in early delayed (90 min after FDG administration) time point imaging (dual-time-point imaging; DTPI). Image interpretation was performed by consensus of two nuclear medicine physicians.
Result
All consecutive dynamic whole-body PET images of 3 min duration had acceptable image quality. Many of the areas with physiologically high FDG uptake had altered uptake on serial images. On the other hand, most of the benign and malignant lesions did not show visual changes on serial images. In the study of 60 patients with suspected colorectal cancer, unchanged uptake was noted in almost all regions with pathologically proved FDG uptake, indicating high sensitivity with high negative predictive value on both serial dynamic imaging and on DTPI. We proposed another application of serial dynamic imaging for minimizing motion artifacts for patients who may be likely to move during PET studies.
Discussion
Dynamic whole-body imaging has several advantages over the static imaging. Serial assessment of changes in FDG uptake over a short period of time is useful for distinguishing pathological from physiological uptake, especially in the abdominal regions. These dynamic PET studies may minimize the need for DPTI. In addition, continuous dynamic imaging has the potential to reduce motion artifacts in patients who are likely to move during PET imaging. Furthermore, kinetic analysis of the FDG distribution in tumor areas has a potential for precise tissue characterization.
Conclusion
Dynamic whole-body FDG-PET imaging permits assessment of serial FDG uptake change which is particularly useful for differentiation of pathological uptake from physiological uptake with high diagnostic accuracy. This imaging can be applied for minimizing motion artifacts. Wide clinical applications of such serial, dynamic whole-body PET imaging is expected in oncological studies in the near future.
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24
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Vorster M, Sathekge MM. Positron Emission Tomography (PET) Imaging in Tuberculosis. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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Absolute Quantification in Diagnostic SPECT/CT: The Phantom Premise. Diagnostics (Basel) 2021; 11:diagnostics11122333. [PMID: 34943570 PMCID: PMC8700635 DOI: 10.3390/diagnostics11122333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023] Open
Abstract
The application of absolute quantification in SPECT/CT has seen increased interest in the context of radionuclide therapies where patient-specific dosimetry is a requirement within the European Union (EU) legislation. However, the translation of this technique to diagnostic nuclear medicine outside this setting is rather slow. Clinical research has, in some examples, already shown an association between imaging metrics and clinical diagnosis, but the applications, in general, lack proper validation because of the absence of a ground truth measurement. Meanwhile, additive manufacturing or 3D printing has seen rapid improvements, increasing its uptake in medical imaging. Three-dimensional printed phantoms have already made a significant impact on quantitative imaging, a trend that is likely to increase in the future. In this review, we summarize the data of recent literature to underpin our premise that the validation of diagnostic applications in nuclear medicine using application-specific phantoms is within reach given the current state-of-the-art in additive manufacturing or 3D printing.
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26
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More S, Marakalala MJ, Sathekge M. Tuberculosis: Role of Nuclear Medicine and Molecular Imaging With Potential Impact of Neutrophil-Specific Tracers. Front Med (Lausanne) 2021; 8:758636. [PMID: 34957144 PMCID: PMC8703031 DOI: 10.3389/fmed.2021.758636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/03/2021] [Indexed: 01/02/2023] Open
Abstract
With Tuberculosis (TB) affecting millions of people worldwide, novel imaging modalities and tools, particularly nuclear medicine and molecular imaging, have grown with greater interest to assess the biology of the tuberculous granuloma and evolution thereof. Much early work has been performed at the pre-clinical level using gamma single photon emission computed tomography (SPECT) agents exploiting certain characteristics of Mycobacterium tuberculosis (MTb). Both antituberculous SPECT and positron emission tomography (PET) agents have been utilised to characterise MTb. Other PET tracers have been utilised to help to characterise the biology of MTb (including Gallium-68-labelled radiopharmaceuticals). Of all the tracers, 2-[18F]FDG has been studied extensively over the last two decades in many aspects of the treatment paradigm of TB: at diagnosis, staging, response assessment, restaging, and in potentially predicting the outcome of patients with latent TB infection. Its lower specificity in being able to distinguish different inflammatory cell types in the granuloma has garnered interest in reviewing more specific agents that can portend prognostic implications in the management of MTb. With the neutrophil being a cell type that portends this poorer prognosis, imaging this cell type may be able to answer more accurately questions relating to the tuberculous granuloma transmissivity and may help in characterising patients who may be at risk of developing active TB. The formyl peptide receptor 1(FPR1) expressed by neutrophils is a key marker in this process and is a potential target to characterise these areas. The pre-clinical work regarding the role of radiolabelled N-cinnamoyl –F-(D) L – F – (D) –L F (cFLFLF) (which is an antagonist for FPR1) using Technetium 99m-labelled conjugates and more recently radiolabelled with Gallium-68 and Copper 64 is discussed. It is the hope that further work with this tracer may accelerate its potential to be utilised in responding to many of the current diagnostic dilemmas and challenges in TB management, thereby making the tracer a translatable option in routine clinical care.
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Affiliation(s)
- Stuart More
- Division of Nuclear Medicine, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
- Nuclear Medicine Research Infrastructure, Steve Biko Academic Hospital, Pretoria, South Africa
- *Correspondence: Stuart More
| | - Mohlopheni J. Marakalala
- Africa Health Research Institute, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Michael Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
- Nuclear Medicine Research Infrastructure, Steve Biko Academic Hospital, Pretoria, South Africa
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27
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Dilsizian V, Budde RPJ, Chen W, Mankad SV, Lindner JR, Nieman K. Best Practices for Imaging Cardiac Device-Related Infections and Endocarditis: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging 2021; 15:891-911. [PMID: 34922877 DOI: 10.1016/j.jcmg.2021.09.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
The diagnosis of cardiac device infection and, more importantly, accurate localization of the infection site, such as defibrillator pocket, pacemaker lead, along the peripheral driveline or central portion of the left ventricular assist device, prosthetic valve ring abscesses, and perivalvular extensions, remain clinically challenging. Although transthoracic and transesophageal echocardiography are the first-line imaging tests in suspected endocarditis and for assessing hemodynamic complications, recent studies suggest that cardiac computed tomography (CT) or CT angiography and functional imaging with 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) with CT (FDG PET/CT) may have an incremental role in technically limited or inconclusive cases on echocardiography. One of the key benefits of FDG PET/CT is in its detection of inflammatory cells early in the infection process, before morphological damages ensue. However, there are many unanswered questions in the literature. In this document, we provide consensus on best practices among the various imaging studies, which includes the detection of cardiac device infection, differentiation of infection from inflammation, image-guided patient management, and detailed recommendations on patient preparation, image acquisition, processing, interpretation, and standardized reporting.
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Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute and the Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Koen Nieman
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
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28
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Hansen JA, Naghavi-Behzad M, Gerke O, Baun C, Falch K, Duvnjak S, Alavi A, Høilund-Carlsen PF, Hildebrandt MG. Diagnosis of bone metastases in breast cancer: Lesion-based sensitivity of dual-time-point FDG-PET/CT compared to low-dose CT and bone scintigraphy. PLoS One 2021; 16:e0260066. [PMID: 34793550 PMCID: PMC8601566 DOI: 10.1371/journal.pone.0260066] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Abstract
We compared lesion-based sensitivity of dual-time-point FDG-PET/CT, bone scintigraphy (BS), and low-dose CT (LDCT) for detection of various types of bone metastases in patients with metastatic breast cancer. Prospectively, we included 18 patients with recurrent breast cancer who underwent dual-time-point FDG-PET/CT with LDCT and BS within a median time interval of three days. A total of 488 bone lesions were detected on any of the modalities and were categorized by the LDCT into osteolytic, osteosclerotic, mixed morphologic, and CT-negative lesions. Lesion-based sensitivity was 98.2% (95.4-99.3) and 98.8% (96.8-99.5) for early and delayed FDG-PET/CT, respectively, compared with 79.9% (51.1-93.8) for LDCT, 76.0% (36.3-94.6) for BS, and 98.6% (95.4-99.6) for the combined BS+LDCT. BS detected only 51.2% of osteolytic lesions which was significantly lower than other metastatic types. SUVs were significantly higher for all lesion types on delayed scans than on early scans (P<0.0001). Osteolytic and mixed-type lesions had higher SUVs than osteosclerotic and CT-negative metastases at both time-points. FDG-PET/CT had significantly higher lesion-based sensitivity than LDCT and BS, while a combination of the two yielded sensitivity comparable to that of FDG-PET/CT. Therefore, FDG-PET/CT could be considered as a sensitive one-stop-shop in case of clinical suspicion of bone metastases in breast cancer patients.
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Affiliation(s)
- Jeanette Ansholm Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Mohammad Naghavi-Behzad
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- * E-mail:
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Christina Baun
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Kirsten Falch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sandra Duvnjak
- Radiology Department–Breast Imaging, Herlev Gentofte Hospital, Copenhagen, Denmark
- Mammography Screening Center in the Capital Region, Herlev Gentofte Hospital, Copenhagen, Denmark
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Poul Flemming Høilund-Carlsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Malene Grubbe Hildebrandt
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark
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29
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Huang S, Chong H, Sun X, Wu Z, Jia Q, Zhang Y, Lan X. The Value of 18F-FDG PET/CT in Diagnosing Pancreatic Lesions: Comparison With CA19-9, Enhanced CT or Enhanced MR. Front Med (Lausanne) 2021; 8:668697. [PMID: 34692714 PMCID: PMC8531126 DOI: 10.3389/fmed.2021.668697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the value of 18F-FDG PET/CT in diagnosing pancreatic lesions, and compare it with CA19-9, contrast-enhanced CT (CECT), and contrast-enhanced MRI (CEMR). Methods: Cases of patients with suspected pancreatic lesions examined between January 1, 2011 and June 30, 2017 were retrospectively analyzed. CA19-9, CECT and CEMR within 2 weeks of PET/CT were evaluated. We compared the diagnostic efficacy of PET/CT with CA19-9, CECT and CEMR as well as combined tests. Results: A total of 467 cases were examined in this study, including 293 males and 174 females, with an average age of 57.79 ± 12.68 y (16-95 y). Cases in the malignant group (n = 248) had significantly higher SUVmax (7.34 ± 4.17 vs. 1.70 ± 2.68, P < 0.001) and CA19-9 (663.21 ± 531.98 vs. 87.80 ± 218.47, P < 0.001) than those in the benign group (n = 219). The sensitivity, specificity and accuracy of PET/CT were 91.9, 96.3, and 94.0%, respectively. Those for CECT were 83.6, 77.8, 81.2%, respectively; and 91.2, 75.0, 81.7% were for CEMR. PET/CT corrected 14.7% (28/191) CECT diagnoses and 12.2% (10/82) CEMR diagnoses. Although the diagnostic efficiency of CA19-9 was acceptable (80.0, 69.0, 74.9% respectively), the joint application of PET/CT and CA19-9 could significantly enhance the diagnostic efficiency compared with PET/CT alone (sen 97.4 vs. 90.5%, P = 0.0003; spe 100.0 vs. 95.2%, P = 0.0047). Conclusions: PET/CT has sensitivity similar to CECT, CEMR and significantly higher specificity and accuracy, helping reduce false diagnoses of morphological images. Combining PET/CT with CA19-9 could enhance diagnostic efficiency.
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Affiliation(s)
- Shengyun Huang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Huanhuan Chong
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China.,Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xun Sun
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Zhijian Wu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Jia
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yongxue Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
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30
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Qin LP, Lv J, Li MZ, Xie LJ, Li JP, Li JF, Cheng MH. Biphasic GA 68-labeled prostate specific membrane antigen-11 positron emission tomography/computed tomography scans in the differential diagnosis and risk stratification of initial primary prostate cancer. Quant Imaging Med Surg 2021; 11:3619-3628. [PMID: 34341736 DOI: 10.21037/qims-20-1312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/07/2021] [Indexed: 12/09/2022]
Abstract
Background This study aimed to assess the value of biphasic GA 68-labeled prostate-specific membrane antigen-11 (68Ga-PSMA-11) positron emission tomography/computed tomography (PET/CT) scan in the differential diagnosis and risk stratification of initial primary prostate cancer (PCa). Methods A total of 51 patients with PCa (8 low- and intermediate-risk PCa patients and 43 high-risk PCa patients) and 36 patients with benign prostate lesions, who underwent standard whole-body imaging and delayed pelvic imaging of 68Ga-PSMA-11 PET/CT, were enrolled in this prospective study. The PET parameters, such as maximum and mean standard uptake value (SUVmax and SUVmean), and maximum and mean standard retention index of PET images were calculated and compared in different prostate lesions. The diagnostic performances of the PET parameters were evaluated by receiver operating characteristic (ROC) curves. Results All the PET parameters of PCa participants were significantly higher than those of participants with benign prostate lesions (P<0.001). The SUVmean of delayed imaging had the best performance in the diagnosis of PCa with an area under the curve (AUC) of 0.918 (95% CI: 0.858 to 0.977), the sensitivity of 90.0%, and specificity of 83.3%. The SUVmax and SUVmean of high-risk PCa participants were significantly higher than those of low- and intermediate-risk PCa participants (P<0.005). The SUVmax of standard imaging had the best performance in predicting high-risk PCa with an AUC of 0.890 (95% CI: 0.799 to 0.980), a sensitivity of 76.7%, and a specificity of 100.0%. Conclusions The biphasic 68Ga-PSMA-11 PET/CT scan had good performance in discriminating prostate cancer from benign prostate diseases. The SUVmean of the prostate lesion at delayed imaging of 68Ga-PSMA-11 PET/CT had the best value in the differential diagnosis of PCa, and the SUVmax at standard imaging was most valuable in predicting the risk stratification of PCa.
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Affiliation(s)
- Lu-Ping Qin
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Lv
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming-Zhao Li
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liang-Jun Xie
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jin-Ping Li
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian-Fang Li
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mu-Hua Cheng
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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31
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Wu J, Liu H, Ye Q, Gallezot JD, Naganawa M, Miao T, Lu Y, Chen MK, Esserman DA, Kyriakides TC, Carson RE, Liu C. Generation of parametric K i images for FDG PET using two 5-min scans. Med Phys 2021; 48:5219-5231. [PMID: 34287939 DOI: 10.1002/mp.15113] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The net uptake rate constant (Ki ) derived from dynamic imaging is considered the gold standard quantification index for FDG PET. In this study, we investigated the feasibility and assessed the clinical usefulness of generating Ki images for FDG PET using only two 5-min scans with population-based input function (PBIF). METHODS Using a Siemens Biograph mCT, 10 subjects with solid lung nodules underwent a single-bed dynamic FDG PET scan and 13 subjects (five healthy and eight cancer patients) underwent a whole-body dynamic FDG PET scan in continuous-bed-motion mode. For each subject, a standard Ki image was generated using the complete 0-90 min dynamic data with Patlak analysis (t* = 20 min) and individual patient's input function, while a dual-time-point Ki image was generated from two 5-min scans based on the Patlak equations at early and late scans with the PBIF. Different start times for the early (ranging from 20 to 55 min with an increment of 5 min) and late (ranging from 50 to 85 min with an increment of 5 min) scans were investigated with the interval between scans being at least 30 min (36 protocols in total). The optimal dual-time-point protocols were then identified. Regions of interest (ROI) were drawn on nodules for the lung nodule subjects, and on tumors, cerebellum, and bone marrow for the whole-body-imaging subjects. Quantification accuracy was compared using the mean value of each ROI between standard Ki (gold standard) and dual-time-point Ki , as well as between standard Ki and relative standardized uptake value (SUV) change that is currently used in clinical practice. Correlation coefficients and least squares fits were calculated for each dual-time-point protocol and for each ROI. Then, the predefined criteria for identifying a reliable dual-time-point Ki estimation for each ROI were empirically determined as: (1) the squared correlation coefficient (R2 ) between standard Ki and dual-time-point Ki is larger than 0.9; (2) the absolute difference between the slope of the equality line (1.0) and that of the fitted line when plotting standard Ki versus dual-time-point Ki is smaller than 0.1; (3) the absolute value of the intercept of the fitted line when plotting standard Ki versus dual-time-point Ki normalized by the mean of the standard Ki across all subjects for each ROI is smaller than 10%. Using Williams' one-tailed t test, the correlation coefficient (R) between standard Ki and dual-time-point Ki was further compared with that between standard Ki and relative SUV change, for each dual-time-point protocol and for each ROI. RESULTS Reliable dual-time-point Ki images were obtained for all the subjects using our proposed method. The percentage error introduced by the PBIF on the dual-time-point Ki estimation was smaller than 1% for all 36 protocols. Using the predefined criteria, reliable dual-time-point Ki estimation could be obtained in 25 of 36 protocols for nodules and in 34 of 36 protocols for tumors. A longer time interval between scans provided a more accurate Ki estimation in general. Using the protocol of 20-25 min plus 80-85 or 85-90 min, very high correlations were obtained between standard Ki and dual-time-point Ki (R2 = 0.994, 0.980, 0.971 and 0.925 for nodule, tumor, cerebellum, and bone marrow), with all the slope values with differences ≤0.033 from 1 and all the intercept values with differences ≤0.0006 mL/min/cm3 from 0. The corresponding correlations were much lower between standard Ki and relative SUV change (R2 = 0.673, 0.684, 0.065, 0.246). Dual-time-point Ki showed a significantly higher quantification accuracy with respect to standard Ki than relative SUV change for all the 36 protocols (p < 0.05 using Williams' one-tailed t test). CONCLUSIONS Our proposed approach can obtain reliable Ki images and accurate Ki quantification from dual-time-point scans (5-min per scan), and provide significantly higher quantification accuracy than relative SUV change that is currently used in clinical practice.
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Affiliation(s)
- Jing Wu
- Center for Advanced Quantum Studies and Department of Physics, Beijing Normal University, Beijing, China.,Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Hui Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.,Department of Engineering Physics, Tsinghua University, Beijing, China.,Key Laboratory of Particle & Radiation Imaging, Ministry of Education (Tsinghua University), Beijing, China
| | - Qing Ye
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.,Department of Engineering Physics, Tsinghua University, Beijing, China.,Key Laboratory of Particle & Radiation Imaging, Ministry of Education (Tsinghua University), Beijing, China
| | | | - Mika Naganawa
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Tianshun Miao
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Yihuan Lu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Ming-Kai Chen
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Denise A Esserman
- School of Public Health: Biostatistics, Yale University, New Haven, CT, USA
| | | | - Richard E Carson
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
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32
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Grisanti F, Zulueta J, Rosales JJ, Morales MI, Sancho L, Lozano MD, Mesa-Guzman M, Garcia-Velloso MJ. Diagnostic accuracy of visual analysis versus dual time-point imaging with 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remnie.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhang J, Shi X, Xiao Y, Ma C, Cao G, Liu Y, Li Y. Early SUV max is the best predictor of axillary lymph node metastasis in stage III breast cancers. Quant Imaging Med Surg 2021; 11:1680-1691. [PMID: 33936956 DOI: 10.21037/qims-20-423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Although fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission/computed tomography (PET/CT) imaging has been investigated for its ability to evaluate lymph node metastasis of breast cancer, few comparative analyses have evaluated the preoperative and postoperative regional lymph node metastasis of breast cancer by dual-phase imaging, especially in patients with stage III (N2) disease. Methods The clinical, pathological, and imaging data of 40 patients with stage III (N2) breast cancer were retrospectively analyzed. All patients underwent dual-time point 18F-FDG imaging before surgery and postoperative pathology examinations were obtained. The short-axis lymph node diameter was measured, and the maximum standardized uptake value (SUVmax) and the percentage difference of SUVmax between dual-phase (ΔSUVmax) were calculated to compare metastatic and non-metastatic lymph nodes on dual-time point images. Results A total of 398 axillary lymph nodes were inspected, and 209 lymph nodes were matched with those on PET/CT images, including 97 metastatic and 112 non-metastatic lymph nodes. The SUVmax values were significantly different between metastatic and non-metastatic lymph nodes, in both the early and delayed scans (P<0.001). For metastatic lymph nodes, the SUVmax value on the delayed scan (6.17±2.62) was significantly higher compared with the early scan (5.45±1.35; ΔSUVmax =0.08±0.21, P<0.001). Moreover, the SUVmax values were not significantly different between the delayed (2.82±0.91) and early scans (2.79±0.72; ΔSUVmax=-0.00±0.11, P=0.77). The short diameters were not significantly different between metastatic and non-metastatic lymph nodes (P=0.12), and the SUVmax values of metastatic lymph nodes with short diameters of >4.00 and ≤6.00 mm were not significantly different between the early and delayed scans (P=0.06). However, the SUVmax values of metastatic lymph nodes with short diameters of >6.00 and ≤8.00 mm (7.11±0.19 vs. 5.96±0.08) and short diameters of >8.00 and ≤10.00 mm (10.76±0.35 vs. 6.82±0.50) were higher on the delayed scan versus the early scan, respectively (P<0.01 for each comparison). The difference between the ΔSUVmax values among the three subgroups was statistically significant (F=78.98, P<0.001).The receiver operating characteristic (ROC) curve analysis of the lymph nodes showed that the area under the curve (AUC) of the early and delayed PET/CT scans was 0.961 (0.925-0.983, P=0.013) and 0.897 (0.847-0.934, P=0.022), respectively. The ROC curves of the early and delayed scans were also significantly different (z=4.46, P<0.001). AUC of the ΔSUVmax for the early scan was significantly lower compared with delayed scans (z=8.95 vs. 9.13, respectively; P<0.001). Conclusions Dual-time point 18F-FDG PET imaging significantly improved the prediction and detection of axillary lymph node metastasis, compared with prediction based on size of lymph node alone, in patients with stage III breast cancer. We found that lymph nodes with continuously increased SUVmax values tended to show metastasis, and early SUVmax assessment offers the best capacity for prediction of axillary lymph node metastasis.
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Affiliation(s)
- Jiangong Zhang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Nuclear Medicine, The First People's Hospital of Yancheng, The Fourth Affiliated Hospital of Nantong University, Yancheng, China
| | - Xun Shi
- Department of Nuclear Medicine, The First People's Hospital of Yancheng, The Fourth Affiliated Hospital of Nantong University, Yancheng, China
| | - Yong Xiao
- Department of MRI Room, The First People's Hospital of Yancheng, The Fourth Affiliated Hospital of Nantong University, Yancheng, China
| | - Chao Ma
- Department of Nuclear Medicine, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Gang Cao
- Department of Radiology, Peking University Lu'an Hospital, Changzhi, China
| | - Yongbo Liu
- Department of Radiology, Peking University Lu'an Hospital, Changzhi, China
| | - Yonggang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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34
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Chuang PJ, Wang HP, Lin YJ, Chen CC, Tien YW, Hsieh MS, Yang SH, Yen RF, Ko CL, Wu YW, Cheng MF. Preoperative 2-[ 18F]FDG PET-CT aids in the prognostic stratification for patients with primary ampullary carcinoma. Eur Radiol 2021; 31:8040-8049. [PMID: 33864503 DOI: 10.1007/s00330-021-07923-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/01/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We sought to investigate whether preoperative dual-phase 2-[18F]FDG PET-CT identify predictors for poor survival in patients with ampullary carcinoma receiving pancreaticoduodenectomy. METHODS The preoperative PET-CT images of patients with resected ampullary carcinoma from June 2007 to July 2017 were analyzed. Survival curves were analyzed using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazard model was used to identify potential prognostic factors associated with disease-free survival (DFS) and overall survival (OS). RESULTS Fifty-four subjects (26 men, 28 women) were enrolled with a median tumor size of 20 mm. All patients were followed for a median period of 36.9 months with 3- and 5-year DFS of 50.3% and 44.2%, and OS of 77.0% and 68.2%, respectively. Parameters associated with DFS in multivariate analysis were lymphovascular invasion (hazard ratio [HR]: 9.45, p < 0.001), involved margin in pathology (HR: 7.67, p < 0.001), and tumor retention index (RI) from the dual-phase PET (HR: 2.41, p = 0.03), whereas involved margin (HR: 13.14, p < 0.001), post-recurrence chemotherapy (HR: 0.10, p < 0.001), and metabolic tumor volume (MTV) (HR: 4.62, p = 0.009) emerged as independent prognostic factors for OS. CONCLUSIONS Preoperative 2-[18F]FDG PET-CT offered independent prognostic biomarkers in patients with ampullary carcinoma receiving standard surgical resection. KEY POINTS • 2-[18F]FDG PET-CT offers good survival prediction before operation in primary malignant neoplasms at ampulla of Vater. • Dual-phase PET scan with bowel distention can better delineate Ampulla of Vater and characterize tumor physiology. • Preoperative risk stratification might aid in better treatment planning.
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Affiliation(s)
- Pei-Ju Chuang
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Chung-Cheng District, Taipei, 100, Taiwan, Republic of China
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Jen Lin
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei, Taiwan
| | - Chieh-Chang Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Hung Yang
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Chung-Cheng District, Taipei, 100, Taiwan, Republic of China
| | - Chi-Lun Ko
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Chung-Cheng District, Taipei, 100, Taiwan, Republic of China
| | - Yen-Wen Wu
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Nuclear Medicine and Cardiovascular Medical Centre (Cardiology), Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Chung-Cheng District, Taipei, 100, Taiwan, Republic of China. .,Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei, Taiwan.
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35
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Grisanti F, Zulueta J, Rosales JJ, Morales MI, Sancho L, Lozano MD, Mesa-Guzmán M, García-Velloso MJ. Diagnostic accuracy of visual analysis versus dual time-point imaging with 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake. Rev Esp Med Nucl Imagen Mol 2021; 40:155-160. [PMID: 33781718 DOI: 10.1016/j.remn.2020.03.019] [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] [Received: 12/23/2019] [Revised: 02/21/2020] [Accepted: 03/17/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine the accuracy of visual analysis and the retention index (RI) with dual-time point 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules (IPN) with low FDG uptake. MATERIALS AND METHODS A retrospective analysis was performed on 43 patients (28 men, 64 ± 11 years old, range 36-83 years) referred for IPN characterization with 18F-FDG-PET/CT and maximum standard uptake value ≤ 2.5 at 60 minutes post-injection (SUVmax1). Nodules were analyzed by size, visual score for FDG uptake on standard (OSEM 2,8) and high definition (HD) reconstructions, SUVmax1, SUVmax at 180 minutes post-injection (SUVmax2), and RI was calculated. The definitive diagnosis was based on histopathological confirmation (n = 28) or ≥ 2 years of follow-up. RESULTS Twenty-four (56%) nodules were malignant. RI ≥ 10% on standard reconstruction detected 18 nodules that would have been considered negative using the standard SUVmax ≥ 2.5 criterion for malignancy. RI ≥ 10% had a sensitivity, specificity, PPV, NPV and accuracy of 75, 73.7, 78.3, 70, and 74.4%, respectively, while for FDG uptake > liver on HD these were 79.1, 63.2, 73.1, 70.6, and 72.1%, respectively. SUVmax1 ≥ 2, SUVmax2 > 2.5 and FDG uptake > liver on standard reconstruction had a PPV of 100%. FDG uptake > mediastinum on HD had a NPV of 100%. CONCLUSIONS RI ≥ 10% was the most accurate criterion for malignancy, followed by FDG uptake > liver on HD reconstruction. On standard reconstruction, SUVmax1 ≥2 was highly predictive of malignancy, as well as SUVmax2 > 2.5 and FDG uptake > liver. FDG uptake < mediastinum on HD was highly predictive of benign nodules.
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Affiliation(s)
- F Grisanti
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España.
| | - J Zulueta
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, España
| | - J J Rosales
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
| | - M I Morales
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
| | - L Sancho
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Madrid, España
| | - M D Lozano
- Departamento de Patología, Clínica Universidad de Navarra, Pamplona, España
| | - M Mesa-Guzmán
- Departamento de Cirugía Torácica, Clínica Universidad de Navarra, Pamplona, España
| | - M J García-Velloso
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
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Koa B, Borja AJ, Aly M, Padmanabhan S, Tran J, Zhang V, Rojulpote C, Pierson SK, Tamakloe MA, Khor JS, Werner TJ, Fajgenbaum DC, Alavi A, Revheim ME. Emerging role of 18F-FDG PET/CT in Castleman disease: a review. Insights Imaging 2021; 12:35. [PMID: 33709329 PMCID: PMC7952491 DOI: 10.1186/s13244-021-00963-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Castleman disease (CD) describes a group of rare hematologic conditions involving lymphadenopathy with characteristic histopathology and a spectrum of clinical abnormalities. CD is divided into localized or unicentric CD (UCD) and multicentric CD (MCD) by imaging. MCD is further divided based on etiological driver into human herpesvirus-8-associated MCD, POEMS-associated MCD, and idiopathic MCD. There is notable heterogeneity across MCD, but increased level of pro-inflammatory cytokines, particularly interleukin-6, is an established disease driver in a portion of patients. FDG-PET/CT can help determine UCD versus MCD, evaluate for neoplastic conditions that can mimic MCD clinico-pathologically, and monitor therapy responses. CD requires more robust characterization, earlier diagnosis, and an accurate tool for both monitoring and treatment response evaluation; FDG-PET/CT is particularly suited for this. Moving forward, future prospective studies should further characterize the use of FDG-PET/CT in CD and specifically explore the utility of global disease assessment and dual time point imaging. Trial registration ClinicalTrials.gov, NCT02817997, Registered 29 June 2016, https://clinicaltrials.gov/ct2/show/NCT02817997
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Affiliation(s)
- Benjamin Koa
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mahmoud Aly
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sayuri Padmanabhan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Tran
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Zhang
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sheila K Pierson
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark-Avery Tamakloe
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Johnson S Khor
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David C Fajgenbaum
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, 0316, Oslo, Norway.
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37
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Triumbari EKA, de Koster EJ, Rufini V, Fragomeni SM, Garganese G, Collarino A. 18F-FDG PET and 18F-FDG PET/CT in Vulvar Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2021; 46:125-132. [PMID: 33234921 DOI: 10.1097/rlu.0000000000003411] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM The aims of this study were to determine the role of 18F-FDG PET/CT in vulvar cancer patients and to extract summary estimates of its diagnostic performance for preoperative lymph node staging. PATIENTS AND METHODS PubMed/Medline and Embase databases were searched to identify studies evaluating 18F-FDG PET/CT in vulvar cancer patients. The assessment of methodological quality of the included articles was performed. Per-patient and per-groin pooled estimates, with 95% confidence intervals (CIs), of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) were calculated. RESULTS Ten articles were included in the systematic review, 7 among which evaluated the diagnostic performance of preoperative 18F-FDG PET/CT for lymph node staging. Qualitative per-patient analysis (72 patients from 4 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.70 (95% CI, 0.44-0.95), 0.90 (95% CI, 0.76-1.04), 0.86 (95% CI, 0.66-1.06), 0.77 (95% CI, 0.56-0.97), and 10.49 (95% CI, 1.68-65.50), respectively. Qualitative per-groin analysis (245 groins from 5 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.76 (95% CI, 0.57-0.94), 0.88 (95% CI, 0.82-0.94), 0.70 (95% CI, 0.55-0.85), 0.92 (95% CI, 0.86-0.97), and 19.43 (95% CI, 6.40-58.95), respectively. CONCLUSIONS Despite limited literature data, this systematic review and meta-analysis revealed that a negative preoperative PET/CT scan may exclude groin metastases in at least early-stage vulvar cancer patients currently unfit for sentinel node biopsy and select those eligible for a less invasive surgical treatment. A positive PET/CT result should otherwise be interpreted with caution. Larger prospective studies are needed to confirm these results and to evaluate the diagnostic value of standardized semiquantitative analysis compared with the qualitative one.
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Affiliation(s)
- Elizabeth K A Triumbari
- From the Section of Nuclear Medicine, University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Simona M Fragomeni
- Department of Woman and Child Health and Public Health, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
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Picardi M, Cavaliere C, Della Pepa R, Nicolai E, Soricelli A, Giordano C, Pugliese N, Rascato M, Cappuccio I, Campagna G, Cerchione C, Vigliar E, Troncone G, Mascolo M, Franzese M, Castaldo R, Salvatore M, Pane F. PET/MRI for staging patients with Hodgkin lymphoma: equivalent results with PET/CT in a prospective trial. Ann Hematol 2021; 100:1525-1535. [PMID: 33909101 PMCID: PMC8116299 DOI: 10.1007/s00277-021-04537-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/16/2021] [Indexed: 01/07/2023]
Abstract
To compare FDG-PET/unenhanced MRI and FDG-PET/diagnostic CT in detecting infiltration in patients with newly diagnosed Hodgkin lymphoma (HL). The endpoint was equivalence between PET/MRI and PET/CT in correctly defining the revised Ann Arbor staging system. Seventy consecutive patients with classical-HL were prospectively investigated for nodal and extra-nodal involvement during pretreatment staging with same-day PET/CT and PET/MRI. Findings indicative of malignancy with the imaging procedures were regarded as lymphoma infiltration; in case of discrepancy, positive-biopsy and/or response to treatment were evidenced as lymphoma. Sixty of the 70 (86%) patients were evaluable having completed the staging program. Disease staging based on either PET/MRI or PET/CT was correct for 54 of the 60 patients (90% vs. 90%), with difference between proportions of 0.0 (95% CI, -9 to 9%; P=0.034 for the equivalence test). As compared with reference standard, invasion of lymph nodes was identified with PET/MRI in 100% and with PET/CT in 100%, of the spleen with PET/MRI in 66% and PET/CT in 55%, of the lung with PET/MRI in 60% and PET/CT in 100%, of the liver with PET/MRI in 67% and PET/CT in 100%, and of the bone with PET/MRI in 100% and PET/CT in 50%. The only statistically significant difference between PET/MRI and PET/CT was observed in bony infiltration detection rates. For PET/CT, iodinate contrast medium infusions' average was 86 mL, and exposure to ionizing radiation was estimated to be 4-fold higher than PET/MRI. PET/MRI is a promising safe new alternative in the care of patients with HL.
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Affiliation(s)
- M. Picardi
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - C. Cavaliere
- Department of Nuclear Medicine and Radiology, IRCCS SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - R. Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - E. Nicolai
- Department of Nuclear Medicine and Radiology, IRCCS SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - A. Soricelli
- Department of Radiology, University of Naples Parthenope -IRCCS SDN, Via Ferdinando Acton 38, 80143 Naples, Italy
| | - C. Giordano
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - N. Pugliese
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - M.G. Rascato
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - I. Cappuccio
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - G. Campagna
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - C. Cerchione
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - E. Vigliar
- Department of Public Health, Federico II University Medical School Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - G. Troncone
- Department of Public Health, Federico II University Medical School Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - M. Mascolo
- Department of Advanced Biomedical Sciences, Federico II University Medical School Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - M. Franzese
- Department of Nuclear Medicine and Radiology, IRCCS SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - R. Castaldo
- Department of Nuclear Medicine and Radiology, IRCCS SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - M. Salvatore
- Department of Nuclear Medicine and Radiology, IRCCS SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - F. Pane
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
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Saboury B, Morris MA, Nikpanah M, Werner TJ, Jones EC, Alavi A. Reinventing Molecular Imaging with Total-Body PET, Part II: Clinical Applications. PET Clin 2020; 15:463-475. [PMID: 32888545 PMCID: PMC7462547 DOI: 10.1016/j.cpet.2020.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Total-body PET scans will initiate a new era for the PET clinic. The benefits of 40-fold effective sensitivity improvement provide new capabilities to image with lower radiation dose, perform delayed imaging, and achieve improved temporal resolution. These technical features are detailed in the first of this 2-part series. In this part, the clinical impacts of the novel features of total-body PET scans are further explored. Applications of total-body PET scans focus on the real-time interrogation of systemic disease manifestations in a variety of practical clinical contexts. Total-body PET scans make clinical systems biology imaging a reality.
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Affiliation(s)
- Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Michael A Morris
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Moozhan Nikpanah
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Elizabeth C Jones
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
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40
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de Mooij CM, Sunen I, Mitea C, Lalji UC, Vanwetswinkel S, Smidt ML, van Nijnatten TJ. Diagnostic performance of PET/computed tomography versus PET/MRI and diffusion-weighted imaging in the N- and M-staging of breast cancer patients. Nucl Med Commun 2020; 41:995-1004. [PMID: 32769814 PMCID: PMC7497599 DOI: 10.1097/mnm.0000000000001254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/22/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To provide a systematic review regarding the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) and diffusion-weighted imaging (DWI) compared to 18F-FDG PET/computed tomography (CT) focused on nodal and distant staging in breast cancer patients. METHODS The PubMed and Embase databases were searched for relevant publications until April 2020. Two independent reviewers searched for eligible articles based on predefined in- and exclusion criteria, assessed quality and extracted data. RESULTS Eleven eligible studies were selected from 561 publications identified by the search. In seven studies, PET/CT was compared with PET/MRI, and in five, PET/CT with DWI. Significantly higher sensitivity for PET/MRI compared to PET/CT in a lesion-based analysis was reported for all lesions together (77% versus 89%) in one study, osseous metastases (69-99% versus 92-98%) in two studies and hepatic metastases (70-75% versus 80-100%) in one study. Moreover, PET/MRI revealed a significantly higher amount of osseous metastases (90 versus 141) than PET/CT. PET/CT is associated with a statistically higher specificity than PET/MRI in the lesion detection of all lesions together (98% versus 96%) and of osseous metastases (100% versus 95%), both in one study. None of the reviewed studies reported significant differences between PET/CT and DWI for any of the evaluated sites. There is a trend toward higher specificity for PET/CT. CONCLUSION In general, there is a trend toward higher sensitivity and lower specificity of PET/MRI when compared to PET/CT. Results on the diagnostic performance of DWI are conflicting. Rather than evaluating it separate, it seems to have complementary value when combined with other MR sequences.
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Affiliation(s)
- Cornelis Maarten de Mooij
- Departments of Radiology and Nuclear Medicine
- Surgery
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Inés Sunen
- Departments of Radiology and Nuclear Medicine
- Department of Radiology, Miguel Servet Hospital, Zaragoza, Spain
| | - Cristina Mitea
- Departments of Radiology and Nuclear Medicine
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | | | - Marjolein L. Smidt
- Surgery
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Thiemo J.A. van Nijnatten
- Departments of Radiology and Nuclear Medicine
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
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Farghaly H, Alshareef M, Alqarni A, Sayed M, Nasr H. Dual time point [18F]Flurodeoxyglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) with water gastric distension in differentiation between malignant and benign gastric lesions. Eur J Radiol Open 2020; 7:100268. [PMID: 32964074 PMCID: PMC7490534 DOI: 10.1016/j.ejro.2020.100268] [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: 05/29/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
Objectives To assess diagnostic accuracy and added value of dual time point 18F-FDG PET/CT after gastric distention using oral water in differentiating malignant from benign gastric lesions. Methods Patients (n = 30, 19 males, mean age 58.6 ± 16.4 years). All patients are known or suspected oncology patients. All patients underwent whole body 18F-FDG PET/CT scan and 2 h delayed PET/CT abdominal images following oral water gastric distension. The best cut off values for early SUVmax (SUVmax1), delayed SUVmax (SUVmax2) and SUVmax2-SUVmax1 (ΔSUVmax) to differentiate benign from malignant lesions were set based on ROC analysis. Data analyzed included in addition; age, sex and 18F-FDG uptake pattern in delayed images. Suspicious gastric lesions were correlated with biopsy in 18 patients (60 %) and with clinical and follow-up imaging (18F-FDG PET/CT, CT or MRI) in 12 patients (40 %). Unpaired t-test was used to compare the mean deference in continuous variables between patients with gastric malignancy and those with benign gastric lesions. Fisher's exact test was used to analyze categorical variables. Logistic regression analysis was performed to identify the most powerful factors to predict malignant lesions. Results Fifteen patients (50 %) had confirmed malignant gastric lesions. Patients with confirmed gastric malignancy were older (65 ± 13 vs 52 ± 17; p = 0.023) and had significantly higher mean ΔSUVmax (1.29 ± 1.76 vs -0.89 ± 1.59; p = 0.003). The mean SUVmax1 (6.99 ± 6.66 vs 5.31 ± 2.53; p = 0.367) and SUVmax2 (8.29 ± 7.41 vs 4.44 ± 3.34; p = 0.077) although both higher in patients with malignant lesions, they did not reach statistical significance. Sensitivity, specificity, PPV, NPV, and accuracy to detect malignant gastric lesions were highest for lesions with localized uptake pattern in delayed images post water oral contrast as well as for lesions with ΔSUVmax>0. Regression analysis revealed both variables as independent predictors for malignant lesions with odd ratios of 22.9 and 9.5 respectively and final model Chi-Square of 19.9 (p < 0.0001). The model correctly identified 12/15 (80 %) malignant lesions and 13/15 (86.7 %) benign lesions with 2 false positives confirmed as chronic active gastritis with helicobacter pylori and 3 false negatives including 1 signet ring gastric cancer and 1 low grade gastrointestinal stromal tumor (GIST), both with poor 18 F-FDG uptake. Conclusion Localized uptake pattern in delayed PET/CT images following gastric distention with oral water contrast as well as ΔSUVmax>0 are powerful independent variables to identify malignant gastric lesions with fairly high sensitivity and reasonable accuracy. Malignancies with inherently low 18F-FDG avidity are the main cause of false negatives while active gastritis is the main cause of false positives.
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Affiliation(s)
- Hussein Farghaly
- Department of Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Alshareef
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alqarni
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Sayed
- Department of Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hatem Nasr
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Department of Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Kim HO, Kim BS, Kang SY, Bang JI, An J, Kim JH, Yoon HJ. Metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging according to primary tumor uptake and background parenchymal enhancement. Ann Nucl Med 2020; 34:942-951. [PMID: 32974848 DOI: 10.1007/s12149-020-01525-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/09/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study was aimed at investigating metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging (DTPI) according to primary tumor uptake and determining whether this technique is affected by background parenchymal enhancement (BPE). METHODS A total of 189 patients with newly diagnosed breast cancer who underwent DTPI examination were retrospectively evaluated. DTPI was performed using a standard FDG/PET protocol followed by delayed image acquisition at 120 min after injection. Patients were divided into two groups according to primary tumor uptake as breast cancer with low maximum standard uptake value (SUVmax) (< 2.5) and high SUVmax (≥ 2.5). The maximal SUV of the primary breast tumor (T-SUVmax), contralateral breast parenchyma uptake (B-SUVmax) according to different BPE grades, tumor to background ratio (T/B-SUVmax), and their percentage changes between early and delayed images (retention index, RI) were calculated. RESULTS For primary tumor uptake, tumors with high SUV had a significant increase in mean T-SUVmax between early and delayed images (8.17 vs. 9.16, P < 0.001), and %RI T-SUVmax was 10.52%. Conversely, mean T-SUVmax did not change between early and delayed images for tumors with low SUV (1.96 vs. 1.94, P = 0.610), and %RI T-SUVmax was - 1.41%. The mean %RI B-SUVmax was - 12.43% for minimal BPE, - 14.19% for mild BPE, - 19.49% for moderate BPE, and - 21.25% for marked BPE grade, indicating that higher BPE grades undergo better washouts on delayed imaging (β = - 3.220, P < 0.001 for trend). The %RI T/B-SUVmax of both breast cancer groups with low SUV and high SUV was 18.86% and 32.47%, respectively. CONCLUSIONS Breast cancer with low SUV undergoes no significant change in SUV on DTPI; however, washing of background parenchymal activity was evident over time, resulting in significantly increased tumor contrast in delayed images, which leads to increased sensitivity. Breast parenchymal washout was more significant with increased BPE level. Therefore, DTPI is expected to be more useful for evaluating breast lesions in regions with marked BPE on MRI.
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Affiliation(s)
- Hye Ok Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Anyangcheon-ro, Yangcheon-gu, (07985) 1071, Seoul, Republic of Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Anyangcheon-ro, Yangcheon-gu, (07985) 1071, Seoul, Republic of Korea.
| | - Seo Young Kang
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Anyangcheon-ro, Yangcheon-gu, (07985) 1071, Seoul, Republic of Korea
| | - Ji-In Bang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jeongshin An
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jeoung Hyun Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Anyangcheon-ro, Yangcheon-gu, (07985) 1071, Seoul, Republic of Korea.
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Does Routine Triple-Time-Point FDG PET/CT Imaging Improve the Detection of Liver Metastases? Diagnostics (Basel) 2020; 10:diagnostics10090609. [PMID: 32825064 PMCID: PMC7554868 DOI: 10.3390/diagnostics10090609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 12/23/2022] Open
Abstract
Prior reports have demonstrated the improved ability of delayed fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging (dual-time-point imaging) in detecting more patients with liver metastases. To evaluate whether routine triple-time-point FDG PET/CT imaging improves the detection of liver metastasis not visualized on initial imaging. To our knowledge, no triple-time-point imaging has been reported. This retrospective study included total 310 patients with various malignancies who underwent PET/CT scans. Triple-time-point imaging including the liver was obtained. The comparison between negative and positive liver lesions on delayed imaging for patients with initial negative imaging were analyzed. Of the 310 patients, 286 did not exhibit liver lesions on initial imaging, but six of the 286 patients exhibited lesions on delayed imaging. No additional liver lesions were detected on further delayed imaging in the 286 patients. The other 24 patients with liver lesions identified on initial imaging still showed lesions on delayed and further delayed imaging. The analysis showed a significant difference in the percentage of colorectal cancer (66.7%) and liver lesions before the PET scan (50.0%) compared with unchanged results (22.1% and 3.9%, respectively). Routine triple-time-point imaging did not improve the detection of liver metastases; however, it may be recommended in patients with colorectal cancer and liver lesions before the PET scan.
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Assessment of Suspected Malignancy or Infection in Immunocompromised Patients After Solid Organ Transplantation by [ 18F]FDG PET/CT and [ 18F]FDG PET/MRI. Nucl Med Mol Imaging 2020; 54:183-191. [PMID: 32831964 DOI: 10.1007/s13139-020-00648-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/24/2020] [Accepted: 06/24/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To study the value of 2-deoxy-2-[18F]fluoro-D-glucose([18F]FDG) positron emission tomography/computed tomography (PET/CT) and [18F]FDG positron emission tomography/magnetic resonance imaging (PET/MRI) in assessing immunocompromised patients with suspected malignancy or infection. Methods [18F]FDG-PET/CT and [18F]FDG-PET/MRI examinations of patients who were immunocompromised after receiving lung, heart, pancreas, kidney, liver, or combined kidney-liver transplants were analyzed in this retrospective study. Patients underwent whole-body hybrid-imaging because of clinical signs of malignancy and/or infection. Findings were assessed by molecular features ([18F]FDG-uptake) and morphological changes. The final diagnosis, which was arrived at after review of clinical, laboratory, and histopathologic analyses and follow-up imaging studies, served as the reference standard. Results Altogether, (i) 28 contrast-enhanced [18F]FDG-PET/CT scans (CE-PET/CT), (ii) 33 non-contrast [18F]FDG-PET/CT scans (NC-PET/CT), and (iii) 18 [18F]FDG-PET/MRI scans were included. Additionally, 12/62 patients underwent follow-up PET imaging to rule out vital tumor or metabolic active inflammatory processes. CE-PET/CT exhibited 94.4% sensitivity, 80.0% specificity, 89.5% positive predictive value (PPV), 88.9% negative predictive value (NPV), and 89.3% accuracy with regard to the reference standard. NC-PET/CT exhibited 91.3% sensitivity, 80.0% specificity, 91.3% PPV, 80.0% NPV, and 87.9% accuracy. PET/MRI exhibited 88.6% sensitivity, 99.2% specificity, 99.6% PPV, 81.3% NPV, and 94.4% accuracy. Exact McNemar statistical test (one-sided) showed significant difference between the CT-/MR-component alone and the integrated PET/CT and PET/MRI for diagnosis of malignancy or infection (p value < 0.001). Radiation exposure was 4- to 7-fold higher with PET/CT than with PET/MRI. Conclusion For immunocompromised patients with clinically unresolved symptoms, to rule out vital tumor manifestations or metabolic active inflammation, [18F]FDG-PET/MRI, CE-[18F]FDG-PET/CT, and NC-[18F]FDG-PET/CT exhibit excellent performance in diagnosing malignancy or infection. The main strength of PET/MRI is its considerably lower level of radiation exposure than that associated with PET/CT.
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Kim MJ, Lee CH, Lee Y, Youn H, Kang KW, Kwon J, Alavi A, Carlin S, Cheon GJ, Chung JK. Glucose-6-phosphatase Expression-Mediated [ 18F]FDG Efflux in Murine Inflammation and Cancer Models. Mol Imaging Biol 2020; 21:917-925. [PMID: 30719695 DOI: 10.1007/s11307-019-01316-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) accumulation in inflammatory lesions can confound the diagnosis of cancer. In this study, we investigated [18F]FDG accumulation and efflux in relation to the genes and proteins involved in glucose metabolism in murine inflammation and cancer models. PROCEDURES [18F]FDG accumulation and [18F]FDG efflux were measured in cancer cells (breast cancer, glioma, thyroid cancer, and hepatoma cells) and RAW 264.7 cells (macrophages) activated with lipopolysaccharide (LPS). The levels of mRNA expression were measured by real-time quantitative PCR (qPCR). The expression of glucose metabolism-related proteins was detected by western blotting. Dynamic [18F]FDG positron emission tomography-computed tomography (PET/CT) images were acquired for 2 h in tumor-bearing BALB/c nude mice and inflammatory mice induced by turpentine oil. RESULTS [18F]FDG accumulation in MDA-MB-231 (breast cancer) increased with time, but that of HepG2 (hepatoma) reached a constant level after 120 min. [18F]FDG efflux in HepG2 was faster than that in MDA-MB-231. HepG2 strongly expressed glucose-6-phosphatase (G6Pase) compared with MDA-MB-231. [18F]FDG accumulation increased with time, and [18F]FDG efflux accelerated after the activation of RAW 264.7 cells. The expression levels of G6Pase, glucose transporter1 and glucose transporter3 (GLUT1 and GLUT3), and hexokinase II (HK II) increased after the activation of RAW 264.7 cells. [18F]FDG efflux in activated macrophages was faster than that in MDA-MB-231 cancer cells. MDA-MB-231 strongly expressed HK II protein compared with the activated RAW 264.7. In murine models, [18F]FDG accumulation in MDA-MB-231 cancer and inflammatory lesions increased with time, but that in HepG2 tumor increased until 20-30 min (SUVmeans ± SD (tumor/muscle), 3.0 ± 1.3) and then decreased (2.1 ± 0.9 at 110-120 min). CONCLUSIONS There was no difference in the pattern of [18F]FDG accumulation with time in MDA-MB-231 tumors and inflammatory lesions. We found that [18F]FDG efflux accelerated in activated macrophages reflecting increased G6Pase expression after activation and lower expression of HK II protein than that in MDA-MB-231 cancer cells.
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Affiliation(s)
- Mi Jeong Kim
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, South Korea
| | - Chul-Hee Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Youngeun Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Tumor Biology Program, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyewon Youn
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, South Korea.,Cancer Imaging Center, Seoul National University Cancer Hospital, Seoul, South Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - JoonHo Kwon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Sean Carlin
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Tumor Biology Program, Seoul National University College of Medicine, Seoul, South Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. .,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, South Korea. .,Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Nuclear Medicine, National Cancer Center, Goyang, Republic of Korea.
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The added value of dual-time-point 18F-FDG PET/CT imaging in the diagnosis of colorectal cancer liver metastases. Abdom Radiol (NY) 2020; 45:1075-1081. [PMID: 31927618 DOI: 10.1007/s00261-019-02396-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the added value of dual-time-point 18F-FDG PET/CT imaging in the diagnosis of colorectal cancer liver metastases (CRLM). METHODS One hundred and eight patients with CRLM preoperatively underwent a dual-time-point 18F-FDG PET/CT scan. All hepatic lesions were diagnosed by histopathology. The diagnostic sensitivity of 18F-FDG PET/CT for CRLM was calculated on early scan and delayed scan, respectively. The McNemar test was used to test the differences of the sensitivity and the specificity between early scan and delayed scan. RESULTS On a per-patient basis, no significant difference in sensitivity was found between early scan and delayed scan (92.93% vs. 96.97%, P = 0.125). The per-patient specificity of early and delayed scans was 77.78%. On a per-lesion basis, overall sensitivity of delayed scan was significantly higher than that of early scan (83.49% vs. 76.61%, P < 0.001). The per-lesion specificity of early and delayed scans was 69.23%. For the lesion size of CRLM ≤ 10 mm, delayed imaging had significantly higher sensitivity than early imaging (47.17% vs. 26.42%, P < 0.001). However, for CRLM > 10 mm, there was no significant difference in sensitivity between early and delayed scans (92.73% vs. 95.15%, P = 0.125). Of the detected 182 liver metastatic lesions on delayed scan, the SUVmax on delayed scan was significantly higher than that on early scan (12.13 ± 7.13 vs. 9.16 ± 4.74, P < 0.001). The SUVmean of the normal liver on delayed scan was significantly lower than that on early scan (1.91 ± 0.29 vs. 2.33 ± 0.31, P < 0.001). The tumor to normal background ratio on delayed scan was significantly higher than that on early scan (6.59 ± 4.43 vs. 4.02 ± 2.23, P < 0.001). CONCLUSION The dual-time-point 18F-FDG PET/CT imaging might detect more CRLM lesions compared with single-time-point imaging, especially for small (< 10 mm) lesions.
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Priftakis D, Riaz S, Zumla A, Bomanji J. Towards more accurate 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) imaging in active and latent tuberculosis. Int J Infect Dis 2020; 92S:S85-S90. [DOI: 10.1016/j.ijid.2020.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/18/2022] Open
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Lovinfosse P, Rousseau C, Pierga JY, Bouchet F, Cochet A, Alberini JL, Girault S, Vera P, Olivier P, Uwer L, Cachin F, Scarwell B, Lemonnier J, Fourme E, Mesleard C, Martin AL, Lacœuille F, Couturier OF. Dual time point [ 18F]FLT-PET for differentiating proliferating tissues vs non-proliferating tissues. EJNMMI Res 2019; 9:109. [PMID: 31832803 PMCID: PMC6908533 DOI: 10.1186/s13550-019-0579-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose For differentiating tumor from inflammation and normal tissues, fluorodeoxyglucose ([18F]FDG) dual time point PET could be helpful. Albeit [18F]FLT is more specific for tumors than [18F]FDG; we explored the role of dual time point [18F]FLT-PET for discriminating benign from malignant tissues. Methods Before any treatment, 85 womens with de novo unifocal breast cancer underwent three PET acquisitions at 33.94 ± 8.01 min (PET30), 61.45 ± 8.30 min (PET60), and 81.06 ± 12.12 min (PET80) after [18F]FLT injection. Semiquantitative analyses of [18F]FLT uptake (SUV) were carried out on tumors, liver, bone marrow (4th thoracic vertebra (T4) and humeral head), descending thoracic aorta, muscle (deltoid), and contralateral normal breast. Repeated measures ANOVA tests and Tukey’s posttests were used to compare SUVmax of each site at the three time points. Results There was a significant increase in SUVmax over time for breast lesions (5.58 ± 3.80; 5.97 ± 4.56; 6.19 ± 4.42; p < 0.0001) (m ± SD for PET30, PET60, and PET80, respectively), and bone marrow (for T4, 8.21 ± 3.17, 9.64 ± 3.66, 10.85 ± 3.63, p < 0.0001; for humeral head, 3.36 ± 1.79, 3.87 ± 1.89, 4.39 ± 2.00, p < 0.0001). A significant decrease in SUVmax over time was observed for liver (6.79 ± 2.03; 6.24 ± 1.99; 5.57 ± 1.74; p < 0.0001), muscle (0.95 ± 0.28; 0.93 ± 0.29; 0.86 ± 0.20; p < 0.027), and aorta (1.18 ± 0.34; 1.01 ± 0.32; 0.97 ± 0.30; p < 0.0001). No significant difference was observed for SUVmax in contralateral breast (0.8364 ± 0.40; 0.78 ± 0.38; 0.80 ± 0.35). Conclusion [18F]FLT-SUVmax increased between 30 and 80 min only in proliferating tissues. This could be helpful for discriminating between residual tumor and scar tissue.
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Affiliation(s)
- Pierre Lovinfosse
- Nuclear Medicine Department and Inserm UMR_S 1066 MINT, University of Angers, Angers, France
| | - Caroline Rousseau
- Nuclear Medicine Department, West Cancer Institut (ICO), René Gauducheau Centre, Saint Herblain, France
| | | | - Francis Bouchet
- Nuclear Medicine Department and Inserm UMR_S 1066 MINT, University of Angers, Angers, France
| | - Alexandre Cochet
- Nuclear Medicine Department, Georges-François Leclerc Centre, Dijon, France
| | | | - Sylvie Girault
- Nuclear Medicine Department, West Cancer Institut (ICO), Paul Papin Centre, Angers, France
| | - Pierre Vera
- Nuclear Medicine Department, Henri Becquerel Centre, Rouen, France
| | - Pierre Olivier
- Nuclear Medicine Department, University of Nancy, Nancy, France
| | - Lionel Uwer
- Nuclear Medicine Department, Institut de cancerologie de lorraine, Vandoeuvre-les-, Nancy, France
| | - Florent Cachin
- Nuclear Medicine Department, Jean Perrin Center, Clermont Ferrand, France
| | - Benoit Scarwell
- Nuclear Medicine Department, Centre Hospitalier de la Cote Basque, Bayonne, France
| | | | | | | | | | - Franck Lacœuille
- Nuclear Medicine Department and Inserm UMR_S 1066 MINT, University of Angers, Angers, France
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Prognostic Value of the Volumetric Parameters of Dual–Time-Point18F-FDG PET/CT in Non–Small Cell Lung Cancer Treated With Definitive Radiation Therapy. AJR Am J Roentgenol 2019; 213:1366-1373. [DOI: 10.2214/ajr.19.21376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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50
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Initial experience with a PET/computed tomography system using silicon photomultiplier detectors. Nucl Med Commun 2019; 40:1174-1178. [PMID: 31568189 DOI: 10.1097/mnm.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE A PET/computed tomography (CT) that uses silicon photomultiplier (SiPM) technology was installed at our institution. Here, we report the initial use of the new scanner and evaluate the image quality in comparison to standard PET/CT scanners. PROCEDURES Seventy-two patients were scanned first using standard PET/CT followed immediately by the new PET/CT system. Images from the new PET/CT system were reconstructed using a conventional [non time-of-flight (TOF)] algorithm, TOF alone and TOF in combination with BSREM. Images from standard PET/CT were reconstructed using clinical standard-of-care settings. Three blinded readers randomly reviewed four datasets (standard, non-TOF, TOF alone, TOF+BSREM) per patient for image quality using a five-point Likert scale. SUV measurements for the single most avid lesion on each dataset were also recorded. RESULTS Datasets from the new scanner had higher image quality (P < 0.001) and SUV measurements (P < 0.001) compared with the standard scanners, and scores further improved when TOF and BSREM algorithms were added (mean scores for standard, non-TOF, TOF alone and TOF+BSREM were 3.1, 3.9, 4.3 and 5.0, respectively; mean SUVmax for hottest lesion were 8.8, 10.3, 10.7 and 13.3, respectively). CONCLUSION The SiPM-based PET/CT system outperforms two standard Bismuth germanium oxide- and Lutetium-yttrium oxyorthosilicate-based scanners in terms of image quality, with further benefits added using TOF and BSREM. This may be beneficial for detecting small lesions and more accurate disease staging.
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