Nuove applicazioni della medicina nucleare in ambito diagnostico: II parte

The role of 18F-FDG-PET and PET/CT in patients with sarcoidosis: an updated evidence-based review

RATIONALE AND OBJECTIVES

To provide an updated evidence-based review of the literature on the role of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) or PET/computed tomography (PET/CT) in patients with sarcoidosis.

MATERIALS AND METHODS

A comprehensive literature search of PubMed/MEDLINE, Scopus, and Embase databases was conducted to find relevant published articles on FDG-PET or PET/CT in patients with sarcoidosis. Only those studies that satisfied all the following criteria were included: (1) FDG-PET or PET/CT performed in patients with histologically confirmed sarcoidosis, (2) sample size of at least 10 patients, and (3) whole-body PET studies performed. Information was collected concerning basic study, patient characteristics, and technical aspects. The main findings of the articles included have been described.

RESULTS

Reviewing titles and abstracts, 21 articles were selected. The role of FDG-PET or PET/CT was analyzed in assessing disease extent and activity and in treatment response evaluation. Comparison with other tracers had also been investigated. Recent studies evaluated the influence of these methods in the clinical management and their role as predictive tools in patients with sarcoidosis.

CONCLUSIONS

FDG-PET and PET/CT seem to be useful in staging, evaluating disease activity, and monitoring treatment response in patients with sarcoidosis. PET appears to have higher diagnostic accuracy compared to Gallium-67-citrate scintigraphy. Conversely, there is not enough evidence about the use of other PET tracers in patients with sarcoidosis. FDG-PET and PET/CT seem to have a role as predictive tools and may influence the clinical management in patients with sarcoidosis, but more studies are needed in this regard.

Diagnostic performance of Fluorine-18-Fluorodeoxyglucose positron emission tomography for the diagnosis of osteomyelitis related to diabetic foot: a systematic review and a meta-analysis

OBJECTIVE

To systematically review and meta-analyse published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in osteomyelitis related to diabetic foot.

METHODS

A comprehensive literature search of studies on (18)F-FDG-PET and PET/CT in patients with diabetic foot was performed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odds ratio (DOR) and area under the summary ROC curve of (18)F-FDG-PET and PET/CT in patients with osteomyelitis related to diabetic foot were calculated.

RESULTS

Nine studies comprising 299 patients with diabetic foot were included in the qualitative analysis (systematic review) and discussed. The quantitative analysis (meta-analysis) of four selected studies provided the following results on a per patient-based analysis: sensitivity was 74% [95% confidence interval (95%CI): 60-85%], specificity 91% (95%CI: 85-96%), LR+ 5.56 (95%CI: 2.02-15.27), LR- 0.37 (95%CI: 0.10-1.35), and DOR 16.96 (95%CI: 2.06-139.66). The area under the summary ROC curve was 0.874.

CONCLUSIONS

In patients with suspected osteomyelitis related to diabetic foot (18)F-FDG-PET and PET/CT demonstrated a high specificity, being potentially useful tools if combined with other imaging methods such as MRI. Nevertheless, the literature focusing on the use of (18)F-FDG-PET and PET/CT in this setting remains still limited.

Diagnostic performance of Fluorine-18-Fluorodeoxyglucose positron emission tomography in patients with chronic inflammatory bowel disease: a systematic review and a meta-analysis

OBJECTIVE

To systematically review and meta-analyze published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in patients with chronic inflammatory bowel disease (IBD).

METHODS

A comprehensive computer literature search of studies published through May 2012 regarding (18)F-FDG-PET and PET/CT in patients with IBD was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odd ratio (DOR) of (18)F-FDG PET and PET/CT in patients with IBD on a per segment-based analysis were calculated. The area under the ROC curve was calculated to measure the accuracy of (18)F-FDG PET and PET/CT in patients with IBD.

RESULTS

Nineteen studies comprising 454 patients with suspected IBD were included in the qualitative analysis (systematic review) and discussed. The quantitative analysis (meta-analysis) of seven selected studies (including 219 patients with IBD) provided the following results on a per segment-based analysis: sensitivity was 85% [95% confidence interval (95%CI) 81-88%], specificity 87% (95%CI 84-90%), LR+ 6.19 (95%CI: 2.86-13.41), LR- 0.19 (95%CI: 0.10-0.34), and DOR 44.35 (95%CI: 11.77-167.07). The area under the ROC curve was 0.933.

CONCLUSIONS

In patients with suspected IBD (18)F-FDG PET and PET/CT demonstrated good sensitivity and specificity, being accurate methods in this setting. Nevertheless, the literature focusing on the use of PET and PET/CT in IBD remains still limited; thus, further large multicenter studies will be necessary to substantiate the diagnostic accuracy of these methods in patients with IBD.

Emerging role of Fluorine-18-fluorodeoxyglucose positron emission tomography in patients with retroperitoneal fibrosis: a systematic review

To systematically review the literature data on the role of Fluorine-18-fluorodeoxyglucose positron emission tomography and positron emission tomography/computed tomography (FDG-PET and PET/CT) in patients with retroperitoneal fibrosis (RF), PubMed/MEDLINE, Embase and Scopus databases were searched for articles that evaluated the usefulness of FDG-PET and PET/CT in patients with RF from inception to March 31, 2012. Review articles or editorials, articles not in the field of interest of this review, case reports and preclinical studies were excluded. Only studies including FDG-PET or PET/CT scans performed in at least three patients with RF were included. Ten studies comprising a total of 101 patients with RF were found. The main findings of the included studies are described. FDG-PET and PET/CT are feasible and suitable imaging methods for evaluating patients with RF. These functional imaging techniques seem to be useful both in the diagnosis (mainly in the assessment of activity and extent of the disease) and in evaluating the treatment response in patients with RF. Given the heterogeneity among the various studies for PET analysis and diagnostic criteria, a standardization of the technique is required in order to achieve reproducible and inter-observer independent results. Moreover, further studies are needed to substantiate the role of FDG-PET and PET/CT in patients with RF.

Fluorine-18-fluorodeoxyglucose positron emission tomography in assessing retroperitoneal fibrosis: a literature review

Background and Purpose. Several studies have evaluated the role of fluorine-18-fluorodeoxyglucose positron emission tomography and positron emission tomography/computed tomography (FDG-PET and PET/CT) in diagnosing and assessing disease activity in patients with retroperitoneal fibrosis (RF). The aim of our paper is to perform a literature review on this topic. Methods. Scientific articles that evaluated the usefulness of FDG-PET and PET/CT in patients with RF were searched and discussed. Results. Eleven studies were found, and the main findings of these articles were described. Conclusion. FDG-PET and PET/CT are useful functional imaging methods for assessing patients with RF both in the diagnosis and in the treatment response evaluation. Moreover, further studies are needed to substantiate the role of FDG-PET and PET/CT in patients with RF.

Usefulness of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography in patients with large-vessel vasculitis: a systematic review

The objective of this study is to systematically review the role of positron emission tomography (PET) and PET/computed tomography (PET/CT) with fluorine-18-fluorodeoxyglucose (FDG) in patients with large-vessel vasculitis (LVV). A comprehensive literature search of published studies through April 2011 in PubMed/MEDLINE and Scopus databases regarding whole-body FDG-PET and PET/CT in patients with LVV was performed. We identified 32 studies including 604 LVV patients. The main findings of these studies are presented. The conclusions are the following: (1) FDG-PET and PET/CT are useful imaging methods in the initial diagnosis and in the assessment of activity and extent of disease in patients with LVV; (2) the correlation between FDG-PET findings and serological levels of inflammatory markers, as well as the usefulness of FDG-PET and PET/CT in evaluating treatment response, remains unclear; (3) it appears that there is a superiority of FDG-PET and PET/CT over conventional imaging methods in the diagnosis of LVV, but not in assessing disease activity under immunosuppressive treatment, in predicting relapse or in evaluating vascular complications; and (4) given the heterogeneity between studies with regard to PET analysis and diagnostic criteria, a standardization of the technique is needed.