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Barrington SF, Kluge R. FDG PET for therapy monitoring in Hodgkin and non-Hodgkin lymphomas. Eur J Nucl Med Mol Imaging 2017; 44:97-110. [PMID: 28411336 PMCID: PMC5541086 DOI: 10.1007/s00259-017-3690-8] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/15/2022]
Abstract
PET using 18F-FDG for treatment monitoring in patients with lymphoma is one of the most well-developed clinical applications. PET/CT is nowadays used during treatment to assess chemosensitivity, with response-adapted therapy given according to 'interim' PET in clinical practice to adults and children with Hodgkin lymphoma. PET is also used to assess remission from disease and to predict prognosis in the pretransplant setting. Mature data have been reported for the common subtypes of aggressive B-cell lymphomas, with more recent data also supporting the use of PET for response assessment in T-cell lymphomas. The Deauville five-point scale incorporating the Deauville criteria (DC) is recommended for response assessment in international guidelines. FDG uptake is graded in relation to the reference regions of normal mediastinum and liver. The DC have been validated in most lymphoma subtypes. The DC permit the threshold for adequate or inadequate response to be adapted according to the clinical context or research question. It is important for PET readers to understand how the DC have been applied in response-adapted trials for correct interpretation and discussion with the multidisciplinary team. Quantitative methods to perform PET in standardized ways have also been developed which may further improve response assessment including a quantitative extension to the DC (qPET). This may have advantages in providing a continuous scale to refine the threshold for adequate/inadequate response in specific clinical situations or treatment optimization in trials. qPET is also less observer-dependent and limits the problem of optical misinterpretation due to the influence of background activity.
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Affiliation(s)
- Sally F Barrington
- PET Imaging Centre, King's College London and Guy's, King's Health Partners, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, 0410, Leipzig, Germany
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Wei WX, Huang JJ, Li WY, Zhang X, Xia Y, Jiang WQ, Fan W, Li ZM. Prognostic values of interim and post-therapy 18F-FDG PET/CT scanning in adult patients with Burkitt's lymphoma. CHINESE JOURNAL OF CANCER 2015; 34:608-13. [PMID: 26630874 PMCID: PMC4668634 DOI: 10.1186/s40880-015-0057-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/27/2015] [Indexed: 12/16/2022]
Abstract
Background The prognostic values of interim and post-therapy fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) scanning have been confirmed in several subtypes of lymphoma. However, its prognostic value in Burkitt’s lymphoma has not been clearly defined. The aim of the present study was to assess the prognostic value of PET/CT scanning during different treatment processes of Burkitt’s lymphoma. Methods A total of 29 adult patients with newly diagnosed Burkitt’s lymphoma were retrospectively involved in this study; of them, 23 patients underwent baseline PET/CT, 15 patients underwent mid-therapy PET/CT after 1–4 cycles of chemotherapy, and 17 patients underwent post-therapy PET/CT after all planned first-line chemotherapy cycles. Mid-therapy and post-therapy PET/CT results (positive vs. negative) were visually interpreted according to the criteria of the International Harmonization Project. The reduction in the maximum standardizes uptake values (∆SUVmax) of 25%, 50%, and 75% were regarded as cutoff points. Overall survival (OS) and progression-free survival (PFS) were regarded as the major endpoints. Results The median OS and PFS were 27.6 months (range 6.5–78.3 months) and 27.2 months (range 3.0–78.3 months), respectively. The median SUVmax of the baseline PET/CT was 18.3 (range 1.6–35.9), whereas the median SUVmax of the mid-therapy and post-therapy PET/CT decreased to 4.0 (range 0–17.6) and 3.0 (range 0–14.5), respectively. The patients’ Eastern Cooperative Oncology Group (ECOG) scores (<2 vs. ≥2) were significantly associated with the baseline PET/CT SUVmax. The mid-therapy and post-therapy PET/CT results (positive vs. negative) showed no significant association with OS or PFS. The optimal cutoff ∆SUVmax from the baseline to the post-therapy PET/CT that could predict a change in OS in patients with Burkitt’s lymphoma was 50% (P = 0.019). Conclusions 18F-FDG uptake was intense in Burkitt’s lymphoma, and there was a significant reduction in SUVmax during the interim and post-therapy PET/CT procedures. A ∆SUVmax of greater than 50% was a favorable cutoff point to predict the OS of Burkitt’s lymphoma patients.
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Affiliation(s)
- Wen-Xiao Wei
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Jia-Jia Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Wen-Yu Li
- Lymphoma Division, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, P.R. China.
| | - Xu Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Yi Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Wei Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Zhi-Ming Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
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Karantanis D, Durski JM, Lowe VJ, Nathan MA, Mullan BP, Georgiou E, Johnston PB, Wiseman GA. 18F-FDG PET and PET/CT in Burkitt's lymphoma. Eur J Radiol 2009; 75:e68-73. [PMID: 19716248 DOI: 10.1016/j.ejrad.2009.07.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 07/27/2009] [Accepted: 07/28/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the value of (18)F fluorodeoxy-glucose (FDG) positron emission tomography (PET) in Burkitt's lymphoma. METHODS All Burkitt's lymphoma patients referred for FDG PET or FDG PET/computed tomography (CT) exams at our institution from June 2003 to June 2006 were included. Selected patients were followed and clinical information was reviewed retrospectively. Results from FDG PET-PET/CT, as blindly reviewed by a consensus of two experienced readers, were compared with the status of the disease as determined by other laboratory, clinical and imaging exams and clinical follow-up. FDG PET-PET/CT results were classified as true positive or negative and false positive or negative. The degree of FDG uptake in the positive lesions was semiquantified as maximum standard uptake value (SUVmax). RESULTS Fifty-seven FDG PET-PET/CT exams were done in 15 patients. Seven exams were done for initial staging, 8 during and 14 after the completion of therapy, and 28 for disease surveillance. For nodal disease FDG PET-PET/CT was true positive in 8, true negative in 47 and false positive in 2 exams (sensitivity 100%, specificity 96%). For extranodal disease FDG PET-PET/CT was true positive in 6, true negative in 48 and false positive in 3 exams (sensitivity 100%, specificity 94%). The mean SUVmax for the positive nodal lesions was 15.7 (range 6.9-21.7, median 18.5) and for extranodal lesions was 14.2 (range 6.2-24.3, median 12.4). CONCLUSIONS FDG PET-PET/CT is sensitive for the detection of viable disease in Burkitt's lymphoma. Affected areas demonstrated high degree of uptake that was reversible upon successful implementation of treatment.
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Affiliation(s)
- Dimitrios Karantanis
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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Kulkarni KP, Marwaha RK, Trehan A, Bansal D. Survival outcome in childhood ALL: experience from a tertiary care centre in North India. Pediatr Blood Cancer 2009; 53:168-73. [PMID: 19405133 DOI: 10.1002/pbc.21897] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Survival of children with ALL, in developing nations has not kept pace with cure rates in developed countries. Our study was designed to assess survival data and identify risk factors. PROCEDURE Data of 762 patients with ALL were analyzed. Information regarding the clinical-demographic profile, therapy and course of illness were recorded. Status and duration at last follow-up were utilized to generate Kaplan-Meier survival curves. RESULTS The mean age was 5.7 +/- 0.23 years (M/F, 3.2:1). Parents of 230 (30.2%) patients opted for no therapy. There were 68 and 60 deaths in induction and remission phases respectively. Besides these, 111 children either defaulted therapy or were lost to follow up. Relapsed disease was documented in 125 cases. The 5-year OS and EFS was 46% and 43% respectively. Survival analysis, using the Cox multivariate regression, for gender (P = 0.659, CI: 0.852-1.161), age (P = 0.943, CI: 0.725-1.225), symptom-diagnosis interval (P = 0.002, CI: 1.116-1.668), WCC (P < 0.001, CI: 1.353-1.814) and platelet count (P = 0.001, CI: 0.546-0.849) was performed. Bulk disease (P = 0.049, CI: 0.428-0.986), mediastinal adenopathy (P = 0.045, CI: 1.040-3.697), WCC (P = 0.016, CI: 1.395-2.691), platelet count (P = 0.031, CI: 0.431-0.967) and administration of 2 intensification blocks (P = 0.012, CI: 0.624-0.940) were found to be significant predictors of outcome by multivariate analysis. CONCLUSIONS The management of ALL requires financial resources and access to quality supportive care. One third of our patients opted for no therapy. The other problem areas were a high proportion of therapy defaulters, lost to follow up and infection related deaths during induction and remission phases. The introduction of remedial measures for resolving the difficulties identified would hopefully improve cure rates in ALL in developing nations.
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Affiliation(s)
- K P Kulkarni
- Division of Pediatric Hematology-Oncology, Advanced Pediatric Center, PGIMER, Chandigarh, India
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Abstract
PURPOSE F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) is known to be a useful diagnostic tool for staging, restaging, and monitoring therapy for lymphoma. The purpose of this retrospective study is to present a spectrum of FDG PET findings at initial presentation of Burkitt lymphoma and subsequent findings after therapy. METHOD AND MATERIALS We retrospectively reviewed 48 patients with Burkitt lymphoma referred for a total of 160 FDG PET/computed tomography (CT) scans at our institution. We characterized the disease distribution of Burkitt lymphoma in all patients and measured representative FDG activity from initial staging scans. Therapeutic response and disease remission were assessed in patients with PET/CT and clinical follow-up studies. RESULTS Of the 48 patients diagnosed with Burkitt lymphoma, 25 patients had FDG PET/CT scans for initial staging. All untreated lesions of Burkitt lymphoma were highly FDG avid. The mean maximum standardized uptake value of 54 representative lesions is 16.5 (range: 6-54). Twelve patients were immune compromised. The majority of patients had disease localized to the abdomen and the pelvis. Extranodal involvement was identified in more than half of the patients studied. CONCLUSION The American (or sporadic) form of Burkitt lymphoma presented with intense hypermetabolic lesions when untreated. The information is useful in evaluating post-treatment studies in the absence of a pretreatment scan.
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Analysis of 18F-FDG PET diffuse bone marrow uptake and splenic uptake in staging of Hodgkin’s lymphoma: a reflection of disease infiltration or just inflammation? Eur J Nucl Med Mol Imaging 2009; 36:1813-21. [DOI: 10.1007/s00259-009-1183-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 05/14/2009] [Indexed: 10/20/2022]
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Hoppe BS, Moskowitz CH, Zhang Z, Maragulia JC, Rice RD, Reiner AS, Hamlin PA, Zelenetz AD, Yahalom J. The role of FDG-PET imaging and involved field radiotherapy in relapsed or refractory diffuse large B-cell lymphoma. Bone Marrow Transplant 2009; 43:941-8. [PMID: 19139730 DOI: 10.1038/bmt.2008.408] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We examined the role of fluorodeoxyglucose-positron emission tomography (FDG-PET) and the addition of involved field radiotherapy (IFRT) as potential modifiers of salvage therapy. From January 2000 to June 2007, 83 patients with chemosensitive relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) underwent FDG-PET scans following second-line chemotherapy before high-dose therapy with autologous stem cell rescue (HDT/ASCR). We evaluated the prognostic value of having a negative FDG-PET scan before HDT/ASCR and whether IFRT improved the outcomes. Median follow-up was 45 months, and the 3-year PFS, disease-specific survival (DSS) and OS were 72, 80 and 78%, respectively. Multivariate analysis revealed that a positive FDG-PET scan had worse PFS (hazard ratio=(HR) 3.4; P=0.014), DSS (HR=7.7; P=0.001) and OS (HR=5.4; P=0.001), and that patients not receiving IFRT had worse PFS (HR=2.7; P=0.03) and DSS (HR=2.8, P=0.059). Patients who received IFRT had better local control with fewer relapses within prior involved sites compared with those that did not receive IFRT (P=0.006). These outcomes confirm the important prognostic value of FDG-PET scans before undergoing HDT/ASCR. It also suggests that the role of IFRT should be evaluated further.
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Affiliation(s)
- B S Hoppe
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Houseni M, Chamroonrat W, Servaes S, Alavi A, Zhuang H. Applications of PET/CT in Pediatric Patients with Fever of Unknown Origin. PET Clin 2008; 3:605-19. [DOI: 10.1016/j.cpet.2009.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Just PA, Fieschi C, Baillet G, Galicier L, Oksenhendler E, Moretti JL. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in AIDS-related Burkitt lymphoma. AIDS Patient Care STDS 2008; 22:695-700. [PMID: 18793085 DOI: 10.1089/apc.2008.0174] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aims to describe 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) findings in patients with AIDS-related Burkitt lymphoma, at various times of treatment, and to define its utility for a better patient management. We retrospectively studied 13 consecutive HIV-positive patients with Burkitt lymphoma who underwent one or more PET/CT. In 5 of 5 patients imaged before treatment, PET/CT confirmed all involved sites detected at conventional work-up and demonstrated additional sites in 4 of 5 patients. Lymph node involvement, which is known to be uncommon in endemic or sporadic Burkitt lymphoma, was present in 54% of patients. Additionally, in 3 patients, Burkitt lymphoma was predominantly located in parotid lymph nodes, which is also an unusual finding. A negative scan was encountered in 3 of 10 patients imaged during treatment and in 1 of 4 patients imaged after treatment completion and was always associated with lasting complete remission. Presence of residual area of uptake was related to both favorable and unfavorable outcome whether performed during treatment (5/7 and 2/7, respectively) or after (1/3 and 2/3, respectively). Areas of increased uptake could be observed in lung (4 cases) or esophagus (3 cases), and were clinically related to pneumonia or esophagitis. We recommend PET/CT for accurate initial staging of patients with AIDS-related Burkitt lymphoma. PET/CT is also useful to monitor treatment response, as regression of initial disease can be early observed. Furthermore, PET/CT appears to have prognostic value, as a negative scan was always associated with a favorable outcome.
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Affiliation(s)
- Pierre-Alexandre Just
- Department of Nuclear Medicine, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- EMDCT, Universitary Institute of Haematology, Paris VII University, Paris, France
| | - Claire Fieschi
- Department of Clinical Immunopathology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Georges Baillet
- Department of Nuclear Medicine, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- EMDCT, Universitary Institute of Haematology, Paris VII University, Paris, France
| | - Lionel Galicier
- Department of Clinical Immunopathology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Eric Oksenhendler
- Department of Clinical Immunopathology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jean-Luc Moretti
- Department of Nuclear Medicine, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- EMDCT, Universitary Institute of Haematology, Paris VII University, Paris, France
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Abstract
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and FDG-PET/computed tomography (CT) are becoming increasingly important imaging tools in the noninvasive evaluation and monitoring of children with known or suspected malignant diseases. In this review, we discuss the preparation of children undergoing PET studies and review radiation dosimetry and its implications for family and caregivers. We review the normal distribution of 18F-fluorodeoxyglucose (FDG) in children, common variations of the normal distribution, and various artifacts that may arise. We show that most tumors in children accumulate and retain FDG, allowing high-quality images of their distribution and pathophysiology. We explore the use of FDG-PET in the study of children with the more common malignancies, such as brain neoplasms and lymphomas, and the less-common tumors, including neuroblastomas, bone and soft-tissue sarcomas, Wilms' tumors, and hepatoblastomas. For comparison, other PET tracers are included because they have been applied in pediatric oncology. Multiple multicenter trials are underway that use FDG-PET in the management of children with neoplastic disease; these studies should give us greater insight into the impact FDG-PET can make in their care. PET is emerging as an important diagnostic imaging tool in the evaluation of pediatric cancers. The recent advent of dual-modality PET-computed tomography (PET/CT) imaging systems has added unprecedented diagnostic capability by revealing the precise anatomical localization of metabolic information and metabolic characterization of normal and abnormal structures. The use of CT transmission scanning for attenuation correction has shortened the total acquisition time, which is an especially desirable attribute in pediatric imaging. Moreover, expansion of the regional distribution of the most common PET radiotracer, FDG, and the introduction of mobile PET units have greatly increased access to this powerful diagnostic imaging technology. Here, we review the clinical applications of PET and PET/CT in pediatric oncology. General considerations in patient preparation and radiation dosimetry will be discussed.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, and Children's Hospital Boston, MA, USA
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Abstract
Computed tomography (CT) is currently the most commonly used means for staging malignant lymphoma. 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), FDG-PET/CT fusion, and whole-body magnetic resonance imaging (WB-MRI) are potential alternatives. The purpose of this study was to systematically review published data on the diagnostic performance of CT, FDG-PET, FDG-PET/CT fusion, and WB-MRI in staging of malignant lymphoma. In addition, technical aspects, procedures, advantages, and drawbacks of each imaging modality are outlined. Three CT studies, 17 FDG-PET studies, and 4 FDG-PET/CT fusion studies were included in this systematic review. The studies were of moderate methodological quality and used different scoring systems to stage malignant lymphoma. CT remains the standard imaging modality for initial staging of malignant lymphoma, while FDG-PET has an essential role in restaging after treatment. Early results suggest that FDG-PET/CT fusion outperforms both CT alone and FDG-PET alone. Data on the diagnostic performance of WB-MRI are lacking. Future well-designed studies, expressing their results according to the Ann Arbor staging system, are needed to determine which imaging modality is most accurate and cost-effective in staging malignant lymphoma.
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Abstract
FDG-PET is being increasingly applied to pediatric conditions, particularly in oncology. PET and PET/CT scanning in children are not currently supported by Centers for Medicare and Medicaid Services unless the disease condition coincides with a reimbursed adult condition. The recent merger of the Children's Cancer Group and the Pediatric Oncology Group to form the Children's Oncology Group creates an opportunity to examine the use of FDG-PET in the management of childhood tumors in multi-institutional, cooperative efforts. The interest in incorporating PET imaging technology in pediatric medicine has been evidenced by several recent review articles summarizing the ongoing progress in this area. Future data will show that FDG-PET provides useful diagnostic information and can play a pivotal role in the clinical management and care of children with disease.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, GNH 5250, Los Angeles, CA 90033, USA.
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Hernández Allende R, Banzo I, Quirce R, Pena FJ, Carril JM. [Scintigraphic image in a case of atypical presentation of Burkitt lymphoma. The role of the scintigraphy with 67Ga SPECT in the diagnosis and post-treatment control]. ACTA ACUST UNITED AC 2004; 23:119-23. [PMID: 15000943 DOI: 10.1016/s0212-6982(04)72266-1] [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: 10/27/2022]
Abstract
We present a case of Burkitt's disease with bone (thoracic wall, femur) and lymph node involvement. The patient had symptoms of fever with thoracic wall and femur pain. Lymph node involvement was detected by clinical exploration. A chest X-ray showed rib abnormalities. 99mTc-DPD scan showed thoracic wall (one rib) and femur involvement. 67Gallium SPECT and CT were performed at diagnosis. 67Gallium SPECT showed thoracic wall (one rib more) and abdominal lymph node involvement that was not detected by planar images. A CT scan did not show metastatic disease in mediastinal and abdominal lymph node chains but did show it in one rib and femur. After 6 chemotherapy sessions a new 67gallium scan and CT scan were performed. 67Gallium SPECT showed involvement in the thoracic wall (one rib) that was not detected in planar images. The CT scan was considered normal.
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Affiliation(s)
- R Hernández Allende
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria. Santander
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Bar-Shalom R, Mor M, Yefremov N, Goldsmith SJ. The value of Ga-67 scintigraphy and F-18 fluorodeoxyglucose positron emission tomography in staging and monitoring the response of lymphoma to treatment. Semin Nucl Med 2001; 31:177-90. [PMID: 11430525 DOI: 10.1053/snuc.2001.23519] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gallium-67 scintigraphy (GS) has the ability to provide important diagnostic and prognostic information for the evaluation of patients with lymphoma. GS is superior to morphologic imaging techniques because of its affinity to viable lymphoma cells. The value of GS lies not in the initial diagnosis but primarily in assessing the results of treatment and in the follow-up of patients with lymphoma. Nevertheless, GS has not gained the expected wide acceptance, possibly because of the meticulous technique required and the expertise needed for optimal interpretation. The introduction of positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) as a tumor-seeking agent, which provides images of superior quality, may have an impact on the current role of GS in the management of patients with lymphoma. FDG-PET seems to share with GS the advantages of a tumor viability agent. It appears to be more sensitive for detecting nodal and extranodal sites of disease than GS and may have predictive value during and after therapy for lymphoma. These potential clinical and economic advantages of FDG-PET need to be confirmed in systematic, large-scale prospective studies.
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Affiliation(s)
- R Bar-Shalom
- Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel
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de Wit M, Bohuslavizki KH, Buchert R, Bumann D, Clausen M, Hossfeld DK. 18FDG-PET following treatment as valid predictor for disease-free survival in Hodgkin's lymphoma. Ann Oncol 2001; 12:29-37. [PMID: 11249046 DOI: 10.1023/a:1008357126404] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The value of 18FDG-PET to predict the outcome after therapy in Hodgkin's lymphoma was compared to morphologic staging and ESR. PATIENTS AND METHODS A total of 50 concurrent 18FDG-PET and CT studies were performed in 37 patients with Hodgkin's lymphoma. ESR was evaluated 32 times after treatment was completed. RESULTS Out of 39 residual masses found by CT 8 relapses could be proven. Out of 11 CT exams with CR 3 relapses occurred. CT turned out to show a sensitivity, specificity, PPV, NPV, and accuracy of 72%, 21%, 21%, 73%, and 32%, with respect to predict disease-free survival (DFS). 18FDG-PET was positive in 22 examinations with 10 recurrences in this group. Out of 28 negative 18FDG-PET 1 relapse developed 3 years later. 18FDG-PET turned out to show promising sensitivity, specificity, PPV, NPV, and accuracy of 91%, 69%, 46%, 96%, 74%, with respect to predict DFS. ESR was elevated in 12 studies of which 5 relapses could be proven, while out of 20 normal ESR-studies 3 relapses occurred. Thus, ESR turned out to show sensitivity, specificity, PPV, NPV, and accuracy of 63%, 71%, 42%, 85%, and 75%, with respect to predict DFS. In summary, only 18FDG-PET was able to predict DFS statistically significant. CONCLUSION 18FDG-PET can be very useful in patients with residual masses after treatment.
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Affiliation(s)
- M de Wit
- Department of Oncology and Hematology, University Hospital Eppendorf, Hamburg, Germany.
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Abstract
Abstract
Positron emission tomography (PET) is a whole-body imaging technique using 18 fluorine-fluorodeoxyglucose (FDG), whose uptake is increased in tumor cells. Published studies have shown PET to be an effective method of staging lymphoma and to be more sensitive than CT at detecting extranodal disease. The purpose of this study was to determine whether the increased marrow uptake of FDG observed in some lymphoma patients during routine staging PET scans represented marrow involvement by disease. PET scans of 50 patients with Hodgkin's (12) and non-Hodgkin's (38) lymphoma were analyzed by three independent observers and the marrow graded as normal or abnormal using a visual grading system. Unilateral iliac crest marrow aspirates and biopsies were performed on all patients. The PET scan and marrow histology agreed in 39 patients (78%), being concordant positive in 13 and concordant negative in 26 patients. In 8 patients the PET scan showed increased FDG uptake but staging biopsy was negative; in 4 of these 8 patients the PET scan showed a normal marrow background with focal FDG “hot spots” distant from the site biopsied. In 3 patients the marrow biopsy specimen was positive but the PET scan normal; 2 of these 3 patients had non-Hodgkin's lymphoma whose malignant cells did not take up FDG at lymph node or marrow disease sites. Therefore, there were only 5 patients (10%) in whom there was a difference between the PET scan and biopsy result which could not be fully explained. Visual interpretation of marrow FDG uptake during whole-body staging PET scans can correctly assess marrow disease status in a high proportion of lymphoma patients. PET has the potential to reduce the need for staging marrow biopsy.
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Abstract
Positron emission tomography (PET) is a whole-body imaging technique using 18 fluorine-fluorodeoxyglucose (FDG), whose uptake is increased in tumor cells. Published studies have shown PET to be an effective method of staging lymphoma and to be more sensitive than CT at detecting extranodal disease. The purpose of this study was to determine whether the increased marrow uptake of FDG observed in some lymphoma patients during routine staging PET scans represented marrow involvement by disease. PET scans of 50 patients with Hodgkin's (12) and non-Hodgkin's (38) lymphoma were analyzed by three independent observers and the marrow graded as normal or abnormal using a visual grading system. Unilateral iliac crest marrow aspirates and biopsies were performed on all patients. The PET scan and marrow histology agreed in 39 patients (78%), being concordant positive in 13 and concordant negative in 26 patients. In 8 patients the PET scan showed increased FDG uptake but staging biopsy was negative; in 4 of these 8 patients the PET scan showed a normal marrow background with focal FDG “hot spots” distant from the site biopsied. In 3 patients the marrow biopsy specimen was positive but the PET scan normal; 2 of these 3 patients had non-Hodgkin's lymphoma whose malignant cells did not take up FDG at lymph node or marrow disease sites. Therefore, there were only 5 patients (10%) in whom there was a difference between the PET scan and biopsy result which could not be fully explained. Visual interpretation of marrow FDG uptake during whole-body staging PET scans can correctly assess marrow disease status in a high proportion of lymphoma patients. PET has the potential to reduce the need for staging marrow biopsy.
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de Wit M, Bumann D, Beyer W, Herbst K, Clausen M, Hossfeld D. Whole-body positron emission tomography (PET) for diagnosis of residual mass in patients with lymphoma. Ann Oncol 1997. [DOI: 10.1093/annonc/8.suppl_1.s57] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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