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Ozturk A, Aktas Z, Yilmaz A, Tari P, Demirag F. An amazing cause of false PET positivity: Diagnosed after a lung cancer surgery. Diagn Cytopathol 2017; 45:1122-1124. [DOI: 10.1002/dc.23775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Ayperi Ozturk
- Interventional Pulmonology Department; Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital; Ankara Turkey
| | - Zafer Aktas
- Interventional Pulmonology Department; Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital; Ankara Turkey
| | - Aydin Yilmaz
- Interventional Pulmonology Department; Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital; Ankara Turkey
| | - Pinar Tari
- Department of Nucleer Medicine; Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital; Ankara Turkey
| | - Funda Demirag
- Department of Pathology; Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital; Ankara Turkey
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Meirelles GDSP, Capobianco J, de Oliveira MAC. Pitfalls and artifacts in the interpretation of oncologic PET/CT of the chest. Radiol Bras 2017; 50:55-59. [PMID: 28298733 PMCID: PMC5347504 DOI: 10.1590/0100-3984.2015.0194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PET/CT is widely used for the evaluation of patients with thoracic malignancies.
Although the levels of 18F-fluorodeoxyglucose (FDG) uptake are
usually high in neoplastic diseases, they can also be physiological, due to
artifacts. In addition, FDG uptake can occur in benign conditions such as
infectious, inflammatory, and iatrogenic lesions. Furthermore, some malignant
tumors, such as adenocarcinoma in situ (formerly known as bronchoalveolar
carcinoma) and carcinoid tumors, may not show FDG uptake. Here, we illustrate
the main pitfalls and artifacts in the interpretation of the results of
oncologic PET/CT of the chest, outlining strategies for avoiding
misinterpretation.
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Affiliation(s)
| | - Julia Capobianco
- MD, Specialist in PET/CT, Radiologist for the Grupo Fleury, São Paulo, SP, Brazil
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Abstract
OBJECTIVE The goal of this study was to quantify aging effects upon the global knee joint and surrounding capsule and soft tissue inflammation using fluorine-18 fluorodeoxyglucose (18F-FDG) PET imaging. METHODS This reanalysis of a prospective study included 64 patients who had undergone 18F-FDG-PET for evaluation of hip joint prostheses, and whose scans included the knee joints in the field of view. Mean patient age was 53 years (range: 33-84 years). A fixed-sized three-dimensional region of interest was placed around each knee joint, paying close attention to exclude the popliteal vessels. 18F-FDG-avid regions in each knee joint were then segmented using an adaptive contrast-oriented thresholding method, and metabolically active volume (MAV), mean standardized uptake value (SUV mean), partial volume-corrected SUV mean (cSUV mean), and partial volume-corrected mean metabolic volumetric product (cMVP mean = cSUV mean × MAV) of the segmented regions were calculated. Finally, global knee inflammation (GKI) for each knee joint was calculated as the sum of cMVP mean in all segmented regions. Association of GKI with age was assessed with Pearson's correlation and linear regression methods, and GKI was compared between patients at different ages - between patients younger than 55 years and those older than 55 years - using the unpaired t-test. RESULTS The correlation coefficient of GKI with advancing age was 0.57 (P = 0.02). In the linear regression model, considering GKI as the dependent variable and age and sex as independent covariates, the β coefficient of age was 2.1 (95% confidence interval: 1.1-3.2). For patients aged younger than 55 years versus those aged older than 55 years, the mean GKI was 157 and 190 cm3, respectively (P = 0.01). CONCLUSION Through the use of novel quantitative techniques, we were able to calculate GKI and demonstrate a significant increase in the entity of joint inflammation with advancing age. As degenerative disease is age-related and inflammation is implicated in its pathogenesis, our findings further support this association. These preliminary data suggest that this approach can potentially provide a means to objectively quantify the degree of inflammation in various joint disorders, and possibly in other knee degenerative/inflammatory diseases.
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Abstract
Sarcoidosis is a chronic granulomatous disease of unknown origin. There are several modalities for diagnosis, staging and therapeutic management of patients with sarcoidosis. Among these, whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography is found to useful in patients with complex and multisystem forms of sarcoidosis. Other modalities include Gallium scanning, assesment of angiotensin converting enzyme levels in blood, chest radiography, mediastinoscopy etcetera.
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Affiliation(s)
- Beth Vettiyil
- Radiology Research Fellow, Diagnostic Radiology, Massachusetts General Hospital, Boston 02114, USA
| | - Nikitha Gupta
- Department of Biology (Premed Student), New York University, New York 10012, USA
| | - Rajesh Kumar
- Department of Pharmacology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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The scar sign: a useful finding on FDG PET/CT to distinguish sarcoidosis from other causes of lymphadenopathy. Clin Nucl Med 2013; 38:205-8. [PMID: 23354040 DOI: 10.1097/rlu.0b013e31827a22e0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Scar involvement is a rare but characteristic cutaneous manifestation of sarcoidosis. The concurrent presence of FDG-avid lymphadenopathy and scar involvement (the "scar sign") is a useful finding on FDG PET/CT to suggest sarcoidosis, especially when biopsy specimens are difficult to obtain. A 46-year-old woman who presented with fever, cough, and weight loss was found to have mediastinal and hilar lymphadenopathy on chest radiography and CT scan. FDG PET/CT scan showed FDG-avid lower cervical, mediastinal, hilar, and inguinal lymphadenopathy. There was also increased FDG uptake along an old hysterectomy scar. Mediastinoscopy and nodal biopsy revealed noncaseating granulomas compatible with sarcoidosis.
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Saboury B, Ziai P, Parsons M, Zhuang H, Basu S, Alavi A. Promising Roles of PET in Management of Arthroplasty-Associated Infection. PET Clin 2012; 7:139-50. [PMID: 27157232 DOI: 10.1016/j.cpet.2012.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A number of diagnostic tests is often necessary to differentiate aseptic loosening from periprosthetic infection in most clinical settings. The accuracy of [(18)F]Fluorodeoxyglucose examined with positron emission tomography imaging (FDG PET) in diagnosing periprosthetic infection has been determined by a number of investigations. In general, Images are considered positive for infection if they demonstrate increased FDG activity at the bone-prosthesis interface of the prostheses. Based on the large number of reports in the literature the sensitivity and specificity for FDG PET are about 85-90%. The overall accuracy of this non-invasive imaging modality is superior to the other existing imaging techniques. Therefore, FDG PET appears a very promising and accurate diagnosing tool for distinguishing septic from aseptic painful hip prostheses.
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Affiliation(s)
- Babak Saboury
- Department of Radiology, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Pouya Ziai
- Department of Radiology, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Molly Parsons
- Department of Radiology, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Hongming Zhuang
- Division of Nuclear Medicine, Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Bombay 400012, India
| | - Abass Alavi
- Department of Radiology, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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7
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Abstract
Sarcoidosis as a distinct disease entity was diagnosed more than 100 years ago. The signs and symptoms of the disease are nonspecific, posing a challenge for early and accurate diagnosis. IgG4 disease or syndrome has various clinical manifestations, such as sclerosing pancreatitis, sclerosing cholangitis, prostatitis, tubulointerstitial nephritis, interstitial pneumonia, and enlargement of salivary glands. This article discusses the role of the different diagnostic imaging modalities in sarcoidosis and IgG4 disease, including radiographs, computed tomography, magnetic resonance imaging, and conventional nuclear medicine, with a special emphasis on positron emission tomography as a superior modality for assessing these inflammatory diseases.
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Aragon-Ching JB, Akin EA. Positron emission tomography findings in clinical mimics of lymphoma. Ann N Y Acad Sci 2011; 1228:19-28. [DOI: 10.1111/j.1749-6632.2011.06019.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chung A, Schoder H, Sampson M, Morrow M, Port E. Incidental breast lesions identified by 18F-fluorodeoxyglucose-positron emission tomography. Ann Surg Oncol 2010; 17:2119-25. [PMID: 20162459 DOI: 10.1245/s10434-010-0950-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Positron emission tomography (PET) scanning is now part of the standard evaluation for patients with a variety of different malignancies. We describe our experience with breast incidentalomas in a large series of PET scans performed for patients without a known history of breast cancer. MATERIALS AND METHODS From March 2000 through June 2007, approximately 45,000 PET scans were performed; 163 had breast findings unrelated to the primary malignancy. In 103 of 163 (63%), findings included physiologic variation, lactation, implants, or benign calcifications. Chart review was conducted in the remaining 60 of 163 patients (37%). RESULTS In 20 of 60 patients (33%), no additional evaluation was performed due to advanced stage of the primary malignancy; 40 of 60 (67%) underwent additional imaging and evaluation. In 16 of 40 patients (40%), the lesion resolved on repeat PET; the lesion persisted in 10 of 40 (25%). Additional breast imaging was performed in 14 of 40 (35%). In total, 12 of 40 (30%) underwent biopsy; 7 of 40 (18%) were positive for malignancy. CONCLUSIONS In our experience, 29% of breast incidentalomas (7 of 24) with persistent imaging findings were malignant. Further evaluation of these lesions should be based on overall clinical status. In patients where results would not change overall management, biopsy may not be warranted.
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Affiliation(s)
- Alice Chung
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Krüger S, Buck AK, Mottaghy FM, Pauls S, Schelzig H, Hombach V, Reske SN. Use of integrated FDG-PET/CT in sarcoidosis. Clin Imaging 2008; 32:269-73. [PMID: 18603181 DOI: 10.1016/j.clinimag.2007.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 11/16/2007] [Indexed: 11/15/2022]
Abstract
We studied five patients with mediastinal lymph node enlargement suggestive of malignant lymphoma, lung cancer, or sarcoidosis. Integrated [(18)F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) was performed on all patients. Sarcoidosis can be a pitfall in PET/CT imaging, which may lead to false-positive results of malignancy. Increased FDG uptake in mediastinal lymph nodes is often comparable with malignant lymphoma or lymph node metastases. Histological confirmation of the lesions should be mandatory, except for patients in whom sarcoidosis can be accurately confirmed by other diagnostic methods.
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Affiliation(s)
- Stefan Krüger
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
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12
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Mortensen J, Loft A, Baslund B. 18F-fluoro-deoxyglucose PET for monitoring treatment in sarcoidosis. CLINICAL RESPIRATORY JOURNAL 2007; 1:124-6. [DOI: 10.1111/j.1752-699x.2007.00035.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Tolaney SM, Colson YL, Gill RR, Schulte S, Duggan MM, Shulman LN, Winer EP. Sarcoidosis Mimicking Metastatic Breast Cancer. Clin Breast Cancer 2007; 7:804-10. [DOI: 10.3816/cbc.2007.n.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kaira K, Ishizuka T, Yanagitani N, Sunaga N, Hisada T, Mori M. Value of FDG positron emission tomography in monitoring the effects of therapy in progressive pulmonary sarcoidosis. Clin Nucl Med 2007; 32:114-6. [PMID: 17242564 DOI: 10.1097/01.rlu.0000252216.68848.d7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kyoichi Kaira
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
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15
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Cheng CY, Huang WS, Shen DH, Fan YM, Hsu HH, Cherng SC, Lee SC. FDG PET/CT Demonstrated Rapid Progression of Mediastinal Lymphadenopathy in Sarcoidosis. Clin Nucl Med 2007; 32:117-21. [PMID: 17242565 DOI: 10.1097/01.rlu.0000252217.14064.0f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Cheng-Yi Cheng
- Tri-Service General Hospital, Department of Nuclear Medicine, Taipei, Taiwan.
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Sonet A, Graux C, Nollevaux MC, Krug B, Bosly A, Vander Borght T. Unsuspected FDG–PET findings in the follow-up of patients with lymphoma. Ann Hematol 2006; 86:9-15. [PMID: 17021839 DOI: 10.1007/s00277-006-0167-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
Abstract
18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) plays an increasing role in the management of patients with lymphoma, for which it is successfully used for staging and treatment monitoring. We report seven patients with a history of lymphoma who presented a positive FDG-PET suggestive of lymphoma relapse and for which FDG-PET oriented biopsies revealed alternative diagnoses. Early in lymphoma follow-up, persistence of focal increased FDG activity corresponded to inflammatory or infectious lesions in two patients: one aspergillosis and one sarcoidosis. Later in the follow-up, five cases of secondary malignancies were identified (three lung cancers, one epidermoid carcinoma, and one villous tumor) in this particularly exposed population. The routine use of FDG PET to evaluate lymphoma significantly increases the probability of detecting unexpected diseases. These cases illustrate the potential pitfalls in PET follow-up. Because FDG is not lymphoma-specific, a relapse suspected only on FDG-PET imaging requires biopsy, as alternative diagnoses--infectious or malignant--are possible. Our data draws clinician's attention to potential false-positive FDG-PET findings, which may lead to therapeutic mistakes. Our data also suggests that FDG-PET might be a new imaging modality for long-term monitoring of late effects, especially second cancer occurrence.
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Affiliation(s)
- Anne Sonet
- Department of Hematology, Mont-Godinne Medical Center, Université Catholique de Louvain, 1 Dr. G. Therasse, Yvoir, Belgium.
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Yu JQ, Zhuang H, Mavi A, Alavi A. Evaluating the Role of Fluorodeoxyglucose PET Imaging in the Management of Patients with Sarcoidosis. PET Clin 2006; 1:141-52. [DOI: 10.1016/j.cpet.2006.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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El-Haddad G, Zhuang H, Gupta N, Alavi A. Evolving role of positron emission tomography in the management of patients with inflammatory and other benign disorders. Semin Nucl Med 2005; 34:313-29. [PMID: 15493008 DOI: 10.1053/j.semnuclmed.2004.06.006] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) has evolved from a research imaging modality assessing brain function in physiologic and pathologic states to a pure clinical necessity. It has been successfully used for diagnosing, staging, and monitoring a variety of malignancies. FDG-PET imaging also is evolving into a powerful imaging modality that can be effectively used for the diagnosis and monitoring of a certain nononcological diseases. PET has been shown to be very useful in the diagnosis of osteomyelitis, painful prostheses, sarcoidosis, fever of unknown etiology, and acquired immunodeficiency syndrome. Based on recent observations, several other disorders, such as environment-induced lung diseases, atherosclerosis, vasculitis, back pain, transplantation, and blood clot, can be successfully assessed with this technique. With the development and the introduction of several new PET radiotracers, it is expected that PET will secure a major role in the management of patients with inflammatory and other benign disorders.
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Affiliation(s)
- Ghassan El-Haddad
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Xiu Y, Yu JQ, Cheng E, Kumar R, Alavi A, Zhuang H. Sarcoidosis Demonstrated by FDG PET Imaging With Negative Findings on Gallium Scintigraphy. Clin Nucl Med 2005; 30:193-5. [PMID: 15722828 DOI: 10.1097/00003072-200503000-00013] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yan Xiu
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Alavi A, Lakhani P, Mavi A, Kung JW, Zhuang H. PET: a revolution in medical imaging. Radiol Clin North Am 2004; 42:983-1001, vii. [PMID: 15488553 DOI: 10.1016/j.rcl.2004.08.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
FDG-PET has had remarkable influence on the assessment of physiologic and pathologic states. The authors predict that FDG-PET imaging could soon become the most common procedure used by nuclear medicine laboratories and could remain so for an extended period of time. The power of molecular imaging lies in the vast potential for using biochemical and pharmacologic probes to extend applications arising from an understanding of cell biology to a large number of well-characterized pathologic states. Molecular imaging based upon tracer kinetics with positron-emitting radiopharmaceuticals could become the main source of information for the management of cancer patients. In that case, nuclear medicine procedures might become the most common imaging studies performed in the practice of medicine. This speculation is not farfetched when one realizes the enormous change that a single biologically important compound, FDG, has brought to the medical arena. The major challenge today is to attract the highly qualified individuals and to secure the resources needed to harness the opportunities in the specialty of molecular imaging.
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Affiliation(s)
- Abass Alavi
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Abstract
Tumor staging according to the TNM-system influences prognosis and therapeutical options of patients with a malignant disease. It is the challenge of diagnostic imaging to depict the exact localization of the primary tumor and to detect or rule out lymph node involvement or distant metastases. In doing so, the complete body anatomy should be covered with a modality that offers high sensitivity and specificity. As these requirements could not or only partially be achieved by previous ordinary procedures, the use of multiple different modalities became necessary. Last but not least, in consideration of the costs it would be preferable to replace this cascade of different modalities by a "whole body examination", preconditioned that the same accuracy is achieved.With PET/CT and whole-body MRI, two newly available promising methods for a systemic tumor staging have been developed. First experiences indicate PET/CT as a method of first choice. With the introduction of new whole-body MRI scanners using parallel imaging technique (iPAT) and free table movement, MRI plays a more and more important role in whole body tumor staging.
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Affiliation(s)
- G P Schmidt
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München.
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Khan N, Oriuchi N, Ninomiya H, Higuchi T, Kamada H, Endo K. Positron emission tomographic imaging with11C-choline in differential diagnosis of head and neck tumors: comparison with18F-FDG PET. Ann Nucl Med 2004; 18:409-17. [PMID: 15462403 DOI: 10.1007/bf02984484] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED The aim of this study was to evaluate the clinical value of positron emission tomography (PET) with 11C-labeled choline (CHOL) for the differential diagnosis of malignant head and neck tumors from benign lesions as compared with 18F-fluorodeoxyglucose PET. METHODS We studied 45 patients (28 males, 17 females, age range, 29-84 years) with suspected lesions in the head and neck region using both CHOL and FDG PET within a 2-week period on each patient. All patients fasted for at least 6 hours for both the CHOL and FDG studies. PET imaging was performed 5 min and 50-60 min after intravenous injection of CHOL and FDG, respectively. After data acquisition, PET images were corrected for attenuation, and the reconstructed images were analyzed by visual interpretation. Then, the standardized uptake value (SUV) was calculated for semiquantitative evaluation of tumor tracer uptake. Finally the results of PET scans were compared with the histological diagnoses from surgical specimens or biopsies. RESULTS With CHOL PET, malignant tumors were correctly detected in 24 (96%) of 25 patients, and benign lesions in 14 (70%) of 20 patients with an accuracy of 84.4%. With FDG PET, malignancy was correctly diagnosed in 23 (92%) of 25 patients, and benign lesions in 13 (65%) of 20 patients resulting an accuracy of 80%. A significant positive correlation between CHOL and FDG SUVs was found for all lesions (r = 0.677, p = 0.004, n = 45). Malignant tumors showed significantly higher tracer accumulation than the benign lesions in both CHOL and FDG studies (5.69 +/- 1.61, n = 25 vs. 2.98 +/- 2.13, n = 20, p < 0.0001; 9.21 +/- 4.23, n = 25 vs. 3.60 +/- 2.57, n = 20, p < 0.0001). The cutoff SUV for differentiating malignant and benign lesions was 3.5 for CHOL and 3.9 for FDG. CHOL showed slightly better differentiation between malignant and benign lesions than FDG although some overlap existed on both studies. But the difference was not statistically significant. CONCLUSION The results of this study indicate that CHOL PET may be feasible clinically for head and neck tumor imaging. PET imaging with CHOL seems to be able to detect malignant head and neck tumors as effectively as FDG PET. The advantages of CHOL PET were shorter examination period and low uptake in the muscle. However, both CHOL and FDG have some limitations in the evaluation of salivary gland lesions.
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Affiliation(s)
- Nasim Khan
- Department of Nuclear Medicine & Diagnostic Radiology, Gunma University, Faculty of Medicine, Japan.
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Alavi A, Kung JW, Zhuang H. Implications of PET based molecular imaging on the current and future practice of medicine. Semin Nucl Med 2004; 34:56-69. [PMID: 14735459 DOI: 10.1053/j.semnuclmed.2003.09.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The last quarter century has witnessed the introduction of a variety of powerful techniques that have allowed visualization of organ structure and function with exquisite detail. This in turn has brought about a true revolution in the day-to-day practice of medicine. Structural imaging with x-ray computerized tomography and magnetic resonance imaging has added tremendously to many areas of medicine, including preoperative evaluation of patients. Many surgical procedures have been replaced by minimally invasive techniques, which have become a reality only because of the availability of modern imaging modalities. However, despite such accomplishments, structural imaging is quite insensitive for detecting early disease in which there often are no gross structural alterations in organ anatomy. Therefore, these modalities should be complemented by methodologies that can detect abnormalities at the molecular and cellular levels. The introduction of [(18)F]-fluorodeoxyglucose positron emission tomography (FDG-PET) in 1976 as a molecular imaging technique clearly has shown the power of this approach for treating a multitude of serious disorders. The impact of FDG-PET has been particularly impressive in patients with cancer diagnosis, for whom it has become important in staging, monitoring response to treatment, and detecting recurrence. In this review, we emphasize the role of FDG-PET in the assessment of central nervous system maladies, malignant neoplastic processes, infectious and inflammatory diseases, and cardiovascular disorders. New radiotracers are being developed and promise to expand further the list of indications for PET. These include novel tracers for cancer diagnosis and treatment capable of detecting hypoxia and angiogenesis. Prospects for developing new tracers for imaging other organ diseases also appear very promising.
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Affiliation(s)
- Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Milman N, Mortensen J, Sloth C. Fluorodeoxyglucose PET Scan in Pulmonary Sarcoidosis during Treatment with Inhaled and Oral Corticosteroids. Respiration 2003; 70:408-13. [PMID: 14512678 DOI: 10.1159/000072906] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2001] [Accepted: 11/06/2002] [Indexed: 11/19/2022] Open
Abstract
The objective was to investigate longitudinal changes in fluorodeoxyglucose PET scan (FDG-PET) in a patient with pulmonary sarcoidosis prior to and during treatment with inhaled corticosteroids followed by systemic corticosteroids. The patient was a 41-year-old man presenting with stage I pulmonary sarcoidosis (hilar adenopathy), which had progressed to stage II (pulmonary infiltrates) 19 months later. FDG-PET was performed at 19, 29 and 33 months after presentation. No treatment was given prior to the 1st PET. Subsequently, before the 2nd PET, the patient was treated with inhaled beclomethasone (QVAR Autohaler) 0.8 mg/day for 8 months. Finally, prior to the 3rd PET, the patient was treated with oral prednisolone 30 mg/day for 3 months. The 1st PET showed a high FDG uptake in the hilar and mediastinal lymph nodes and a high focal uptake in the peripheral parts of the lungs. The 2nd PET showed a slight uptake in a few mediastinal lymph nodes and an unchanged high focal uptake in the peripheral parts of the lungs and the pleura. The 3rd PET showed no abnormal uptake at all. In conclusion, as assessed by FDG-PET, inhaled beclomethasone had no recognizable influence on sarcoid inflammatory activity. Treatment with oral prednisolone depressed the inflammatory activity to such a degree that it was undetectable by PET. The results are in accordance with clinical studies on pulmonary sarcoidosis, showing a marginal effect of inhaled corticosteroids and a marked effect of systemic corticosteroids.
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Affiliation(s)
- Nils Milman
- Department of Medicine B, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Alavi A, Gupta N, Alberini JL, Hickeson M, Adam LE, Bhargava P, Zhuang H. Positron emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med 2002; 32:293-321. [PMID: 12524653 DOI: 10.1053/snuc.2002.127291] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The role of the fluorodeoxyglucose (FDG) technique positron emission tomography (PET) is well established in the management of patients with lung cancer. Increasingly, it is becoming evident that FDG-PET can be effectively employed to diagnose a variety of benign pulmonary disorders. Knowledge of such applications further expands the domain of this powerful modality and further improves the ability to differentiate benign from malignant diseases of the chest. We describe pertinent technical factors that substantially contribute to optimal imaging of the thoracic structures. Particularly, the complementary role of attenuation correction (AC) to that of non-AC images is emphasized. We further outline the need for and the state of the art for co-registration of PET and anatomic images for diagnostic and therapeutic purposes. We then review patterns of physiologic uptake of FDG in thoracic structures, including the lung, the heart, the aorta and large arteries, esophagus, thymus, trachea, thoracic muscles, bone marrow, and joints and alterations following radiation therapy to the thorax. A great deal of information is provided with regard to differentiating benign from malignant nodules and in particular, we emphasize the role of dual time point imaging and partial volume correction for accurate assessment of such lesions. Following a brief review of the diagnostic issues related to the assessment of mediastinal adenopathies, the role of FDG-PET imaging in environment-induced lung diseases, including pneumoconiosis, smoking, and asthma are described. A large body of information is provided about the role of this technology in the management of patients with suspected infection and inflammation of the lungs such as acquired immunodeficiency syndrome, fever of unknown origin, sarcoidosis, chronic granulomatous disease and monitoring the disease process and response to therapy. Finally, the value of FDG-PET in differentiating benign from malignant diseases of the pleura including asbestosis-related disorders is described at the conclusion of this comprehensive review.
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Affiliation(s)
- Abass Alavi
- Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Zhuang H, Alavi A. 18-fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation. Semin Nucl Med 2002; 32:47-59. [PMID: 11839069 DOI: 10.1053/snuc.2002.29278] [Citation(s) in RCA: 422] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
During the past decade, 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) has rapidly evolved from a pure research modality to a clinical necessity. FDG-PET was introduced to determine the state of brain function in physiologic and pathologic states. Its use as a powerful tool to diagnose, stage, and monitor patients with a variety of malignancies has been truly revolutionary. However, FDG is a nonspecific tracer and it has been found to accumulate at sites of infection and inflammation. It is becoming evident that PET imaging will play a major role in the treatement of patients with suspected infection and inflammation. PET has been shown to be particularly valuable in the evaluation of chronic osteomyelitis, infected prostheses, sarcoidosis, fever of unknown origin, and acquired immunodeficiency syndrome. Because of its ability to quantitate the rate of FDG uptake, PET may prove to be a powerful modality for the monitoring of disease activity and response to therapy. Novel PET tracers are being tested for imaging infection and inflammation that may further enhance the role of this technique in the appropriate clinical setting. PET imaging to detect and characterize infection and inflammation may become a major clinical indication in the day-to-day practice of medicine.
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Affiliation(s)
- Hongming Zhuang
- Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Affiliation(s)
- K Taaleb
- Department of Nuclear Medicine, Central Military Hospital, Koblenz, Germany
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Gotway MB, Storto ML, Golden JA, Reddy GP, Webb WR. Incidental detection of thoracic sarcoidosis on whole-body 18fluorine-2- fluoro-2-deoxy-D-glucose positron emission tomography. J Thorac Imaging 2000; 15:201-4. [PMID: 10928615 DOI: 10.1097/00005382-200007000-00010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
18 Fluorine-2- Fluoro-2-Deoxy-D-Glucose positron emission tomography (18FDG PET) allows imaging of sites with increased metabolic activity. Increased metabolic activity in mediastinal nodes in sarcoidosis has been described. We report the prospective diagnosis of thoracic sarcoidosis on 18FDG PET based on extensive, peripheral, upper lobe parenchymal, and mediastinal nodal tracer uptake.
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Affiliation(s)
- M B Gotway
- University of California, Department of Radiology, San Francisco General Hospital, 94110, USA.
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