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Aso K, Gohda Y, Hotta M, Minamimoto R, Shimizu Y, Uemura Y, Yano H. Clinical Effectiveness of Preoperative 18F-FDG PET/CT in Predicting Pathological Tumor Grade in Patients with Pseudomyxoma Peritonei Originating from Appendix: A Retrospective Cohort Study. Ann Surg Oncol 2024; 31:1990-1995. [PMID: 38082170 DOI: 10.1245/s10434-023-14755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/25/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is the standard treatment for patients with pseudomyxoma peritonei (PMP). In some malignancies, the standard uptake value of positron emission tomography with 2-deoxy-2-18F-fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) is now accepted as a reliable indicator of neoplastic behavior. This study aimed to evaluate the association between the maximum standardized uptake value (SUVmax) and pathological grade in patients with PMP and to investigate the significance of SUVmax in the preoperative assessment of these patients. PATIENTS AND METHODS In this retrospective single-center study, consecutively enrolled patients diagnosed with PMP of appendiceal origin underwent preoperative 18F-FDG PET/CT. SUVmax was calculated as the highest SUVmax value in the abdomen excluding the primary site. SUVmax was compared with the pathological grade (low or high grade) of PMP tumors according to the World Health Organization classification and further analyzed with respect to the estimated cutoff point, sensitivity, specificity, and receiver operating characteristic. RESULTS In total, 160 patients were included. CRS was successfully performed in 93 patients and palliative debulking surgery in 67 patients. The pathological grade was high in 45 patients and low in 115. High-grade patients had a higher median SUVmax on 18F-FDG PET/CT than did low-grade patients (3.83 versus 2.34, p < 0.001). The highest area under the curve was 0.81, with a sensitivity of 77.8%, specificity of 72.3%, and cutoff point of 2.63. CONCLUSION This study suggests that the SUVmax of preoperative 18F-FDG PET/CT is associated with the pathological grade in patients with PMP.
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Affiliation(s)
- Kenta Aso
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimasa Gohda
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Masatoshi Hotta
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yosuke Shimizu
- Center of Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukari Uemura
- Center of Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideaki Yano
- Consultant Colorectal Surgeon, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Brown AH, Shah S, Groves AM, Wan S, Malhotra A. The Challenge of Staging Breast Cancer With PET/CT in the Era of COVID Vaccination. Clin Nucl Med 2021; 46:1006-1010. [PMID: 33795590 PMCID: PMC8575097 DOI: 10.1097/rlu.0000000000003683] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/13/2021] [Accepted: 03/13/2021] [Indexed: 12/02/2022]
Abstract
ABSTRACT We report a case series of biopsy-proven reactive axillary lymph nodes, which were avid on FDG PET/CT in breast cancer patients post COVID-19 vaccination. With 4 cases presenting in a consecutive 10-day period, it became apparent that metabolically active axillary lymphadenopathy is an adverse effect of COVID-19 vaccines, currently being deployed worldwide. This may lead to patients undergoing unnecessary biopsy. We have started taking a COVID-19 vaccine status history before PET/CT. If enlarged/metabolically active axillary nodes are identified in the ipsilateral vaccinated arm, then axillary ultrasound at 4 weeks is suggested.
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Affiliation(s)
| | - Sweni Shah
- Department of Nuclear Medicine, Royal Free Hospital
| | - Ashley M. Groves
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Simon Wan
- Institute of Nuclear Medicine, University College London, London, United Kingdom
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Kikano EG, Avril S, Marshall H, Jones RS, Montero AJ, Avril N. PET/CT Variants and Pitfalls in Breast Cancers. Semin Nucl Med 2021; 51:474-484. [PMID: 34088473 DOI: 10.1053/j.semnuclmed.2021.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There are a number of normal variants and pitfalls which are important to consider when evaluating F-18 Fluorodeoxyglucose (FDG) with Positron Emission Tomography (PET) in breast cancer patients. Although FDG-PET is not indicated for the initial diagnosis of breast cancer, focally increased glucose metabolism within breast tissue represents a high likelihood for a neoplastic process and requires further evaluation. Focally increased glucose metabolism is not unique to breast cancer. Other malignancies such as lymphoma, metastases from solid tumors as well as inflammatory changes also may demonstrate increased glucose metabolism either within the breast or at other sites throughout the body. Importantly, benign breast disease may also exhibit increased glucose metabolism, limiting the specificity of FDG-PET. Breast cancer has a wide range of metabolic activity attributed to tumor heterogeneity and breast cancer subtype. Intracellular signaling pathways regulating tumor glucose utilization contribute to these pitfalls of PET/CT in breast cancer. The evaluation of axillary lymph nodes by FDG-PET is less accurate than sentinel lymph node procedure, however is very accurate in identifying level II and III axillary lymph node metastases or retropectoral metastases. It is important to note that non-malignant inflammation in lymph nodes are often detected by modern PET/CT technology. Therefore, particular consideration should be given to recent vaccinations, particularly to COVID-19, which can commonly result in increased metabolic activity of axillary nodes. Whole body FDG-PET for staging of breast cancer requires specific attention to physiologic variants of FDG distribution and a careful comparison with co-registered anatomical imaging. The most important pitfalls are related to inflammatory changes including sarcoidosis, sarcoid like reactions, and other granulomatous diseases as well as secondary neoplastic processes.
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Affiliation(s)
- Elias George Kikano
- Department of Radiology, Division of Nuclear Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Stefanie Avril
- Department of Pathology, Cleveland, Ohio; University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Holly Marshall
- Department of Radiology, Division of Breast Imaging, Cleveland, Ohio; University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Robert Stanley Jones
- Department of Radiology, Division of Nuclear Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Alberto J Montero
- Department of Medicine, Solid Tumor Oncology, Cleveland, Ohio; University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Norbert Avril
- Department of Radiology, Division of Nuclear Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
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False-Positive 18F-FDG PET/CT Uptake in Unilateral Lactation. Case Rep Radiol 2021; 2020:8850052. [PMID: 33489403 PMCID: PMC7803103 DOI: 10.1155/2020/8850052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022] Open
Abstract
A 31-year-old woman (7 months postpartum and lactating) with multiple sclerotic bone lesions was referred for an 18F-FDG PET/CT scan for characterization. The scan demonstrated unilateral diffuse intense FDG uptake corresponding to dense soft tissue in the right breast, likely related to secretory hyperplasia. On further questioning, it was made apparent that she had only been breastfeeding from the right breast. While the left breast also demonstrated dense soft tissue to a lesser degree, no significant FDG uptake was seen. The sclerotic bone lesions were not FDG avid, likely due to a separate non-FDG avid benign condition or bony metastases from a non-FDG avid primary malignancy. This was reinforced by the fact that subsequent investigations including serial bilateral breast ultrasound and percutaneous biopsy demonstrated no definite evidence of malignancy in the bilateral breasts. The histopathology findings of an open surgical biopsy of sclerotic lesions in the left posterior ilium were also nonspecific, favouring bone dysplasia with no evidence of malignancy.
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Jeon I, Kong E, Yu D, Hong CP. Clinical and Radiological Analysis of Pyogenic Vertebral Osteomyelitis Immediately after Successful Antimicrobial Therapy: Considerations for Assessing Therapeutic Response. Diagnostics (Basel) 2020; 10:diagnostics10110861. [PMID: 33105849 PMCID: PMC7690620 DOI: 10.3390/diagnostics10110861] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose: The clinical and radiological abnormal findings continue even after successful treatment in pyogenic vertebral osteomyelitis (PVO). We analyzed the clinical and radiological features of cured PVO based on 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (FDG-PET/MRI) and compared the radiological differences between FDG-PET and MRI for assessing therapeutic response in PVO. Methods: This study included 43 patients (28 men and 15 women) with lumbar PVO who had no recurrence after successful antimicrobial therapy. They were divided into two groups based on the location of maximum standardized FDG uptake value (SUVmax) of PVO lesion on FDG-PET/MRI when parenteral antibiotics were discontinued (31 in group A: Intervertebral structure; 12 in group B: Vertebral body and paravertebral muscle). The differences of clinical symptoms, hematological inflammatory indices, and radiological features were retrospectively analyzed. Results: The patients were treated with 42.28 ± 14.58 (21–89) days of parenteral antibiotics. There were significant differences in C-reactive protein (0.97 ± 1.10 vs. 0.51 ± 0.31 mg/dL, p = 0.041; normal range of CRP < 0.5), back pain (4.29 ± 1.13 vs. 3.50 ± 1.00, p = 0.040; visual analog scale), and SUVmax (4.34 ± 1.24 vs. 5.89 ± 1.57, p < 0.001) between the two groups. In the distribution pattern of PVO lesions, FDG-PET overall showed recovery pattern earlier than MRI did (p < 0.001). Conclusions: In cured PVO, the clinical features vary depending on the location of major structural damage of PVO lesion. The involvement of intervertebral structure is related with sustained back pain and elevation of CRP, and vertebral body/paravertebral muscle shows favorable clinical features despite advanced structural damages.
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Affiliation(s)
- Ikchan Jeon
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu 42415, Korea;
- Correspondence:
| | - Eunjung Kong
- Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu 42415, Korea;
| | - Dongwoo Yu
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu 42415, Korea;
| | - Cheol Pyo Hong
- Department of Radiological Science, Catholic University of Daegu, Gyeongbuk 38430, Korea;
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Abstract
A 32-year-old woman was treated for breast carcinoma. Posttreatment FDG PET/CT scan revealed complete response, but in the contralateral breast, unexpected incidental intense FDG uptake was seen with a differential diagnosis of both malignant and benign causes. Medical history revealed recent breast contusion. The lesion was further evaluated by mammogram and ultrasound, which were compatible with deep breast bruise. Histopathology showed no malignancy. Subsequent FDG PET/CT study showed breast uptake normalization. This case shows that postcontusion breast hematoma can cause a potential pitfall mimicking breast malignancy on FDG PET/CT.
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Wang P, Kim T, Harada M, Contag C, Huang X, Smith BR. Nano-immunoimaging. NANOSCALE HORIZONS 2020; 5:628-653. [PMID: 32226975 DOI: 10.1039/c9nh00514e] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Immunoimaging is a rapidly growing field stoked in large part by the intriguing triumphs of immunotherapy. On the heels of immunotherapy's successes, there exists a growing need to evaluate tumor response to therapy particularly immunotherapy, stratify patients into responders vs. non-responders, identify inflammation, and better understand the fundamental roles of immune system components to improve both immunoimaging and immunotherapy. Innovative nanomaterials have begun to provide novel opportunities for immunoimaging, in part due to their sensitivity, modularity, capacity for many potentially varied ligands (high avidity), and potential for multifunctionality/multimodality imaging. This review strives to comprehensively summarize the integration of nanotechnology and immunoimaging, and the field's potential for clinical applications.
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Affiliation(s)
- Ping Wang
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, Room #1118, East Lansing, MI 488824, USA. and Precision Health Program, Michigan State University, East Lansing, MI 488824, USA
| | - Taeho Kim
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, Room #1118, East Lansing, MI 488824, USA. and Department of Biomedical Engineering, Michigan State University, East Lansing, MI 488824, USA
| | - Masako Harada
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, Room #1118, East Lansing, MI 488824, USA. and Department of Biomedical Engineering, Michigan State University, East Lansing, MI 488824, USA
| | - Christopher Contag
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, Room #1118, East Lansing, MI 488824, USA. and Precision Health Program, Michigan State University, East Lansing, MI 488824, USA and Department of Biomedical Engineering, Michigan State University, East Lansing, MI 488824, USA and Department of Microbiology & Molecular Genetics, Michigan State University, East Lansing, MI 488824, USA
| | - Xuefei Huang
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, Room #1118, East Lansing, MI 488824, USA. and Department of Biomedical Engineering, Michigan State University, East Lansing, MI 488824, USA and Department of Chemistry, Michigan State University, East Lansing, MI 488824, USA
| | - Bryan Ronain Smith
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, Room #1118, East Lansing, MI 488824, USA. and Department of Biomedical Engineering, Michigan State University, East Lansing, MI 488824, USA and Department of Radiology, Stanford University, Stanford, CA 94306, USA
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Hutomo F, Yudistiro R, Mulyanto ID, Budiawan H. False positive finding from malignancy-like lesions on FDG PET/CT: case report of tuberculosis patients. BMC Med Imaging 2020; 20:26. [PMID: 32138682 PMCID: PMC7059263 DOI: 10.1186/s12880-020-00427-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background The F-18 fluorodeoxyglucose positron emission/computed tomography (FDG PET/CT) has become an established diagnostic imaging for malignancy. However, there are other diseases that can also be identified with FDG, some of them are infections such as tuberculosis. Case presentation In this case report, two patients showed multiple hypermetabolic tuberculosis lesions on FDG PET/CT, with one of the patients having history of malignancy. The objective of the present case report is to emphasize the need to use other differential diagnosis techniques for tuberculosis especially in tuberculosis-endemic countries when interpreting FDG PET/CT. Conclusion By analyzing diagnostic imaging alone, there is a high chance of misinterpreting asymptomatic tuberculosis patient as having malignancy. Therefore, there is need for correlation with clinical data as well as other imaging modalities and PET/CT with more specific tracer in order to differentiate malignancy from benign disease such as tuberculosis.
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Affiliation(s)
- Febby Hutomo
- Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Centre Siloam Hospital, Jakarta, Indonesia
| | - Ryan Yudistiro
- Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Centre Siloam Hospital, Jakarta, Indonesia. .,Department of Nuclear Medicine, School of Medicine of Pelita Harapan University, Tangerang, Indonesia.
| | - Ivana Dewi Mulyanto
- Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Centre Siloam Hospital, Jakarta, Indonesia.,Department of Nuclear Medicine, School of Medicine of Pelita Harapan University, Tangerang, Indonesia
| | - Hendra Budiawan
- Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Centre Siloam Hospital, Jakarta, Indonesia.,Department of Nuclear Medicine and Molecular Imaging, School of Medicine of Padjadjaran University, Dr Hasan Sadikin Hospital, Bandung, Indonesia
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9
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18F-FDG PET/CT Findings in a Patient With Primary Mucinous Cystadenocarcinoma of the Breast. Clin Nucl Med 2019; 45:159-160. [DOI: 10.1097/rlu.0000000000002902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Diah LH, Kartamihardja AHS. The role of Technetium-99m-Ethambutol scintigraphy in the management of spinal tuberculosis. World J Nucl Med 2019; 18:13-17. [PMID: 30774540 PMCID: PMC6357715 DOI: 10.4103/1450-1147.250325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spines is a common site of extrapulmonary Mycobacterium tuberculosis infection (MTI). Spine destruction due to MTI can mimic other etiologies. Treatment of choice for spinal tuberculosis (STB) is anti-TB drugs while surgery could be needed in other causes. The gold standard for STB diagnosis is histopathology examination from biopsy tissue. Technetium-99m-ethambutol (99mTc-EMB) scintigraphy can be used to detect and localize of TB. The aim of this study was to evaluate the role of 99mTc-EMB scintigraphy in STB management. Retrospective study was carried out from 2006 to 2014. Subject STB were patient STB with suspected of STB and underwent 99mTc-EMB scintigraphy. The histopathologic result was used as gold standard. Whole body planar acquisition was taken at 1 and 3 h postinjection of 370 MBq. Single-photon emission computed tomography/computed tomography acquisition was performed on suspected area. 99mTc-EMB image were analyzed by two nuclear medicine specialis. The 93 subject STB were included in this study. Histopathologic data were available in 40/93 subject STB. Positive and negative 99mTc-EMB scintigraphy were 32 and 8 subject STB. 99mTc-EMB scintigraphy result STB was concordance with the histopathologic finding in 37 subject STB. Sensitivity, specivicity, positive- and negative-predictive value, and accuracy of 99mTc-EMB scintigraphy 90.91%, 71.43%, 93.75%, 62.5%, and 87.5%, respectively. This study showed that patient STB with suspected 99mTc-EMB scintigraphy result could be directly treated with anti-TB. 99mTc-EMB scintigraphy has significant role in the management of STB.
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Affiliation(s)
- Lisa Herawati Diah
- Departement of Nuclear Medicine and Molecular Imaging, Faculty of Medicine, Dr. Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia
| | - Achmad Hussein Sundawa Kartamihardja
- Departement of Nuclear Medicine and Molecular Imaging, Faculty of Medicine, Dr. Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia
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Zhang J, Mao F, Niu G, Peng L, Lang L, Li F, Ying H, Wu H, Pan B, Zhu Z, Chen X. 68Ga-BBN-RGD PET/CT for GRPR and Integrin α vβ 3 Imaging in Patients with Breast Cancer. Am J Cancer Res 2018; 8:1121-1130. [PMID: 29464003 PMCID: PMC5817114 DOI: 10.7150/thno.22601] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/09/2017] [Indexed: 12/29/2022] Open
Abstract
Purpose: This study was to assess a gastrin-releasing peptide receptor (GRPR) and integrin αvβ3 dual targeting tracer 68Ga-BBN-RGD for positron emission tomography (PET)/computed tomography (CT) imaging of breast cancer and metastasis. Materials and Methods: Twenty-two female patients were recruited either with suspected breast cancer on screening mammography (n = 16) or underwent breast cancer radical mastectomy (n = 6). All the 22 patients underwent PET/CT at 30-45 min after intravenous injection of 68Ga-BBN-RGD. Eleven out of 22 patients also accepted 68Ga-BBN PET/CT within 2 weeks for comparison. A final diagnosis was made based on the histopathologic examination of surgical excision or biopsy. Results: Both the primary cancer and metastases showed positive 68Ga-BBN-RGD accumulation. The T/B ratios of 68Ga-BBN-RGD accumulation were 2.10 to 9.44 in primary cancer and 1.10 to 3.71 in axillary lymph node metastasis, 3.80 to 10.7 in distant lymph nodes, 2.70 to 5.35 in lung metastasis and 3.17 to 22.8 in bone metastasis, respectively. For primary lesions, the SUVmax from 68Ga-BBN-RGD PET in ER positive group was higher than that in ER negative group (P < 0.01). For both primary and metastatic lesions, SUVmean quantified from 68Ga-BBN-RGD PET correlated well with both GRPR expression and integrin αvβ3 expression. Conclusion: This study demonstrated significant uptake of a new type of dual integrin αvβ3 and GRPR targeting radiotracer in both the primary lesion and the metastases of breast cancer. 68Ga-BBN-RGD PET/CT may be of great value in discerning both primary breast cancers, axillary lymph node metastasis and distant metastases.
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Diagnostic value of 99mTc-ethambutol scintigraphy in tuberculosis: compared to microbiological and histopathological tests. Ann Nucl Med 2017; 32:60-68. [PMID: 29209953 DOI: 10.1007/s12149-017-1220-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Tuberculosis (TB) still remains the world's endemic infection. TB affects the lungs and any part of the body other than the lung. The diagnosis of TB has not changed much over the decades. Ethambutol is one of the first line treatments for TB. It can be labeled using 99mTc. 99mTc-ethambutol will be accumulated in the site of TB lesion and can be imaged using gamma camera. The aim of this study was to evaluate the diagnostic value of 99mTc-ethambutol scintigraphy in detecting and localizing of TB. METHODS Retrospective cross-sectional study was done. Subjects were patients suspected of having TB infection. Whole body and SPECT-CT imaging at the suspected area was done 1 and 4 h after injection of 370-555 MBq 99mTc-ethambutol. 99mTc-ethambutol scintigraphy was analyzed visually. The results were compared with that of histopathological or microbiological tests. Statistical analysis was done to determine the sensitivity, specificity, PPV, NPV and accuracy. RESULTS One hundred and sixty-eight subjects were involved in this study. There were 110 men and 58 women with mean age of 34.52 ± 11.94 years. There were concordance results in 156 (92.86%) and discordant in 12 (7.14%) subjects between 99mTc-ethambutol scintigraphy and histopathological or microbiological result. The sensitivity, specificity, PPV, NPV and accuracy of 99mTc-ethambutol scintigraphy in the diagnosis of pulmonary TB were 93.9, 85.7, 93.9, 85.7 and 91.4%, respectively, for extra-pulmonary TB 95.5, 77.8, 97.9, 63.6, and 85.1%, respectively, and for total tuberculosis 94.9, 83.3, 96.3, 78.1 and 92.8%, respectively. There was no side effect observed in this study. CONCLUSION 99mTc-ethambutol scintigraphy is a useful diagnostic imaging technique to detect and localize intra- and extra-pulmonary TB. It is safe to be performed even in pediatric patient. Consuming ethambutol less than 2 weeks did not influence the result.
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13
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Ankrah AO, Glaudemans AWJM, Maes A, Van de Wiele C, Dierckx RAJO, Vorster M, Sathekge MM. Tuberculosis. Semin Nucl Med 2017; 48:108-130. [PMID: 29452616 DOI: 10.1053/j.semnuclmed.2017.10.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tuberculosis (TB) is currently the world's leading cause of infectious mortality. Imaging plays an important role in the management of this disease. The complex immune response of the human body to Mycobacterium tuberculosis results in a wide array of clinical manifestations, making clinical and radiological diagnosis challenging. 18F-FDG-PET/CT is very sensitive in the early detection of TB in most parts of the body; however, the lack of specificity is a major limitation. 18F-FDG-PET/CT images the whole body and provides a pre-therapeutic metabolic map of the infection, enabling clinicians to accurately assess the burden of disease. It enables the most appropriate site of biopsy to be selected, stages the infection, and detects disease in previously unknown sites. 18F-FDG-PET/CT has recently been shown to be able to identify a subset of patients with latent TB infection who have subclinical disease. Lung inflammation as detected by 18F-FDG-PET/CT has shown promising signs that it may be a useful predictor of progression from latent to active infection. A number of studies have identified imaging features that might improve the specificity of 18F-FDG-PET/CT at some sites of extrapulmonary TB. Other PET tracers have also been investigated for their use in TB, with some promising results. The potential role and future perspectives of PET/CT in imaging TB is considered. Literature abounds on the very important role of 18F-FDG-PET/CT in assessing therapy response in TB. The use of 18F-FDG for monitoring response to treatment is addressed in a separate review.
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Affiliation(s)
- Alfred O Ankrah
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa; Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Alex Maes
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa; Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium; Department of Morphology and Medical Imaging, University Hospital Leuven, Leuven, Belgium
| | - Christophe Van de Wiele
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa; Department of Nuclear Medicine and Radiology, University of Ghent, Ghent, Belgium
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa.
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Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls. Semin Nucl Med 2017; 47:579-594. [PMID: 28969758 DOI: 10.1053/j.semnuclmed.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
FDG-PET/CT as a modality is increasingly used for detection of recurrence and for restaging in patients with clinical suspicion of malignancy, as well as in patients with elevated tumor markers. However, there are many pitfalls in the interpretation of these scans when the studies are performed after some treatment. Some of these are attributed to normal physiological distribution and are compounded when there are inflammatory changes occurring after surgery. The body's inherent response to the surgical insult results in this inflammation. In addition, there are also complications that can happen following surgery, causing increased FDG uptake. Despite various fallacies, FDG-PET/CT provides valuable information in evaluation of residual and recurrent malignant disease. In this article, we aim to describe some of these postsurgical changes secondary to inflammation, common surgical complications, and finally, the utility of FDG-PET/CT in these patients to detect recurrent disease, even in the background of postsurgical changes.
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Affiliation(s)
- Gunjan Garg
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Mohammed Taoudi Benchekroun
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Tony Abraham
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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Abstract
Interpretation of 18F-FDG PET/CT studies in breast is challenging owing to nonspecific FDG uptake in various benign and malignant conditions. Benign conditions include breast changes in pregnancy and lactation, gynecomastia, mastitis, fat necrosis, fibroadenoma, intraductal papilloma, and atypical ductal hyperplasia. Among malignancies, invasive ductal carcinoma and invasive lobular carcinoma are common histological types of breast carcinoma. Rarely, other unusual histological types of breast carcinomas (eg, intraductal papillary carcinoma, invasive micropapillary carcinoma, medullary carcinoma, mucinous carcinoma, and metaplastic carcinoma), lymphoma, and metastasis can be the causes. Knowledge of a wide spectrum of hypermetabolic breast lesions on FDG PET/CT is essential in accurate reading of FDG PET/CT. The purpose of this atlas article is to demonstrate features of various breast lesions encountered at our institution, both benign and malignant, which can result in hypermetabolism on FDG PET/CT imaging.
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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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Toney LK, Lam DL, Rahbar H. Drug injection-related fat necrosis of the breast with FDG PET-CT uptake. Radiol Case Rep 2015; 10:12-7. [PMID: 26649110 PMCID: PMC4633983 DOI: 10.1016/j.radcr.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/19/2015] [Indexed: 11/18/2022] Open
Abstract
A 52-year-old woman was found to have a lung mass and bilateral breast lesions on computed tomography (CT). Subsequent positron emission tomography/CT demonstrated marked uptake in the lung mass and mild uptake within the breast lesions. A diagnostic mammogram and targeted ultrasound were performed to exclude primary breast malignancy or metastases from presumed pulmonary malignancy. A pertinent history of recent intravenous drug use with heroin injection into bilateral breasts, together with imaging features, facilitated diagnosis of fat necrosis. Fat necrosis is a common diagnosis in breast imaging and may be an incidental finding on positron emission tomography/CT in the oncologic setting. The presence of fat along with suggestive clinical history can lead to the diagnosis and appropriate assignment of either benign, breast imaging-reporting and data system (BI-RADS) 2, or probably benign, BI-RADS 3, category with short interval follow-up. Appropriate work-up of incidental fluorodeoxyglucose-avid breast masses with diagnostic mammogram ± ultrasound is warranted to avoid incorrect interpretation as neoplastic processes.
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Affiliation(s)
- Lauren Kay Toney
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Box 357115, Seattle, WA, 98195-7115, USA
| | - Diana L Lam
- Division of Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Habib Rahbar
- Division of Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
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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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Benveniste AP, Yang W, Benveniste MF, Mawlawi OR, Marom EM. Benign breast lesions detected by positron emission tomography-computed tomography. Eur J Radiol 2014; 83:919-929. [PMID: 24657106 DOI: 10.1016/j.ejrad.2014.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/06/2014] [Accepted: 02/09/2014] [Indexed: 02/03/2023]
Abstract
(18)F-fluorodeoxyglucose positron emission computed tomography (FDG PET-CT) is widely used in the initial staging and response evaluation of patients with malignancy. This review describes a spectrum of benign breast findings incidentally detected by FDG PET-CT at staging that may be misinterpreted as malignancy. We describe the pattern of distribution and intensity of FDG uptake in a spectrum of benign breast diseases with their corresponding typical morphological imaging characteristics to help the nuclear medicine physician and/or general radiologist identify benign lesions, avoiding unnecessary breast imaging work-up and biopsies.
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Affiliation(s)
- Ana P Benveniste
- Department of Diagnostic Radiology,The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Wei Yang
- Department of Diagnostic Radiology,The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Marcelo F Benveniste
- Department of Diagnostic Radiology,The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Osama R Mawlawi
- Department of imaging physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Edith M Marom
- Department of Diagnostic Radiology,The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Schelhaas S, Wachsmuth L, Viel T, Honess DJ, Heinzmann K, Smith DM, Hermann S, Wagner S, Kuhlmann MT, Müller-Tidow C, Kopka K, Schober O, Schäfers M, Schneider R, Aboagye EO, Griffiths J, Faber C, Jacobs AH. Variability of Proliferation and Diffusion in Different Lung Cancer Models as Measured by 3'-Deoxy-3'-¹⁸F-Fluorothymidine PET and Diffusion-Weighted MR Imaging. J Nucl Med 2014; 55:983-8. [PMID: 24777288 DOI: 10.2967/jnumed.113.133348] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 02/15/2014] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED Molecular imaging allows the noninvasive assessment of cancer progression and response to therapy. The aim of this study was to investigate molecular and cellular determinants of 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) PET and diffusion-weighted (DW) MR imaging in lung carcinoma xenografts. METHODS Four lung cancer cell lines (A549, HTB56, EBC1, and H1975) were subcutaneously implanted in nude mice, and growth was followed by caliper measurements. Glucose uptake and tumor proliferation were determined by (18)F-FDG and (18)F-FLT PET, respectively. T2-weighted MR imaging was performed, and the apparent diffusion coefficient (ADC) was determined by DW MR imaging as an indicator of cell death. Imaging findings were correlated to histology with markers for tumor proliferation (Ki67, 5-bromo-2'-deoxyuridine [BrdU]) and cell death (caspase-3, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling). The expression of human equilibrative nucleoside transporter 1 (hENT1), thymidine kinase 1 (TK1), thymidylate synthase, and thymidine phosphorylase (TP) were analyzed by Western blot and immunohistochemistry. Thymidine levels were determined by liquid chromatography-mass spectrometry. RESULTS Xenografts varied with respect to in vivo growth rates. MR imaging and PET revealed intratumoral heterogeneities, which were confirmed by histology. (18)F-FLT uptake differed significantly between tumor lines, with A549 and H1975 demonstrating the highest radiotracer accumulation (A549, 8.5 ± 3.2; HTB56, 4.4 ± 0.7; EBC1, 4.4 ± 1.2; and H1975, 12.1 ± 3.5 maximal percentage injected dose per milliliter). In contrast, differences in (18)F-FDG uptake were only marginal. No clear relationship between (18)F-FLT accumulation and immunohistochemical markers for tumor proliferation (Ki67, BrdU) as well as hENT1, TK1, or TS expression was detected. However, TP was highly expressed in A549 and H1975 xenografts, which was accompanied by low tumor thymidine concentrations, suggesting that tumor thymidine levels influence (18)F-FLT uptake in the tumor models investigated. MR imaging revealed higher ADC values within proliferative regions of H1975 and A549 tumors than in HTB56 and EBC1. These ADC values were negatively correlated with cell density but not directly related to cell death. CONCLUSION A direct relationship of (18)F-FLT with proliferation or ADC with cell death might be complicated by the interplay of multiple processes at the cellular and physiologic levels in untreated tumors. This issue must be considered when using these imaging modalities in preclinical or clinical settings.
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Affiliation(s)
- Sonja Schelhaas
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität (WWU) Münster, Münster, Germany
| | - Lydia Wachsmuth
- Department of Clinical Radiology, University Hospital of Münster, Münster, Germany
| | - Thomas Viel
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität (WWU) Münster, Münster, Germany
| | - Davina J Honess
- Cancer Research United Kingdom Cambridge Institute, Cambridge, United Kingdom
| | - Kathrin Heinzmann
- Cancer Research United Kingdom Cambridge Institute, Cambridge, United Kingdom
| | | | - Sven Hermann
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität (WWU) Münster, Münster, Germany
| | - Stefan Wagner
- Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany
| | - Michael T Kuhlmann
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität (WWU) Münster, Münster, Germany
| | - Carsten Müller-Tidow
- Department of Hematology and Oncology, University Hospital of Münster, Münster, Germany
| | - Klaus Kopka
- Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany
| | - Otmar Schober
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität (WWU) Münster, Münster, Germany Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany
| | - Michael Schäfers
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität (WWU) Münster, Münster, Germany Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany
| | | | - Eric O Aboagye
- Comprehensive Cancer Imaging Centre, Imperial College London, London, United Kingdom; and
| | - John Griffiths
- Cancer Research United Kingdom Cambridge Institute, Cambridge, United Kingdom
| | - Cornelius Faber
- Department of Clinical Radiology, University Hospital of Münster, Münster, Germany
| | - Andreas H Jacobs
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität (WWU) Münster, Münster, Germany Department of Geriatric Medicine, Johanniter Hospital, Bonn, Germany
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Synthesis and biological evaluation of 99mTc-ECF: a new ethionamide derivative for tuberculosis diagnosis. J Radioanal Nucl Chem 2014. [DOI: 10.1007/s10967-014-3059-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ulaner GA, Lyall A. Identifying and Distinguishing Treatment Effects and Complications from Malignancy at FDG PET/CT. Radiographics 2013; 33:1817-34. [DOI: 10.1148/rg.336125105] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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La mastite granulomateuse idiopathique. Rev Med Interne 2013; 34:358-62. [DOI: 10.1016/j.revmed.2012.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/31/2012] [Indexed: 01/14/2023]
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HAMEEDUDDIN A, SINGH NK, COOK GJR, CHUA SC. Assessment of incidental and clinically unsuspected fluorodeoxyglucose-avid foci detected on oncological positron emission tomography/CT. IMAGING 2013. [DOI: 10.1259/imaging.20110088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chang WY, Kuo WT, Wu CY, Lin CY, Chan PC, Shen CC, Liu RS, Wang HE, Chen CL. Evaluation of (131/123)I-5-iodo-2'-deoxycytidine as a novel proliferation probe in a tumor mouse model. Appl Radiat Isot 2013; 77:166-73. [PMID: 23602704 DOI: 10.1016/j.apradiso.2013.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 02/01/2013] [Accepted: 03/10/2013] [Indexed: 10/27/2022]
Abstract
This study evaluated a radioiodinated deoxycytidine analog, (131)I-5-iodo-2'-deoxycytidine ([(131)I]ICdR), as a novel proliferation probe and compared it with (131)I-5-iodo-2'-deoxyuridine ([(131)I]IUdR) in a NG4TL4 sarcoma-bearing mouse model. As an imaging agent, the biological characteristics of [(123)I]IUdR is not satisfactory due to its metabolic instability and short biological half-life in vivo. With [(123)I]ICdR/SPECT it was possible to clearly delineate the tumor lesion at 1h post-injection (tumor-to-muscle ratio 7.74) in tumor-bearing mice. The results of biodistribution were consistent with those observed in scintigraphic imaging. This study demonstrated that [(131)I]ICdR is a more promising SPECT probe than [(131)I]IUdR for imaging proliferation.
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Affiliation(s)
- Wen-Yi Chang
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
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Isolated Mediastinal Lymph Node False Positivity of [18F]-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography in Patients With Cervical Cancer. Int J Gynecol Cancer 2013; 23:337-42. [DOI: 10.1097/igc.0b013e31827e00cc] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
OBJECTIVE Incidental (18)F-FDG-avid breast lesions are commonly encountered in patients with cancer who undergo staging PET/CT. This pictorial essay discusses breast lesions that show increased FDG activity, mimicking breast cancer, with biopsy-confirmed benign diagnosis. CONCLUSION Acute and chronic inflammation, physiologic lactation, and benign breast masses, including silicone granuloma, fat necrosis, fibroadenoma, and postsurgical changes, may show increased FDG uptake on PET/CT. These conditions can often be differentiated from malignancy by correlative imaging, including mammography, sonography, or MRI.
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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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Essouissi I, Malek Saied N, Bernard S, Guizani S, Mejri N, Barc C, Ben Hamouda S, Asmi A, Saidi M. 99mTc-N-IFC: a new isoniazid derivative for Mycobacterium diagnostic. RADIOCHIM ACTA 2011. [DOI: 10.1524/ract.2012.1905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
We present in this work a new technetium-99m-labeled derivative from isoniazid. The labeling was achieved with a double-ligand transfer through the use of a ferrocene derivative. A further referred to as 99mTc-N-IFC (N-Isonicotinamide ferrocene carboxamide labeled with 99mTc), targeting infections in experimental animals, has been synthesized. The N-IFC was chemically synthesized and then labeled with technetium-99m. It has been confirmed through this work that it was obtained with high radiolabelling yield (95%). Radiochemical analyses of 99mTc-N-IFC revealed that the molecule was efficiently labeled with a little free pertechnetate in the preparations containing purified compound. Only 1–2% of the tracer was leached out from the complex at 24 h when incubated in serum at 37 ºC confirmed its high stability. The radiolabeled complex was found to be 10% bound to blood protein, which corresponds to a fast retention advantage. Biodistribution study showed the renal route of excretion and has also demonstrated that our radiolabeled compound is rapidly and significantly accumulated (P<0.5) at infection sites. Thigh model of localized infection was prepared in mice by injecting of BCG (pGFM-11) (fluorexcente BCG) live bacteria in growing phase. The confirmation of the bacteria presence in infection sites has been established through its fluorescence characteristic. The comparison of the 99mTc-N-IFC accumulation at sites of BCG (pGFM-11) infected animals, which is expressed as target-to-non-target ratio, (3.14) with other radiotracers was discussed. This allowed us to consider that 99mTc-N-IFC could be a good radiotracer for mycobacterial infections. Obtained results were in good and encourage to undergo a similar labeling for the Mycobacterium tuberculosis as perspective of this work.
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Affiliation(s)
| | - Nadia Malek Saied
- Unit of Medical, Agricultural and Environmental Techniques Nuclear Applications (CNSTN), 2020 Sidi Thabet, Tunesien
| | - Serge Bernard
- Experimental Infectiology Platform (PFIE3), INRA, Centre of Tours, Frankreich
| | - Sihem Guizani
- Unit of Medical, Agricultural and Environmental Techniques Nuclear Applications (CNSTN), 2020 Sidi Thabet, Tunesien
| | - Najoua Mejri
- Unit of Medical, Agricultural and Environmental Techniques Nuclear Applications (CNSTN), 2020 Sidi Thabet, Tunesien
| | - Celine Barc
- Experimental Infectiology Platform (PFIE3), INRA, Centre of Tours, Frankreich
| | - Salem Ben Hamouda
- Unit of Medical, Agricultural and Environmental Techniques Nuclear Applications (CNSTN), 2020 Sidi Thabet, Tunesien
| | - Amin Asmi
- Unit of Medical, Agricultural and Environmental Techniques Nuclear Applications (CNSTN), 2020 Sidi Thabet, Tunesien
| | - Mouldi Saidi
- Unit of Medical, Agricultural and Environmental Techniques Nuclear Applications (CNSTN), 2020 Sidi Thabet, Tunesien
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Abstract
We report on the imaging findings of Tolosa-Hunt syndrome in a 59-year-old patient. Clinical findings included periorbital pain, ptosis, disordered eye movements, and blurred vision. Treatment with intravenous administration of steroid resolved all symptoms. Currently, magnetic resonance imaging plays a key role in the diagnosis of Tolosa-Hunter syndrome for locating the inflammatory tissue and follow-up. This case of Tolosa-Hunter syndrome with representative (FDG PET/CT) images may imply that FDG PET/CT is a useful tool in detecting and monitoring of this disease.
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Clinical Applications of PET-Computed Tomography in Planning Radiotherapy: General Principles and an Overview. PET Clin 2011; 6:105-15. [DOI: 10.1016/j.cpet.2011.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Clinical Evaluation of Efficacy of (99m)TC -Ethambutol in Tubercular Lesion Imaging. Tuberc Res Treat 2010; 2010:618051. [PMID: 22567260 PMCID: PMC3335573 DOI: 10.1155/2010/618051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 08/02/2010] [Indexed: 11/29/2022] Open
Abstract
Purpose. The aim of this work was to develop specific radiopharmaceutical and to evaluate its efficacy in human to detect and locate the tubercular lesion. Materials and Methods. 99mTc-Ethambutol (EMB) was produced by direct labeling method. In vitro and in vivo biological studies and animal experiments were done. Phase I Clinical trial was performed. As per plan, 2 normal human subjects for biodistribution studies and fourteen patients (8 males and 6 females; age range of 25–50, with one patient aged 12 years as an exception) were chosen for clinical trial. Whole body scan and spots were acquired at 1 hour and 4 hour. Angiography, blood pool, and 24-hours spot images of the infected areas were also acquired. Result. Radiolabeling yielded >85% of labeled complex. In vitro and in vivo biological studies and animal experiments indicated 99mTc-EMB as a specific tuberculosis imaging agent. The biodistribution study in normal human subjects suggested stability of 99mTc-EMB, with main excretory pathways being renal and hepatobiliary, which appeared to be similar to the known behavior of unlabeled EMB. No adverse reactions were observed. 99mTc-EMB got localized in pulmonary and bone tubercular lesions. Scintigrams of 99mTc-EMB and 99mTc-Ciprofloxacin were compared at different time intervals. Conclusion. The present study states that developed 99mTc-EMB has high potential to qualify as a specific tuberculosis imaging radiopharmaceutical and is safe for human use.
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Kawai S, Sugiyama M. Imaging analysis of the brain in a primate model of cerebral malaria. Acta Trop 2010; 114:152-6. [PMID: 19467218 DOI: 10.1016/j.actatropica.2009.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 04/03/2009] [Indexed: 11/30/2022]
Abstract
This paper reviews our studies concerning imaging analysis of the brain in a primate model of cerebral malaria. To elucidate the clinical features of cerebral malaria, we performed positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) scanning and magnetic resonance imaging (MRI) of the brain in Japanese macaques (Macaca fuscata) infected with Plasmodium coatneyi, a primate model of severe human malaria with cerebral involvement. On FDG-PET scanning, we observed diffuse and heterogeneous reduction of metabolism in the cerebral cortex in the acute phase of malaria infection. Although the monkey exhibited severe clinical signs, MR imaging did not reveal any significant changes during the course of infection. Histopathologic examination frequently revealed preferential sequestration of PRBCs in the cerebral and cerebellum capillaries, but neither parenchymal injury nor neuronal necrosis was found in the tissues. These results suggest that heterogeneous metabolic reduction and lack of abnormalities on MRI in the acute phase of CM may be due to any avoidance mechanisms from ischemia caused by sequestration. This may be one reason why more than half of CM patients have no neurological sequelae following recovery.
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Affiliation(s)
- Satoru Kawai
- Center for Tropical Medicine and Parasitology, Dokkyo Medical University, Mibu, Tochigi, Japan.
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Kiyoto S, Sugawara Y, Inoue T, Takabatake D, Ohsumi S, Nishimura R. False-positive (18)F-fluorodeoxyglucose positron emission tomography/computed tomography caused by incidental injury in a bulky intracystic carcinoma of the breast. Jpn J Radiol 2010; 28:305-8. [PMID: 20512549 DOI: 10.1007/s11604-009-0417-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 12/27/2009] [Indexed: 11/28/2022]
Abstract
We present a case of right intracystic carcinoma of the breast. An 83-year-old woman was seen at our hospital with a growing bulky mass in the right breast for the last 2 years. Whole-body fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography ((18)F-FDG-PET/CT) was performed 15 days after mammography (MMG). (18)F-FDGPET/CT showed a right bulky cystic mass and intense FDG uptake in the intracystic nodules as well as in the adjacent extracystic lesion and the underlying pectoralis major muscle. It suggested tumor invasion of the pectoralis major muscle. Right mastectomy combined with partial resection of adherent pectoral muscle was performed. The main cystic lesion was diagnosed to be solid-papillary carcinoma, but the area of the pectoralis muscle was diagnosed to be a "foreign body" inflammation. It was thought that the compression related to MMG and core needle biopsy induced an injury in the bulky breast mass with leakage of contents into adjacent tissue, resulting in the foreign body inflammation. In conclusion, the coexisting foreign body inflammation was responsible for a false-positive (18)F-FDG-PET/CT scan in the current case.
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Affiliation(s)
- Sachiko Kiyoto
- Department of Breast Oncology, Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan.
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Oude Munnink TH, Nagengast WB, Brouwers AH, Schröder CP, Hospers GA, Lub-de Hooge MN, van der Wall E, van Diest PJ, de Vries EGE. Molecular imaging of breast cancer. Breast 2010; 18 Suppl 3:S66-73. [PMID: 19914546 DOI: 10.1016/s0960-9776(09)70276-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Molecular imaging of breast cancer can potentially be used for breast cancer screening, staging, restaging, response evaluation and guiding therapies. Techniques for molecular breast cancer imaging include magnetic resonance imaging (MRI), optical imaging, and radionuclide imaging with positron emission tomography (PET) or single photon emission computed tomography (SPECT). This review focuses on PET and SPECT imaging which can provide sensitive serial non invasive information of tumor characteristics. Most clinical data are gathered on the visualization of general processes such as glucose metabolism with the PET-tracer [(18)F]fluorodeoxyglucose (FDG) and DNA synthesis with [18F]fluoro-L-thymidine (FLT). Increasingly more breast cancer specific targets are imaged such as the estrogen receptor (ER), growth factors and growth factor receptors. Imaging of the ER with the PET tracer 16-alpha-[(18)F]fluoro-17-beta-estradiol (FES) has shown a good correlation between FES tumor uptake and ER density. (111)In-trastuzumab SPECT to image the human epidermal growth factor receptor 2 (HER2) showed that in most patients with metastatic HER2 overexpressing disease more lesions were detected than with conventional staging procedures. The PET tracer (89)Zr-trastuzumab showed excellent, quantifiable, and specific tumor uptake. (111)In-bevacizumab for SPECT and (89)Zr-bevacizumab for PET-imaging have been developed for vascular endothelial growth factor (VEGF) imaging as an angiogenic marker. Lastly, tracers for the receptors EGFR, IGF-1R, PDGF-betaR and the ligand TGFbeta are under development. Although molecular imaging of breast cancer is still not commonly used in daily clinical practice, its application portfolio is expanding rapidly.
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Affiliation(s)
- T H Oude Munnink
- Department of Medical Oncology, University Medical Center, Groningen, The Netherlands
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Application of positron emission tomography – computerized tomography in breast cancer. Breast Cancer 2010. [DOI: 10.1017/cbo9780511676314.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Focal uptake of F-18 fluorodeoxyglucose in pseudoangiomatous stromal hyperplasia. Clin Nucl Med 2010; 35:194-5. [PMID: 20173457 DOI: 10.1097/rlu.0b013e3181cc6390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alberini JL, Lerebours F, Wartski M, Fourme E, Le Stanc E, Gontier E, Madar O, Cherel P, Pecking AP. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging in the staging and prognosis of inflammatory breast cancer. Cancer 2009; 115:5038-47. [PMID: 19645022 DOI: 10.1002/cncr.24534] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jean-Louis Alberini
- Nuclear Medicine Department, Cancer Research Center Rene Huguenin, Saint-Cloud, France.
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Passarella RJ, Zhou L, Phillips JG, Wu H, Hallahan DE, Diaz R. Recombinant peptides as biomarkers for tumor response to molecular targeted therapy. Clin Cancer Res 2009; 15:6421-9. [PMID: 19825959 DOI: 10.1158/1078-0432.ccr-09-0945] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Phage display technology can be used to identify peptide sequences that bind rapidly and specifically to tumors responding to sunitinib therapy. These peptides may help to address problems with current methods of assessing tumor response to therapy that can be slow and have limited usage. EXPERIMENTAL DESIGN The peptide of interest was isolated after four rounds of biopanning in MDA-MB-231 and MCF-7 xenografted tumors. The binding location of the peptide was investigated with immunohistochemistry. Its in vivo ability to bind to breast tumors responding to therapy was determined by treating nude mice, xenografted with various tumor cell lines, with sunitinib and using near IR imaging to assess the ability of the peptide conjugated to Alexafluor-750 to bind tumors. RESULTS EGEVGLG was the dominant sequence isolated from biopanning. This peptide showed increased binding relative to control groups in two cancer cell lines (MDA-MB-435 and MCF-7 human breast) responding to sunitinib treatment, whereas no elevated binding occurred in vitro when samples were incubated with tumor cells that are unresponsive to sunitinib treatment (B16 melanoma and BxPC3 pancreatic). Mice xenografted with tumors that are responsive to sunitinib therapy showed increased peptide binding when compared with untreated control. Mice bearing tumors unresponsive to sunitinib therapy showed no increased peptide binding between treated and untreated groups. CONCLUSION The use of recombinant peptides to assess the pharmacodynamic response of cancer holds promise in minimizing the duration of ineffective treatment regimens in patients, potentially providing a more rapid and less invasive assessment of cancer response to systemic therapy.
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Affiliation(s)
- Ralph J Passarella
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
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Kumar R, Rani N, Patel C, Basu S, Alavi A. False-Negative and False-Positive Results in FDG-PET and PET/CT in Breast Cancer. PET Clin 2009; 4:289-98. [DOI: 10.1016/j.cpet.2009.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
FDG PET-CT imaging is increasingly accepted as a modality for evaluation of many malignancies, but FDG also can be accumulated intensely by inflammatory lesions. We present a case of a 60-year-old woman with intermittent fever, chills, fatigue, and dyschezia. CT scans indicated colon carcinoma with thoracic and retroperitoneal lymph node metastases. Whole body FDG PET-CT was performed to confirm and stage the malignant disease and showed intense FDG uptake in those lesions. However, histopathology confirmed tuberculosis. The literature describing FDG accumulation in constitutional tuberculous lesions is sparse, and one must be aware of patterns of FDG accumulation in tuberculosis in the diagnosing malignancies.
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Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, Coleman RE, Wahl R, Paschold JC, Avril N, Einhorn LH, Suh WW, Samson D, Delbeke D, Gorman M, Shields AF. Recommendations on the Use of 18F-FDG PET in Oncology. J Nucl Med 2008; 49:480-508. [PMID: 18287273 DOI: 10.2967/jnumed.107.047787] [Citation(s) in RCA: 716] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- James W Fletcher
- Department of Radiology, Indiana/Purdue University, Indiana University School of Medicine, Indianapolis, Indiana 46202-5253, USA.
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Lim HS, Yoon W, Chung TW, Kim JK, Park JG, Kang HK, Bom HS, Yoon JH. FDG PET/CT for the Detection and Evaluation of Breast Diseases: Usefulness and Limitations. Radiographics 2007; 27 Suppl 1:S197-213. [DOI: 10.1148/rg.27si075507] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nakajo M, Jinnouchi S, Tateno R, Nakajo M. 18F-FDG PET/CT findings of a right subphrenic foreign-body granuioma. Ann Nucl Med 2006; 20:553-6. [PMID: 17134023 DOI: 10.1007/bf03026820] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report a case of an 85-year-old woman with a foreign-body granuloma which accumulated 18F-fluorodeoxyglucose (FDG). Unenhanced computed tomography showed a hyperdense mass with a hypodense rim in the right subphrenic space. FDG PET/CT images showed intense FDG uptake in the hypodense rim and little FDG uptake in the center of the mass, showing a ring-shaped appearance. The fusion imaging of FDG PET/CT represented the metabolic features of the foreign-body granuloma. When a ring-shaped FDG uptake is noted in the abdomen of a patient with a history of abdominal surgery, a foreign-body granuloma should be included in the differential diagnosis.
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