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Bilici Salman R, Gülbahar Ateş S, Satiş H, Tufan A, Akdemir ÜÖ, Yapar D, Ataş N, Güler AA, Karadeniz H, Babaoglu H, Aydos U, Göker B, Haznedaroğlu Ş, Atay LÖ, Öztürk MA. Diagnostic Role of 18F-Fluorodeoxyglucose Positron Emission Tomography for the Evaluation of Patients With Inflammation of Unknown Origin. J Clin Rheumatol 2021; 27:219-225. [PMID: 32195847 DOI: 10.1097/rhu.0000000000001297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sometimes, the underlying causes of inflammation cannot be established despite meticulous investigation, including medical history, physical examination, laboratory tests, and radiologic procedures. Rheumatologists are often faced with patients whose condition is known as inflammation of unknown origin (IUO). Differential diagnosis of IUO is diverse, and investigation of these cases is challenging and time-consuming. OBJECTIVE The study aimed to assess the diagnostic role of positron emission tomography/computed tomography (PET/CT) in the evaluation of patients with IUO. METHODS The study sample consisted of 97 adult patients with IUO who have not been previously diagnosed with an infectious, inflammatory, or malignant disease. The necessary data were collected from January 2015 to June 2018 with a 6-month follow-up period. The patients were screened using PET/CT after a specific diagnosis could not be established with detailed laboratory and radiologic evaluations. RESULTS A final diagnosis was established at follow-up, and 47 (54%) of the 97 patients had inflammatory diseases, 30 (34.4%) had malignancies, and 10 (11.4%) had infections. Despite meticulous investigation, 10 patients were left undiagnosed in the follow-up. PET/CT aided diagnosis in 59 patients (60.8%), but it was not helpful in 38 patients (39.2%). PET/CT was positive in 30 (63%) of the 47 patients with inflammatory diseases, whose final diagnosis was inflammatory rheumatic disease, as follows: large-vessel vasculitis in 19 patients, polymyalgia rheumatica in 7 patients, and seronegative arthritis or other rare miscellaneous diseases in 4 patients. The sensitivity of PET/CT was 67% with a specificity and diagnostic accuracy of 100% and 71%, respectively. CONCLUSIONS Investigation of the underlying etiology of IUO is time-consuming and challenging. PET/CT may help identify the final diagnosis more quickly by locating an obscure inflammatory site; thus, it may reduce the number of unnecessary biopsies, diagnostic time, anxiety, work loss, morbidity, and mortality.
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Affiliation(s)
| | | | - Hasan Satiş
- From the Division of Rheumatology, Department of Internal Medicine
| | | | | | - Dilek Yapar
- Department of Public Health, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nuh Ataş
- From the Division of Rheumatology, Department of Internal Medicine
| | | | - Hazan Karadeniz
- From the Division of Rheumatology, Department of Internal Medicine
| | - Hakan Babaoglu
- From the Division of Rheumatology, Department of Internal Medicine
| | | | - Berna Göker
- From the Division of Rheumatology, Department of Internal Medicine
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Zhao Z, Zhou Y, Wang J, Zhang T, Li J, Zhang B, Li Q, Deng S. The value of 18F-FDG PET/CT in the prediction of clinical outcomes of patients with acute leukemia treated with allogeneic hematopoietic stem cell transplantation. Oncol Lett 2020; 20:175. [PMID: 32934742 PMCID: PMC7471646 DOI: 10.3892/ol.2020.12036] [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: 01/17/2020] [Accepted: 06/12/2020] [Indexed: 11/26/2022] Open
Abstract
The present study aimed to determine whether 18F-FDG PET/CT performed before and/or after allogeneic hematopoietic stem cell transplantation (allo-HSCT) can predict clinical outcomes in acute leukemia (AL). A total of 79 examinations comprising 72 patients with AL who underwent 18F-FDG PET/CT before and/or after allo-HSCT were retrospectively enrolled between January 2011 and January 2019. Outcomes were assessed using overall survival (OS) and disease-free survival (DFS). A total of 63 examinations were PET-positive, while 16 examinations were PET-negative. Increased BM and splenic 18F-FDG uptake were observed in 24 (19/79) and 14% (11/79) of examinations, respectively. 18F-FDG-avid lymph nodes were observed in 38% (30/79) of examinations. ENEMES involvement was detected in 44% (35/79) of examinations. The presence of ENEMES involvement [OS hazard ratio (HR), 6.399; 95% confidence interval (CI), 1.843–22.224; P=0.003; post-HSCT OS: HR, 7.203; 95% CI, 1.510–34.369; P=0.013; DFS HR, 3.671; 95% CI, 1.145–11.768; P=0.029], post-transplantation minimal residual disease (DFS HR, 4.381; 95% CI, 1.594–12.040; P=0.004; pre-HSCT OS HR, 11.455; 95% CI, 1.336–98.179; P=0.026) and disease status (OS HR, 0.330; 95% CI, 0.128–0.848; P=0.021; post-HSCT OS HR, 0.195; 95% CI, 0.050–0.762; P=0.019; DFS: HR, 0.278; 95% CI, 0.091–0.851; P=0.025) could serve as an adverse prognostic factor in patients with AL treated with allo-HSCT. 18F-FDG PET/CT before and/or after allo-HSCT was a predictor for OS and DFS in patients with AL. ENEMES involvement detected using 18F-FDG PET/CT may help identify patients with AL who are likely to have unfavorable clinical outcomes.
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Affiliation(s)
- Zixuan Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Yeye Zhou
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jing Wang
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Tongtong Zhang
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jihui Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Bin Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Qingru Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Shengming Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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Mattonen SA, Davidzon GA, Benson J, Leung ANC, Vasanawala M, Horng G, Shrager JB, Napel S, Nair VS. Bone Marrow and Tumor Radiomics at 18F-FDG PET/CT: Impact on Outcome Prediction in Non-Small Cell Lung Cancer. Radiology 2019; 293:451-459. [PMID: 31526257 DOI: 10.1148/radiol.2019190357] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Primary tumor maximum standardized uptake value is a prognostic marker for non-small cell lung cancer. In the setting of malignancy, bone marrow activity from fluorine 18-fluorodeoxyglucose (FDG) PET may be informative for clinical risk stratification. Purpose To determine whether integrating FDG PET radiomic features of the primary tumor, tumor penumbra, and bone marrow identifies lung cancer disease-free survival more accurately than clinical features alone. Materials and Methods Patients were retrospectively analyzed from two distinct cohorts collected between 2008 and 2016. Each tumor, its surrounding penumbra, and bone marrow from the L3-L5 vertebral bodies was contoured on pretreatment FDG PET/CT images. There were 156 bone marrow and 512 tumor and penumbra radiomic features computed from the PET series. Randomized sparse Cox regression by least absolute shrinkage and selection operator identified features that predicted disease-free survival in the training cohort. Cox proportional hazards models were built and locked in the training cohort, then evaluated in an independent cohort for temporal validation. Results There were 227 patients analyzed; 136 for training (mean age, 69 years ± 9 [standard deviation]; 101 men) and 91 for temporal validation (mean age, 72 years ± 10; 91 men). The top clinical model included stage; adding tumor region features alone improved outcome prediction (log likelihood, -158 vs -152; P = .007). Adding bone marrow features continued to improve performance (log likelihood, -158 vs -145; P = .001). The top model integrated stage, two bone marrow texture features, one tumor with penumbra texture feature, and two penumbra texture features (concordance, 0.78; 95% confidence interval: 0.70, 0.85; P < .001). This fully integrated model was a predictor of poor outcome in the independent cohort (concordance, 0.72; 95% confidence interval: 0.64, 0.80; P < .001) and a binary score stratified patients into high and low risk of poor outcome (P < .001). Conclusion A model that includes pretreatment fluorine 18-fluorodeoxyglucose PET texture features from the primary tumor, tumor penumbra, and bone marrow predicts disease-free survival of patients with non-small cell lung cancer more accurately than clinical features alone. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Sarah A Mattonen
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Guido A Davidzon
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Jalen Benson
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Ann N C Leung
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Minal Vasanawala
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - George Horng
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Joseph B Shrager
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Sandy Napel
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Viswam S Nair
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
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Lee JW, Ban MJ, Park JH, Lee SM. Effect of F-18 Fluorodeoxyglucose Uptake by Bone Marrow on the Prognosis of Head and Neck Squamous Cell Carcinoma. J Clin Med 2019; 8:jcm8081169. [PMID: 31382679 PMCID: PMC6723329 DOI: 10.3390/jcm8081169] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study was to assess the relationship between F-18 fluorodeoxyglucose (FDG) uptake in bone marrow (BM) on positron emission tomography/computed tomography (PET/CT) and survival in patients with head and neck squamous cell carcinoma (HNSCC). We retrospectively enrolled 157 HNSCC patients who underwent staging FDG PET/CT and subsequent treatment. On PET/CT, primary tumor metabolic characteristics, mean FDG uptake of BM (BM SUV), and BM-to-liver uptake ratio (BLR) were measured. The prognostic significance of FDG uptake of BM for predicting disease progression-free survival and distant failure-free survival was assessed using a Cox proportional hazards regression model. In univariate analysis for disease progression-free survival, increased BM SUV and BLR were associated with poor survival. In multivariate analysis, BLR (p = 0.044; hazard ratio, 1.96), TNM stage (p = 0.014; hazard ratio, 2.87) and maximum FDG uptake of the primary tumor (p = 0.046; hazard ratio, 2.38) were independently associated with disease progression-free survival. For distant failure-free survival, BLR, TNM stage, tumor size, and metabolic parameters of the primary tumor showed prognostic significance in univariate analysis. However, none of the variables showed significance in multivariate analysis. FDG uptake of BM in HNSCC patients might be a significant predictor for disease progression-free survival. Further studies with large patient population are needed to validate the results.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon 22711, Korea
| | - Myung Jin Ban
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea.
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