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Iyalomhe O, Farwell MD. Immune PET Imaging. Radiol Clin North Am 2021; 59:875-886. [PMID: 34392924 PMCID: PMC8371717 DOI: 10.1016/j.rcl.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fluorodeoxyglucose (FDG) PET/CT is sensitive to metabolic, immune-related, and structural changes that can occur in tumors in cancer immunotherapy. Unique mechanisms of immune checkpoint inhibitors (ICIs) occasionally make response evaluation challenging, because tumors and inflammatory changes are both FDG avid. These response patterns and sequelae of ICI immunotherapy, such as immune-related adverse events, are discussed. Immune-specific PET imaging probes at preclinical stage or in early clinical trials, which may help guide clinical management of cancer patients treated with immunotherapy and likely have applications outside of oncology for other diseases in which the immune system plays a role, are reviewed.
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Affiliation(s)
- Osigbemhe Iyalomhe
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael D. Farwell
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Lin J, Wang L, Ji X, Zheng X, Tang K. Characterization of 18F-fluorodeoxyglucose metabolic spatial distribution improves the differential diagnosis of indeterminate pulmonary nodules and masses with high fluorodeoxyglucose uptake. Quant Imaging Med Surg 2021; 11:1543-1553. [PMID: 33816190 DOI: 10.21037/qims-20-768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The aim of this study was to investigate the value of visual assessment of 18F-fluorodeoxyglucose (18F-FDG) metabolic spatial distribution (V-FMSD) in the diagnosis of indeterminate pulmonary nodules and masses with high 18F-FDG uptake. Methods A total of 301 patients with indeterminate pulmonary nodules or masses who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) imaging were retrospectively studied. The characteristics of 18F-FDG metabolic spatial distribution (FMSD) in the proximal and distal regions of the lesions were visually analyzed using a 5-point scoring system. The sensitivity, specificity, accuracy, and area under receiver operating characteristic curve (AUC) were compared between V-FMSD and conventional PET/CT methods for the diagnosis of hypermetabolic indeterminate pulmonary nodules and masses. Results The V-FMSD results showed that 180 (92.8%) malignant lesions had a score of ≥3 and 78 (72.9%) benign lesions had a score of ≤2. This indicated that the FMSD in the proximal region of malignant lesions was significantly higher than that of the distal region, and the FMSD in the proximal region of benign lesions was significantly lower than that of the distal region. V-FMSD had a specificity of 72.9%, which was markedly higher than those of the maximum standard uptake value (SUVmax; 0%, P<0.001) and the retention index (RI; 26.2%, P<0.001). The AUC of V-FMSD was 0.886, which was significantly larger than those of the SUVmax (0.626, P<0.001), RI (0.670, P<0.001), and PET/CT (0.788, P<0.05). Conclusions Our study found that pulmonary benign and malignant lesions have distinct FMSD characteristics. V-FMSD can therefore be used as a novel auxiliary marker to improve the diagnostic accuracy of hypermetabolic indeterminate pulmonary nodules and masses.
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Affiliation(s)
- Jie Lin
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ling Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaowei Ji
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiangwu Zheng
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kun Tang
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Wood DE, Kazerooni EA, Baum SL, Eapen GA, Ettinger DS, Hou L, Jackman DM, Klippenstein D, Kumar R, Lackner RP, Leard LE, Lennes IT, Leung ANC, Makani SS, Massion PP, Mazzone P, Merritt RE, Meyers BF, Midthun DE, Pipavath S, Pratt C, Reddy C, Reid ME, Rotter AJ, Sachs PB, Schabath MB, Schiebler ML, Tong BC, Travis WD, Wei B, Yang SC, Gregory KM, Hughes M. Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:412-441. [PMID: 29632061 DOI: 10.6004/jnccn.2018.0020] [Citation(s) in RCA: 383] [Impact Index Per Article: 76.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.
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Jenks JD, Salzer HJF, Hoenigl M. Improving the rates of Aspergillus detection: an update on current diagnostic strategies. Expert Rev Anti Infect Ther 2018; 17:39-50. [PMID: 30556438 DOI: 10.1080/14787210.2018.1558054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The spectrum of disease caused by Aspergillus spp. is dependent on the immune system of the host, and ranges from invasive aspergillosis (IA) to chronic pulmonary aspergillosis (CPA). Early and reliable diagnosis of Aspergillus disease is important to decrease associated morbidity and mortality. Areas covered: The following review will give an update on current diagnostic strategies for the diagnosis of IA and CPA. Expert commentary: Several new diagnostics for IA (including point-of-care tests) are now available to complement galactomannan testing. In particular, immunoPET/MRI imaging may be a promising approach for diagnosing IA in the near future. Notably, nearly all new biomarkers and tests for IA have been evaluated in the hematology setting only. Validation of biomarkers and tests is therefore needed for the increasing proportion of patients who develop IA outside the hematology setting. As an important first step, reliable definitions of IA are needed for non-hematology settings as clinical presentation and radiologic findings differ in these settings. CPA diagnosis is based on a combination of radiological findings in chest CT, mycological evidence (e.g. by the Aspergillus-specific IgG assay), exclusion of alternative diagnosis and chronicity. ([18F]FDG) PET/CT and immuno PET/MRI imaging are promising new imaging approaches.
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Affiliation(s)
- Jeffrey D Jenks
- a Department of Medicine , University of California-San Diego , San Diego , CA , USA
| | - Helmut J F Salzer
- b Department of Pulmonary Medicine , Kepler University Hospital , Linz , Austria.,c Institute of Nuclear Medicine and Endocrinology , Kepler University Hospital , Linz , Austria
| | - Martin Hoenigl
- d Division of Infectious Diseases, Department of Medicine , University of California-San Diego , San Diego , CA , USA.,e Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology , Medical University of Graz , Graz , Austria
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SUV as a Possible Predictor of Disease Extent and Therapy Duration in Complex Tuberculosis. Clin Nucl Med 2018; 43:94-100. [DOI: 10.1097/rlu.0000000000001895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ohshimo S, Guzman J, Costabel U, Bonella F. Differential diagnosis of granulomatous lung disease: clues and pitfalls. Eur Respir Rev 2017; 26:26/145/170012. [PMID: 28794143 PMCID: PMC9488688 DOI: 10.1183/16000617.0012-2017] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/25/2017] [Indexed: 01/11/2023] Open
Abstract
Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi) and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis). Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis. A multidisciplinary approach is crucial for the accurate differential diagnosis of granulomatous lung diseaseshttp://ow.ly/FxsP30cebtf
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18F-FDG PET/CT in the Initial Assessment and for Follow-up in Patients With Tuberculosis. Clin Nucl Med 2016; 41:e187-94. [PMID: 26704732 DOI: 10.1097/rlu.0000000000001102] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this retrospective study was to assess the value of 18F-FDG PET/CT in the initial evaluation and follow-up of patients with tuberculosis (TB). PATIENTS AND METHODS Thirty-five patients (18 men) with pulmonary or extrapulmonary TB were included. Diagnosis of TB was based either on histology or microbiological assessment in 32 patients and was based on typical morphological features of TB in CT and improvement on antimycobacterial medication in 3 patients. Eighty-eight 18F-FDG PET/CT scans were performed at initial assessment and during treatment, on a Siemens Biograph PET/CT. Diagnostic contrast-enhanced CT scans were performed on the 40-slice multidetector CT of the PET/CT scanner. Mean (SD) anti-TB treatment duration was 16.1 (8.9) months. RESULTS The initial 18F-FDG PET identified 64 affected regions in 34 among 35 patients, whereas CT identified 34 affected organs in 23 patients. Matching image results between PET and CT were observed at first visit in 11 patients (31.4%), with relevant differences in 23 (65.7%). In 1 patient, both modalities remained negative. During follow-up 18F-FDG PET scans, we recorded 15 cases with remission of disease, 16 with residual disease (2 patients with multidrug-resistant infection), and 4 cases with progressive disease or delayed onset of adequate immunological response. In only 3 patients, both modalities, PET and CT, showed completely equivalent results. CONCLUSIONS Both components of 18F-FDG PET/CT provide complementary information at initial evaluation and during follow-up; however, 18F-FDG showed more abnormal findings than CT. 18F-FDG PET/CT might be useful for the establishment of individualized treatment regimes, but this requires further prospective studies.
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Tertemiz KC, Alpaydin AO, Karacam V. The role of endobronchial ultrasonography for mediastinal lymphadenopathy in cases with extrathoracic malignancy. Surg Endosc 2016; 31:2829-2836. [PMID: 27770251 DOI: 10.1007/s00464-016-5293-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 10/13/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Many extrathoracic malignancies can metastasize to lungs and mediastinal lymph nodes. Whether mediastinal lesions are metastasis in these patients changes staging, prognosis, and treatment strategy. In this study, we aimed to find out the contribution of EBUS-TBNA to the diagnosis in cases with extrathoracic malignancy. MATERIALS AND METHODS Patients who had been previously diagnosed as extrapulmonary solid organ malignancy and in whom mediastinal or hilar lymphadenopathy developed during their follow-up and EBUS-TBNA was applied for diagnostic purposes were retrospectively included in this study. RESULTS A total of 91 patients consisting of 35 females (38.5 %) and 56 males (61.5 %) were included in the study. The mean age of the patients was 60.5 (±11.4). Malignancy was not observed in 54 (59.3 %) patients; primary malignancy metastasis was detected in 33 (36.3 %) patients, and primary lung cancer was detected in 4 (4.4 %) patients with EBUS-TBNA. The sensitivity of EBUS-TBNA in extrathoracic malignancies was determined as 90.2 %; its specificity was determined as 100 %, its negative predictive value as 92.5 %, its positive predictive value as 100 %, and its diagnostic accuracy as 95.6 %. The highest rate was determined in the left lower paratracheal lymph node when they were examined in terms of malignancy detection rate in lymph node stations. CONCLUSION EBUS-TBNA is a minimally invasive method with quite a low complication rate that does not require general anesthesia. It should be the first step method to be used in the diagnosis of mediastinal and hilar lymphadenopathies seen in extrathoracic malignancies since it has high diagnostic accuracy, sensitivity, and specificity. EBUS-TBNA significantly reduces the need for surgical intervention. Further surgical interventions can be planned in patients in whom diagnostic competence is not ensured.
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Affiliation(s)
- Kemal Can Tertemiz
- Department of Pulmonary Diseases, Dokuz Eylul University Medical Faculty, 35340, Balcova, Izmir, Turkey.
| | - Aylin Ozgen Alpaydin
- Department of Pulmonary Diseases, Dokuz Eylul University Medical Faculty, 35340, Balcova, Izmir, Turkey
| | - Volkan Karacam
- Thoracic Surgery, Dokuz Eylul University Medical Faculty, Balcova, Izmir, Turkey
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Ankrah AO, van der Werf TS, de Vries EFJ, Dierckx RAJO, Sathekge MM, Glaudemans AWJM. PET/CT imaging of Mycobacterium tuberculosis infection. Clin Transl Imaging 2016; 4:131-144. [PMID: 27077068 PMCID: PMC4820496 DOI: 10.1007/s40336-016-0164-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/09/2016] [Indexed: 12/17/2022]
Abstract
Tuberculosis has a high morbidity and mortality worldwide. Mycobacterium tuberculosis (Mtb) has a complex pathophysiology; it is an aerobic bacillus capable of surviving in anaerobic conditions in a latent state for a very long time before reactivation to active disease. In the latent tuberculosis infection, the individual has no clinical evidence of active disease, but exhibits a hypersensitive response to proteins of Mtb. Only some 5–10 % of latently infected individuals appear to have reactivation of tuberculosis at any one time point after infection, and neither imaging nor immune tests have been shown to predict tuberculosis reactivation reliably. The complex pathology of the organism provides multiple molecular targets for imaging the infection and targeting therapy. Positron emission tomography (PET) integrated with computer tomography (CT) provides a unique opportunity to noninvasively image the whole body for diagnosing, staging and assessing therapy response in many infectious and inflammatory diseases. PET/CT is a powerful noninvasive tool that can rapidly provide three-dimensional views of disease deep within the body and conduct longitudinal assessment over time in one particular patient. Some PET tracers, such as 18F-fluorodeoxyglucose (18F-FDG), have been found to be useful in various infectious diseases for detection, assessing disease activity, staging and monitoring response to therapy. This tracer has also been used for imaging tuberculosis. 18F-FDG PET relies on the glucose uptake of inflammatory cells as a result of the respiratory burst that occurs with infection. Other PET tracers have also been used to image different aspects of the pathology or microbiology of Mtb. The synthesis of the complex cell membrane of the bacilli for example can be imaged with 11C-choline or 18F-fluoroethylcholine PET/CT while the uptake of amino acids during cell growth can be imaged by 3′-deoxy-3′-[18F]fluoro-l-thymidine. PET/CT provides a noninvasive and sensitive method of assessing histopathological information on different aspects of tuberculosis and is already playing a role in the management of tuberculosis. As our understanding of the pathophysiology of tuberculosis increases, the role of PET/CT in the management of this disease would become more important. In this review, we highlight the various tracers that have been used in tuberculosis and explain the underlying mechanisms for their use.
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Affiliation(s)
- Alfred O Ankrah
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands ; Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
| | - Tjip S van der Werf
- Department of Internal Medicine, Infectious Diseases, and Pulmonary Diseases and Tuberculosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands
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