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Ince S, Laforest R, Itani M, Prasad V, Ashrafinia S, Smith AM, Wahl RL, Fraum TJ. Patlak Slope versus Standardized Uptake Value Image Quality in an Oncologic PET/CT Population: A Prospective Cross-Sectional Study. Diagnostics (Basel) 2024; 14:883. [PMID: 38732298 PMCID: PMC11083784 DOI: 10.3390/diagnostics14090883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Patlak slope (PS) images have the potential to improve lesion conspicuity compared with standardized uptake value (SUV) images but may be more artifact-prone. This study compared PS versus SUV image quality and hepatic tumor-to-background ratios (TBRs) at matched time points. Early and late SUV and PS images were reconstructed from dynamic positron emission tomography (PET) data. Two independent, blinded readers scored image quality metrics (a four-point Likert scale) and counted tracer-avid lesions. Hepatic lesions and parenchyma were segmented and quantitatively analyzed. Differences were assessed via the Wilcoxon signed-rank test (alpha, 0.05). Forty-three subjects were included. For overall quality and lesion detection, early PS images were significantly inferior to other reconstructions. For overall quality, late PS images (reader 1 [R1]: 3.95, reader 2 [R2]: 3.95) were similar (p > 0.05) to early SUV images (R1: 3.88, R2: 3.84) but slightly superior (p ≤ 0.002) to late SUV images (R1: 2.97, R2: 3.44). For lesion detection, late PS images were slightly inferior to late SUV images (R1 only) but slightly superior to early SUV images (both readers). PS-based TBRs were significantly higher than SUV-based TBRs at the early time point, with opposite findings at the late time point. In conclusion, late PS images are similar to early/late SUV images in image quality and lesion detection; the superiority of SUV versus PS hepatic TBRs is time-dependent.
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Affiliation(s)
- Semra Ince
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110, USA; (S.I.); (R.L.); (M.I.); (V.P.); (R.L.W.)
| | - Richard Laforest
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110, USA; (S.I.); (R.L.); (M.I.); (V.P.); (R.L.W.)
| | - Malak Itani
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110, USA; (S.I.); (R.L.); (M.I.); (V.P.); (R.L.W.)
| | - Vikas Prasad
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110, USA; (S.I.); (R.L.); (M.I.); (V.P.); (R.L.W.)
| | - Saeed Ashrafinia
- Siemens Medical Solutions USA, Inc., 810 Innovation Drive, Knoxville, TN 37932, USA; (S.A.); (A.M.S.)
| | - Anne M. Smith
- Siemens Medical Solutions USA, Inc., 810 Innovation Drive, Knoxville, TN 37932, USA; (S.A.); (A.M.S.)
| | - Richard L. Wahl
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110, USA; (S.I.); (R.L.); (M.I.); (V.P.); (R.L.W.)
- Department of Radiation Oncology, Washington University School of Medicine, 660 S. Euclid Ave, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Tyler J. Fraum
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110, USA; (S.I.); (R.L.); (M.I.); (V.P.); (R.L.W.)
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2
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Ince S, Laforest R, Ashrafinia S, Smith AM, Wahl RL, Fraum TJ. Test-Retest Repeatability of Patlak Slopes versus Standardized Uptake Values for Hypermetabolic Lesions and Normal Organs in an Oncologic PET/CT Population. Mol Imaging Biol 2024; 26:284-293. [PMID: 38466523 DOI: 10.1007/s11307-024-01909-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/15/2024] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE We aimed to determine the test-retest repeatability of quantitative metrics based on the Patlak slope (PS) versus the standardized uptake value (SUV) among lesions and normal organs on oncologic [18F]FDG-PET/CT. PROCEDURES This prospective, single-center study enrolled adults undergoing standard-of-care oncologic [18F]FDG-PET/CTs. Early (35-50 min post-injection) and late (75-90 min post-injection) SUV and PS images were reconstructed from dynamic whole-body PET data. Repeat imaging occurred within 7 days. Relevant quantitative metrics were extracted from lesions and normal organs. Repeatability was assessed via mean test-retest percent changes [T-RT %Δ], within-subject coefficients of variation (wCVs), and intra-class correlation coefficients (ICCs). RESULTS Nine subjects (mean age, 61.7 ± 6.2 years; 6 females) completed the test-retest protocol. Four subjects collectively had 17 [18F]FDG-avid lesions. Lesion wCVs were higher (i.e., worse repeatability) for PS-early-max (16.2%) and PS-early-peak (15.6%) than for SUV-early-max (8.9%) and SUV-early-peak (8.1%), with similar early metric ICCs (0.95-0.98). Lesion wCVs were similar for PS-late-max (8.5%) and PS-late-peak (6.4%) relative to SUV-late-max (9.7%) and SUV-late-peak (7.2%), with similar late metric ICCs (0.93-0.98). There was a significant bias toward higher retest SUV and PS values in the lesion analysis (T-RT %Δ [95% CI]: SUV-late-max, 10.0% [2.6%, 17.0%]; PS-late-max, 20.4% [14.3%, 26.4%]) but not in the normal organ analysis. CONCLUSIONS Among [18F]FDG-avid lesions, the repeatability of PS-based metrics is similar to equivalent SUV-based metrics at late post-injection time points, indicating that PS-based metrics may be suitable for tracking response to oncologic therapies. However, further validation is required in light of our study's limitations, including small sample size and bias toward higher retest values for some metrics.
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Affiliation(s)
- Semra Ince
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
| | - Richard Laforest
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
| | - Saeed Ashrafinia
- Siemens Medical Solutions USA, Inc., 810 Innovation Drive, Knoxville, TN, 37932, USA
| | - Anne M Smith
- Siemens Medical Solutions USA, Inc., 810 Innovation Drive, Knoxville, TN, 37932, USA
| | - Richard L Wahl
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tyler J Fraum
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA.
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Alam MA, Hanaoka S, Nomura Y, Kikuchi T, Nakao T, Takenaga T, Hayashi N, Yoshikawa T, Abe O. Improved identification of tumors in 18F-FDG-PET examination by normalizing the standard uptake in the liver based on blood test data. Int J Comput Assist Radiol Surg 2024; 19:581-590. [PMID: 38180621 PMCID: PMC10881646 DOI: 10.1007/s11548-023-03044-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Standardized uptake values (SUVs) derived from 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography are a crucial parameter for identifying tumors or abnormalities in an organ. Moreover, exploring ways to improve the identification of tumors or abnormalities using a statistical measurement tool is important in clinical research. Therefore, we developed a fully automatic method to create a personally normalized Z-score map of the liver SUV. METHODS The normalized Z-score map for each patient was created using the SUV mean and standard deviation estimated from blood-test-derived variables, such as alanine aminotransferase and aspartate aminotransferase, as well as other demographic information. This was performed using the least absolute shrinkage and selection operator (LASSO)-based estimation formula. We also used receiver operating characteristic (ROC) to analyze the results of people with and without hepatic tumors and compared them to the ROC curve of normal SUV. RESULTS A total of 7757 people were selected for this study. Of these, 7744 were healthy, while 13 had abnormalities. The area under the ROC curve results indicated that the anomaly detection approach (0.91) outperformed only the maximum SUV (0.89). To build the LASSO regression, sets of covariates, including sex, weight, body mass index, blood glucose level, triglyceride, total cholesterol, γ-glutamyl transpeptidase, total protein, creatinine, insulin, albumin, and cholinesterase, were used to determine the SUV mean, whereas weight was used to determine the SUV standard deviation. CONCLUSION The Z-score normalizes the mean and standard deviation. It is effective in ROC curve analysis and increases the clarity of the abnormality. This normalization is a key technique for effective measurement of maximum glucose consumption by tumors in the liver.
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Affiliation(s)
- Md Ashraful Alam
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Shouhei Hanaoka
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yukihiro Nomura
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba, Japan
| | - Tomohiro Kikuchi
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Radiology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takahiro Nakao
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomomi Takenaga
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Naoto Hayashi
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takeharu Yoshikawa
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Radiology and Biomedical Engineering, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Sayed MHM, Abdelnaim AKM, Mohamadien NRA. Intrapatient variability of 18F-FDG uptake in normal tissues. J Clin Imaging Sci 2022; 12:37. [PMID: 36128350 PMCID: PMC9479622 DOI: 10.25259/jcis_23_2022] [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: 02/26/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives To investigate the effect of serum glucose level and other confounding factors on the variability of maximum standardized uptake value (SUVmax) in normal tissues within the same patient on two separate occasions and to suggest an ideal reference tissue. Materials and Methods We retrospectively reviewed 334 18F-FDG PET/CT scans of 167 cancer patients including 38 diabetics. All patients had two studies, on average 152 ± 68 days apart. Ten matched volumes of interest were drawn on the brain, right tonsil, blood pool, heart, lung, liver, spleen, bone marrow, fat, and iliopsoas muscle opposite third lumber vertebra away from any pathological 18F-FDG uptake to calculate SUVmax. Results SUVmax of the lungs and heart were significantly different in the two studies (P = 0.003 and P = 0.024 respectively). Only the brain uptake showed a significant moderate negative correlation with the level of blood glucose in diabetic patients (r = −0.537, P = 0.001) in the first study, while the SUVmax of other tissues showed negligible or weak correlation with the level of blood glucose in both studies. The liver showed significant moderate positive correlation with body mass index (BMI) in both studies (r = .416, P = <0.001 versus r = 0.453, P = <0.001, respectively), and blood pool activity showed significant moderate positive correlation with BMI in the first study only (r = 0.414, P = <0.001). The liver and blood pool activities showed significant moderate negative correlation with 18F-FDG uptake time in first study only (r = −0.405, P-value = <0.001; and r = −0.409, P-value = <0.001, respectively). In the multivariate analysis, the liver showed a consistent effect of the injected 18F-FDG dose and uptake duration on its SUVmax on the two occasions. In comparison, spleen and muscle showed consistent effect only of the injected dose on the two occasions. Conclusion The liver, muscle, and splenic activities showed satisfactory test/retest stability and can be used as reference activities. The spleen and muscle appear to be more optimal reference than the liver, as it is only associated with the injected dose of 18F-FDG.
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Affiliation(s)
- Mohamed Hosny Mohamed Sayed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt,
| | - Aya KM Abdelnaim
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt,
| | - Nsreen RA Mohamadien
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt,
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5
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Sarikaya I, Schierz JH, Sarikaya A. Liver: glucose metabolism and 18F-fluorodeoxyglucose PET findings in normal parenchyma and diseases. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2021; 11:233-249. [PMID: 34513277 PMCID: PMC8414405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
Liver has a complex and unique energy metabolism and plays a major role in glucose homeostasis. Liver is the main control center for glycogenesis, glycogenolysis, glycolysis and gluconeogenesis which are essential to provide energy for other tissues. Liver meets its own energy need from various sources which is mainly glucose in the fed state and fatty acids in the fasting state. In this review article, we will mainly describe the glucose metabolism of the liver, effect of various factors on 18F-fluorodeoxyglucose (FDG) activity/uptake in the normal liver and 18F- FDG positron emission tomography (PET) uptake patterns in various malignant and benign liver pathologies. Brief information on metabolomics profiling analyses in liver disorders will also be provided.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of MedicineSafat, Kuwait
| | | | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of MedicineTurkey
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6
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Keramida G, Peters AM. FDG PET/CT of the non‐malignant liver in an increasingly obese world population. Clin Physiol Funct Imaging 2020; 40:304-319. [DOI: 10.1111/cpf.12651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Georgia Keramida
- Department of Nuclear Medicine Royal Brompton and HarefieldNHS Foundation Trust London UK
| | - A. Michael Peters
- Department of Nuclear Medicine King’s College HospitalNHS Foundation Trusts London UK
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7
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Aide N, Tainturier LE, Nganoa C, Houdu B, Kammerer J, Galais MP, Ciappuccini R, Lasnon C. HYPHYCA: a prospective study in 613 patients conducting a comprehensive analysis for predictive factors of physiological 18F-FDG anal uptake. EJNMMI Res 2020; 10:28. [PMID: 32193623 PMCID: PMC7082447 DOI: 10.1186/s13550-020-0615-5] [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: 12/17/2019] [Accepted: 02/25/2020] [Indexed: 01/20/2023] Open
Abstract
Background Anal cancer is a relatively rare tumor of which incidence increases in developed countries. 18F-FDG PET has been increasingly used for its post radio-chemotherapy evaluation. However, several authors have reported the risk of local false-positive findings leading to low specificity and positive predictive values. These false-positive results could be due to post-radiotherapy inflammation or infection but certainly also to physiological anal canal uptake that is observed on a regular basis in clinical practice. The purpose of this prospective study (NCT03506529; HYPHYCA) was therefore to seek predictive factors of physiological anal canal hypermetabolism. Materials and methods Over a 2-month period, patients aged 18 years old and more, referred for 18F-FDG PET-CT at two EARL-accredited PET centers were included, after obtaining their informed and written consent. They were asked to fill in a questionnaire including seven closed questions about usual intestinal transit, ongoing medications relative to intestinal transit, history of digestive, and anal and/or pelvic diseases. Age, gender, and body mass index (BMI) were recorded. A single nuclear medicine physician visually and quantitatively analyzed anal canal uptake (SUVmax_EARL) and assessed visual rectal content (air, feces, or both) and the largest rectal diameter (mm). Results Six hundred and thirteen patients were included (sex ratio F/M = 0.99) and 545 (89%) questionnaires were entirely completed. Significantly more males presented anal canal hypermetabolism (sex ratio (M/F) = 1.18 versus 0.85, p = 0.048). Moreover, patients with anal canal hypermetabolism had higher BMI (27.6 (5.7) kg/m2 versus 23.9 (4.5) kg/m2, p < 0.0001), higher rate of hemorrhoid history (43% versus 27%, p = 0.016), and higher rate of rectum filled with only feces (21% versus 12%, p = 0.019) as compared to patients with no anal canal uptake. On logistic regression, all these variables were found to be independent predictors of the occurrence of an anal canal hypermetabolism. Odds ratio were 1.16 (1.12–1.20) per unit of BMI (kg/m2) (p < 0.0001), 1.48 (1.04–2.11) for males (p = 0.030), 1.64 (1.10–2.45) for hemorrhoids history (p = 0.016), and 1.94 (1.147–3.22) for the rectum filled with only feces (p = 0.010). Conclusion According to our study, the predictive factors of physiological anal canal hypermetabolism are high BMI, male gender, hemorrhoid history, and rectum filled with only feces. This may pave the way to a more specific interpretation of post radio-chemotherapy PET evaluations of anal canal cancer, provided that other studies are conducted in this specific population. Trial registration This prospective study was registered at Clinicaltrial.gov: NCT03506529; HYPHYCA on April 24, 2018
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Affiliation(s)
- Nicolas Aide
- Normandie University, Caen, France. .,Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France. .,INSERM 1086 ANTICIPE, Normandie University, Caen, France.
| | - Laure-Eugénie Tainturier
- Normandie University, Caen, France.,Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Cathy Nganoa
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Benjamin Houdu
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Jennifer Kammerer
- Normandie University, Caen, France.,Radiation Oncology Department, François Baclesse Cancer Centre, Caen, France
| | - Marie-Pierre Galais
- Digestive Oncology Department, François Baclesse Cancer Centre, Caen, France
| | - Renaud Ciappuccini
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Charline Lasnon
- INSERM 1086 ANTICIPE, Normandie University, Caen, France.,Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
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8
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Vollenbrock SE, Nowee ME, Voncken FE, Kotte AN, Goense L, van Rossum PS, van Lier AL, Heijmink SW, Bartels-Rutten A, Wessels FJ, Aleman BM, Dewit L, Kerkmeijer LG, Jansen EP, Intven M, Lips IM, Meijer GJ, Nijkamp J. Gross Tumor Delineation in Esophageal Cancer on MRI Compared With 18F-FDG-PET/CT. Adv Radiat Oncol 2019; 4:596-604. [PMID: 31673653 PMCID: PMC6817537 DOI: 10.1016/j.adro.2019.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Current delineation of the gross tumor volume (GTV) in esophageal cancer relies on computed tomography (CT) and combination with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). There is increasing interest in integrating magnetic resonance imaging (MRI) in radiation treatment, which can potentially obviate CT- or FDG-PET/CT-based delineation. The aim of this study is to evaluate the feasibility of target delineation on T2-weighted (T2W) MRI and T2W including diffusion-weighted MRI (T2W + DW-MRI) compared with current-practice FDG-PET/CT. METHODS Ten observers delineated primary esophageal tumor GTVs of 6 patients on FDG-PET/CT, T2W-MRI, and T2W + DW-MRI. GTVs, generalized conformity indices, in-slice delineation variation (root mean square), and standard deviations in the position of the most cranial and caudal delineated slice were calculated. RESULTS Delineations on MRI showed smaller GTVs compared with FDG-PET/CT-based delineations. The main variation was seen at the cranial and caudal border. No differences were observed in conformity indices (FDG-PET/CT, 0.68; T2W-MRI, 0.66; T2W + DW-MRI, 0.68) and in-slice variation (root mean square, 0.13 cm on FDG-PET/CT; 0.10 cm on T2W-MRI; 0.14 cm on T2W + DW-MRI). In the 2 tumors involving the gastroesophageal junction, addition of DW-MRI to T2W-MRI significantly decreased caudal border variation. CONCLUSIONS MRI-based target delineation of the esophageal tumor is feasible with interobserver variability comparable to that with FDG-PET/CT, despite limited experience with delineation on MRI. Most variation was seen at cranial-caudal borders, and addition of DW-MRI to T2W-MRI may reduce caudal delineation variation of gastroesophageal junction tumors.
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Affiliation(s)
- Sophie E. Vollenbrock
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marlies E. Nowee
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Francine E.M. Voncken
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alexis N.T.J. Kotte
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucas Goense
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter S.N. van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Stijn W. Heijmink
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Frank J. Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berthe M.P. Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc Dewit
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Linda G.W. Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edwin P.M. Jansen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Martijn Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene M. Lips
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gert J. Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jasper Nijkamp
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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9
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The Evolving Role of PET-Based Novel Quantitative Techniques in the Interventional Radiology Procedures of the Liver. PET Clin 2019; 14:419-425. [PMID: 31472739 DOI: 10.1016/j.cpet.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Interventional radiology procedures have revolutionized the treatment of cancer and interventional oncology is now the fourth pillar of cancer care. The article discusses the importance of fluorodeoxyglucose (FDG)-PET imaging, and dual time-point imaging in the context of PET/computed tomography as applied to treatments of liver malignancy. The necessary paradigm shift in the adoption of novel segmentation methodologies to express global disease burden is explored.
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10
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Ross JC, Vilić D, Sanderson T, Vöö S, Dickson J. Does quantification have a role to play in the future of bone SPECT? Eur J Hybrid Imaging 2019; 3:8. [PMID: 34191209 PMCID: PMC8218028 DOI: 10.1186/s41824-019-0054-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/01/2019] [Indexed: 12/26/2022] Open
Abstract
Routinely, there is a visual basis to nuclear medicine reporting: a reporter subjectively places a patient's condition into one of multiple discrete classes based on what they see. The addition of a quantitative result, such as a standardised uptake value (SUV), would provide a numerical insight into the nature of uptake, delivering greater objectivity, and perhaps improved patient management.For bone scintigraphy in particular quantification could increase the accuracy of diagnosis by helping to differentiate normal from abnormal uptake. Access to quantitative data might also enhance our ability to characterise lesions, stratify and monitor patients' conditions, and perform reliable dosimetry for radionuclide therapies. But is there enough evidence to suggest that we, as a community, should be making more effort to implement quantitative bone SPECT in routine clinical practice?We carried out multiple queries through the PubMed search engine to facilitate a cross-sectional review of the current status of bone SPECT quantification. Highly cited papers were assessed in more focus to scrutinise their conclusions.An increasing number of authors are reporting findings in terms of metrics such as SUVmax. Although interest in the field in general remains high, the rate of clinical implementation of quantitative bone SPECT remains slow and there is a significant amount of validation required before we get carried away.
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Affiliation(s)
- James C. Ross
- Institute of Nuclear Medicine T05, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU UK
| | - Dijana Vilić
- Radiological Sciences Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Tom Sanderson
- Institute of Nuclear Medicine T05, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU UK
| | - Stefan Vöö
- Institute of Nuclear Medicine T05, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU UK
| | - John Dickson
- Institute of Nuclear Medicine T05, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU UK
- Institute of Nuclear Medicine, University College London, London, UK
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Dynamics of fluorine-18-fluorodeoxyglucose uptake in the liver and its correlation with hepatic fat content and BMI. Nucl Med Commun 2019; 40:545-551. [PMID: 30807535 DOI: 10.1097/mnm.0000000000001000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to explore the rate of elimination of fluorine-18-fluorodeoxyglucose (F-FDG) from the liver and assess the impact of hepatic fat and obesity on F-FDG clearance in early and delayed PET scans. We hypothesized that an increase in liver fat may cause a decline in hepatic F-FDG elimination with potential consequences as measured by dual time-point F-FDG PET/CT imaging. PATIENTS AND METHODS A total of 32 patients from the Cardiovascular Molecular Calcification Assessed by F-NaF PET/CT (CAMONA) clinical trial (17 males, 15 females; mean age: 47.2 years, range: 23-69 years, mean BMI: 27.2 kg/m) were enrolled and underwent F-FDG PET/CT 90 and 180 min after tracer injection. Global mean standardized uptake value (SUVmean) (i.e. the average of SUVmean in segmented liver slices) and average maximum standardized uptake value (SUVmax) (i.e. the average of the SUVmax values recorded in same slices) were calculated for semiquantification of liver F-FDG uptake at both time-points. Percentage difference in global SUVmean and average SUVmax were also calculated to yield respective retention indices (RImean and RImax). Changes in global SUVmean, average SUVmax, RImean, and RImax from 90 to 180 min were correlated with BMI and liver fat content as measured by CT Hounsfield units. RESULTS There was a 12.2±3.5 percent reduction in global liver SUVmean and a 4.1±5.8 percent reduction in average SUVmax at 180 min scan as compared with the 90 min time-point. RImean and RImax were inversely correlated with liver fat content and positively correlated with BMI. CONCLUSION We observed a time-dependent decrease in global hepatic SUVmean and average SUVmax, which was affected by the amount of liver fat. Patients with higher BMI and hepatic fat content tended to retain F-FDG.
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Patel N, Foley KG, Powell AG, Wheat JR, Chan D, Fielding P, Roberts SA, Lewis WG. Propensity score analysis of 18-FDG PET/CT-enhanced staging in patients undergoing surgery for esophageal cancer. Eur J Nucl Med Mol Imaging 2018; 46:801-809. [PMID: 30116837 PMCID: PMC6450839 DOI: 10.1007/s00259-018-4118-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE PET/CT is now integral to the staging pathway for potentially curable esophageal cancer (EC), primarily to identify distant metastases undetected by computed tomography. The aim of this study was to analyze the effect of PET/CT introduction on survival and assess patterns of recurrence after esophagectomy. METHODS A longitudinal cohort of EC patients staged between 1998 and 2016 were considered for inclusion. After co-variate adjustment using propensity scoring, a cohort of 496 patients (273 pre-PET/CT and 223 post-PET/CT) who underwent esophagectomy [median age 63 years (31-80), 395 males, 425 adenocarcinomas, 71 squamous cell carcinomas, 325 neoadjuvant therapy] were included. The primary outcome measure was overall survival (OS) based on intention to treat. RESULTS Three-year OS pre-PET/CT was 42.5% compared with 57.8% post-PET/CT (Chi2 6.571, df 1, p = 0.004). On multivariable analysis, pT stage (HR 1.496 [95% CI 1.28-1.75], p < 0.0001), pN stage (HR 1.114 [95% CI 1.04-1.19], p = 0.001) and PET/CT staging (HR 0.688 [95% CI 0.53-0.89] p = 0.004) were independently associated with OS. Recurrent cancer was observed in 125 patients (51.4%) pre-PET/CT, compared with 74 patients post-PET/CT (37.8%, p = 0.004), and was less likely to be distant recurrence after PET/CT introduction (39.5 vs. 27.0%, p = 0.006). CONCLUSIONS Enhanced PET/CT staging is an important modality and independent factor associated with improved survival in patients undergoing esophagectomy for cancer.
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Affiliation(s)
- N Patel
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Kieran G Foley
- Division of Cancer & Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK.
| | - A G Powell
- Division of Cancer & Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - J R Wheat
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - D Chan
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - P Fielding
- Wales Research & Diagnostic Positron Emission Tomography Imaging Centre (PETIC), UHW, Cardiff, CF14 4XN, UK
| | - S A Roberts
- Department of Radiology, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - W G Lewis
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
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Azmi NHM, Suppiah S, Liong CW, Noor NM, Said SM, Hanafi MH, Kaewput C, Saad FFA, Vinjamuri S. Reliability of standardized uptake value normalized to lean body mass using the liver as a reference organ, in contrast-enhanced 18F-FDG PET/CT imaging. Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2018.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Quantification of FDG-PET/CT with delayed imaging in patients with newly diagnosed recurrent breast cancer. BMC Med Imaging 2018; 18:11. [PMID: 29743027 PMCID: PMC5943993 DOI: 10.1186/s12880-018-0254-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 04/30/2018] [Indexed: 12/11/2022] Open
Abstract
Background Several studies have shown the advantage of delayed-time-point imaging with 18F-FDG-PET/CT to distinguish malignant from benign uptake. This may be relevant in cancer diseases with low metabolism, such as breast cancer. We aimed at examining the change in SUV from 1 h (1h) to 3 h (3h) time-point imaging in local and distant lesions in patients with recurrent breast cancer. Furthermore, we investigated the effect of partial volume correction in the different types of metastases, using semi-automatic quantitative software (ROVER™). Methods One-hundred and two patients with suspected breast cancer recurrence underwent whole-body PET/CT scans 1h and 3h after FDG injection. Semi-quantitative standardised uptake values (SUVmax, SUVmean) and partial volume corrected SUVmean (cSUVmean), were estimated in malignant lesions, and as reference in healthy liver tissue. The change in quantitative measures from 1h to 3h was calculated, and SUVmean was compared to cSUVmean. Metastases were verified by biopsy. Results Of the 102 included patients, 41 had verified recurrent disease with in median 15 lesions (range 1-70) amounting to a total of 337 malignant lesions included in the analysis. SUVmax of malignant lesions increased from 6.4 ± 3.4 [0.9-19.7] (mean ± SD, min and max) at 1h to 8.1 ± 4.4 [0.7-29.7] at 3h. SUVmax in breast, lung, lymph node and bone lesions increased significantly (p < 0.0001) between 1h and 3h by on average 25, 40, 33, and 27%, respectively. A similar pattern was observed with (uncorrected) SUVmean. Partial volume correction increased SUVmean significantly, by 63 and 71% at 1h and 3h imaging, respectively. The highest impact was in breast lesions at 3h, where cSUVmean increased by 87% compared to SUVmean. Conclusion SUVs increased from 1h to 3h in malignant lesions, SUVs of distant recurrence were in general about twice as high as those of local recurrence. Partial volume correction caused significant increases in these values. However, it is questionable, if these relatively modest quantitative advances of 3h imaging are sufficient to warrant delayed imaging in this patient group. Trial registration ClinicalTrails.gov NCT01552655. Registered 28 February 2012, partly retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12880-018-0254-8) contains supplementary material, which is available to authorized users.
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Berzaczy D, Mayerhoefer ME, Azizi AA, Haug AR, Senn D, Beitzke D, Weber M, Traub-Weidinger T. Does elevated glucose metabolism correlate with higher cell density in Neurofibromatosis type 1 associated peripheral nerve sheath tumors? PLoS One 2017; 12:e0189093. [PMID: 29206885 PMCID: PMC5716584 DOI: 10.1371/journal.pone.0189093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/17/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate whether elevated glucose metabolism in neurofibroma, determined by [F18]-FDG-PET, is correlated with cell density in MRI, as expressed through the apparent diffusion coefficient. MATERIALS AND METHODS Patients diagnosed with neurofibromatosis type 1 and peripheral nerve sheath tumors (PNST) were enrolled in this prospective, IRB-approved study. After a single [F18]-FDG injection, patients consecutively underwent [F18]-FDG-PET/CT and [F18]-FDG-PET/MRI on the same day. Maximum and mean standardized uptake values (SUVmax, SUVmean) on [F18]-FDG-PET/CT and [F18]-FDG-PET/MRI were compared, and correlated with minimum and mean apparent diffusion coefficients (ADCmean, ADCmin). RESULTS A total of 12 (6 male/6 female, mean age was 16.2 ± 5.2 years) patients were prospectively included and analyzed on a per-lesion (n = 39) basis. The SUVmean of examined PNST showed a moderate negative correlation with the ADCmean (r = -.441) and ADCmin (r = -.477), which proved to be statistically significant (p = .005 and p = .002). The SUVmax of the respective lesions, however, showed a weaker negative correlation for ADCmean (r: -.311) and ADCmin (r: -.300) and did not reach statistical significance (p = .054 and p = .057). Lesion-based correlation between [F18]-FDG-PET/MRI and [F18]-FDG-PET/CT showed a moderate correlation for SUVmax (r = .353; p = .027) and a strong one for SUVmean (r = .879; p = .001)). Patient-based liver uptake (SUVmax and mean) of [F18]-FDG-PET/MRI and [F18]-FDG-PET/CT were strongly positively correlated (r = .827; p < .001 and r = .721; p < .001) but differed significantly (p < .001). CONCLUSIONS We found a statistically significant, negative correlation between glucose metabolism and cell density in PNST. Thus, ADCmean and ADCmin could possibly add complimentary information to the SUVmax and SUVmean and may serve as a potential determinant of malignant transformation of PNST.
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Affiliation(s)
- Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Marius E. Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Amedeo A. Azizi
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Alexander R. Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Daniela Senn
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
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Keramida G, Anagnostopoulos CD, Peters AM. The extent to which standardized uptake values reflect FDG phosphorylation in the liver and spleen as functions of time after injection of 18F-fluorodeoxyglucose. EJNMMI Res 2017; 7:13. [PMID: 28176243 PMCID: PMC5296268 DOI: 10.1186/s13550-017-0254-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 01/23/2023] Open
Abstract
Purpose In FDG PET/CT, standardized uptake value (SUV) is used to measure metabolic activity but detects un-phosphorylated FDG as well as phosphorylated FDG (FDG6P). Our aim was to determine the proportions of intrahepatic and intrasplenic FDG that are phosphorylated after FDG injection and compare them with SUVs. Methods Sixty patients undergoing whole-body PET/CT 60 min post-injection of FDG first had dynamic PET imaging for 30 min with measurement of hepatic and splenic FDG clearances using Patlak-Rutland analysis. The gradient of the Patlak-Rutland plot, which is proportional to clearance (Ki), was normalized to the intercept, which is proportional to FDG distribution volume (V(0)) with the same proportionality constant. Using measured values of Ki/V(0), FDG6P/FDG ratios as functions of time in the two organs were measured for assumed FDG blood disappearance half-times of 40, 50 and 60 min. Hepatic and splenic SUVs were measured from whole-body PET/CT. Results The mean (SD) Ki/V(0) was 0.0036 (0.0021) and 0.0060 (0.0041) ml/min/ml for the liver and spleen, respectively, but the hepatic SUV was 1.36-fold higher than the splenic SUV. This discrepancy was explained by the hepatic V(0) being 1.6-fold higher than the splenic V(0). The percentages of FDG phosphorylated 60 min post-injection were 27, 25 and 23% for the liver and 39, 36 and 34% for the spleen, for blood clearance half-times of 40, 50 and 60 min, respectively. SUV indices correlated poorly with Ki/V(0) for both organs. Conclusions SUV is largely determined by un-phosphorylated FDG in dynamic exchange with blood FDG, explaining the poor correlations between SUV indices and Ki/V(0).
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Affiliation(s)
- Georgia Keramida
- Clinical Imaging Sciences Centre, Brighton Sussex Medical School, Brighton, UK
| | - Constantinos D Anagnostopoulos
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - A Michael Peters
- Clinical Imaging Sciences Centre, Brighton Sussex Medical School, Brighton, UK. .,Department of Nuclear Medicine, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
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Does Delayed-Time-Point Imaging Improve 18F-FDG-PET in Patients With MALT Lymphoma?: Observations in a Series of 13 Patients. Clin Nucl Med 2016; 41:101-5. [PMID: 26402137 PMCID: PMC4703065 DOI: 10.1097/rlu.0000000000001005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To determine whether in patients with extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue lymphoma (MALT), delayed–time-point 2-18F-fluoro-2-deoxy-d-glucose-positron emission tomography (18F-FDG-PET) performs better than standard–time-point 18F-FDG-PET.
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Mahmud MH, Nordin AJ, Ahmad Saad FF, Azman AZF. Impacts of biological and procedural factors on semiquantification uptake value of liver in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging. Quant Imaging Med Surg 2015; 5:700-7. [PMID: 26682140 DOI: 10.3978/j.issn.2223-4292.2015.05.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Increased metabolic activity of fluorodeoxyglucose (FDG) in tissue is not only resulting of pathological uptake, but due to physiological uptake as well. This study aimed to determine the impacts of biological and procedural factors on FDG uptake of liver in whole body positron emission tomography/computed tomography (PET/CT) imaging. METHODS Whole body fluorine-18 ((18)F) FDG PET/CT scans of 51 oncology patients have been reviewed. Maximum standardized uptake value (SUVmax) of lesion-free liver was quantified in each patient. Pearson correlation was performed to determine the association between the factors of age, body mass index (BMI), blood glucose level, FDG dose and incubation period and liver SUVmax. Multivariate regression analysis was established to determine the significant factors that best predicted the liver SUVmax. Then the subjects were dichotomised into four BMI groups. Analysis of variance (ANOVA) was established for mean difference of SUVmax of liver between those BMI groups. RESULTS BMI and incubation period were significantly associated with liver SUVmax. These factors were accounted for 29.6% of the liver SUVmax variance. Statistically significant differences were observed in the mean SUVmax of liver among those BMI groups (P<0.05). CONCLUSIONS BMI and incubation period are significant factors affecting physiological FDG uptake of liver. It would be recommended to employ different cut-off value for physiological liver SUVmax as a reference standard for different BMI of patients in PET/CT interpretation and use a standard protocol for incubation period of patient to reduce variation in physiological FDG uptake of liver in PET/CT study.
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Affiliation(s)
- Mohd Hafizi Mahmud
- 1 Faculty of Medicine and Health Sciences, 2 Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia, Selangor, Malaysia ; 3 Department of Medical Imaging, Faculty of Health Sciences, Universiti Teknologi MARA Puncak Alam Campus, Selangor, Malaysia ; 4 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Abdul Jalil Nordin
- 1 Faculty of Medicine and Health Sciences, 2 Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia, Selangor, Malaysia ; 3 Department of Medical Imaging, Faculty of Health Sciences, Universiti Teknologi MARA Puncak Alam Campus, Selangor, Malaysia ; 4 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Fathinul Fikri Ahmad Saad
- 1 Faculty of Medicine and Health Sciences, 2 Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia, Selangor, Malaysia ; 3 Department of Medical Imaging, Faculty of Health Sciences, Universiti Teknologi MARA Puncak Alam Campus, Selangor, Malaysia ; 4 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Ahmad Zaid Fattah Azman
- 1 Faculty of Medicine and Health Sciences, 2 Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia, Selangor, Malaysia ; 3 Department of Medical Imaging, Faculty of Health Sciences, Universiti Teknologi MARA Puncak Alam Campus, Selangor, Malaysia ; 4 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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Liver metabolic activity changes over time with neoadjuvant therapy in locally advanced rectal cancer. Nucl Med Commun 2015; 37:116-21. [PMID: 26440564 DOI: 10.1097/mnm.0000000000000412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate, using PET/computed tomography (CT), changes in liver metabolic activity in patients with locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT). PATIENTS AND METHODS A total of 29 biopsy-proven LARC patients between 2009 and 2012 were studied. Liver standardized uptake values (SUVs) and SUVs adjusted for lean body mass (SULs) were obtained from PET/CT images obtained at 1 h (early) and 2 h (late) after (18)F-fluorodeoxyglucose ((18)F-FDG) administration both before and after neoadjuvant CRT. Age, sex, BMI, lean body mass, blood glucose level, and (18)F-FDG dose, which can influence liver SUVs and SULs, were also analyzed. RESULTS Fourteen (48%) men and 15 (52%) women with a mean age of 62±11 years (range 34-80 years) were included in the study. The mean SUVs and SULs were significantly decreased in the late scans. Sex was significantly correlated with the mean liver SUV in early and late scans. The mean SUV differed significantly between male and female patients in early and late images (P<0.05). In a multivariate stepwise regression analysis, only liver SUVs (maximum and mean) were significantly associated with BMI before and after therapy. SUVs were significantly higher in the high (≥25) BMI group after but not before therapy. Mean SUL was not influenced by BMI. CONCLUSION Liver (18)F-FDG uptake is consistent before and after neoadjuvant CRT therapy in patients with LARC. When assessing response to therapy and using liver metabolic activity to indicate background activity, BMI should be considered as it can influence liver metabolic activity.
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