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Preliminary evaluation of 18F-FDG-PET/MRI for differentiation of serous from nonserous pancreatic cystic neoplasms: a pilot study. Nucl Med Commun 2021; 41:1257-1264. [PMID: 32925829 DOI: 10.1097/mnm.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate preliminary feasibility of 18F-FDG-PET/MRI in differentiation of pancreatic serous cystic neoplasms (SCNs) from non-SCNs. METHODS From August 2017 to June 2019, 10 patients (3 men, 7 women; mean age, 63 years) previously diagnosed with pancreatic cystic neoplasm underwent simultaneous 18F-FDG-PET/MRI prospectively on an integrated 3-Tesla hybrid PET/MRI scanner. PET images were analyzed visually and semiquantitatively measuring standardized uptake values (SUV) including lesion SUVmax and SUVmean, lesion to pancreas and lesion to liver SUVmax and SUVmean ratio independent of MRI diagnosis. The reference standard for lesion diagnosis was by MRI features and interval follow-up. RESULTS Visual assessment of PET images demonstrated uptake in 57% of SCNs. Lesion to liver SUVmax ratio of ≥0.5 showed the highest accuracy (90%) and area under the curve (0.9) followed by lesion SUVmax of ≥1.6 and lesion to pancreas SUVmax ratio of ≥0.77 for diagnosis of SCN. The sensitivity for lesion SUVmax of ≥1.6 was less than two other ones (71 versus 100%). All non-SCNs exhibited SUVmax value less than 1.6 while 33 and 66% demonstrated lesion to liver SUVmax ratio of >0.5 and lesion to pancreas SUVmax ratio of >0.77, respectively. PET/MRI specificity was 67, 100, 67 and 33% through lesion to liver SUVmax ratio, lesion SUVmax, lesion SUVmean and lesion to pancreas SUVmax ratio, respectively, for diagnosis of SCN. CONCLUSION Preliminary results show that PET/MRI utilization is promising for differentiation of pancreatic SCN from non-SCN lesions. This could reduce need for surveillance imaging or avoidance of unnecessary intervention in pancreatic cystic neoplasms with uncertain diagnoses.
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Bohl CE, Federico SM, Robinson GW, Bahrami A, Shulkin BL. FDG-PET CT in the evaluation of primary and secondary pancreatic malignancies. Pediatr Blood Cancer 2018; 65:e27115. [PMID: 29750397 DOI: 10.1002/pbc.27115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/28/2018] [Accepted: 03/16/2018] [Indexed: 11/06/2022]
Abstract
PURPOSE Primary pancreatic carcinoma and pancreatic metastases are rare in the pediatric population. Pancreatoblastoma is the most common pancreatic malignant tumor in young children and solid-pseudopapillary tumor in teenagers. Pancreatic adenocarcinoma is extremely rare under the age of 40 and is usually associated with underlying genetic abnormalities. Secondary malignancies of the pancreas occur more frequently than primary pancreatic malignancies in children and are most commonly seen with non-Hodgkin lymphomas (NHL) and mesenchymal sarcomas. The purpose of this study was to characterize the metabolism of primary and secondary tumors of the pancreas in pediatric patients. MATERIALS AND METHODS A retrospective analysis of all primary and secondary pancreatic malignancies imaged with 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) computed tomography (CT) was conducted. RESULTS Three patients with primary pancreatic cancers were identified, one each with pancreatoblastoma, solid-pseudopapillary tumor, and adenocarcinoma. Each tumor showed elevated uptake of FDG. Metastatic disease in the pancreas was identified in 12 patients-five NHL (including three Burkitt lymphomas), six sarcomas (three osteosarcomas, two rhabdomyosarcomas, and one Ewing sarcoma family tumor), and one malignant rhabdoid tumor. Elevated but variable uptake of FDG was found in each of the tumors of patients with metastatic disease within the pancreas. CONCLUSION Both primary malignancies and metastatic disease within the pancreas, though very rare in children, adolescents, and young adults, are metabolically active and can be functionally characterized using FDG-PET CT.
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Affiliation(s)
- Casey E Bohl
- Department of Radiology, Methodist University Hospital, Memphis, Tennessee
| | - Sara M Federico
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Giles W Robinson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
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Gunda V, Souchek J, Abrego J, Shukla SK, Goode GD, Vernucci E, Dasgupta A, Chaika NV, King RJ, Li S, Wang S, Yu F, Bessho T, Lin C, Singh PK. MUC1-Mediated Metabolic Alterations Regulate Response to Radiotherapy in Pancreatic Cancer. Clin Cancer Res 2017; 23:5881-5891. [PMID: 28720669 DOI: 10.1158/1078-0432.ccr-17-1151] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/03/2017] [Accepted: 07/14/2017] [Indexed: 11/16/2022]
Abstract
Purpose:MUC1, an oncogene overexpressed in multiple solid tumors, including pancreatic cancer, reduces overall survival and imparts resistance to radiation and chemotherapies. We previously identified that MUC1 facilitates growth-promoting metabolic alterations in pancreatic cancer cells. The present study investigates the role of MUC1-mediated metabolism in radiation resistance of pancreatic cancer by utilizing cell lines and in vivo models.Experimental Design: We used MUC1-knockdown and -overexpressed cell line models for evaluating the role of MUC1-mediated metabolism in radiation resistance through in vitro cytotoxicity, clonogenicity, DNA damage response, and metabolomic evaluations. We also investigated whether inhibition of glycolysis could revert MUC1-mediated metabolic alterations and radiation resistance by using in vitro and in vivo models.Results: MUC1 expression diminished radiation-induced cytotoxicity and DNA damage in pancreatic cancer cells by enhancing glycolysis, pentose phosphate pathway, and nucleotide biosynthesis. Such metabolic reprogramming resulted in high nucleotide pools and radiation resistance in in vitro models. Pretreatment with the glycolysis inhibitor 3-bromopyruvate abrogated MUC1-mediated radiation resistance both in vitro and in vivo, by reducing glucose flux into nucleotide biosynthetic pathways and enhancing DNA damage, which could again be reversed by pretreatment with nucleoside pools.Conclusions: MUC1-mediated nucleotide metabolism plays a key role in facilitating radiation resistance in pancreatic cancer and targeted effectively through glycolytic inhibition. Clin Cancer Res; 23(19); 5881-91. ©2017 AACR.
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Affiliation(s)
- Venugopal Gunda
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joshua Souchek
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jaime Abrego
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Surendra K Shukla
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gennifer D Goode
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Enza Vernucci
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Aneesha Dasgupta
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nina V Chaika
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ryan J King
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sicong Li
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Shuo Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Fang Yu
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tadayoshi Bessho
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Pankaj K Singh
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska. .,Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska
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Best LMJ, Rawji V, Pereira SP, Davidson BR, Gurusamy KS. Imaging modalities for characterising focal pancreatic lesions. Cochrane Database Syst Rev 2017; 4:CD010213. [PMID: 28415140 PMCID: PMC6478242 DOI: 10.1002/14651858.cd010213.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Increasing numbers of incidental pancreatic lesions are being detected each year. Accurate characterisation of pancreatic lesions into benign, precancerous, and cancer masses is crucial in deciding whether to use treatment or surveillance. Distinguishing benign lesions from precancerous and cancerous lesions can prevent patients from undergoing unnecessary major surgery. Despite the importance of accurately classifying pancreatic lesions, there is no clear algorithm for management of focal pancreatic lesions. OBJECTIVES To determine and compare the diagnostic accuracy of various imaging modalities in detecting cancerous and precancerous lesions in people with focal pancreatic lesions. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, and Science Citation Index until 19 July 2016. We searched the references of included studies to identify further studies. We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA We planned to include studies reporting cross-sectional information on the index test (CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), EUS (endoscopic ultrasound), EUS elastography, and EUS-guided biopsy or FNA (fine-needle aspiration)) and reference standard (confirmation of the nature of the lesion was obtained by histopathological examination of the entire lesion by surgical excision, or histopathological examination for confirmation of precancer or cancer by biopsy and clinical follow-up of at least six months in people with negative index tests) in people with pancreatic lesions irrespective of language or publication status or whether the data were collected prospectively or retrospectively. DATA COLLECTION AND ANALYSIS Two review authors independently searched the references to identify relevant studies and extracted the data. We planned to use the bivariate analysis to calculate the summary sensitivity and specificity with their 95% confidence intervals and the hierarchical summary receiver operating characteristic (HSROC) to compare the tests and assess heterogeneity, but used simpler models (such as univariate random-effects model and univariate fixed-effect model) for combining studies when appropriate because of the sparse data. We were unable to compare the diagnostic performance of the tests using formal statistical methods because of sparse data. MAIN RESULTS We included 54 studies involving a total of 3,196 participants evaluating the diagnostic accuracy of various index tests. In these 54 studies, eight different target conditions were identified with different final diagnoses constituting benign, precancerous, and cancerous lesions. None of the studies was of high methodological quality. None of the comparisons in which single studies were included was of sufficiently high methodological quality to warrant highlighting of the results. For differentiation of cancerous lesions from benign or precancerous lesions, we identified only one study per index test. The second analysis, of studies differentiating cancerous versus benign lesions, provided three tests in which meta-analysis could be performed. The sensitivities and specificities for diagnosing cancer were: EUS-FNA: sensitivity 0.79 (95% confidence interval (CI) 0.07 to 1.00), specificity 1.00 (95% CI 0.91 to 1.00); EUS: sensitivity 0.95 (95% CI 0.84 to 0.99), specificity 0.53 (95% CI 0.31 to 0.74); PET: sensitivity 0.92 (95% CI 0.80 to 0.97), specificity 0.65 (95% CI 0.39 to 0.84). The third analysis, of studies differentiating precancerous or cancerous lesions from benign lesions, only provided one test (EUS-FNA) in which meta-analysis was performed. EUS-FNA had moderate sensitivity for diagnosing precancerous or cancerous lesions (sensitivity 0.73 (95% CI 0.01 to 1.00) and high specificity 0.94 (95% CI 0.15 to 1.00), the extremely wide confidence intervals reflecting the heterogeneity between the studies). The fourth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (dysplasia) provided three tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing invasive carcinoma were: CT: sensitivity 0.72 (95% CI 0.50 to 0.87), specificity 0.92 (95% CI 0.81 to 0.97); EUS: sensitivity 0.78 (95% CI 0.44 to 0.94), specificity 0.91 (95% CI 0.61 to 0.98); EUS-FNA: sensitivity 0.66 (95% CI 0.03 to 0.99), specificity 0.92 (95% CI 0.73 to 0.98). The fifth analysis, of studies differentiating cancerous (high-grade dysplasia or invasive carcinoma) versus precancerous (low- or intermediate-grade dysplasia) provided six tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing cancer (high-grade dysplasia or invasive carcinoma) were: CT: sensitivity 0.87 (95% CI 0.00 to 1.00), specificity 0.96 (95% CI 0.00 to 1.00); EUS: sensitivity 0.86 (95% CI 0.74 to 0.92), specificity 0.91 (95% CI 0.83 to 0.96); EUS-FNA: sensitivity 0.47 (95% CI 0.24 to 0.70), specificity 0.91 (95% CI 0.32 to 1.00); EUS-FNA carcinoembryonic antigen 200 ng/mL: sensitivity 0.58 (95% CI 0.28 to 0.83), specificity 0.51 (95% CI 0.19 to 0.81); MRI: sensitivity 0.69 (95% CI 0.44 to 0.86), specificity 0.93 (95% CI 0.43 to 1.00); PET: sensitivity 0.90 (95% CI 0.79 to 0.96), specificity 0.94 (95% CI 0.81 to 0.99). The sixth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (low-grade dysplasia) provided no tests in which meta-analysis was performed. The seventh analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) provided two tests in which meta-analysis was performed. The sensitivity and specificity for diagnosing cancer were: CT: sensitivity 0.83 (95% CI 0.68 to 0.92), specificity 0.83 (95% CI 0.64 to 0.93) and MRI: sensitivity 0.80 (95% CI 0.58 to 0.92), specificity 0.81 (95% CI 0.53 to 0.95), respectively. The eighth analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) or benign lesions provided no test in which meta-analysis was performed.There were no major alterations in the subgroup analysis of cystic pancreatic focal lesions (42 studies; 2086 participants). None of the included studies evaluated EUS elastography or sequential testing. AUTHORS' CONCLUSIONS We were unable to arrive at any firm conclusions because of the differences in the way that study authors classified focal pancreatic lesions into cancerous, precancerous, and benign lesions; the inclusion of few studies with wide confidence intervals for each comparison; poor methodological quality in the studies; and heterogeneity in the estimates within comparisons.
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Affiliation(s)
- Lawrence MJ Best
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
| | - Vishal Rawji
- University College London Medical SchoolLondonUK
| | - Stephen P Pereira
- Royal Free Hospital CampusUCL Institute for Liver and Digestive HealthUpper 3rd FloorLondonUKNW3 2PF
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
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Rasmussen I, Sörensen J, Långström B, Haglund U. Is Positron Emission Tomography Using 18F-Fluorodeoxyglucose and 11C-Acetate Valuable in Diagnosing Indeterminate Pancreatic Masses? Scand J Surg 2016; 93:191-7. [PMID: 15544073 DOI: 10.1177/145749690409300304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: It can be impossible to differentiate a mass forming chronic pancreatitis from adenocarcinoma of the pancreas using standard anatomical imaging. Positron emission tomography using 2-[18F] fluoro-2deoxy-D-glucose (18FDG-PET) and 1-[11C]-acetate (11C-acetate-PET) are methods taking advantage of the metabolic differences between benign and malignant tissues. Aims: To determine the diagnostic accuracy of 18FDG-PET and 11C-acetate-PET in indeterminate pancreatic masses. Methods: Twenty patients with an indeterminate mass of the head of the pancreas were prospectively studied. All patients underwent 18FDG-PET and eighteen of them 11C-acetate-PET. Scans were evaluated qualitatively and quantitatively; the later by using regional standardised uptake value (SUV). Final diagnosis was established using histopathologic evaluation of resected specimen or biopsy. Results: Adenocarcinoma was diagnosed in twelve patients and chronic pancreatitis in eight. Qualitative evaluation of 18FDG-PET imaging revealed three false negative and one false-positive results. The sensitivity, specificity, and diagnostic accuracy were 75 %, 88 %, and 80 %, respectively. The cut-off SUV to differentiate malignant from benign disease was 3,5 demonstrating a sensitivity of 91.7 % and a specificity of 75 %. Conclusion: 18FDG-PET imaging could not confirm or exclude malignancy in indeterminate masses of the head of the pancreas with high sensitivity and diagnostic accuracy. 11C-acetate-PET provided no additional diagnostic benefits.
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Affiliation(s)
- I Rasmussen
- Department of Surgery, University Hospital, Uppsala, Sweden.
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Rijkers AP, Valkema R, Duivenvoorden HJ, van Eijck CHJ. Usefulness of F-18-fluorodeoxyglucose positron emission tomography to confirm suspected pancreatic cancer: a meta-analysis. Eur J Surg Oncol 2014; 40:794-804. [PMID: 24755095 DOI: 10.1016/j.ejso.2014.03.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Pancreatic cancer is among the five most lethal malignancies in the world. Unfortunately, many malignant tumors go undetected by the current primary diagnostic tools. (18)FDG-PET and (18)FDG-PET/CT might be useful to confirm suspected pancreatic cancer. METHODS A meta-analysis was performed using all major search engines. Methodological quality of included studies was assessed as well as quality of the PET-protocol. The following pooled estimates served as primary outcome measures: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. RESULTS Thirty-five studies were included. Pooled estimates for (18)FDG-PET were: sensitivity 90%, specificity 76%, PPV 90%, NPV 76% and accuracy 86%. Pooled estimates for (18)FDG-PET/CT were: sensitivity 90%, specificity 76%, PPV 89%, NPV 78% and accuracy 86%. The pooled sensitivity and specificity for (18)FDG-PET to differentiate between pancreatic cancer and chronic pancreatitis were 90% and 84%, respectively. CONCLUSION Both (18)FDG-PET and (18)FDG-PET/CT offer no benefit over the current primary diagnostic tools in diagnosing pancreatic cancer. However, the (18)FDG-PET/CT systems are still improving. We should investigate the sensitivity and specificity of these new systems while reevaluating the tradeoff between false positive and false negative results. Yet, (18)FDG-PET/CT may have a role in the staging of pancreatic cancer, in survival prediction, and may add to other diagnostic information, like histology.
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Affiliation(s)
- A P Rijkers
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - R Valkema
- Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - H J Duivenvoorden
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C H J van Eijck
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Kadhim LA, Dholakia AS, Herman JM, Wahl RL, Chaudhry MA. The role of 18F-fluorodeoxyglucose positron emission tomography in the management of patients with pancreatic adenocarcinoma. JOURNAL OF RADIATION ONCOLOGY 2013; 2:341-352. [PMID: 29423019 PMCID: PMC5800762 DOI: 10.1007/s13566-013-0130-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pancreatic cancer continues to have a grim prognosis with 5-year survival rates at less than 5 %. It is a particularly challenging health problem given these poor survival outcomes, aggressive tumor biology, and late onset of symptoms. Most patients present with advanced unresectable cancer however, margin-negative resection provides a rare chance for cure for patients with resectable disease. The standard imaging modality for the diagnosis and management of pancreatic cancer is contrast-enhanced multidetector computed tomography. Remarkable advances in CT technology have led to improvements in the ability to detect small tumors and intricate vasculature involvement by the tumor, yet CT is still restricted to providing a morphological portrait of the tumor. Diagnosis can be challenging due to similar appearance of certain benign and malignant disease. Distant metastatic disease can be silent on CT leading to improper staging, and thus management, of certain patients. Furthermore, radiation-induced fibrosis and necrosis complicate assessment of treatment response by CT alone. F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is becoming a prevalent tool employed by physicians to improve accuracy in these clinical scenarios. Malignant transformation causes a high metabolic activity of cancer cells. 18F-FDG-PET captures this functional activity of malignancies by capturing areas with high glucose utilization rates. Imaging function rather than morphological appearance, 18F-FDG-PET has a unique role in the management of oncology patients with the ability to detect regions of tumor involvement that may be silent on conventional imaging. Literature on the sensitivity and specificity of 18F-FDG-PET fails to reach a consensus, and improvements resulting in hybridization of 18F-FDG-PET and CT imaging techniques are preliminary. Here we review the potential role of 18F-FDG-PET and PET/CT in improving accuracy in the initial evaluation and subsequent steps in the management of pancreatic cancer patients.
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Affiliation(s)
- Lujaien A Kadhim
- Tawam Molecular Imaging Center, P.O. Box 220323, Al Ain, United Arab Emirates
| | - Avani S Dholakia
- Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA
| | - Joseph M Herman
- Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA
| | - Richard L Wahl
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD 21287-0817, USA
| | - Muhammad A Chaudhry
- Tawam Molecular Imaging Center, P.O. Box 220323, Al Ain, United Arab Emirates
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Limited efficacy of (18)F-FDG PET/CT for differentiation between metastasis-free pancreatic cancer and mass-forming pancreatitis. Clin Nucl Med 2013; 38:417-21. [PMID: 23486318 DOI: 10.1097/rlu.0b013e3182817d9d] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Differentiation between metastasis-free pancreatic cancer and mass-forming pancreatitis is important to avoid unnecessary operative procedures. This study was aimed at evaluating the efficacy of PET/CT with F-FDG (FDG PET/CT) for the differential diagnosis between them. PATIENTS AND METHODS FDG-PET/CT was performed in 47 study patients with pancreatic masses and without any detectable metastases, 33 of which cases were finally diagnosed as pancreatic cancer and the other 14 as pancreatitis, and the corresponding imaging data were evaluated retrospectively. The maximal SUV (SUVmax) within the masses were determined at 1 hour and mostly at 2 hours after intravenous injection of FDG. RESULTS SUVmax at 1 hour in pancreatic cancer was significantly higher than that in mass-forming pancreatitis, and the change in SUVmax from 1- to 2-hour time points was more consistent with pancreatic cancer than with mass-forming pancreatitis. However, there remained considerable overlapping between the SUVmax values of both diseases except either at the higher range for pancreatic cancer (> 7.7 at 1 hour or > 9.98 at 2 hours) or at the lower range for mass-forming pancreatitis (<3.37 at 1 hour or <3.53 at 2 hours). No obvious difference was found in the FDG uptake patterns of the mass areas between both diseases. CONCLUSIONS Differentiation between metastasis-free pancreatic cancer and mass-forming pancreatitis is difficult by FDG-PET/CT due to considerable overlapping between the SUVmax values of the two diseases, although the differential diagnosis may be possible either at the higher range of SUVmax (> 7.7 at 1 hour or > 9.98 at 2 hours) for pancreatic cancer or at the lower range of SUVmax (<3.37 at 1 hour or <3.53 at 2 hours) for mass-forming pancreatitis.
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Wang YJ, Wu SJ, Guo KY, Chen C, Xie Q, Gu WW, Cai L, Zou F. ¹⁸F-FDG uptake by spleen helps rapidly predict the dose level after total body irradiation in a Tibetan minipig model. Eur Radiol 2012; 22:1844-51. [PMID: 22549103 DOI: 10.1007/s00330-012-2451-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/14/2012] [Accepted: 03/19/2012] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To investigate whether (18)F- FDG uptake can be applied in dosimetry to facilitate the rapid and accurate evaluation of individual radiation doses after a nuclear accident. METHODS Forty-eight Tibetan minipigs were randomised into a control group (n = 3) and treatment groups (n = 45). (18)F-FDG combined positron-emission tomography and computed tomography (PET/CT) were carried out before total body irradiation (TBI) and at 6, 24 and 72 h after receiving TBI doses ranging from 1 to 11 Gy. Spleen tissues and blood samples were also collected for histological examination, apoptosis and blood analysis. RESULTS Mean standardised uptake values (SUVs) of the spleen showed significant differences between the experimental and the control groups. Spleen SUV at 6 h post-irradiation showed significant correlation with radiation dose; Spearman's correlation coefficient was 0.97 (P < 0.01). Histological observations showed that damage to the splenic lymphocyte became more severe with an increase in the radiation dose. Moreover, apoptosis was one of the major routes of splenic lymphocyte death, which was also confirmed by flow cytometry analysis. CONCLUSIONS In the Tibetan minipig model, radiation doses have a close relationship with the (18)F-FDG uptake of the spleen. This finding suggests that (18)F-FDG PET/CT may be useful for the rapid detection of individual radiation doses.
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Affiliation(s)
- Yu Jue Wang
- Department of Laboratory Animal Center, Southern Medical University, 1838 Guangzhou North Road, 510515, Guangzhou, Guangdong, China
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Clinical applications of 18F-FDG PET in the management of hepatobiliary and pancreatic tumors. ACTA ACUST UNITED AC 2012; 37:983-1003. [DOI: 10.1007/s00261-012-9845-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Smyth EC, Shah MA. Role of ( 18F) 2-fluoro-2-deoxyglucose positron emission tomography in upper gastrointestinal malignancies. World J Gastroenterol 2011; 17:5059-74. [PMID: 22171140 PMCID: PMC3235589 DOI: 10.3748/wjg.v17.i46.5059] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 06/09/2011] [Accepted: 06/16/2011] [Indexed: 02/06/2023] Open
Abstract
The role of whole-body FDG [(18F) 2-fluoro-2-deoxyglucose] positron emission tomography (PET) scanning as an imaging modality in the management of patients with malignancy has evolved enormously over the past two decades. FDG-PET has demonstrated significant efficacy in the staging, prognostication and detection of occult metastatic disease in malignancies of the gastrointestinal tract, in addition to assessment of the response to cytotoxic chemotherapy in a more timely manner than has traditionally been possible by more conventional imaging tools. The sensitivity and specificity of FDG-PET for the detection and staging of malignancy depend not only on the site and size of the primary tumor and metastases, but also on histological cell type, reflecting underlying disparities in glucose metabolism. The metabolic response to neo-adjuvant chemotherapy or to chemo-radiotherapy in cancers of the gastro-esophageal junction or stomach has been demonstrated in several prospective studies to correlate significantly with both the histological tumor response to treatment and with consequent improvements in overall survival. This may offer a future paradigm of personalized treatment based on the PET response to chemotherapy. FDG-PET has been less successful in efforts to screen for and detect recurrent upper gastrointestinal malignancies, and in the detection of low volume metastatic peritoneal disease. Efforts to improve the accuracy of PET include the use of novel radiotracers such as (18F) FLT (3-deoxy-3-fluorothymidine) or 11C-choline, or fusion PET-CT with concurrent high-resolution computed tomography. This review focuses on the role of FDG-PET scanning in staging and response assessment in malignancies of the upper gastrointestinal tract, specifically gastric, esophageal and pancreas carcinoma.
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Topkan E, Parlak C, Kotek A, Yapar AF, Pehlivan B. Predictive value of metabolic 18FDG-PET response on outcomes in patients with locally advanced pancreatic carcinoma treated with definitive concurrent chemoradiotherapy. BMC Gastroenterol 2011; 11:123. [PMID: 22074002 PMCID: PMC3224773 DOI: 10.1186/1471-230x-11-123] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/10/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We aimed to study the predictive value of combined 18F-fluoro-deoxy-D-glucose positron emission tomography and computerized tomography (FDG-PET-CT), on outcomes in locally advanced pancreatic carcinoma (LAPC) patients treated with concurrent chemoradiotherapy (C-CRT). METHODS Thirty-two unresectable LAPC patients received 50.4 Gy (1.8 Gy/fr) of RT and concurrent 5-FU followed by 4 to 6 cycles of gemcitabine consolidation. Response was evaluated by FDG-PET-CT at post-C-CRT 12-week. Patients were stratified into two groups according to the median difference between pre- and post-treatment maximum standard uptake values (SUVmax) as an indicator of response for comparative analysis. RESULTS At a median follow-up of 16.1 months, 16 (50.0%) patients experienced local/regional failures, 6 of which were detected on the first follow-up FDG-PET-CT. There were no marginal or isolated regional failures. Median pre- and post-treatment SUVmax and median difference were 14.5, 3.9, and -63.7%, respectively. Median overall survival (OS), progression-free survival (PFS), and local-regional progression-free survival (LRPFS) were 14.5, 7.3, and 10.3 months, respectively. Median OS, PFS, and LRPFS for those with greater (N = 16) versus lesser (N = 16) SUVmax change were 17.0 versus 9.8 (p = 0.001), 8.4 versus 3.8 (p = 0.005), and 12.3 versus 6.9 months (p = 0.02), respectively. On multivariate analysis, SUVmax difference was predictive of OS, PFS, and LRPFS, independent of existing covariates. CONCLUSIONS Significantly higher OS, PFS, and LRPFS in patients with greater SUVmax difference suggest that FDG-PET-CT-based metabolic response assessment is an independent predictor of clinical outcomes in LAPC patients treated with definitive C-CRT.
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Affiliation(s)
- Erkan Topkan
- Baskent University Adana Medical Faculty, Department of Radiation Oncology, Adana, Turkey
| | - Cem Parlak
- Baskent University Adana Medical Faculty, Department of Radiation Oncology, Adana, Turkey
| | - Ayşe Kotek
- Baskent University Adana Medical Faculty, Department of Radiation Oncology, Adana, Turkey
| | - Ali Fuat Yapar
- Baskent University Adana Medical Faculty, Department of Nuclear Medicine, Adana, Turkey
| | - Berrin Pehlivan
- Akdeniz University Medical Faculty, Department of Radiation Oncology, Antalya, Turkey
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Abstract
Morphology-based imaging modalities have replaced classical conventional nuclear medicine modalities for detection of liver or pancreatic lesions. With positron emission tomography and the glucose analog F-18 fluorodeoxyglucose (FDG), a sensitive and specific modality for the detection of hepatic metastases and extrahepatic tumor deposits from hepatocellular or pancreatic cancer is available. F-18 FDG PET can increase the accuracy of staging primary tumors of the liver or the pancreas, and can be used for response monitoring. Radiopharmaceuticals such as Ga-68 DOTATOC and F-18 DOPA allow the specific detection of neuroendocrine pancreatic tumors and their metastatic deposits. Hybrid scanners such as PET-CT integrate morphologic and metabolic information, and allow to increase the sensitivity and specificity of noninvasive imaging in many tumor entities. The development of specific radiopharmaceuticals and technical innovations such as SPECT-CT has increased the reliability of conventional scintigraphic imaging. This chapter focuses on the use of PET-CT in hepatobiliary and pancreatic cancers.
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Affiliation(s)
- Andreas K Buck
- Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, München, Germany.
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15
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Abstract
The strength of functional imaging lies in its ability to detect malignant disease irrespective of lesion morphology. In this setting, 18FDG-PET can complement management by providing a more accurate diagnosis. When combined as an adjunct to CT, 18FDG-PET can increase the sensitivity, specificity, and accuracy for detecting a pancreatic malignancy, especially in patients in whom CT alone fails to identify a discrete mass or in whom biopsy results are indeterminate. This capability is accentuated with small lesions of the pancreas. 18FDG-PET is significantly more sensitive in detecting metastatic disease than conventional CT imaging. Moreover, 18FDG-PET is able to differentiate tumor response to therapy in the postoperative setting, and could potentially serve to monitor recurrence patterns in the setting of neoadjuvant or adjuvant chemoradiotherapy. Finally, as 18FDG-PET/CT fusion modalities become more widespread and technical advances in image acquisition progress, 18FDG-PET will continue to have an increasing role in the diagnosis, staging, and surveillance of pancreatic cancer, integrating anatomic information with functional imaging.
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Affiliation(s)
- Oscar K Serrano
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, 733 North Broadway, Baltimore, MD 21205, USA
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16
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Matsushita T, Kusakabe Y, Fujii H, Murase K, Yamazaki Y, Murase K. Inflammatory imaging with ultrasmall superparamagnetic iron oxide. Magn Reson Imaging 2010; 29:173-8. [PMID: 20850245 DOI: 10.1016/j.mri.2010.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 07/10/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to investigate the usefulness and feasibility of magnetic resonance imaging (MRI) with ultrasmall superparamagnetic iron oxide (USPIO) (USPIO-enhanced MRI) for imaging inflammatory tissues. First, we investigated the relationship between the apparent transverse relaxation rate (R2*) and the concentration of USPIO by phantom studies and measured the apparent transverse relaxivity (r2*) of USPIO. Second, we performed animal experiments using a total of 30 mice. The mice were divided into five groups [A (n=6), B (n=6), C (n=6), sham control (n=6), and control (n=6)]. The mice in Groups A, B, C and control were subcutaneously injected with 0.1 ml of turpentine oil on Day 0, while those in the sham control group were subcutaneously injected with 0.1 ml of saline. The mice in Groups A, B, C and sham control were intraperitoneally injected with 200 μmol Fe per kilogram body weight of USPIO (28 nm in diameter) immediately after the first MRI study on Days 3, 5, 7 and 7, respectively, and those in the control group were not injected with USPIO. The second and third MRI studies were performed at 24 and 48 h after USPIO administration, respectively. The maps of R2* were generated from the apparent transverse relaxation time (T2*)-weighted images with six different echo times. The phantom studies showed that there was a linear relationship between R2* and the concentration of USPIO (r=0.99) and the r2* value of USPIO was 105.7 mM(-1) s(-1). There was a significant increase of R2* in inflammatory tissues in Group C at 24 h after USPIO administration compared with the precontrast R2* value. Our results suggest that USPIO-enhanced MRI combined with R2* measurement is useful for detecting inflammatory tissues.
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Affiliation(s)
- Taro Matsushita
- Department of Medical Physics and Engineering, Division of Medical Technology and Science, Faculty of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
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17
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Hurtuk MG, Shoup M, Oshima K, Yong S, Aranha GV. Pancreaticoduodenectomies in patients without periampullary neoplasms: lesions that masquerade as cancer. Am J Surg 2010; 199:372-6; discussion 376. [DOI: 10.1016/j.amjsurg.2009.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/08/2009] [Accepted: 09/09/2009] [Indexed: 12/24/2022]
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18
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Tang S, Huang G, Liu J, Liu T, Treven L, Song S, Zhang C, Pan L, Zhang T. Usefulness of 18F-FDG PET, combined FDG-PET/CT and EUS in diagnosing primary pancreatic carcinoma: a meta-analysis. Eur J Radiol 2009; 78:142-50. [PMID: 19854016 DOI: 10.1016/j.ejrad.2009.09.026] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 09/23/2009] [Indexed: 12/13/2022]
Abstract
UNLABELLED The aim was to evaluate the diagnostic value of (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG PET), combined (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography ((18)F-FDG PET/CT) and endoscopic ultrasonography (EUS) in diagnosing patients with pancreatic carcinoma. MEDLINE, EMBASE, Cochrane library and some other databases, from January 1966 to April 2009, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of (18)F-FDG PET, PET/CT and EUS for patients with pancreatic cancer were collected. Methodological quality was assessed. The statistic software called "Meta-Disc 1.4" was used for data analysis. RESULTS 51 studies were included in this meta-analysis. The pooled sensitivity estimate for combined PET/CT (90.1%) was significantly higher than PET (88.4%) and EUS (81.2%). The pooled specificity estimate for EUS (93.2%) was significantly higher than PET (83.1%) and PET/CT (80.1%). The pooled DOR estimate for EUS (49.774) was significantly higher than PET (32.778) and PET/CT (27.105). SROC curves for PET/CT and EUS showed a little better diagnostic accuracy than PET alone. For PET alone, when interpreted the results with knowledge of other imaging tests, its sensitivity (89.4%) and specificity (80.1%) were closer to PET/CT. For EUS, its diagnostic value decreased in differentiating pancreatic cancer for patients with chronic pancreatitis. In conclusion, PET/CT was a high sensitive and EUS was a high specific modality in diagnosing patients with pancreatic cancer. PET/CT and EUS could play different roles during different conditions in diagnosing pancreatic carcinoma.
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Affiliation(s)
- Shuang Tang
- Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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19
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Matsubayashi H, Furukawa H, Maeda A, Matsunaga K, Kanemoto H, Uesaka K, Fukutomi A, Ono H. Usefulness of positron emission tomography in the evaluation of distribution and activity of systemic lesions associated with autoimmune pancreatitis. Pancreatology 2009; 9:694-9. [PMID: 19684434 DOI: 10.1159/000199439] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 01/23/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Autoimmune pancreatitis (AIP) is an IgG4-related systemic disease often accompanied with a variety of lesions outside of the pancreas and is treated with steroid therapy. The aim of this study is to analyze the usefulness of positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) in the evaluation of distribution and activity of systemic lesions of AIP during steroid therapy. METHODS Eleven cases of AIP had their FDG-PET images evaluated before and 3 months after steroid therapy and another 2 cases only before therapy. AIP activity was determined by the level of serum markers, IgG and IgG4, and compared with findings of PET. RESULTS In all 13 cases of AIP, a moderate to intense level of FDG accumulation was recognized in the pancreatic lesion before steroid therapy. Of 13 patients, 11 (84.6%) showed FDG accumulation in the multiple organs, such as mediastinal and other lymph nodes, salivary gland, biliary tract, prostate, and aortic wall. In 11 patients who underwent PET before and after steroid therapy, FDG accumulation was diminished in almost all systemic lesions, with a mean of maximum standardized uptake value (SUV(max)) in the pancreatic lesion from 5.12 to 2.69. Similar to the SUV level, serum IgG and IgG4 were decreased in most of the cases after steroid therapy. CONCLUSIONS FDG-PET is an effective modality to evaluate the response of steroid therapy and the distribution and activity of various systemic lesions of AIP.
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20
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Nishi M, Ikegami T, Imura S, Morine Y, Kanemura H, Mori H, Arakawa Y, Hanaoka J, Sugimoto K, Shimada M. Mass-forming pancreatitis with positive fluoro-2-deoxy-D: -glucose positron emission tomography and positive diffusion-weighted imaging-magnetic resonance imaging: Report of a case. Surg Today 2009; 39:157-61. [PMID: 19198997 DOI: 10.1007/s00595-008-3813-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 02/01/2008] [Indexed: 12/27/2022]
Abstract
It is difficult to make an accurate radiological diagnosis of a pancreatic tumor because of its location and anatomical characteristics. Mass-forming pancreatitis and pancreatic cancer are particularly difficult to differentiate. New diagnostic technology, which includes diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI) and 2-[(18)F]-fluoro-2-deoxy-Dglucose positron emission tomography (FDG-PET), offers hope for the detection of classical pancreatic cancer. Few studies have been conducted on FDG-PET and DWI-MRI as tools used to distinguish between mass-forming pancreatitis and pancreatic cancers. Furthermore, positive findings of mass-forming pancreatitis on DWI-MRI and FDG-PET have yet to be documented. We report a case of a pancreatic head tumor, present on FDG-PET and DWI-MRI which, on closer examination, revealed benign mass-forming pancreatitis. We discuss the utility of FDG-PET and DWI-MRI as preoperative diagnostic tools.
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Affiliation(s)
- Masaaki Nishi
- Department of Surgery, Institute of Health Biosciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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21
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Seo S, Doi R, Machimoto T, Kami K, Masui T, Hatano E, Ogawa K, Higashi T, Uemoto S. Contribution of 18F-fluorodeoxyglucose positron emission tomography to the diagnosis of early pancreatic carcinoma. ACTA ACUST UNITED AC 2008; 15:634-9. [DOI: 10.1007/s00534-007-1339-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 12/28/2007] [Indexed: 01/27/2023]
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22
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Topkan E, Yavuz AA, Aydin M, Onal C, Yapar F, Yavuz MN. Comparison of CT and PET-CT based planning of radiation therapy in locally advanced pancreatic carcinoma. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2008; 27:41. [PMID: 18808725 PMCID: PMC2562364 DOI: 10.1186/1756-9966-27-41] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 09/23/2008] [Indexed: 01/08/2023]
Abstract
BACKGROUND To compare computed tomography (CT) with co-registered positron emission tomography-computed tomography (PET-CT) as the basis for delineating gross tumor volume (GTV) in unresectable, locally advanced pancreatic carcinoma (LAPC). METHODS Fourteen patients with unresectable LAPC had both CT and PET images acquired. For each patient, two three-dimensional conformal plans were made using the CT and PET-CT fusion data sets. We analyzed differences in treatment plans and doses of radiation to primary tumors and critical organs. RESULTS Changes in GTV delineation were necessary in 5 patients based on PET-CT information. In these patients, the average increase in GTV was 29.7%, due to the incorporation of additional lymph node metastases and extension of the primary tumor beyond that defined by CT. For all patients, the GTVCT versus GTVPET-CT was 92.5 +/- 32.3 cm3 versus 104.5 +/- 32.6 cm3 (p = 0.009). Toxicity analysis revealed no clinically significant differences between two plans with regard to doses to critical organs. CONCLUSION Co-registration of PET and CT information in unresectable LAPC may improve the delineation of GTV and theoretically reduce the likelihood of geographic misses.
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Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Baskent University Medical Faculty, Adana Medical and Research Center, Kisla Saglik Yerleskesi, Adana, Turkey.
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23
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Preoperative evaluation of pancreatic adenocarcinoma. ACTA ACUST UNITED AC 2008; 15:429-35. [PMID: 18670846 DOI: 10.1007/s00534-007-1240-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 04/11/2007] [Indexed: 12/22/2022]
Abstract
The preoperative evaluation of resectability for pancreatic cancer fails to identify up to 25% of patients who are unfortunately found to be unresectable at surgical exploration. Inoperative findings in this circumstance is usually due to either small volume metastatic disease or regional tumor invasion. While advances in computed tomography (CT) technology has increased accuracy of local tumor extent, occult metastatic disease remains a common problem. Although 2-[(18)F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has been demonstrated to be useful in the staging of many malignancies (e.g. esophageal cancer, recurrent colorectal cancer, lung cancer), it has not been found to significantly increase the accuracy of determining resectability preoperatively in pancreatic cancer, especially with regard to detection of small volume metastatic disease. There are a variety of pancreatic cancer-specific antigens which are being developed as a method for targeted molecular imaging; we provide preliminary data targeting the integrin alpha(v)beta(6) to demonstrate the potential feasibility of this approach. Further developments may allow the accurate determination of patients with resectable pancreatic cancer, and more importantly, those with unresectable disease that may forego unnecessary surgery, the associated morbidity, and the subsequent delay of appropriate therapy.
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24
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Intraductal papillary mucinous neoplasms of the pancreas: clinicopathologic characteristics and long-term follow-up after resection. World J Surg 2008; 32:271-8; discussion 279-80. [PMID: 18027021 DOI: 10.1007/s00268-007-9281-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Resection is recommended for main duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas because of the high risk of malignancy, but the indications for resection of branch duct and mixed-type IPMNs remain controversial. Our objective was to determine the appropriate management of IPMNs based on clinicopathologic characteristics and survival data obtained after resection. METHODS A total of 72 consecutive IPMN patients who underwent resection between January 1984 and June 2006 were reviewed. The lesions were classified as main duct, branch duct, or mixed-type IPMNs and histologically graded as noninvasive (adenoma, borderline neoplasm, carcinoma in situ) or invasive. RESULTS Main duct IPMNs (n=15) were associated with a significantly worse prognosis than other subtypes. For branch duct (n=49) and mixed-type IPMNs (n=8), the diameter of the cystic lesions was an independent predictor of malignancy by multivariate analysis. However, four patients with cysts<30 mm in diameter and no mural nodules had a malignancy. No patient with noninvasive IPMN died of this disease, showing excellent survival, whereas the 5-year survival rate of patients with invasive IPMNs was only 57.6% and was significantly worse than that of patients with noninvasive IPMNs (p=0.0002). CONCLUSIONS Resection of all main duct IPMNs seems to be reasonable. Invasive IPMNs were associated with significantly worse survival than noninvasive IPMNs. Although the diameter of cystic lesions was a predictor of malignancy for branch duct and mixed-type IPMNs, precise preoperative identification of malignancy was difficult. Therefore, these lesions should be managed by aggressive resection before invasion occurs to improve survival.
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25
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Ozaki Y, Oguchi K, Hamano H, Arakura N, Muraki T, Kiyosawa K, Momose M, Kadoya M, Miyata K, Aizawa T, Kawa S. Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography. J Gastroenterol 2008; 43:144-51. [PMID: 18306988 DOI: 10.1007/s00535-007-2132-y] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 10/11/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer. Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancreatic cancer, we attempted to clarify the differences in FDG-PET findings between the two conditions. METHODS We compared FDG-PET findings between 15 patients with autoimmune pancreatitis and 26 patients with pancreatic cancer. The findings were evaluated visually or semiquantitatively using the maximum standardized uptake value and the accumulation pattern of FDG. RESULTS FDG uptake was found in all 15 patients with autoimmune pancreatitis, whereas it was found in 19 of 26 patients (73.1%) with pancreatic cancer. An accumulation pattern characterized by nodular shapes was significantly more frequent in pancreatic cancer, whereas a longitudinal shape indicated autoimmune pancreatitis. Heterogeneous accumulation was found in almost all cases of autoimmune pancreatitis, whereas homogeneous accumulation was found in pancreatic cancer. Significantly more cases of pancreatic cancer showed solitary localization, whereas multiple localization in the pancreas favored the presence of autoimmune pancreatitis. FDG uptake by the hilar lymph node was significantly more frequent in autoimmune pancreatitis than in pancreatic cancer, and uptake by the lachrymal gland, salivary gland, biliary duct, retroperitoneal space, and prostate were seen only in autoimmune pancreatitis. CONCLUSIONS FDG-PET is a useful tool for differentiating autoimmune pancreatitis from suspected pancreatic cancer, if the accumulation pattern and extrapancreatic involvement are considered. IgG4 measurement and other current image tests can further confirm the diagnosis.
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Affiliation(s)
- Yayoi Ozaki
- Department of Medicine, Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
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26
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Toshikuni N, Kai K, Fujisawa M. Nonfunctioning endocrine pancreatic tumor examined with 18F-FDG PET/CT. Ann Nucl Med 2008; 22:133-7. [PMID: 18311538 DOI: 10.1007/s12149-007-0085-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 09/28/2007] [Indexed: 01/28/2023]
Abstract
A 71-year-old woman with type 2 diabetes mellitus complained of generalized fatigue. A 36-mm tumor in the pancreatic tail was detected with ultrasonography. The tumor was found to have marked hypervascularity with contrast-enhanced computed tomography (CT) and magnetic resonance. Combined (18)F-fluorodeoxyglucose positron emission tomography and CT ((18)F-FDG PET/CT) showed (18)F-FDG by the tumor with a maximal standardized uptake value of 2.98 at 50 min and 3.29 at 100 min following injection of (18)F-FDG. (18)F-FDG PET/CT suggested no extrapancreatic spread of the tumor. The patient had no pancreatic hormone-associated symptoms. Distal pancreatectomy was performed, and a well-differentiated endocrine tumor was diagnosed. The resected specimen showed neither infiltration of adjacent structures nor metastasis to regional lymph nodes. The present case suggests that (18)F-FDG PET/CT is a reliable modality for staging endocrine pancreatic tumors.
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Affiliation(s)
- Nobuyuki Toshikuni
- Department of Internal Medicine, Himeji Red Cross Hospital, Hyogo, Japan,
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27
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Wakabayashi H, Nishiyama Y, Otani T, Sano T, Yachida S, Okano K, Izuishi K, Suzuki Y. Role of 18F-fluorodeoxyglucose positron emission tomography imaging in surgery for pancreatic cancer. World J Gastroenterol 2008; 14:64-9. [PMID: 18176963 PMCID: PMC2673393 DOI: 10.3748/wjg.14.64] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the role of positron emission tomo-graphy using 18F-fluorodeoxyglucose (FDG-PET) in the surgical management of patients with pancreatic cancer, including the diagnosis, staging, and selection of patients for the subsequent surgical treatment.
METHODS: This study involved 53 patients with proven primary pancreatic cancer. The sensitivity of diagnosing the primary cancer was examined for FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of carcinoembrionic antigens (CEA) and carbohydrate antigen 19-9 (CA19-9). Next, the accuracy of staging was compared between FDG-PET and CT. Finally, FDG-PET was analyzed semiquantitatively using the standard uptake value (SUV). The impact of the SUV on patient management was evaluated by examining the correlations between the SUV and the histological findings of cancer.
RESULTS: The sensitivity of FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of CEA and CA19-9 were 92.5%, 88.7%, 46.4%, 37.7% and 69.8%, respectively. In staging, FDG-PET was superior to CT only in diagnosing distant disease (bone metastasis). For local staging, the sensitivity of CT was better than that of FDG-PET. The SUV did not correlate with the pTNM stage, grades, invasions to the vessels and nerve, or with the size of the tumor. However, there was a statistically significant difference (4.6 ± 2.9 vs 7.8 ± 4.5, P = 0.024) in the SUV between patients with respectable and unresectable disease.
CONCLUSION: FDG-PET is thus considered to be useful in the diagnosis of pancreatic cancer. However, regarding the staging of the disease, FDG-PET is not considered to be a sufficiently accurate diagnostic modality. Although the SUV does not correlate with the patho-histological prognostic factors, it may be useful in selecting patients who should undergo subsequent surgical treatment.
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28
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Amthauer H, Ruf J. Nuclear medical methods for the diagnosis of pancreatic cancer: positron emission tomography. Recent Results Cancer Res 2008; 177:15-26. [PMID: 18084943 DOI: 10.1007/978-3-540-71279-4_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The functional imaging approach of nuclear medicine offers important information for the characterization of a tumor's pathobiology. In oncology, positron emission tomography (PET) especially has had great impact on the staging of tumor patients and the assessment of therapy. Both the development of new, tumor-specific, tracers and the introduction of by software- and hardware-driven image fusion emphasize the potential of this modality for an all-embracing diagnostic modality.
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Affiliation(s)
- H Amthauer
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Strahlenheilkunde, Germany
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29
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Pakzad F, Groves AM, Ell PJ. The role of positron emission tomography in the management of pancreatic cancer. Semin Nucl Med 2007; 36:248-56. [PMID: 16762614 DOI: 10.1053/j.semnuclmed.2006.03.005] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The role of positron emission tomography (PET) and PET/computed tomography (CT) in the assessment of a patient presenting with cancer of the pancreas is discussed in the overall context of the management of this condition. The clinical limitations persist, with many patients presenting late with unresectable disease and poor prospects for novel drug therapies. PET and PET/CT are best at diagnosing and staging but are relatively inefficient in the detection of nodal disease. The detection of late disease manifestations such as metastatic spread is often of little clinical consequence. PET/CT may be considered as a first-line imaging investigation but evidence for this approach needs to accrue. Overall detection sensitivity at diagnosis varies between 90% and 95% and specificity from 82% to 100%, whereas for staging, sensitivity data vary from 61% to 100% and specificity data from 67% to 100%.
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Affiliation(s)
- Farrokh Pakzad
- The Institute of Nuclear Medicine, University College London Hospital NHS Trust, UK
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Bang S, Chung HW, Park SW, Chung JB, Yun M, Lee JD, Song SY. The clinical usefulness of 18-fluorodeoxyglucose positron emission tomography in the differential diagnosis, staging, and response evaluation after concurrent chemoradiotherapy for pancreatic cancer. J Clin Gastroenterol 2006; 40:923-9. [PMID: 17063113 DOI: 10.1097/01.mcg.0000225672.68852.05] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
GOALS The aims of this study were to determine the clinical use of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) in the differential diagnosis of patients with suspected pancreatic cancer and in the determination of tumor response after concurrent chemoradiotherapy for pancreatic cancer. BACKGROUND Despite advances in diagnostic tools for pancreatic cancer, it is difficult to differentiate pancreatic cancer from mass-forming pancreatitis. Even with current imaging modalities, it is also difficult to assess tumor response to therapeutic intervention. STUDY One hundred two patients with suspected pancreatic cancer were selected for this study. Dynamic computerized tomography (CT) scan and FDG-PET were used sequentially to diagnose pancreatic cancer. After diagnostic confirmation their diagnostic yields were compared. We also evaluated the treatment response in 15 patients who underwent chemoradiation therapy with dynamic CT scan and FDG-PET and compared their results. RESULTS In 93 out of 102 patients, pancreatic cancer was confirmed. FDG-PET showed higher diagnostic accuracy than CT scan (95.1% vs. 76.5%). FDG-PET was also superior to CT in the detection of liver metastasis. FDG-PET detected treatment response in 5 out of 15 cases after chemoradiation therapy, whereas CT could not detect any treatment response. Comparing responder and nonresponder, FDG-PET was able to predict significantly different prognosis (399 vs. 233 d, P<0.05). CONCLUSIONS FDG-PET is a very useful tool in diagnosing pancreatic cancer. FDG-PET may be also used as an adjunct for determining the treatment modality of pancreatic cancer and evaluating tumor response to chemoradiation therapy.
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MESH Headings
- Aged
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/blood
- CA-19-9 Antigen/blood
- Carcinoma, Pancreatic Ductal/diagnostic imaging
- Carcinoma, Pancreatic Ductal/drug therapy
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/radiotherapy
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Diagnosis, Differential
- Diagnostic Errors
- Female
- Fluorodeoxyglucose F18
- Follow-Up Studies
- Humans
- Korea
- Male
- Middle Aged
- Neoplasm Staging
- Pancreatic Neoplasms/diagnostic imaging
- Pancreatic Neoplasms/drug therapy
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/radiotherapy
- Pancreatitis, Chronic/diagnostic imaging
- Pancreatitis, Chronic/pathology
- Positron-Emission Tomography
- Radiopharmaceuticals
- Radiotherapy, Adjuvant
- Sensitivity and Specificity
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Seungmin Bang
- Department of Internal Medicine, Division of Gastroenterology, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Nishiyama Y, Yamamoto Y, Monden T, Sasakawa Y, Tsutsui K, Wakabayashi H, Ohkawa M. Evaluation of delayed additional FDG PET imaging in patients with pancreatic tumour. Nucl Med Commun 2006; 26:895-901. [PMID: 16160649 DOI: 10.1097/00006231-200510000-00008] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To evaluate whether delayed fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging is more helpful in differentiating between malignant and benign lesions and whether delayed FDG PET imaging can identify more lesions in patients in whom pancreatic cancer is suspected. METHODS The study evaluated 86 patients who were suspected of having pancreatic tumours. FDG PET imaging (whole body) was performed at 1 h (early) post-injection and repeated 2 h (delayed) after injection only in the abdominal region. Qualitative and semi-quantitative evaluation was performed. The semi-quantitative analysis was performed using the standardized uptake value (SUV), obtained from early and delayed images (SUVearly and SUVdelayed, respectively). Retention index (RI) was calculated according to the equation: (SUVdelayed-SUVearly)x100/SUVearly. RESULTS The final diagnosis was pancreatic cancer in 55 and benign disease in 31 patients. On visual and semi-quantitative analysis, the diagnostic accuracy of RI was the highest (88%). The differences between the SUVearly, SUVdelayed and RI value in both pancreatic cancer and benign disease were significant (P<0.01). The mean value of SUVdelayed was significantly higher than that of SUVearly (P<0.01) in pancreatic cancer. Furthermore, new foci of metastasis were seen in the liver in two patients and in the lymph node in one patient only on delayed images. CONCLUSIONS The RI values obtained using early and delayed FDG PET may help in evaluating pancreatic cancer. Furthermore, addition of delayed FDG PET imaging is helpful to identify more lesions in patients with pancreatic cancer.
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van Kouwen MCA, Laverman P, van Krieken JH, Oyen WJG, Jansen JBMJ, Drenth JPH. FDG-PET in the detection of early pancreatic cancer in a BOP hamster model. Nucl Med Biol 2005; 32:445-50. [PMID: 15982574 DOI: 10.1016/j.nucmedbio.2005.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Revised: 03/01/2005] [Accepted: 03/03/2005] [Indexed: 12/30/2022]
Abstract
BACKGROUND The prognosis of pancreatic cancer (PC) is highly dependent on the stage of the disease, and early recognition improves survival. Positron emission tomography (PET) using (18)F-fluoro-2-deoxyglucose ([(18)F]FDG) has been established as an important clinical tool for PC diagnosis, but it is not known whether FDG-PET detects premalignant stages of PC. We speculate that [(18)F]FDG uptake precedes the onset of PC in a hamster model. We used the N-nitrosobis(2-oxopropyl)amine (BOP) model, as these animals consistently develop PC within 20 weeks after first injection. METHODS Male Syrian hamsters were injected once a week with 10 mg BOP/kg body weight for 10 consecutive weeks. Terminal autopsy took place in groups of five hamsters from 4 weeks until 28 weeks after first BOP injection. After an 8-h fast, hamsters were injected with [(18)F]FDG and sacrificed 1 h after [(18)F]FDG injection. The pancreata were histopathologically examined, and the [(18)F]FDG uptake was determined and expressed as percentage of the injected dose per gram tissue (%ID/g). RESULTS Seven of 55 hamsters developed macroscopic signs of tumor. Histopathological examination revealed PC in 13 hamsters. [(18)F]FDG uptake increased gradually with time and was significantly higher in the group with PC compared to the group without PC. CONCLUSION [(18)F]FDG accumulates preferentially in PC, and pancreata exposed to BOP showed a gradual increase in [(18)F]FDG accumulation.
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Kanno A, Satoh K, Kimura K, Masamune A, Asakura T, Unno M, Matsuno S, Moriya T, Shimosegawa T. Autoimmune pancreatitis with hepatic inflammatory pseudotumor. Pancreas 2005; 31:420-3. [PMID: 16258381 DOI: 10.1097/01.mpa.0000179732.46210.da] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We report a case of autoimmune pancreatitis (AIP) with hepatic inflammatory pseudotumor (IP). The patient was clinically diagnosed as having multiple metastatic tumors originated from cholangiocellular carcinoma as well as autoimmune pancreatitis and underwent left lobectomy of the liver. Histological examination showed a diffuse or dense lymphoplasmacytic infiltration with obliterating phlebitis but an absence of neoplastic proliferation both in the liver tumor and in the biopsy specimen of the pancreas. Abundant IgG4-positive plasma cells were seen in the lesions. This is the first case report that shows a simultaneous occurrence of hepatic IP and AIP, suggesting that these lesions appeared on the background of the recently proposed entity of IgG4-related systemic disease.
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Affiliation(s)
- Atsushi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Bipat S, Phoa SSKS, van Delden OM, Bossuyt PMM, Gouma DJ, Laméris JS, Stoker J. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis. J Comput Assist Tomogr 2005; 29:438-45. [PMID: 16012297 DOI: 10.1097/01.rct.0000164513.23407.b3] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis and determination of resectability of pancreatic adenocarcinoma. METHODS Articles reporting US, CT, or MRI data of patients with known or suspected pancreatic adenocarcinoma and at least 20 patients verified with histopathology, surgical findings, or follow-up were included. A bivariate random effects approach was used to calculate sensitivity and specificity for diagnosis and resectability of pancreatic adenocarcinoma. RESULTS Sixty-eight articles fulfilled all inclusion criteria. For diagnosis, sensitivities of helical CT, conventional CT, MRI, and US were 91%, 86%, 84%, and 76% and specificities were 85%, 79%, 82%, and 75% respectively. Sensitivities for MRI and US were significantly lower compared with helical CT (P = 0.04 and P = 0.0001). For determining resectability, sensitivities of helical CT, conventional CT, MRI, and US were 81%, 82%, 82, and 83% and specificities were 82%, 76%, 78%, and 63% respectively. Specificity of US was significantly lower compared with helical CT (P = 0.011). CONCLUSIONS Helical CT is preferable as an imaging modality for the diagnosis and determination of resectability of pancreatic adenocarcinoma.
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Affiliation(s)
- Shandra Bipat
- Department of Radiology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands.
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Lee JK, Tyan YS. Detection of a solid pseudopapillary tumor of the pancreas with F-18 FDG positron emission tomography. Clin Nucl Med 2005; 30:187-8. [PMID: 15722825 DOI: 10.1097/00003072-200503000-00010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jong-Kang Lee
- Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Abstract
INTRODUCTION Endoscopic ultrasound (EUS) has emerged as a promising diagnostic modality for locoregional staging of rectal cancer. However, as with any new technology, publication bias, the selective reporting of studies featuring positive results, may result in overestimation of the capability of EUS. The aim of this study was to systematically assess for publication bias in the reporting of the accuracy of EUS in staging rectal cancer. METHODS A MEDLINE search for all published estimates of EUS accuracy in staging rectal cancer between 1985 and 2003 was performed. All retrieved studies were fully published in the English literature. Published studies were analyzed and the following information was abstracted: accuracy of EUS, year of publication, number of subjects studied, impact factor of journal, and type of journal (gastroenterology, surgery, radiology, other). RESULTS Two hundred and two abstracts were reviewed; 41 publications met the stated criteria for inclusion. EUS T-staging accuracy was reported in 40 studies while EUS N-staging accuracy was reported in 27 studies. The experience of 4, 118 subjects was reported with an overall mean T-staging accuracy of 85.2% (median, 87.5%) and N-staging accuracy of 75.0% (median, 76.0%). There was a paucity of smaller studies expressing low EUS accuracy rates. Both T-staging and N-staging accuracy rates also declined over time with the lowest rates reported in more recent literature. CONCLUSION The performance of EUS in staging rectal cancer may be overestimated in the literature due to publication bias. This inflated estimate of the capability of EUS may lead to unrealistic expectations of this technology.
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Affiliation(s)
- Gavin C Harewood
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Orlando LA, Kulasingam SL, Matchar DB. Meta-analysis: the detection of pancreatic malignancy with positron emission tomography. Aliment Pharmacol Ther 2004; 20:1063-70. [PMID: 15569108 DOI: 10.1111/j.1365-2036.2004.02266.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several factors contribute to the high mortality of pancreatic cancer, including limitations of diagnostic imaging. AIM To perform a meta-analysis to assess the diagnostic accuracy of Fluro-deoxy-glucose positron emission tomography with computed tomography compared with computed tomography alone. METHODS Articles were identified through a MEDLINE search and bibliography review. Summary estimates and receiver operating curves were calculated using Meta-Test 0.6. Publication bias and heterogeneity were assessed with a funnel plot and chi-squared test. RESULTS The summary estimate and 95% confidence interval for sensitivity and specificity were as follows: computed tomography 81% (72-88%) and 66% (53-77%), PET after a positive computed tomography 92% (87-95%) and 68% (51-81%), PET after a negative computed tomography 73% (50-88%) and 86% (75-93%) and PET after an indeterminate computed tomography 100 and 68%. The area under the summary receiver operating curve was 0.82 for computed tomography and 0.94 for PET. There was no heterogeneity or publication bias. CONCLUSIONS Our results suggest that although adding Fluro-deoxy-glucose positron emission tomography to the diagnostic work-up may enhance the diagnosis of pancreatic malignancy, its usefulness will vary depending upon the pretest probability of the patient, the results of computed tomography and the provider's testing thresholds. Further evaluation using a well-designed prospective study with a cost-effectiveness analysis is needed to clarify the appropriate role of Fluro-deoxy-glucose positron emission tomography.
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Affiliation(s)
- L A Orlando
- Center for Clinical Health Policy Research, Duke University and the Durham VA Medical Center, Durham, NC, USA.
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van Kouwen MCA, Jansen JBMJ, van Goor H, de Castro S, Oyen WJG, Drenth JPH. FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis. Eur J Nucl Med Mol Imaging 2004; 32:399-404. [PMID: 15549297 DOI: 10.1007/s00259-004-1689-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2004] [Accepted: 08/20/2004] [Indexed: 12/14/2022]
Abstract
PURPOSE 2-(18F)-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is an imaging technique which enables detection of malignancies. FDG-PET has been established as a tool for the diagnosis of pancreatic carcinoma (CA). Early detection is mandatory as cure can only be achieved in non-advanced disease. This is, however, very difficult with conventional radiological techniques. Patients with chronic pancreatitis (CP) are at risk of developing CA. A simple, reliable screening method for malignant degeneration is highly desirable. We set out to investigate whether FDG-PET is able to detect CA in the setting of CP and can fulfil a potential role in the early detection of CA in CP. METHODS FDG-PET was performed in 77 CP patients and in six patients with CP complicated by CA (CP + CA). We included 26 CA patients as a positive control. A positive scan was defined as focal FDG accumulation in the pancreas region. RESULTS In 67 of the 77 CP (87%) patients, pancreatic FDG accumulation was absent. Six patients had significant accumulation. In CA, 24/26 patients had a positive PET. Five out of the six patients with CP + CA had focal uptake, while minor uptake was seen in one patient. FDG-PET was positive in almost all CA patients and CP + CA patients. FDG-PET was negative in the large majority (87%) of CP patients, which suggests that a positive PET scan in CP patients must lead to efforts to exclude a malignancy. CONCLUSION These data suggest that FDG-PET has a potential role as a diagnostic tool for detecting CA in longstanding CP.
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Affiliation(s)
- Mariëtte C A van Kouwen
- Department of Gastroenterology, University Medical Center, St. Radboud, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Abstract
The clinical usefulness of FDG-PET imaging is now firmly established in various situations, such as the preoperative staging of esophageal cancer and recurrent colorectal carcinoma and the detection and staging of recurrent colorectal cancer when there is a clinical or biologic suspicion with inconclusive conventional findings. Encouraging results were obtained in the evaluation of the therapeutic response of various gastrointestinal malignancies, either during the treatment or after its completion. There is no firm consensus regarding its role in pancreatic cancer, either proved or suspected, but it may be valuable in selected clinical situations. Its role seems fairly limited in patients with hepatocellular carcinoma, although PET findings may have prognostic implications. Evaluation of cholangiocarcinoma is an emerging indication, albeit with limited data to date. Finally, PET/CT is very likely to enhance the role of FDG imaging further in the work-up of patients with gastrointestinal tumors.
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Affiliation(s)
- Roland Hustinx
- Division of Nuclear Medicine, University Hospital of Liège, Campus Universitaire du Sart Tilman B35, 4000 Liège, Belgium.
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Rodríguez-Fernández A, Gómez-Río M, Llamas-Elvira JM, Ortega-Lozano S, Ferrón-Orihuela JA, Ramia-Angel JM, Mansilla-Roselló A, Martínez-del-Valle MD, Ramos-Font C. Positron-emission tomography with fluorine-18-fluoro-2-deoxy-D-glucose for gallbladder cancer diagnosis. Am J Surg 2004; 188:171-5. [PMID: 15249245 DOI: 10.1016/j.amjsurg.2003.12.070] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Revised: 12/28/2003] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recent advances in hepatobiliary surgery have underscored the need for presurgical diagnosis of gallbladder cancer. Frequently, clinical presentation, biochemical analysis, and structural ultrasound or computed axial tomography images do not enable definitive differentiation of cholecystitis or cholethiasis from gallbladder cancer. The aim of this study was to evaluate the role of fludeoxy glucose-positron-emission tomography (FDG-PET) in establishing the benign or malignant nature of gallbladder lesions. METHODS A case series of 16 patients with clinical symptoms suggestive of biliary colic or chronic cholecystitis and with inconclusive ultrasound and/or computed axial tomography findings for presence of gallbladder cancer were studied by FDG-PET. RESULTS FDG-PET showed a sensitivity of 0.80, a specificity of 0.82, and positive and negative predictive values of 0.67 and 0.90, respectively. There was 1 false- negative result in 1 patient with mucinous adenocarcinoma and 2 false-positive results in 1 patient with tuberculoid granulomatous reaction and 1 patient with polypoid lesion with adenomyomatosis. CONCLUSIONS FDG-PET may be of utility to establish the diagnosis of gallbladder cancer in patients with nonspecific clinical and imaging findings.
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Affiliation(s)
- Antonio Rodríguez-Fernández
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital, Avda/ Fuerzas Armadas 2, Granada 18014, Spain.
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41
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Pinto Giorgi M, Martins Cunha R, Soares J, Izaki M, Toshimi Saito E, De Barros Mott C, Guido Cerri G, Francchini Ramirez J, Meneghetti J. Dual-Head gamma camera coincidence imaging in pancreatic cancer. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s0212-6982(04)72261-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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van Kouwen MCA, Oyen WJG, Nagengast FM, Jansen JBMJ, Drenth JPH. FDG-PET scanning in the diagnosis of gastrointestinal cancers. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 2004:85-92. [PMID: 15696855 DOI: 10.1080/00855920410014614] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review deals with the current, well-established indications for two-(18F)-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scanning in patients with gastrointestinal cancers. FDG-PET is a non-invasive, functional imaging technique. FDG exploits the native glucose transporter to enter the cell. Since many tumours have enhanced glucose uptake, FDG is readily accumulated in malignant cells and can be detected by a PET camera. FDG-PET has been established as an important diagnostic tool in clinical oncology. This review deals with the current, well-established indications for FDG-PET scanning in patients with gastrointestinal cancers. In the current practice, FDG-PET is most commonly used to stage oesophageal carcinoma, to detect and stage recurrence of colorectal carcinoma and to differentiate between benign and malignant pancreatic lesions. The benefit of FDG-PET scanning in patients with oesophagus carcinoma is best established in stage IV disease, as the diagnostic accuracy to detect metastatic disease is higher compared to the combination of computed tomography (CT) and endoscopic ultrasound (EUS). In patients with a history of colorectal carcinoma, FDG-PET scanning is particularly effective in diagnosing recurrent disease, especially in those with a rising carcinoembryonic antigen without a suspect lesion on conventional imaging. Large series have indicated that the sensitivity and specificity for detecting recurrent colorectal carcinoma are in the range of 87%-100% and 66%-100%, respectively. Equally, FDG-PET has a high sensitivity (68%-96%) and specificity (78%-100%) in detecting pancreatic carcinoma in patients with a suspicious-looking pancreatic mass on CT scan. Lastly, we focus on the use of FDG-PET as a modality for early monitoring of treatment response in patients with gastrointestinal stromal cell tumours. Without doubt, future developments will further establish the diagnostic role of the FDG-PET scan in the care of patients with gastrointestinal cancers.
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Affiliation(s)
- M C A van Kouwen
- Dept. of Medicine, Division of Gastroenterology and Hepatology, University Medical Centre St Radboud, Nijmegen, The Netherlands
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Taylor B. Carcinoma of the head of the pancreas versus chronic pancreatitis: diagnostic dilemma with significant consequences. World J Surg 2003; 27:1249-57. [PMID: 14502404 DOI: 10.1007/s00268-003-7245-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although carcinoma of the head of the pancreas and chronic pancreatitis are usually easy to distinguish on clinical presentation and subsequent investigation, there can be enough overlap in the presenting features and on imaging studies that differentiation is sometimes extremely difficult. As this confusion may lead to either major pancreatic resection for benign disease, or rejection of surgery for a potentially curable lesion, all attempts to arrive at a correct diagnosis should be pursued. This article provides an update of investigative techniques in pancreatic disease, and offers an algorithm for the clinical approach to the patient who appears to present with this diagnostic and therapeutic dilemma.
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Affiliation(s)
- Bryce Taylor
- Department of Surgery, University of Toronto, Surgical Services, University Health Network, 190 Elizabeth Street, R. Fraser Elliott Building, 1st Floor, Suite 408, Toronto, Ontario M5G 2C4, Canada.
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Nakamoto Y, Saga T, Higashi T, Ishimori T, Kobayashi H, Ishizu K, Sato N, Mamede M, Sakahara H, Imamura M, Konishi J. Optimal scan time for evaluating pancreatic disease with positron emission tomography using F-18-fluorodeoxyglucose. Ann Nucl Med 2003; 17:421-6. [PMID: 12971645 DOI: 10.1007/bf03006614] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Image interpretation in positron emission tomography (PET) using F-18-fluoro-2-deoxy-D-glucose (FDG) is usually performed for images obtained at 1 h postinjection (PI) of FDG, but it remains unknown whether this is the optimal time for imaging patients with pancreatic disease. The aim of this study was to assess the optimal scan time for FDG-PET for patients suspected of having pancreatic cancer. PATIENTS AND METHODS Forty-four patients with suspected pancreatic cancer underwent FDG-PET scans at both 1 h and 2 h PI. Tracer uptake in the pancreatic lesions and possible liver metastasis was interpreted qualitatively, using a 5-point grading system (0 = normal, 1 = probably normal, 2 = equivocal, 3 = probably abnormal, and 4 = definitely abnormal) by 4 nuclear medicine physicians independently, who were blind to all clinical information. Detection performance with each image was compared using receiver operating characteristic (ROC) analysis. An average score of the 4 readers for each patient was also defined as consensus average index (CAI) and compared between the two images. RESULTS ROC results indicated no significant differences in detection performance (Averaged areas under ROC curves of 1 h vs. 2 h were 0.92 vs. 0.90 for primary tumor, and 0.81 vs. 0.85 for liver metastases). There were no significant differences in CAIs between 1 h and 2 h PI images in interpreting primary tumor and positive liver metastases, but a significant difference was observed for cases without liver metastases (p < 0.05). CONCLUSIONS The certainty of excluding liver metastases was increased when the 2h image was used, although ROC analysis did not establish a difference between 1 h and 2 h imaging for differentiating malignant and benign lesions in primary pancreatic cancer or its liver metastases.
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Affiliation(s)
- Yuji Nakamoto
- Department of Nuclear Medicine and Diagnostic Imaging, Graduate School of Medicine, Kyoto University, Japan.
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Higashi T, Saga T, Nakamoto Y, Ishimori T, Fujimoto K, Doi R, Imamura M, Konishi J. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) --usefulness and limitations in "clinical reality". Ann Nucl Med 2003; 17:261-79. [PMID: 12932109 DOI: 10.1007/bf02988521] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The present review will provide an overview of the literature concerning the FDG PET diagnosis of pancreatic cancer and a summary from our experience of 231 cases of pancreatic lesions. FDG PET can effectively differentiate pancreatic cancer from benign lesion with high accuracy. Newly-developed PET scanners can detect small pancreatic cancers, up to 7 mm in diameter, by their high resolution, which could make a great contribution to the early detection of resectable and potentially curable pancreatic cancers. FDG PET is useful and cost-beneficial in the pre-operative staging of pancreatic cancer because an unexpected distant metastasis can be detected by whole-body PET in about 40% of the cases, which results in avoidance of unnecessary surgical procedures. FDG PET is also useful in evaluation of the treatment effect, monitoring after the operation and detection of recurrent pancreatic cancers. However, there are some drawbacks in PET diagnosis. A relatively wide overlap has been reported between semiquantitative uptake values obtained in cancers and those in inflammatory lesions. As for false-positive cases, active and chronic pancreatitis and autoimmune pancreatitis sometimes show high FDG accumulation and mimic pancreatic cancer with a shape of focal uptake. There were 8 false negative cases in the detection of pancreatic cancer by FDG PET, up to 33 mm in diameter, mainly because of their poor cellularity in cancer tissues. In addition, there are 19% of cancer cases with a decline in FDG uptake from 1 hr to 2 hr scan. FDG PET was recently applied to and was shown to be feasible in the differential diagnosis of cystic pancreatic lesions, such as intraductal papillary mucinous tumor of the pancreas. Further investigations are required to clarify the clinical value of FDG PET in predicting prognosis of the pancreatic patients.
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Affiliation(s)
- Tatsuya Higashi
- Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate School of Medicine, Sakyo, Japan.
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Keith CJ, Miles KA, Wong D. Pancreatic cancer: preliminary experience with sodium iodide fluorodeoxyglucose positron emission tomography in Australia. AUSTRALASIAN RADIOLOGY 2003; 47:17-21. [PMID: 12581049 DOI: 10.1046/j.1440-1673.2003.01090.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous studies of fluorodeoxyglucose positron emission tomography (FDG-PET) in pancreatic cancer have used Bismuth Germinate detector systems. This preliminary Australian study aims to confirm the accuracy of FDG-PET in pancreatic cancer using a dedicated sodium iodide (NaI) PET system. Fifteen consecutive patients underwent FDG-PET using a GE QUEST dedicated NaI PET scanner. The indications were the characterization of a pancreatic mass seen on CT or ultrasonographic imaging (nine cases), diagnosis or exclusion of recurrent disease following surgery and adjuvant therapy (four cases) and presurgical staging of primary pancreatic cancer (two cases). The final diagnosis was determined from histology or, when no histology was available, by radiological and clinical follow up. The FDG-PET accurately characterized eight out of nine pancreatic masses (seven were true negative, one was true positive and one was false positive). Of the four cases performed to determine recurrent disease, three were accurately diagnosed (two true negatives and one true positive). In the fourth case, PET accurately detected a liver metastasis but did not detect the local recurrence. Results in the two cases where PET was performed for preoperative staging comprised one true positive and one false negative. Sodium iodide FDG-PET is useful in the diagnosis of pancreatic cancer, particularly in the presence of a previously detected mass.
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Affiliation(s)
- C J Keith
- Southern X-ray Clinics, The Wesley Hospital, Auchenflower, Queensland, Australia
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Kalady MF, Clary BM, Clark LA, Gottfried M, Rohren EM, Coleman RE, Pappas TN, Tyler DS. Clinical utility of positron emission tomography in the diagnosis and management of periampullary neoplasms. Ann Surg Oncol 2002; 9:799-806. [PMID: 12374664 DOI: 10.1007/bf02574503] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study examined the effect that 18-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) imaging had on the clinical management of patients with suspected periampullary malignancy. METHODS Fifty-four patients with suspected pancreatic neoplasms underwent both whole-body (18)FDG-PET and abdominal computed tomography (CT). Malignant or benign disease was confirmed pathologically in 47 patients. RESULTS Of the 41 patients with malignancy, (18)FDG-PET failed to identify the primary tumor in 5 patients. (18)FDG-PET demonstrated increased uptake suggesting primary malignancy in 37 patients. Malignant pathology was confirmed in 36 cases. (18)FDG-PET identified malignant locoregional lymph node metastases in six of ten patients. All nodes identified before surgery by (18)FDG-PET were also seen on preoperative CT. Six patients who were thought to have resectable disease by CT were found to have distant metastasis at laparotomy. (18)FDG-PET did not detect metastasis in any of these cases. Before surgery, (18)FDG-PET identified distant metastases that were not detected by CT in one patient. CONCLUSIONS Despite high sensitivity and specificity in diagnosing periampullary malignancy, (18)FDG-PET did not change clinical management in the vast majority of patients previously evaluated by CT. In addition, (18)FDG-PET missed >10% of periampullary malignancies and did not provide the anatomical detail necessary to define unresectabilty.
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Affiliation(s)
- Matthew F Kalady
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Kekis PB, Friess H, Kleeff J, Büchler MW. Timing and extent of surgical intervention in patients from hereditary pancreatic cancer kindreds. Pancreatology 2002; 1:525-30. [PMID: 12120232 DOI: 10.1159/000055855] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Our knowledge of the molecular and genetic etiology of hereditary pancreatic cancer has expanded considerably and is steadily increasing. However, there are only a few hard data available regarding the clinical and surgical management of these patients. Surgery is currently performed when we detect dysplastic changes in the pancreas or when cancer is suspected. Of the available diagnostic modalities, endoscopic ultrasonography has proven so far to be the most useful for detecting dysplastic changes in the pancreases of patients from hereditary pancreatic cancer kindreds. It seems reasonable, once dysplasia has been diagnosed in a high-risk patient, to proceed to total pancreatectomy. The multifocal nature of dysplastic lesions precludes any type of operation that would leave behind pancreatic tissue. Currently, prophylactic whole-organ resection in the absence of premalignant lesions cannot be recommended since we do not know the exact risk for the development of cancer.
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Affiliation(s)
- P B Kekis
- Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, CH-3010 Bern, Switzerland
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Ladabaum U. Positron emission tomography: the gastroenterologists's perspective. Gastrointest Endosc 2002; 55:S64-6. [PMID: 12024125 DOI: 10.1067/mge.2002.124740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Uri Ladabaum
- Division of Gastroenterology, University of California San Francisco, San Francisco, California 94143-0538, USA
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Zhao S, Kuge Y, Tsukamoto E, Mochizuki T, Kato T, Hikosaka K, Nakada K, Hosokawa M, Kohanawa M, Tamaki N. Fluorodeoxyglucose uptake and glucose transporter expression in experimental inflammatory lesions and malignant tumours: effects of insulin and glucose loading. Nucl Med Commun 2002; 23:545-50. [PMID: 12029209 DOI: 10.1097/00006231-200206000-00006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The expression of glucose transporters (GLUTs) and its relationship to fluorodeoxyglucose accumulation in malignant tumours have been well investigated, while such a relation has not been studied in inflammatory lesions. The aim of the present study was to investigate the effects of insulin and glucose loading on the expression of GLUTs in inflammatory lesions and compare them with those in malignant tumours in relation to fluorodeoxyglucose accumulation. All tissue specimens used in this study were obtained in our previous study, in which rats were inoculated with allogenic hepatoma cells (KDH-8), Staphylococcus aureus, or turpentine oil into the left calf muscle and divided into three subgroups: insulin loaded, glucose loaded, and control groups. The expression of glucose transporters (GLUT-1 to GLUT-5) was investigated by immunostaining the lesions (n=5-6, for each group). In all control groups, the expression levels of GLUT-1 and GLUT-3 were significantly higher than those of GLUT-2, GLUT-4 and GLUT-5. Insulin loading did not significantly affect the expression levels of GLUT-1 and GLUT-3 in these lesions except for a significant but slight decrease in the GLUT-1 expression level in the inflammatory lesion of non-infectious origin (89% of the control value). Glucose loading significantly decreased the expression level of GLUT-1 in the inflammatory lesion of non-infectious origin (70% of the control value, P<0.01), and that of GLUT-3 in the inflammatory lesion of infectious origin (70% of the control value, P<0.05), while the expression levels of GLUT-1 and GLUT-3 in the tumour were not significantly affected. These results demonstrate the effects of insulin and glucose loading on the expression level of a molecule (GLUT proteins). The decreased GLUT-1 and GLUT-3 expression levels induced by glucose loading may partly explain the impaired FDG uptake observed in our previous study.
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Affiliation(s)
- S Zhao
- Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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