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Ustsinau U, Kulterer OC, Rausch I, Krššák M, Kiefer FW, Hacker M, Philippe C. A PET/MRI study on the effect of obesity and NAFLD on hepatic [ 18F]FDG uptake. Eur J Radiol 2024; 177:111552. [PMID: 38861905 DOI: 10.1016/j.ejrad.2024.111552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/25/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE The potential limitations of hepatic [18F]FDG-PET imaging for individuals with obesity and excessive liver fat (NAFLD) are being investigated. In this study, we aim to determine the reliability of standardized uptake values (SUVs) focusing on adjustment for liver fat content (LFC) derived from DIXON images and the effects of whole-body normalizations. METHODS Lean and with obesity volunteers who underwent [18F]FDG-PET/MRI were reviewed retrospectively. DIXON fat images were used to determine LFC and for adjustment of SUVmean. The hepatic SUVs (mean, fat adjusted mean and max) were normalized to body weight, lean body mass and body surface area. Blood samples were analysed for glucose, serological liver enzymes and lipoproteins for further correlation of [18F]FDG uptake. RESULTS Out of 11 volunteers with obesity (M:8, F:3, BMI:30-39 kg/m2), 9 confirmed the presence of NAFLD (>5.6 % fat). 22 age-matched lean volunteers (M:10, F:11, BMI:19-26 kg/m2) were used as control group. Both SUVmean, before and after adjustment to LFC, did not provide any difference between lean and with obesity groups under BW, LBM and BSA. SUVmax BW showed a difference between groups (p = 0.05). SUVs were independent of levels of GPT, GOT, gGT, insulin, HOMA-IR, triglycerides, cholesterol and LDL. Volunteers with low HDL were clustered with an increased hepatic [18F]FDG uptake. CONCLUSION Our method for adjustment of hepatic [18F]FDG-PET with DIXON fat images allows to achieve accurate results for individuals with NAFLD and obesity. For homogenic results, raw SUVmean should be combined with adjustment for liver fat, appropriate normalization and consideration of HDL levels.
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Affiliation(s)
- Usevalad Ustsinau
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oana C Kulterer
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Martin Krššák
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian W Kiefer
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Cecile Philippe
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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Wegrzyniak O, Lechi F, Mitran B, Cheung P, Bitzios A, Persson J, Löfblom J, Nordström H, Eriksson J, Frejd FY, Korsgren O, Zhang B, Eriksson O. Non-invasive PET imaging of liver fibrogenesis using a RESCA-conjugated Affibody molecule. iScience 2024; 27:109688. [PMID: 38660405 PMCID: PMC11039342 DOI: 10.1016/j.isci.2024.109688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/02/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
Non-invasive assessment of fibrogenic activity, rather than fibrotic scars, could significantly improve the management of fibrotic diseases and the development of anti-fibrotic drugs. This study explores the potential of an Affibody molecule (Z09591) labeled with the Al(18)F-restrained complexing agent (RESCA) method as a tracer for the non-invasive detection of fibrogenic cells. Z09591 was functionalized with the RESCA chelator for direct labeling with [18F]AlF. In vivo positron emission tomography/magnetic resonance imaging scans on U-87 tumor-bearing mice exhibited high selectivity of the resulting radiotracer, [18F]AlF-RESCA-Z09591, for platelet-derived growth factor receptor β (PDGFRβ), with minimal non-specific background uptake. Evaluation in a mouse model with carbon tetrachloride-induced fibrotic liver followed by a disease regression phase, revealed the radiotracer's high affinity and specificity for fibrogenic cells in fibrotic livers (standardized uptake value [SUV] 0.43 ± 0.05), with uptake decreasing during recovery (SUV 0.29 ± 0.03) (p < 0.0001). [18F]AlF-RESCA-Z09591 accurately detects PDGFRβ, offering non-invasive assessment of fibrogenic cells and promising applications in precise liver fibrogenesis diagnosis, potentially contributing significantly to anti-fibrotic drug development.
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Affiliation(s)
- Olivia Wegrzyniak
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Francesco Lechi
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Bogdan Mitran
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
- Antaros Medical AB, Mölndal, Sweden
| | - Pierre Cheung
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Athanasios Bitzios
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Jonas Persson
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
- Department of Protein Science, Division of Protein Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - John Löfblom
- Department of Protein Science, Division of Protein Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Helena Nordström
- Science for Life Laboratory, Drug Discovery & Development Platform, Department of Chemistry-BMC, Uppsala University, Uppsala, Sweden
| | - Jonas Eriksson
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
- PET Center, Uppsala University Hospital, Uppsala, Sweden
| | - Fredrik Y. Frejd
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Affibody AB, Solna, Sweden
| | - Olle Korsgren
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Bo Zhang
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Olof Eriksson
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
- Antaros Medical AB, Mölndal, Sweden
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3
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Marchal E, Palard-Novello X, Lhomme F, Meyer ME, Manson G, Devillers A, Marolleau JP, Houot R, Girard A. Baseline [ 18F]FDG PET features are associated with survival and toxicity in patients treated with CAR T cells for large B cell lymphoma. Eur J Nucl Med Mol Imaging 2024; 51:481-489. [PMID: 37721580 DOI: 10.1007/s00259-023-06427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE Chimeric antigen receptor (CAR) T cells have established themselves as an effective treatment for refractory or relapsed large B cell lymphoma (LBCL). Recently, the sDmax, which corresponds to the distance separating the two farthest lesions standardized by the patient's body surface area, has appeared as a prognostic factor in LBCL. This study aimed to identify [18F]FDG-PET biomarkers associated with prognosis and predictive of adverse events in patients treated with CAR T cells. METHODS Patients were retrospectively included from two different university hospitals. They were being treated with CAR T cells for LBCL and underwent [18F]FDG-PET just before CAR T cell infusion. Lesions were segmented semi-automatically with a threshold of 41% of the maximal uptake. In addition to clinico-biological features, sDmax, total metabolic tumor volume (TMTV), SUVmax, and uptake intensity of healthy lymphoid organs and liver were collected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The occurrence of adverse events, such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), was reported. RESULTS Fifty-six patients were included. The median follow-up was 9.7 months. Multivariate analysis showed that TMTV (cut-off of 36 mL) was an independent prognostic factor for PFS (p < 0.001) and that sDmax (cut-off of 0.15 m-1) was an independent prognostic factor for OS (p = 0.008). Concerning the occurrence of adverse events, a C-reactive protein level > 35 mg/L (p = 0.006) and a liver SUVmean > 2.5 (p = 0.027) before CAR T cells were associated with grade 2 to 4 CRS and a spleen SUVmean > 1.9 with grade 2 to 4 ICANS. CONCLUSION TMTV and sDmax had independent prognostic values, respectively, on PFS and OS. Regarding adverse events, the mean liver and spleen uptakes were associated with the occurrence of grade 2 to 4 CRS and ICANS, respectively. Integrating these biomarkers into the clinical workflow could be useful for early adaptation of patients management.
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Affiliation(s)
- E Marchal
- Department of Nuclear Medicine, Amiens-Picardie University Hospital, Amiens, France.
| | - X Palard-Novello
- Department of Nuclear Medicine, University Rennes, CLCC Eugène Marquis, INSERM, LTSI-UMR 1099, Rennes, France
| | - F Lhomme
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France
| | - M E Meyer
- Department of Nuclear Medicine, Amiens-Picardie University Hospital, Amiens, France
| | - G Manson
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France
| | - A Devillers
- Department of Nuclear Medicine, CLCC Eugène Marquis, Rennes, France
| | - J P Marolleau
- Department of Hematology, Amiens-Picardie University Hospital, Amiens, France
| | - R Houot
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France
| | - A Girard
- Department of Nuclear Medicine, Amiens-Picardie University Hospital, Amiens, France
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Tonda K, Iwabuchi Y, Shiga T, Owaki Y, Fujita A, Nakahara T, Sakurai R, Shimizu A, Yamada Y, Okada M, Jinzaki M. Impact of patient characteristic factors on the dynamics of liver glucose metabolism: Evaluation of multiparametric imaging with dynamic whole-body 18 F-fluorodeoxyglucose-positron emission tomography. Diabetes Obes Metab 2023; 25:3521-3528. [PMID: 37589247 DOI: 10.1111/dom.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/18/2023]
Abstract
AIMS To assess the impact of various patient characteristics on the dynamics of liver glucose metabolism using automated multiparametric imaging with whole-body dynamic 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET). MATERIALS AND METHODS We retrospectively enrolled 540 patients who underwent whole-body dynamic FDG-PET. Three quantitative indices representing hepatic glucose metabolism [mean standardized uptake value normalized by lean body mass (SULmean), metabolic glucose rate (kinetic index) and distribution volume (DV)] were measured from multiparametric PET images produced automatically based on the Patlak plot model. Patient characteristics including age, sex, body mass index, fasting time, blood glucose level, and the presence of diabetes mellitus (DM) or hepatic steatosis (HS) were collected. We examined the correlations between the characteristic factors and three quantitative indices using multiple regression analysis. RESULTS The success rate of kinetic analysis using multiparametric PET imaging was 93.3% (504/540). Hepatic SULmean was significantly correlated with age (p < .001), sex (p < .001) and blood glucose level (p = .002). DV was significantly correlated with age (p = .033), sex (p < .001), body mass index (p = .002), fasting time (p = .043) and the presence of HS (p = .002). The kinetic index was significantly correlated with age (p < .001) and sex (p = .004). In the comparison of the healthy, DM and HS groups, patients with DM had a significantly increased SULmean, whereas patients with HS had a significantly decreased DV. CONCLUSIONS Our results showed that liver glucose metabolism was influenced by various patient characteristic factors. Multiparametric FDG-PET imaging can be used to analyse the kinetics of liver glucose metabolism in routine clinical practice.
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Affiliation(s)
- Kai Tonda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yu Iwabuchi
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Tohru Shiga
- Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan
| | - Yoshiki Owaki
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Arashi Fujita
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Takehiro Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Ryosuke Sakurai
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Shimizu
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Ali MA, El-Abd E, Morsi M, El Safwany MM, El-Sayed MZ. The effect of hepatic steatosis on 18F-FDG uptake in PET-CT examinations of cancer Egyptian patients. Eur J Hybrid Imaging 2023; 7:19. [PMID: 37840056 PMCID: PMC10577118 DOI: 10.1186/s41824-023-00173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Hepatic steatosis is the most common chronic hepatic disease. Imaging diagnosis of hepatic steatosis has been evaluated as an alternative to invasive histological diagnosis. STUDY AIMS The study aimed to assess the effect of hepatic steatosis on Flourine-18 fluorodeoxyglucose (18F-FDG) uptakes in cancer patients. PATIENTS AND METHODS Blood samples were collected from 50 cancer patients and analyzed to calculate fatty liver index and Hepatic steatosis index (HIS). Hepatic steatosis examined using high-resolution ultrasound and positron emission tomography-computed tomography (PET-CT). Linear attenuation coefficient, standardized-uptake value (SUV) mean (SUV mean), and SUV maximum (SUVmax) were measured. Accordingly, patients were divided equally into non-fatty liver, and fatty liver groups. RESULTS A significant increase in SUVmax and SUV mean was observed in the fatty liver group more than in the non-fatty liver group. HSI significantly increased in the fatty liver group compared to the non-fatty liver group. Liver tissue uptake FDG was significantly correlated with HSI values. SUV max significantly correlated with body mass index (BMI) in the non-fatty group only. CONCLUSION Hepatic changes in cancer patients affect the liver metabolic activity and thus the 18 F-FDG uptake. Therefore, further corrections should be considered when the liver is used as a comparator for PET-CT scans of cancer patients.
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Affiliation(s)
- Magdi A Ali
- Faculty of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates.
| | - Eman El-Abd
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mohamed Morsi
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mohamed M El Safwany
- Faculty of Applied Health Science Technology, Pharos University in Alexandria, Alexandria, Egypt
| | - Mohamed Z El-Sayed
- Faculty of Applied Health Science Technology, Pharos University in Alexandria, Alexandria, Egypt
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Ustsinau U, Ehret V, Fürnsinn C, Scherer T, Helbich TH, Hacker M, Krššák M, Philippe C. Novel approach using [ 18F]FTHA-PET and de novo synthesized VLDL for assessment of FFA metabolism in a rat model of diet induced NAFLD. Clin Nutr 2023; 42:1839-1848. [PMID: 37625314 DOI: 10.1016/j.clnu.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND AND AIMS The worldwide prevalence of Non-alcoholic Fatty Liver Disease (NAFLD) raises concerns about associated risk factors, such as obesity and type 2 Diabetes Mellitus, for leading causes of disability and death. Besides Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS), functional imaging with Positron Emission Tomography (PET) could contribute to a deeper understanding of the pathophysiology of NAFLD. Here we describe a novel approach using the PET tracer [18F]FTHA, which is an analog of long-chain free fatty acids (FFA) and is taken up by tissues to enter mitochondria or to be incorporated into complex lipids for further export as very-low-density lipoprotein (VLDL). METHODS Male Sprague Dawley rats, after 6 weeks on a high-fat diet (HFD), were used as a model of diet induced NAFLD, while a standard diet (SD) served as a control group. Liver fat was estimated by MR spectroscopy at a 9.4 T system for phenotyping. To measure hepatic FFA uptake, rats underwent 60 min dynamic [18F]FTHA-PET scans after unrestricted access to food (HFD: n = 6; SD: n = 6) or overnight (≤16h) fasting (HFD: n = 6; SD: n = 5). FFA removal was assessed from incorporated 18F-residual in de novo synthesized VLDL out of plasma. RESULTS MRS of the liver confirmed the presence of NAFLD (>5.6% fat). Under non-fasting conditions, hepatic [18F]FTHA uptake was significantly increased in NAFLD: SUVmean (p = 0.03) within [0; 60] min interval, SUVmean (p = 0.01) and SUVmax (p = 0.03) within [30; 60] min interval. SUVs for hepatic uptake under fasting conditions were not significantly different between the groups. Analysis of FFA removal demonstrated elevated values of 18F-residue in the VLDL plasma fraction of the healthy group compared to the NAFLD (p = 0.0569). CONCLUSION Our novel approach for assessing FFA metabolism using [18F]FTHA demonstrated differences in the hepatic FFA uptake and FFA incorporation into VLDL between healthy and NAFLD rats. [18F]FTHA-PET could be used to study metabolic disturbances involved in the progression of NAFLD.
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Affiliation(s)
- Usevalad Ustsinau
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Viktoria Ehret
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Clemens Fürnsinn
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Scherer
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Division of Molecular and Structural Preclinical Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin Krššák
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Cecile Philippe
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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Gu F, Wu Q. Quantitation of dynamic total-body PET imaging: recent developments and future perspectives. Eur J Nucl Med Mol Imaging 2023; 50:3538-3557. [PMID: 37460750 PMCID: PMC10547641 DOI: 10.1007/s00259-023-06299-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/05/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Positron emission tomography (PET) scanning is an important diagnostic imaging technique used in disease diagnosis, therapy planning, treatment monitoring, and medical research. The standardized uptake value (SUV) obtained at a single time frame has been widely employed in clinical practice. Well beyond this simple static measure, more detailed metabolic information can be recovered from dynamic PET scans, followed by the recovery of arterial input function and application of appropriate tracer kinetic models. Many efforts have been devoted to the development of quantitative techniques over the last couple of decades. CHALLENGES The advent of new-generation total-body PET scanners characterized by ultra-high sensitivity and long axial field of view, i.e., uEXPLORER (United Imaging Healthcare), PennPET Explorer (University of Pennsylvania), and Biograph Vision Quadra (Siemens Healthineers), further stimulates valuable inspiration to derive kinetics for multiple organs simultaneously. But some emerging issues also need to be addressed, e.g., the large-scale data size and organ-specific physiology. The direct implementation of classical methods for total-body PET imaging without proper validation may lead to less accurate results. CONCLUSIONS In this contribution, the published dynamic total-body PET datasets are outlined, and several challenges/opportunities for quantitation of such types of studies are presented. An overview of the basic equation, calculation of input function (based on blood sampling, image, population or mathematical model), and kinetic analysis encompassing parametric (compartmental model, graphical plot and spectral analysis) and non-parametric (B-spline and piece-wise basis elements) approaches is provided. The discussion mainly focuses on the feasibilities, recent developments, and future perspectives of these methodologies for a diverse-tissue environment.
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Affiliation(s)
- Fengyun Gu
- School of Mathematics and Physics, North China Electric Power University, 102206, Beijing, China.
- School of Mathematical Sciences, University College Cork, T12XF62, Cork, Ireland.
| | - Qi Wu
- School of Mathematical Sciences, University College Cork, T12XF62, Cork, Ireland
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Jordan VC, Sojoodi M, Shroff S, Pagan PG, Barrett SC, Wellen J, Tanabe KK, Chung RT, Caravan P, Gale EM. Molecular magnetic resonance imaging of liver inflammation using an oxidatively activated probe. JHEP Rep 2023; 5:100850. [PMID: 37818152 PMCID: PMC10561122 DOI: 10.1016/j.jhepr.2023.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 10/12/2023] Open
Abstract
Background & Aims Many liver diseases are driven by inflammation, but imaging to non-invasively diagnose and quantify liver inflammation has been underdeveloped. The inflammatory liver microenvironment is aberrantly oxidising owing in part to reactive oxygen species generated by myeloid leucocytes. We hypothesised that magnetic resonance imaging using the oxidatively activated probe Fe-PyC3A will provide a non-invasive biomarker of liver inflammation. Methods A mouse model of drug-induced liver injury was generated through intraperitoneal injection of a hepatoxic dose of acetaminophen. A mouse model of steatohepatitis was generated via a choline-deficient, l-amino acid defined high-fat diet (CDAHFD). Images were acquired dynamically before and after intravenous injection of Fe-PyC3A. The contrast agent gadoterate meglumine was used as a non-oxidatively activated negative control probe in mice fed CDAHFD. The (post-pre) Fe-PyC3A injection change in liver vs. muscle contrast-to-noise ratio (ΔCNR) recorded 2 min post-injection was correlated with liver function test values, histologic scoring assigned using the NASH Clinical Research Network criteria, and intrahepatic myeloid leucocyte composition determined by flow cytometry. Results For mice receiving i.p. injections of acetaminophen, intrahepatic neutrophil composition correlated poorly with liver test values but positively and significantly with ΔCNR (r = 0.64, p <0.0001). For mice fed CDAHFD, ΔCNR generated by Fe-PyC3A in the left lobe was significantly greater in mice meeting histologic criteria strongly associated with a diagnosis NASH compared to mice where histology was consistent with likely non-NASH (p = 0.0001), whereas no differential effect was observed using gadoterate meglumine. In mice fed CDAHFD, ΔCNR did not correlate strongly with fractional composition of any specific myeloid cell subpopulation as determined by flow cytometry. Conclusions Magnetic resonance imaging using Fe-PyC3A merits further evaluation as a non-invasive biomarker for liver inflammation. Impact and implications Non-invasive tests to diagnose and measure liver inflammation are underdeveloped. Inflammatory cells such as neutrophils release reactive oxygen species which creates an inflammatory liver microenvironment that can drive chemical oxidation. We recently invented a new class of magnetic resonance imaging probe that is made visible to the scanner only after chemical oxidation. Here, we demonstrate how this imaging technology could be applied as a non-invasive biomarker for liver inflammation.
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Affiliation(s)
- Veronica Clavijo Jordan
- Athinoula A. Martinos Center for Biomedical Imaging, The Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mozhdeh Sojoodi
- Harvard Medical School, Boston, MA, USA
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Stuti Shroff
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia Gonzalez Pagan
- Athinoula A. Martinos Center for Biomedical Imaging, The Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen Cole Barrett
- Harvard Medical School, Boston, MA, USA
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Kenneth K. Tanabe
- Harvard Medical School, Boston, MA, USA
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Raymond T. Chung
- Harvard Medical School, Boston, MA, USA
- Gastroenterology Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, The Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eric M. Gale
- Athinoula A. Martinos Center for Biomedical Imaging, The Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Weyts K, Quak E, Licaj I, Ciappuccini R, Lasnon C, Corroyer-Dulmont A, Foucras G, Bardet S, Jaudet C. Deep Learning Denoising Improves and Homogenizes Patient [ 18F]FDG PET Image Quality in Digital PET/CT. Diagnostics (Basel) 2023; 13:diagnostics13091626. [PMID: 37175017 PMCID: PMC10177812 DOI: 10.3390/diagnostics13091626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Given the constant pressure to increase patient throughput while respecting radiation protection, global body PET image quality (IQ) is not satisfactory in all patients. We first studied the association between IQ and other variables, in particular body habitus, on a digital PET/CT. Second, to improve and homogenize IQ, we evaluated a deep learning PET denoising solution (Subtle PETTM) using convolutional neural networks. We analysed retrospectively in 113 patients visual IQ (by a 5-point Likert score in two readers) and semi-quantitative IQ (by the coefficient of variation in the liver, CVliv) as well as lesion detection and quantification in native and denoised PET. In native PET, visual and semi-quantitative IQ were lower in patients with larger body habitus (p < 0.0001 for both) and in men vs. women (p ≤ 0.03 for CVliv). After PET denoising, visual IQ scores increased and became more homogeneous between patients (4.8 ± 0.3 in denoised vs. 3.6 ± 0.6 in native PET; p < 0.0001). CVliv were lower in denoised PET than in native PET, 6.9 ± 0.9% vs. 12.2 ± 1.6%; p < 0.0001. The slope calculated by linear regression of CVliv according to weight was significantly lower in denoised than in native PET (p = 0.0002), demonstrating more uniform CVliv. Lesion concordance rate between both PET series was 369/371 (99.5%), with two lesions exclusively detected in native PET. SUVmax and SUVpeak of up to the five most intense native PET lesions per patient were lower in denoised PET (p < 0.001), with an average relative bias of -7.7% and -2.8%, respectively. DL-based PET denoising by Subtle PETTM allowed [18F]FDG PET global image quality to be improved and homogenized, while maintaining satisfactory lesion detection and quantification. DL-based denoising may render body habitus adaptive PET protocols unnecessary, and pave the way for the improvement and homogenization of PET modalities.
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Affiliation(s)
- Kathleen Weyts
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Elske Quak
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Idlir Licaj
- Department of Biostatistics, Baclesse Cancer Centre, 14076 Caen, France
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9019 Tromsø, Norway
| | - Renaud Ciappuccini
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Charline Lasnon
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Aurélien Corroyer-Dulmont
- Department of Medical Physics, Baclesse Cancer Centre, 14076 Caen, France
- ISTCT Unit, CNRS, UNICAEN, Normandy University, GIP CYCERON, 14074 Caen, France
| | - Gauthier Foucras
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Stéphane Bardet
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Cyril Jaudet
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
- Department of Medical Physics, Baclesse Cancer Centre, 14076 Caen, France
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10
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Improvement of liver metabolic activity in people with advanced HIV after antiretroviral therapy initiation. AIDS 2022; 36:1655-1664. [PMID: 35730393 PMCID: PMC9444912 DOI: 10.1097/qad.0000000000003302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Evaluating hepatic metabolic changes in people with HIV (PWH) with advanced disease, before and after antiretroviral therapy (ART) initiation, using [ 18 F]-fluorodeoxyglucose (FDG) PET-computed tomography (PET/CT). FDG PET/CT noninvasively quantifies glucose metabolism in organs. DESIGN/METHODS Forty-eight viremic PWH (CD4 + cell counts <100 cells/μl) underwent FDG PET/CT at baseline and approximately 6 weeks after ART initiation (short-term). Twenty-seven PWH participants underwent follow-up scans 2 years after treatment (long-term). FDG PET/CT scans from 20 healthy controls were used for comparison. Liver FDG uptake was quantified from the PET/CT scans. Imaging findings as well as clinical, laboratory, and immune markers were compared longitudinally and cross-sectionally to healthy controls. RESULTS Liver FDG uptake was lower at baseline and short-term in PWH compared with controls ( P < 0.0001). At the long-term scan, liver FDG uptake of PWH increased relative to baseline and short-term ( P = 0.0083 and 0.0052) but remained lower than controls' values ( P = 0.004). Changes in FDG uptake correlated negatively with levels of glucagon, myeloperoxidase, sCD14, and MCP-1 and positively with markers of recovery (BMI, albumin, and CD4 + cell counts) ( P < 0.01). In multivariable analyses of PWH values across timepoints, BMI and glucagon were the best set of predictors for liver FDG uptake ( P < 0.0001). CONCLUSION Using FDG PET/CT, we found decreased liver glucose metabolism in PWH that could reflect hepatocytes/lymphocytes/myeloid cell loss and metabolic dysfunction because of inflammation. Although long-term ART seems to reverse many hepatic abnormalities, residual liver injury may still exist within 2 years of treatment initiation, especially in PWH who present with low nadir CD4 + cell counts.
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11
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Doroudinia A, Karam MB, Ghadimi N, Yousefi F. Steatotic Hepatitis Presenting as a Huge Hypermetabolic Liver Mass. Clin Nucl Med 2022; 47:e399-e400. [PMID: 35175943 DOI: 10.1097/rlu.0000000000004098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT FDG PET/CT scan is a diagnostic imaging modality for oncologic patients, but with false-positive findings in inflammatory diseases. In this interesting case, we present a 24-year-old woman with history of giant cell tumor of the bone (lumbar vertebrae) who underwent whole-body FDG PET/CT scan for treatment response evaluation. FDG PET/CT scan demonstrated a large hypermetabolic tumoral mass lesion in segment VI/VII of the right hepatic lobe. A range of malignant versus benign lesions should be considered as differential diagnoses, including metastasis, primary cholangiocarcinoma, hepatocellular carcinoma, focal nodular hyperplasia, and infection. Final diagnosis of "steatotic hepatitis" after CT-guided biopsy was established.
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Affiliation(s)
- Abtin Doroudinia
- From the Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Herz CT, Kulterer OC, Prager M, Schmöltzer C, Langer FB, Prager G, Marculescu R, Kautzky-Willer A, Hacker M, Haug AR, Kiefer FW. Active Brown Adipose Tissue is Associated With a Healthier Metabolic Phenotype in Obesity. Diabetes 2021; 71:db210475. [PMID: 34957487 DOI: 10.2337/db21-0475] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022]
Abstract
Obesity is associated with increasing cardiometabolic morbidity and mortality worldwide. Not everyone with obesity, however, develops metabolic complications. Brown adipose tissue (BAT) has been suggested as a promoter of leanness and metabolic health. To date, little is known about the prevalence and metabolic function of BAT in subjects with severe obesity, a population at high cardiometabolic risk. In this cross-sectional study, we included 40 individuals with WHO class II-III obesity (BMI ≥ 35 kg/m2). Employing a 150-minute personalized cooling protocol and 18F-fluorodeoxyglucose positron emission tomography/computed tomography, cold-activated BAT was detectable in 14 (35%) of the participants. Cold-induced thermogenesis was significantly higher in participants with detectable BAT compared to those without. Notably, individuals with obesity and active BAT had 28.8% lower visceral fat mass despite slightly higher total fat mass compared to those without detectable BAT 18F-FDG uptake. This was accompanied by lower insulin resistance and systemic inflammation and improved NAFLD parameters, all adjusted for age, sex, and percent body fat. Contrary to previous assumptions, we show here that a significant fraction of individuals with severe obesity has active BAT. We found that decreased BAT 18F-FDG uptake was not associated with adiposity per se but with higher visceral fat mass. In summary, active BAT is linked to a healthier metabolic phenotype in obesity.
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Affiliation(s)
- Carsten T Herz
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Oana C Kulterer
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marlene Prager
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christoph Schmöltzer
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Division of Medical-Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander R Haug
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Florian W Kiefer
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
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13
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Adel M, Fawzy A, Younes J, ElRasad S. Role of Positron Emission Tomography with 2-Deoxy-2-[fluorine-18]fluoro-D-glucose Integrated with Computed Tomography in the Evaluation of Hepatic Metabolic Activity due to Steatosis in Lymphoma Patients and its Impact on Deauville Score. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Liver uptake of 2-Deoxy-2-[fluorine-18]fluoro-D-glucose integrated (18F-FDG) is taken as the reference tissue in interpretation of Deauville score (DS), which is considered a response assessment.
AIM: This study was conducted to evaluate the prevalence of hepatic steatosis in patients with lymphoma and the impact of hepatic metabolic activity due to steatosis on 18F-FDG liver uptake and its effect on DS.
MATERIAL AND METHODS: This prospective study was conducted on 77 cases. Seventy-seven patients had baseline positron emission tomography/computed tomography (PET/CT), 69 patients had interim PET/CT, 31 patients had end of treatment (EOT) PET/CT, and 3 patients had follow-up (FU) PET/CT after EOT. The study included 49 female patients (63.6%) and 28 male patients (36.4%). The mean age = 39.5 + 13. Forty-one patients (53.2%) diagnosed as non-Hodgkin lymphoma [HL] while 36 patients (46.8%) diagnosed as HL. Steatosis was diagnosed on the unenhanced CT part of PET/CT examinations using a cutoff value of 42 Hounsfield units. Both maximum standardized uptake value (SUVmax) and SULmax were recorded on the liver and the tumor target lesion. DS was then computed.
RESULTS: Among 77 cases, prevalence of steatosis in baseline (10/77, 12.9%), interim (13/69, 18.8%), and EOT/FU (4/31, 12.9%), there was no significant difference in hepatic steatosis during their time course of their treatment. There was correlation between Liver SUVmax with body mass index (BMI) in each of interim and EOT PET/CT. Regarding SULmax, there was no correlation with BMI. There was no change in interpretation of DS using either SUVmax or SULmax.
CONCLUSION: Steatosis has no practical issue regarding liver metabolic activity (either SUVmax or SULmax) in interpretation of DS. Liver SUVmax is affected by body weight. Unlike, SULmax is not affected by body weight.
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ALTUNTUZCU Ş, GUZEL F, UYAR A, KAPLAN İ, GÜZEL Y, TAŞDEMİR B, YALÇIN K. Is there a relationship between the liver SUVmax values in FDG-PET/CT imaging and non-alcoholic fatty liver disease score? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.990487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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15
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Gonzalez-Cantero A, Teklu M, Sorokin AV, Prussick R, González-Cantero J, Martin-Rodriguez JL, Patel N, Parel PM, Manyak GA, Teague HL, Rodante JA, Keel A, Pérez-Hortet C, Sanchéz-Moya AI, Jiménez N, Ballester A, Solis J, Fernandez-Friera L, Barderas MG, Gonzalez-Calvin JL, Jaen P, Playford MP, Dey AK, Gelfand JM, Mehta NN. Subclinical Liver Disease is Associated with Subclinical Atherosclerosis in Psoriasis: Results from Two Observational Studies. J Invest Dermatol 2021; 142:88-96. [PMID: 34293354 DOI: 10.1016/j.jid.2021.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022]
Abstract
Psoriasis is associated with a higher risk of liver diseases. We investigated the impact of hepatic steatosis (European cohort) and hepatic inflammation (United States cohort) on subclinical atherosclerosis. In the European cohort (n=76 psoriasis participants and 76 controls), non-alcoholic fatty liver disease (NAFLD), assessed by the sonographic hepatorenal index (SHRI), was more prevalent in psoriasis than controls (61% vs 45%; p=.04). Psoriasis participants with NAFLD had a higher prevalence of subclinical atherosclerosis (ultrasonographic presence of plaque in femoral or carotid arteries) than psoriasis without NAFLD (61% vs 23%; p=.006) and controls with NAFLD (61% vs 32%; p<.05). SHRI was a determinant of subclinical atherosclerosis in psoriasis (OR, 3.5; p=.01). In the United States cohort, (n=162 psoriasis participants who underwent positron emission tomography and coronary CT angiography), those with high hepatic 18F-FDG uptake had higher noncalcified (1.3 (0.49 mm2) vs 1.0 (0.40 mm2)), fibrofatty (0.23 (0.15 mm2) vs 0.11 (0.087 mm2)), and lipid rich necrotic core (4.3 (2.3 mm2) vs 3.0 (1.7 mm2)) coronary burden (all p<.001,). Hepatic 18F-FDG uptake associated with noncalcified (β=0.28; p<.001), fibrofatty (β=0.49; p<.001) and lipid rich necrotic core (β=0.28; p=.003) burden. These results demonstrate the downstream cardiovascular effects of subclinical liver disease in psoriasis.
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Affiliation(s)
| | - Meron Teklu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexander V Sorokin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ronald Prussick
- Department of Dermatology, The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | - Nidhi Patel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philip M Parel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Grigory A Manyak
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew Keel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Ana I Sanchéz-Moya
- Department of Dermatology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Natalia Jiménez
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Asunción Ballester
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Jorge Solis
- Department of Cardiology, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | - Pedro Jaen
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel M Gelfand
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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16
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Otomi Y, Otsuka H, Shono N, Onishi H, Mitsuhashi R, Matsuzaki S, Takaoka Y, Enomoto H, Sakamoto Y, Sasahara M, Abe T, Shinya T, Harada M. A reduced physiological 18F-fluorodeoxyglucose uptake in the brain and liver caused by malignant lymphoma being deprived of the tracer. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 68:181-185. [PMID: 33994467 DOI: 10.2152/jmi.68.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose : To investigate whether or not the physiological brain and liver FDG uptake are decreased in patients with highly accelerated glycolysis lesions. Methods : We retrospectively analyzed 51 patients with malignant lymphoma. We compared the FDG uptake in the brain and liver of the patients with that in a control group. In 24 patients with a complete response (CR) or partial response (PR) to treatment, we compared the brain and liver uptake before and after treatment. Results : The maximum standardized uptake value (SUVmax) and total glycolytic volume (TGV) of the brain as well as the SUVmax and mean standardized uptake value (SUVmean) of the liver in malignant lymphoma patients were 13.1 ± 2.3, 7386.3 ± 1918.4, 3.2 ± 0.5, and 2.3 ± 0.4, respectively ; in the control group, these values were 14.9 ± 2.4, 8566.2 ± 1659.5, 3.4 ± 0.4, and 2.5 ± 0.3, respectively. The SUVmax and TGV of the brain and the SUVmean of the liver in malignant lymphoma patients were significantly lower than the control group. The SUVmax and TGV of the brain after treatment were significantly higher than before treatment. Both the SUVmax and SUVmean of liver after treatment were higher than before treatment, but not significant. Conclusion : A decreased physiological brain and liver FDG uptake is caused by highly accelerated lesion glycolysis. J. Med. Invest. 68 : 181-185, February, 2021.
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Affiliation(s)
- Yoichi Otomi
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Hideki Otsuka
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Nahomi Shono
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Hajime Onishi
- Department of Radiology, Tsurugi Municipal Handa Hospital, Tokushima, Japan
| | - Ryota Mitsuhashi
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Saya Matsuzaki
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Yukiko Takaoka
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Hideaki Enomoto
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Yuko Sakamoto
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Mihoko Sasahara
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Takashi Abe
- Department of Radiology, Nagoya University Hospital, Aichi, Japan
| | - Takayoshi Shinya
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
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17
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He X, Caoili EM, Avram AM, Miller BS, Else T. 18F-FDG-PET/CT Evaluation of Indeterminate Adrenal Masses in Noncancer Patients. J Clin Endocrinol Metab 2021; 106:1448-1459. [PMID: 33524123 PMCID: PMC8063258 DOI: 10.1210/clinem/dgab005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 01/17/2023]
Abstract
CONTEXT Adrenal tumors in noncancer patients are common. OBJECTIVE Evaluate performance of 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) in distinguishing between benign and malignant adrenal tumors. DESIGN Retrospective chart review 2010-2019. SETTING Academic institution. PATIENTS One hundred and seventeen noncancer patients, defined as having no history of cancer or with cancer in remission for ≥5 years, completed 18F-FDG-PET/CT to evaluate adrenal masses, with pathologic diagnoses or imaging follow-up (≥12 months). INTERVENTION 18F-FDG-PET/CT of 117 indeterminate adrenal masses. MAIN OUTCOME MEASURES Receiver operator characteristic curve of the ratios of adrenal lesion standardized uptake value (SUV)max to liver SUVmean and of adrenal lesion SUVmax to aortic arch blood pool SUVmean were constructed. RESULTS Seventy benign and 47 malignant masses (35 adrenocortical carcinomas [ACCs], 12 adrenal metastases) were identified. Malignant masses had higher median liver SUV and blood pool SUV ratios than benign masses (6.2 and 7.4 vs 1.4 and 2.0, P < .001). Median liver and blood pool SUV ratios of ACC (6.1 and 7.3, respectively) and metastases (6.7 and 7.7, respectively) were higher than those of than adenomas (1.4 and 2.2, P < .05 for all comparisons). Optimal liver SUV ratio to discern between benign and malignant masses was 2.5, yielding 85% sensitivity, 90% specificity, and 7 false negative results (including 3 ACCs). Optimal blood pool SUV ratio was 3.4, yielding 83% sensitivity, 90% specificity, and 8 false negative results (including 4 ACCs). CONCLUSION When used in conjunction with other clinical assessments, 18F-FDG-PET/CT can be a valuable tool in evaluating adrenal masses in noncancer patients.
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Affiliation(s)
- Xin He
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes University of Michigan, Ann Arbor, MI, USA
| | - Elaine M Caoili
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Barbra S Miller
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Tobias Else
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes University of Michigan, Ann Arbor, MI, USA
- Correspondence: Tobias Else, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Virarkar M, Szklaruk J, Jensen CT, Taggart MW, Bhosale P. What's New in Hepatic Steatosis. Semin Ultrasound CT MR 2021; 42:405-415. [PMID: 34130852 DOI: 10.1053/j.sult.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatic steatosis can lead to liver cancer, cirrhosis, and portal hypertension. There are two main types, non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease. The detection and quantification of hepatic steatosis with lifestyle changes can slow the evolution from NAFLD to steatohepatitis. Currently, the gold standard for the quantification of fat in the liver is biopsy, has some limitations. Hepatic steatosis is frequently detected during cross sectional imaging. Ultrasound (US), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) provide noninvasive assessment of liver parenchyma and can detect fat infiltration in the liver. However, the non-invasive quantification of hepatic steatosis by imaging has been challenging. Recent MRI techniques show great promise in the detection and quantification of liver fat. The aim of this article is to review the utilization of non-invasive imaging modalities for the detection and quantification of hepatic steatosis, to evaluate their advantages and limitations.
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Affiliation(s)
- Mayur Virarkar
- Department of Neuroradiology, The University of Texas Health Science Center, Houston, TX.
| | - Janio Szklaruk
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Corey T Jensen
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa W Taggart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Bhosale
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Monfort-Pires M, U-Din M, Nogueira GA, de Almeida-Faria J, Sidarta-Oliveira D, Sant'Ana MR, De Lima-Júnior JC, Cintra DE, de Souza HP, Ferreira SRG, Sapienza MT, Virtanen KA, Velloso LA. Short Dietary Intervention with Olive Oil Increases Brown Adipose Tissue Activity in Lean but not Overweight Subjects. J Clin Endocrinol Metab 2021; 106:472-484. [PMID: 33180910 DOI: 10.1210/clinem/dgaa824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The brown adipose tissue (BAT) is a potential target for the treatment of obesity and metabolic disorders. Its activation by cold exposure or adrenergic drugs can increase systemic insulin sensitivity and improve lipid metabolism; however, little is known about the effects of specific dietary components on BAT activity. OBJECTIVES We asked if a short-term (4 weeks) dietary intervention with olive oil could modify BAT activity in lean and overweight/obese volunteers. DESIGN This was a 4-week open clinical trial in which all participants underwent a dietary intervention with extra-virgin olive oil supplementation. As the initial intake of olive oil was controlled all the participants were controls of themselves. RESULTS The intervention resulted in significant increase in blood monounsaturated fatty acid levels, which was accompanied by increased BAT activity in lean but not in overweight/obese volunteers. In the lean group, an increase in leptin was detected after the intervention, and low leptin values at the beginning of the study were predictive of greater BAT activity after intervention. In addition, increase in leptin concentration was associated with increased BAT activity. Three known endogenous mediators of BAT activity, secretin, fibroblast growth factor 21 (FGF21), and 12,13-dihydroxy-9Z-octadecenoic acid (12,13-diHOME) were increased by intervention in lean, whereas only secretin and FGF21 were increased in subjects with excessive weight. CONCLUSION This study provides clinical evidence for the impact of monounsaturated fatty acids on BAT activity and an advance in the understanding of the beneficial health effects of olive oil.
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Affiliation(s)
- Milena Monfort-Pires
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Mueez U-Din
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Guilherme A Nogueira
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Juliana de Almeida-Faria
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Davi Sidarta-Oliveira
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marcella Ramos Sant'Ana
- Nutritional Genomics Laboratory, LabGeN, School of Applied Sciences, UNICAMP, Limeira, São Paulo, Brazil
| | - José C De Lima-Júnior
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Dennys E Cintra
- Nutritional Genomics Laboratory, LabGeN, School of Applied Sciences, UNICAMP, Limeira, São Paulo, Brazil
| | | | - Sandra R G Ferreira
- Department of Epidemiology, School of Public Health - University of São Paulo, São Paulo, SP, Brazil
| | - Marcelo Tatit Sapienza
- Division of Nuclear Medicine, Department of Radiology and Oncology, Medical School of University of São Paulo (FMUSP), São Paulo, Brazil
| | - Kirsi A Virtanen
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland (UEF), Kuopio, Finland
| | - Licio A Velloso
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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20
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Keramida G, Peters AM. FDG PET/CT of the non‐malignant liver in an increasingly obese world population. Clin Physiol Funct Imaging 2020; 40:304-319. [DOI: 10.1111/cpf.12651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Georgia Keramida
- Department of Nuclear Medicine Royal Brompton and HarefieldNHS Foundation Trust London UK
| | - A. Michael Peters
- Department of Nuclear Medicine King’s College HospitalNHS Foundation Trusts London UK
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Hu L, Shao X, Qiu C, Shao X, Wang X, Niu R, Wang Y. Hepatic steatosis is associated with abnormal hepatic enzymes, visceral adiposity, altered myocardial glucose uptake measured by 18F-FDG PET/CT. BMC Endocr Disord 2020; 20:75. [PMID: 32460891 PMCID: PMC7254706 DOI: 10.1186/s12902-020-00556-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease that affects the liver and a variety of extra-hepatic organ systems. This study aimed to investigate the relationship between hepatic steatosis and glucose metabolism in liver and extra-hepatic tissues and organs. METHODS The whole body 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) images of 191 asymptomatic tumor screening patients were retrospectively analyzed. Patients with the ratio of spleen/liver CT densities > 1.1 were defined to have NAFLD, and their clinical symptoms, laboratory markers, FDG uptake in a variety of tissues and organs including heart, mediastinal blood pool, liver, spleen, pancreas, and skeletal muscle, as well as abdominal adipose tissue volumes including visceral adipose tissue (VAT) volume and subcutaneous adipose tissue (SAT) volume were compared with those of the non-NAFLD patients and used to analyze the independent correlation factors of NAFLD. RESULTS Among the 191 patients, 33 (17.3%) were NAFLD, and 158 (82.7%) were non-NAFLD. There was no significant correlation between the mean standardized uptake value (SUVmean) and CT density of liver as well as the ratio of spleen/liver CT densities. Hepatic steatosis, but not FDG intake, was more significant in NAFLD patients with abnormal liver function than those with normal liver function. Compared with the non-NAFLD patients, NAFLD patients had significantly reduced myocardial glucose metabolism, but significantly increased mediastinal blood pool, spleen SUVmean and abdominal adipose tissue volumes (including VAT and SAT volumes) (P < 0.05). Multivariate regression analysis showed that elevated serum ALT, increased abdominal VAT volume, and decreased myocardial FDG uptake were independent correlation factors for NAFLD. Further studies showed that hepatic steatosis and myocardial FDG uptake were mildly linearly correlated (r = 0.366 with hepatic CT density and - 0.236 with the ratio of spleen/liver CT densities, P < 0.05). CONCLUSIONS NAFLD is a systemic disease that can lead to the change of glucose metabolism in some extra-hepatic tissues and organs, especially the myocardium.
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Affiliation(s)
- Lijun Hu
- Department of Radiation Oncology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, 213003 Jiangsu China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 Jiangsu China
| | - Chun Qiu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 Jiangsu China
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 Jiangsu China
| | - Xiaosong Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 Jiangsu China
| | - Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 Jiangsu China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 Jiangsu China
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Effects of dipeptidyl peptidase 4 inhibition on inflammation in atherosclerosis: A 18F-fluorodeoxyglucose study of a mouse model of atherosclerosis and type 2 diabetes. Atherosclerosis 2020; 305:64-72. [PMID: 32386751 DOI: 10.1016/j.atherosclerosis.2020.03.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Dipeptidyl peptidase 4 (DPP-4) inhibitors have anti-inflammatory and atheroprotective effects. We evaluated the effects of the DPP-4 inhibitor linagliptin on atherosclerotic plaque and hepatic inflammation using histology and 2-deoxy-2-[18F]-fluoro-d-glucose (18F-FDG), a positron emission tomography tracer of inflammation, in a mouse model of hypercholesterolemia and type 2 diabetes. METHODS Igf2/Ldlr-/-Apob100/100 mice were fed a high-fat diet (HFD) for 8 weeks and then randomly allocated to receive HFD (n = 14), or HFD with added linagliptin (n = 15) for additional 12 weeks. Five mice fed a chow diet were studied as an additional control. At the end of the study, glucose tolerance, aortic and liver uptake of 18F-FDG, and histology were studied. RESULTS Mice in linagliptin and HFD groups had similar fasting glucose concentrations, but linagliptin improved glucose tolerance. Aortas of linagliptin and HFD groups showed advanced atherosclerotic plaques with no difference in the mean intima-to-media ratio or number of macrophages in the plaques. Autoradiography showed similar 18F-FDG uptake by atherosclerotic plaques in linagliptin and HFD groups (plaque-to-wall ratio: 1.7 ± 0.25 vs. 1.6 ± 0.21; p = 0.24). In the liver, linagliptin reduced the histologic inflammation score but had no effect on 18F-FDG uptake. Compared with chow diet, uptake of 18F-FDG was similar in the aorta, but higher in the liver after HFD. CONCLUSIONS Linagliptin therapy improved glucose tolerance and reduced hepatic inflammation but had no effect on plaque burden or atherosclerotic inflammation, as determined by histology and 18F-FDG uptake, in atherosclerotic mice with type 2 diabetes.
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Lee SF, Schlicht S, Sutherland T. Non-alcoholic steatohepatitis mimicking solitary liver metastasis. J Med Imaging Radiat Oncol 2020; 64:73-74. [PMID: 31889389 DOI: 10.1111/1754-9485.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/03/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Su-Faye Lee
- Medical Imaging Department, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Stephen Schlicht
- Medical Imaging Department, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Tom Sutherland
- Medical Imaging Department, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Keramida G, Roldao Pereira L, Kaya G, Peters AM. Hepatic and splenic
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F‐FDG blood clearance rates (Ki) in hepatic steatosis and diabetes mellitus. Clin Physiol Funct Imaging 2019; 40:99-105. [DOI: 10.1111/cpf.12610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Georgia Keramida
- Clinical Imaging Sciences Centre Brighton and Sussex Medical School Brighton UK
| | - Luisa Roldao Pereira
- Department of Nuclear Medicine Brighton and Sussex University Hospitals NHS Trust Brighton UK
| | - Guven Kaya
- Department of Nuclear Medicine Brighton and Sussex University Hospitals NHS Trust Brighton UK
| | - A. Michael Peters
- Clinical Imaging Sciences Centre Brighton and Sussex Medical School Brighton UK
- Department of Nuclear Medicine Brighton and Sussex University Hospitals NHS Trust Brighton UK
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Zuo Y, Sarkar S, Corwin MT, Olson K, Badawi RD, Wang G. Structural and practical identifiability of dual-input kinetic modeling in dynamic PET of liver inflammation. Phys Med Biol 2019; 64:175023. [PMID: 31051490 DOI: 10.1088/1361-6560/ab1f29] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dynamic 18F-FDG PET with tracer kinetic modeling has the potential to noninvasively evaluate human liver inflammation using the FDG blood-to-tissue transport rate K 1. Accurate kinetic modeling of dynamic liver PET data and K 1 quantification requires the knowledge of dual-blood input function from the hepatic artery and portal vein. While the arterial input function can be derived from the aortic region on dynamic PET images, it is difficult to extract the portal vein input function accurately from PET images. The optimization-derived dual-input kinetic modeling approach has been proposed to overcome this problem by jointly estimating the portal vein input function and FDG tracer kinetics from time activity curve fitting. In this paper, we further characterize the model properties by analyzing the structural identifiability of the model parameters using the Laplace transform and practical identifiability using computer simulation based on fourteen patient datasets. The theoretical analysis has indicated that all the kinetic parameters of the dual-input kinetic model are structurally identifiable, though subject to local solutions. The computer simulation results have shown that FDG K 1 can be estimated reliably in the whole-liver region of interest with reasonable bias, standard deviation, and high correlation between estimated and original values, indicating of practical identifiability of K 1. The result has also demonstrated the correlation between K 1 and histological liver inflammation scores is reliable. FDG K 1 quantification by the optimization-derived dual-input kinetic model is promising for assessing liver inflammation.
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Affiliation(s)
- Yang Zuo
- Department of Radiology, University of California at Davis, Sacramento, CA 95817, United States of America
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Diffusely Decreased Liver Uptake on FDG PET and Cancer-Associated Cachexia With Reduced Survival. Clin Nucl Med 2019; 44:634-642. [PMID: 31274609 DOI: 10.1097/rlu.0000000000002658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES We investigated clinical characteristics of patients with extremely increased or decreased physiologic F-FDG uptake of the liver and their prognosis. METHODS One thousand four hundred eighty-seven PET/CT scans of patients with known or suspected malignancy were retrospectively analyzed. A spherical volume of interest (3 cm in diameter) was set on the right lobe of the liver to calculate the SUVmean. Scans with extremely high (SUVmean >97.5th percentile) and low (SUVmean <2.5th percentile) FDG uptake in the liver were evaluated. Physical and laboratory data among a control group (n = 30), the extremely high liver uptake group (HG, n = 36), and the extremely low liver uptake group (LG, n = 36) were compared. Overall survival (OS) of the 3 groups was also compared. RESULTS Body weight and body mass index in the HG (SUVmean ≥3.04) were significantly higher than those in the control group. The LG cases (SUVmean ≤1.78) had anemia, impaired liver function, and systemic inflammation. They were also in a poor nutritional state. The characteristics of LG cases had many things in common with those of cachectic patients. Indeed, 36.1% of LG cases met the diagnostic criteria for cachexia. Moreover, in LG cases with viable and/or recurrent malignant lesions on FDG PET, the proportion of cachexia increased by 52.6%. The OS of LG cases (median, 33 months) was significantly worse than that of controls and HG cases. CONCLUSIONS Our data indicate that cancer patients with extremely decreased liver FDG uptake were likely to have cancer cachexia and a lower OS.
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Intrahepatic fluorine-18-fluorodeoxyglucose kinetics measured by least squares nonlinear computer modelling and Gjedde–Patlak–Rutland graphical analysis. Nucl Med Commun 2019; 40:675-683. [DOI: 10.1097/mnm.0000000000001023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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28
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Otomi Y, Otsuka H, Terazawa K, Kondo M, Arai Y, Yamanaka M, Otomo M, Abe T, Shinya T, Harada M. A reduced liver 18F-FDG uptake may be related to hypoalbuminemia in patients with malnutrition. Ann Nucl Med 2019; 33:689-696. [DOI: 10.1007/s12149-019-01377-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/09/2019] [Indexed: 01/18/2023]
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Tissue standardized uptake value is a closer surrogate of blood fluorine-18 fluorodeoxyglucose clearance after division by blood standardized uptake value, illustrated in brain and liver. Nucl Med Commun 2019; 40:552-554. [PMID: 30973842 DOI: 10.1097/mnm.0000000000001003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The numerator and denominator of the left-hand side of the Gjedde-Patlak-Rutland (GPR) equation for measurement of blood fluorine-18 fluorodeoxyglucose (F-FDG) clearance into tissue (Ki) are the standardized uptake values (SUVs) of tissue and blood, respectively. The extent to which normalized time (NT) in the GPR equation exceeds real time depends on half-time of clearance of F-FDG from blood. A literature review shows that NT is fairly constant, about 100 min at 60 min postinjection of F-FDG, in keeping with our own finding of no significant difference in maximum SUV in blood 60 min postinjection of F-FDG between 39 patients with F-FDG-avid malignancy on routine PET/CT (1.74±0.31) and 21 patients with normal PET/CT (1.79±0.32), and similar blood glucose levels (BGLs). Volume of distribution (V0) in the GPR equation is ∼0.4 ml/ml for brain and ∼0.9 ml/ml for lean liver. Using these values of V0 and an NT of 100 min, we used the GPR equation to calculate Ki from our own published values of SUVliver/SUVblood and SUVbrain/SUVblood at 60 min postinjection, obtaining 0.0045 ml/min/ml for liver and 0.036 ml/min/ml for brain at BGL of 5 mmol/l. These values for Ki at this BGL are close to literature values of Ki, which for liver and brain are ∼0.0033 and ∼0.035 ml/min/ml, respectively. We conclude, therefore, that following division with blood pool SUV, tissue SUV becomes a closer surrogate of Ki. This division also eliminates the controversy over which whole body metric to use in the calculation of SUV.
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Hepatic Angiomyolipoma Having FDG Uptake at the Similar Level of the Normal Liver Parenchyma. Clin Nucl Med 2019; 44:599-601. [DOI: 10.1097/rlu.0000000000002551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Relationship between regional hepatic glucose metabolism and regional distribution of hepatic fat. Nucl Med Commun 2019; 40:212-218. [DOI: 10.1097/mnm.0000000000000968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Dynamics of fluorine-18-fluorodeoxyglucose uptake in the liver and its correlation with hepatic fat content and BMI. Nucl Med Commun 2019; 40:545-551. [PMID: 30807535 DOI: 10.1097/mnm.0000000000001000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to explore the rate of elimination of fluorine-18-fluorodeoxyglucose (F-FDG) from the liver and assess the impact of hepatic fat and obesity on F-FDG clearance in early and delayed PET scans. We hypothesized that an increase in liver fat may cause a decline in hepatic F-FDG elimination with potential consequences as measured by dual time-point F-FDG PET/CT imaging. PATIENTS AND METHODS A total of 32 patients from the Cardiovascular Molecular Calcification Assessed by F-NaF PET/CT (CAMONA) clinical trial (17 males, 15 females; mean age: 47.2 years, range: 23-69 years, mean BMI: 27.2 kg/m) were enrolled and underwent F-FDG PET/CT 90 and 180 min after tracer injection. Global mean standardized uptake value (SUVmean) (i.e. the average of SUVmean in segmented liver slices) and average maximum standardized uptake value (SUVmax) (i.e. the average of the SUVmax values recorded in same slices) were calculated for semiquantification of liver F-FDG uptake at both time-points. Percentage difference in global SUVmean and average SUVmax were also calculated to yield respective retention indices (RImean and RImax). Changes in global SUVmean, average SUVmax, RImean, and RImax from 90 to 180 min were correlated with BMI and liver fat content as measured by CT Hounsfield units. RESULTS There was a 12.2±3.5 percent reduction in global liver SUVmean and a 4.1±5.8 percent reduction in average SUVmax at 180 min scan as compared with the 90 min time-point. RImean and RImax were inversely correlated with liver fat content and positively correlated with BMI. CONCLUSION We observed a time-dependent decrease in global hepatic SUVmean and average SUVmax, which was affected by the amount of liver fat. Patients with higher BMI and hepatic fat content tended to retain F-FDG.
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Abstract
Aim To compare weight, lean body mass and body surface area for calculation of standardised uptake value (SUV) in fluorine-18-fluorodeoxyglucose PET/computed tomography, taking sex into account. Patients and methods This was a retrospective study of 161 (97 men) patients. Maximum standardised uptake value (SUVmax) and mean standardised uptake value (SUVmean) were obtained from a 3-cm region of interest over the right lobe of the liver and scaled to weight, scaled to lean body mass (SUL) and scaled to body surface area (SUA). Mean hepatic computed tomography density was used to adjust SUVmean for hepatic fat (SUVFA). Hepatic SUV indices were divided by SUV from left ventricular cavity, thereby, eliminating whole body metric, to obtain a surrogate of blood fluorine-18-fluorodeoxyglucose clearance into liver, and multiplied by blood glucose to give a surrogate of hepatic glucose uptake rate (mSUV). Results SULmax, SUAmax and all scaled to weight indices correlated strongly with weight. SULmean, SULFA, SUAmean and SUAFA, however, correlated weakly or not at all with weight, nor with their corresponding whole body metric in men or women, but correlated strongly when the sexes were combined into one group. This was the result of sex differences in SUL (greater in men) and SUA (greater in women). There was, however, no sex difference in mSUV. Conclusion Weight is unsuitable for calculating SUV. SUL and SUA are also inappropriate as maxima but appropriate as mean and fat-adjusted values. However, SUL is recommended for both sexes because SUA is influenced by both body fat and weight. Sex differences in SUL and SUA give rise to misleading correlations when sexes are combined into one group.
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35
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Wang G, Corwin MT, Olson KA, Badawi RD, Sarkar S. Dynamic PET of human liver inflammation: impact of kinetic modeling with optimization-derived dual-blood input function. Phys Med Biol 2018; 63:155004. [PMID: 29847315 PMCID: PMC6105275 DOI: 10.1088/1361-6560/aac8cb] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The hallmark of nonalcoholic steatohepatitis is hepatocellular inflammation and injury in the setting of hepatic steatosis. Recent work has indicated that dynamic 18F-FDG PET with kinetic modeling has the potential to assess hepatic inflammation noninvasively, while static FDG-PET is less promising. Because the liver has dual blood supplies, kinetic modeling of dynamic liver PET data is challenging in human studies. This paper aims to identify the optimal dual-input kinetic modeling approach for dynamic FDG-PET of human liver inflammation. Fourteen patients with nonalcoholic fatty liver disease were included. Each patient underwent 1 h dynamic FDG-PET/CT scan and had liver biopsy within six weeks. Three models were tested for kinetic analysis: the traditional two-tissue compartmental model with an image-derived single-blood input function (SBIF), a model with population-based dual-blood input function (DBIF), and a new model with optimization-derived DBIF through a joint estimation framework. The three models were compared using Akaike information criterion (AIC), F test and histopathologic inflammation score. Results showed that the optimization-derived DBIF model improved liver time activity curve fitting and achieved lower AIC values and higher F values than the SBIF and population-based DBIF models in all patients. The optimization-derived model significantly increased FDG K1 estimates by 101% and 27% as compared with traditional SBIF and population-based DBIF. K1 by the optimization-derived model was significantly associated with histopathologic grades of liver inflammation while the other two models did not provide a statistical significance. In conclusion, modeling of DBIF is critical for dynamic liver FDG-PET kinetic analysis in human studies. The optimization-derived DBIF model is more appropriate than SBIF and population-based DBIF for dynamic FDG-PET of liver inflammation.
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Affiliation(s)
- Guobao Wang
- Department of Radiology, University of California at Davis, Sacramento CA 95817, USA
| | - Michael T. Corwin
- Department of Radiology, University of California at Davis, Sacramento CA 95817, USA
| | - Kristin A. Olson
- Department of Pathology and Laboratory Medicine, University of California at Davis, Sacramento CA 95817, USA
| | - Ramsey D. Badawi
- Department of Radiology, University of California at Davis, Sacramento CA 95817, USA
| | - Souvik Sarkar
- Department of Internal Medicine, University of California at Davis, Sacramento CA 95817, USA
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Keramida G, Peters AM. Fasting hepatic glucose uptake is higher in men than women. Physiol Rep 2018; 5:5/11/e13174. [PMID: 28583989 PMCID: PMC5471426 DOI: 10.14814/phy2.13174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/04/2017] [Accepted: 01/12/2017] [Indexed: 01/12/2023] Open
Abstract
Differences in glucose metabolism between men and women have previously been reported. Our purpose was to determine if there is a gender difference in fasting hepatic glucose uptake (MRglu). Fifty‐five patients (44 men, 11 women) referred for routine PET/CT using the glucose tracer 2‐deoxy‐2‐[F‐18]fluoro‐D‐glucose (FDG), mainly for cancer, had dynamic imaging for 30 min immediately following injection. Hepatic FDG clearance (mL/min/100 mL) was measured as gradient divided by intercept from Patlak–Rutland graphical analysis using a volume of interest over the abdominal aorta to record input function. Hepatic MRglu was obtained by multiplication of clearance by blood glucose concentration. Hepatic steatosis was diagnosed as CT density ≤40 HU. Mean (standard deviation) hepatic MRglu in 44 men was 2.30 (1.14) μmol/min/100 mL, significantly higher than in 11 women in whom it was 1.07 (1.35) μmol/min/100 mL (P = 0.003). CT density was 52 (12) HU in women compared with 45 (9) HU in men (P = 0.04), but there was no significant difference in blood glucose, BMI, or prevalence of recent chemotherapy (within 6 months preceding PET/CT). When patients were subdivided into those without hepatic steatosis (31 men/9 women), those without evidence of FDG‐avid malignancy on PET/CT (15/6), and those without either (11/5), gender differences in hepatic MRglu remained highly significant, but there were no significant differences in CT density, blood glucose, BMI, or recent chemotherapy history. Despite this being a population of clinically referred patients, the results strongly suggest that fasting hepatic MRglu is higher in men than in women.
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Affiliation(s)
- Georgia Keramida
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - A Michael Peters
- Division of Clinical and Laboratory Investigation, Brighton and Sussex Medical School, Brighton, United Kingdom
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Mancini M, Summers P, Faita F, Brunetto MR, Callea F, De Nicola A, Di Lascio N, Farinati F, Gastaldelli A, Gridelli B, Mirabelli P, Neri E, Salvadori PA, Rebelos E, Tiribelli C, Valenti L, Salvatore M, Bonino F. Digital liver biopsy: Bio-imaging of fatty liver for translational and clinical research. World J Hepatol 2018; 10:231-245. [PMID: 29527259 PMCID: PMC5838442 DOI: 10.4254/wjh.v10.i2.231] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/27/2018] [Accepted: 02/25/2018] [Indexed: 02/06/2023] Open
Abstract
The rapidly growing field of functional, molecular and structural bio-imaging is providing an extraordinary new opportunity to overcome the limits of invasive liver biopsy and introduce a "digital biopsy" for in vivo study of liver pathophysiology. To foster the application of bio-imaging in clinical and translational research, there is a need to standardize the methods of both acquisition and the storage of the bio-images of the liver. It can be hoped that the combination of digital, liquid and histologic liver biopsies will provide an innovative synergistic tri-dimensional approach to identifying new aetiologies, diagnostic and prognostic biomarkers and therapeutic targets for the optimization of personalized therapy of liver diseases and liver cancer. A group of experts of different disciplines (Special Interest Group for Personalized Hepatology of the Italian Association for the Study of the Liver, Institute for Biostructures and Bio-imaging of the National Research Council and Bio-banking and Biomolecular Resources Research Infrastructure) discussed criteria, methods and guidelines for facilitating the requisite application of data collection. This manuscript provides a multi-Author review of the issue with special focus on fatty liver.
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Affiliation(s)
- Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council, Naples 80145, Italy
| | - Paul Summers
- European Institute of Oncology (IEO) IRCCS, Milan 20141, Italy
| | - Francesco Faita
- Institute of Clinical Physiology (IFC), National Research Council (CNR), Pisa 56124, Italy
| | - Maurizia R Brunetto
- Hepatology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56125, Italy
| | - Francesco Callea
- Department of Pathology, Children Hospital Bambino Gesù IRCCS, Rome 00165, Italy
| | | | - Nicole Di Lascio
- Institute of Clinical Physiology (IFC), National Research Council (CNR), Pisa 56124, Italy
| | - Fabio Farinati
- Department of Gastroenterology, Oncology and Surgical Sciences, University of Padua, Padua 35121, Italy
| | - Amalia Gastaldelli
- Cardio-metabolic Risk Laboratory, Institute of Clinical Physiology (IFC), National Research Council (CNR), Pisa 56124, Italy
| | - Bruno Gridelli
- Institute for Health, University of Pittsburgh Medical Center (UPMC), Chianciano Terme 53042, Italy
| | | | - Emanuele Neri
- Diagnostic Radiology 3, Department of Translational Research, University of Pisa and "Ospedale S. Chiara" AOUP, Pisa 56126, Italy
| | - Piero A Salvadori
- Institute of Clinical Physiology (IFC), National Research Council (CNR), Pisa 56124, Italy
| | - Eleni Rebelos
- Hepatology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56125, Italy
| | - Claudio Tiribelli
- Fondazione Italiana Fegato (FIF), Area Science Park, Campus Basovizza, Trieste 34012, Italy
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano and Department of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milan 20122, Italy
| | | | - Ferruccio Bonino
- Institute of Biostructure and Bioimaging, National Research Council, Naples 80145, Italy
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Dimitriu-Leen AC, Scholte AJHA. Hepatic FDG uptake in patients with NAFLD: An important prognostic factor for cardio-cerebrovascular events? J Nucl Cardiol 2017; 24:900-902. [PMID: 26728014 PMCID: PMC5491629 DOI: 10.1007/s12350-015-0380-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Aukelien C Dimitriu-Leen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands.
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Moon SH, Hong SP, Cho YS, Noh TS, Choi JY, Kim BT, Lee KH. Hepatic FDG uptake is associated with future cardiovascular events in asymptomatic individuals with non-alcoholic fatty liver disease. J Nucl Cardiol 2017; 24:892-899. [PMID: 26510948 DOI: 10.1007/s12350-015-0297-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/27/2015] [Accepted: 09/19/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hepatic F-18 fluoro-2-deoxyglucose (FDG) uptake is associated with non-alcoholic fatty liver disease (NAFLD) which is an independent risk factor for cardiovascular disease. However, the value of hepatic FDG uptake for predicting future cardiovascular events has not been explored. METHODS AND RESULTS Study participants were 815 consecutive asymptomatic participants who underwent a health screening program that included FDG positron emission tomography/computed tomography (PET/CT), abdominal ultrasonography, and carotid intima-media thickness (CIMT) measurements (age 51.8 ± 6.0 year; males 93.9%). We measured hepatic FDG uptake and assessed the prognostic significance of this parameter with other cardiovascular risk factors including Framingham risk score and CIMT. Multivariate Cox proportional hazards analyses including all study participants revealed that NAFLD with high-hepatic FDG uptake was the only independent predictor for future cardiovascular events [hazard ratio (HR) 4.23; 95% CI 1.05-17.04; P = .043). Subgroup analysis conducted in the NAFLD group showed that high-hepatic FDG uptake was a significant independent predictor of cardiovascular events (HR 9.29; 95% CI 1.05-81.04; P = .045). CONCLUSIONS This exploratory study suggests that high-hepatic FDG uptake may be a useful prognostic factor for cardiovascular events in individuals with NAFLD.
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Affiliation(s)
- Seung Hwan Moon
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Sun-Pyo Hong
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Young Seok Cho
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Tae Soo Noh
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea.
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Keramida G, Peters AM. New exponential functions based on CT density to estimate the percentage of liver that is fat. Br J Radiol 2017; 90:20170186. [PMID: 28541123 DOI: 10.1259/bjr.20170186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE In fluorine-18 fludeoxyglucose positron emission tomography/CT, hepatic standardized uptake value (SUV) is reduced through "signal dilution" by hepatic fat. The maximum SUV (SUVmax) is less affected than the mean SUV (SUVmean), therefore SUVmax/SUVmean correlates with hepatic fat. The SUV can be corrected for signal dilution using an equation relating CT density (CTD) to %fat. The objective was to exploit the relationship between SUV indices and CTD to assess the validity of two previously published equations (one linear and one sigmoid) for estimating %fat from CTD and two new exponential equations. METHODS Study population comprised 465 patients having routine fluorine-18 fludeoxyglucose positron emission tomography/CT. The SUVmax, SUVmean and CTD were measured from a 3-cm-diameter region of interest over the liver. The exponential equations assumed that 100% fat corresponds to CTD of -50 or -100 HU. The proportion of liver occupied by fat (PF) was estimated from all four equations. Then fat-corrected SUVmean is SUVmean/(1 - PF). The ideal equation should give SUVmean approaching but not exceeding SUVmax and give fat-corrected SUVmean/SUVmax that shows no correlation with CTD. RESULTS The linear equation failed at CTD values exceeding 55.8 HU because it gave negative PF values. Moreover, fat-corrected SUVmean/SUVmax still correlated with CTD. The sigmoid equation grossly overcorrected SUVmean at low CTD. The exponential equations abolished the correlation between fat-corrected SUVmean/SUVmax and CTD. CONCLUSION The sigmoid equation is unsuitable for estimating %fat from CTD. The linear equation performed well, but the exponential equation assuming that 100% fat corresponds to -50 HU performed best. Advances in knowledge: Improved (exponential) equations to estimate hepatic fat from hepatic CTD.
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Venkatesh SK, Hennedige T, Johnson GB, Hough DM, Fletcher JG. Imaging patterns and focal lesions in fatty liver: a pictorial review. Abdom Radiol (NY) 2017; 42:1374-1392. [PMID: 27999887 DOI: 10.1007/s00261-016-1002-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Non-alcoholic fatty liver disease is the most common cause of chronic liver disease and affects nearly one-third of US population. With the increasing trend of obesity in the population, associated fatty change in the liver will be a common feature observed in imaging studies. Fatty liver causes changes in liver parenchyma appearance on imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) and may affect the imaging characteristics of focal liver lesions (FLLs). The imaging characteristics of FLLs were classically described in a non-fatty liver. In addition, focal fatty change and focal fat sparing may also simulate FLLs. Knowledge of characteristic patterns of fatty change in the liver (diffuse, geographical, focal, subcapsular, and perivascular) and their impact on the detection and characterization of FLL is therefore important. In general, fatty change may improve detection of FLLs on MRI using fat suppression sequences, but may reduce sensitivity on a single-phase (portal venous) CT and conventional ultrasound. In patients with fatty liver, MRI is generally superior to ultrasound and CT for detection and characterization of FLL. In this pictorial essay, we describe the imaging patterns of fatty change in the liver and its effect on detection and characterization of FLLs on ultrasound, CT, MRI, and PET.
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Keramida G, Anagnostopoulos CD, Peters AM. The extent to which standardized uptake values reflect FDG phosphorylation in the liver and spleen as functions of time after injection of 18F-fluorodeoxyglucose. EJNMMI Res 2017; 7:13. [PMID: 28176243 PMCID: PMC5296268 DOI: 10.1186/s13550-017-0254-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 01/23/2023] Open
Abstract
Purpose In FDG PET/CT, standardized uptake value (SUV) is used to measure metabolic activity but detects un-phosphorylated FDG as well as phosphorylated FDG (FDG6P). Our aim was to determine the proportions of intrahepatic and intrasplenic FDG that are phosphorylated after FDG injection and compare them with SUVs. Methods Sixty patients undergoing whole-body PET/CT 60 min post-injection of FDG first had dynamic PET imaging for 30 min with measurement of hepatic and splenic FDG clearances using Patlak-Rutland analysis. The gradient of the Patlak-Rutland plot, which is proportional to clearance (Ki), was normalized to the intercept, which is proportional to FDG distribution volume (V(0)) with the same proportionality constant. Using measured values of Ki/V(0), FDG6P/FDG ratios as functions of time in the two organs were measured for assumed FDG blood disappearance half-times of 40, 50 and 60 min. Hepatic and splenic SUVs were measured from whole-body PET/CT. Results The mean (SD) Ki/V(0) was 0.0036 (0.0021) and 0.0060 (0.0041) ml/min/ml for the liver and spleen, respectively, but the hepatic SUV was 1.36-fold higher than the splenic SUV. This discrepancy was explained by the hepatic V(0) being 1.6-fold higher than the splenic V(0). The percentages of FDG phosphorylated 60 min post-injection were 27, 25 and 23% for the liver and 39, 36 and 34% for the spleen, for blood clearance half-times of 40, 50 and 60 min, respectively. SUV indices correlated poorly with Ki/V(0) for both organs. Conclusions SUV is largely determined by un-phosphorylated FDG in dynamic exchange with blood FDG, explaining the poor correlations between SUV indices and Ki/V(0).
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Affiliation(s)
- Georgia Keramida
- Clinical Imaging Sciences Centre, Brighton Sussex Medical School, Brighton, UK
| | - Constantinos D Anagnostopoulos
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - A Michael Peters
- Clinical Imaging Sciences Centre, Brighton Sussex Medical School, Brighton, UK. .,Department of Nuclear Medicine, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
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Feasibility of Preoperative FDG PET/CT Total Hepatic Glycolysis in the Remnant Liver for the Prediction of Postoperative Liver Function. AJR Am J Roentgenol 2016; 208:624-631. [PMID: 28026972 DOI: 10.2214/ajr.16.16450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of our study was to investigate the prognostic value of total glycolysis of the remnant liver, which reflects both metabolic and anatomic liver function, for predicting postoperative hepatic insufficiency. MATERIALS AND METHODS Patients who underwent 18F-FDG PET/CT and abdominal CT within 1 month of major hepatectomy were retrospectively analyzed. Total liver volume, remnant liver volume, the ratio of the remnant hepatic volume to the preoperative hepatic volume (RFRHV), and mean standardized uptake value (SUVmean) were measured, and total glycolysis of the remnant liver was calculated. Clinical hepatic function reserve values, including the indocyanine green retention rate at 15 minutes, the model for end-stage liver disease (MELD) score, and aspartate aminotransferase to platelet ratio index (APRI), were calculated. Univariate and multivariate analyses were performed, and an optimal model for predicting hepatic insufficiency was developed. ROC curves were used to compare diagnostic performance. RESULTS Of 149 patients, seven patients had hepatic insufficiency. The SUVmean showed the highest sensitivity (100%; specificity, 31.7%) for predicting hepatic insufficiency, and total glycolysis of the remnant liver showed the highest specificity (96.5%; sensitivity, 57.1%) for predicting hepatic insufficiency. On multivariate analysis, the odds ratio of APRI (> 5.4) and total glycolysis of the remnant liver (≤ 625.6) was 46.3 and 82.9, respectively, for predicting hepatic insufficiency. On ROC curve analysis, a new model composed of APRI and total glycolysis of the remnant liver showed a higher area under the ROC curve (Az) value (Az = 0.899) than SUVmean (0.659), MELD score (0.618), APRI (0.693), RFRHV (0.797), and remnant liver volume (0.762). CONCLUSION The total glycolysis of the remnant liver has moderate sensitivity and high specificity for predicting hepatic insufficiency. Combining the total glycolysis of the remnant liver and APRI yielded the best diagnostic performance for predicting hepatic insufficiency.
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Hepatic glucose utilization in hepatic steatosis and obesity. Biosci Rep 2016; 36:BSR20160381. [PMID: 27653524 PMCID: PMC5293565 DOI: 10.1042/bsr20160381] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/15/2016] [Accepted: 09/21/2016] [Indexed: 12/21/2022] Open
Abstract
Hepatic steatosis is associated with obesity and insulin resistance. Whether hepatic glucose utilization rate (glucose phosphorylation rate; MRglu) is increased in steatosis and/or obesity is uncertain. Our aim was to determine the separate relationships of steatosis and obesity with MRglu. Sixty patients referred for routine PET/CT had dynamic PET imaging over the abdomen for 30 min post-injection of F-18-fluorodeoxyglucose (FDG), followed by Patlak-Rutland graphical analysis of the liver using abdominal aorta for arterial input signal. The plot gradient was divided by the intercept to give hepatic FDG clearance normalized to hepatic FDG distribution volume (ml/min per 100 ml) and multiplied by blood glucose to give hepatic MRglu (μmol/min per 100 ml). Hepatic steatosis was defined as CT density of ≤40 HU measured from the 60 min whole body routine PET/CT and obesity as body mass index of ≥30 kg/m2 Hepatic MRglu was higher in patients with steatosis (3.3±1.3 μmol/min per 100 ml) than those without (1.7±1.2 μmol/min per 100 ml; P<0.001) but there was no significant difference between obese (2.5±1.6 μmol/min per 100 ml) and non-obese patients (2.1±1.3 μmol/min per 100 ml). MRglu was increased in obese patients only if they had steatosis. Non-obese patients with steatosis still had increased MRglu. There was no association between MRglu and chemotherapy history. We conclude that MRglu is increased in hepatic steatosis probably through insulin resistance, hyperinsulinaemia and up-regulation of hepatic hexokinase, irrespective of obesity.
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Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis. J Hepatol 2016; 65:589-600. [PMID: 27212244 DOI: 10.1016/j.jhep.2016.05.013] [Citation(s) in RCA: 840] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/30/2016] [Accepted: 05/09/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS There have been many studies of the effects of non-alcoholic fatty liver disease (NAFLD) and the risk of cardiovascular disease (CVD), but these have produced conflicting results. We performed a meta-analysis of these studies to quantify the magnitude of the association between NAFLD (and NAFLD severity) and risk of CVD events. METHODS We searched PubMed, Google scholar, and Web of Science databases using terms "NAFLD", "cardiovascular events", "cardiovascular mortality", "prognosis" and their combinations to identify observational studies published through January 2016. We included only observational studies conducted in adults >18years and in which NAFLD was diagnosed on imaging or histology. Data from selected studies were extracted and meta-analysis was then performed using random effects modelling. RESULTS A total of 16 unique, observational prospective and retrospective studies with 34,043 adult individuals (36.3% with NAFLD) and approximately 2,600 CVD outcomes (>70% CVD deaths) over a median period of 6.9years were included in the final analysis. Patients with NAFLD had a higher risk of fatal and/or non-fatal CVD events than those without NAFLD (random effect odds ratio [OR] 1.64, 95% CI 1.26-2.13). Patients with more 'severe' NAFLD were also more likely to develop fatal and non-fatal CVD events (OR 2.58; 1.78-3.75). Sensitivity analyses did not alter these findings. Funnel plot and Egger's test did not reveal significant publication bias. CONCLUSIONS NAFLD is associated with an increased risk of fatal and non-fatal CVD events. However, the observational design of the studies included does not allow to draw definitive causal inferences. LAY SUMMARY The data on whether NAFLD by itself is associated with increased cardiovascular events and death remains an issue of debate. The findings of this updated and large meta-analysis of observational studies indicate that NAFLD is significantly associated with an increased risk of fatal and non-fatal cardiovascular events. However, the observational design of the studies included does not allow us to prove that NAFLD causes cardiovascular disease. Clinicians who manage patients with NAFLD should not focus only on liver disease but should also consider the increased risk of cardiovascular disease and undertake early, aggressive risk factor modification.
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Affiliation(s)
- Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, UK
| | - Amedeo Lonardo
- Outpatient Liver Clinic and Division of Internal Medicine, Department of Biomedical, Metabolic and Neural Sciences, NOCSAE, Azienda USL and University of Modena and Reggio Emilia, Baggiovara, Modena, Italy
| | - Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
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Ozaki K, Harada K, Terayama N, Matsui O, Saitoh S, Tomimaru Y, Fujii T, Gabata T. Hepatocyte nuclear factor 1α-inactivated hepatocellular adenomas exhibit high (18)F-fludeoxyglucose uptake associated with glucose-6-phosphate transporter inactivation. Br J Radiol 2016; 89:20160265. [PMID: 27197745 DOI: 10.1259/bjr.20160265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This immunohistochemical study aimed to elucidate the molecular mechanism underlying the increased fluorine-18 fludeoxyglucose (FDG) uptake in hepatocyte nuclear factor 1α (HNF1α)-inactivated hepatocellular adenomas (H-HCAs). METHODS Three resected H-HCAs were studied using FDG positron emission tomography. Each maximum standardized uptake value (SUVmax) was determined. Resected samples were subjected to immunohistochemical staining for the following glucose metabolism-related proteins: glucose transporter 1 (GLUT1) and glucose transporter 2 (GLUT2), indicative of uptake and transport of glucose into cellular cytoplasm; hexokinase 2 (HK2) and hexokinase 4 (HK4), glucose phosphorylation; glucose-6-phosphate transporter 1 (G6PT1), uptake and transport of glucose-6-phosphate into endoplasmic reticulum; and glucose-6-phosphatase (G6Pase), dephosphorylation. RESULTS All three H-HCAs exhibited increased FDG intake, with an average SUVmax of 6.6 (range: 5.2-8.2). No sample expressed GLUT1 and HK2; all the samples exhibited equivalent GLUT2 and HK4 expression, equivalent or slightly increased G6Pase expression and significantly decreased G6PT1 expression relative to the non-neoplastic hepatocytes of background liver. CONCLUSION The increased FDG uptake observed in H-HCAs is associated with GLUT2 and HK4 expression and G6PT1 inactivation. ADVANCES IN KNOWLEDGE H-HCA exhibits a high FDG uptake owing to the inactivation of G6PT1, which is transcriptionally regulated by HNF1α.
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Affiliation(s)
- Kumi Ozaki
- 1 Department of Radiology, Takaoka City Hospital, Takaoka, Japan.,Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Noboru Terayama
- 1 Department of Radiology, Takaoka City Hospital, Takaoka, Japan
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Satoshi Saitoh
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Yoshito Tomimaru
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Keramida G, Dunford A, Siddique M, Cook GJ, Peters AM. Relationships of body habitus and SUV indices with signal-to-noise ratio of hepatic (18)F-FDG PET. Eur J Radiol 2016; 85:1012-5. [PMID: 27130064 DOI: 10.1016/j.ejrad.2016.02.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Tissue accumulation of (18)F-FDG is quantified as standardised uptake value (SUV), which may be expressed as the voxel maximum (SUVmax) or mean (SUVmean). SUVmax/SUVmean may be a marker of hepatic steatosis, while the coefficient of variation (CV) of SUV may be a marker of hepatic fat distribution heterogeneity (HFDH). Alternatively, they may reflect low signal-to-noise ratio ('noise') in obese persons in whom hepatic steatosis is common. The study aim was to compare the impact of body size on noise versus SUV and CT density (CTD). METHODS Dynamic PET was performed (30×1min frames) following FDG injection in 60 patients undergoing routine PET/CT. Hepatic FDG clearance was measured using Patlak-Rutland graphical analysis with abdominal aorta as input. Noise was quantified as the standard deviation (SD) of the plot residuals (ignoring the first 2 frames), normalised to the intercept (NRMSD). SUVmax, SUVmean and CTD were measured from 60min whole body PET/CT. CV of SUV and SD of CTD were quantified in 28/60 patients using texture analysis. RESULTS NRMSD correlated with weight (r=0.49; p<0.0001) and BMI (r=0.48; p=0.0001). SUVmax, SUVmean, SUVmax/SUVmean, CV of SUV, CTD, and SD of CTD all correlated strongly with weight and BMI (p<0.0001). However, they correlated weakly with NRMSD, the strongest being SUVmax (r=0.34; p=0.008) and SD of CTD (r=0.42; n=28; p=0.026). CONCLUSIONS Noise is increased in overweight/obese persons but has little effect on SUV indices, CTD and their variabilities. SUVmax/SUVmean and CV of SUV are therefore, to some extent, markers of hepatic steatosis and HFDH, respectively.
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Affiliation(s)
- G Keramida
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, UK
| | - A Dunford
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Siddique
- Imaging Sciences and Biomedical Engineering, King's College, London, UK
| | - G J Cook
- Imaging Sciences and Biomedical Engineering, King's College, London, UK
| | - A M Peters
- Division of Clinical and Laboratory Investigation, Brighton and Sussex Medical School, Brighton, UK.
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Heterogeneity of intrahepatic fat distribution determined by 18F-FDG PET and CT. Ann Nucl Med 2016; 30:200-6. [DOI: 10.1007/s12149-015-1045-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/24/2015] [Indexed: 12/12/2022]
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Keramida G, Peters AM. Fallacy of Quantifying Lymphoma Activity by Scaling to the Liver in [18F]Fluorodeoxyglucose Positron Emission Tomography (Deauville criteria). J Clin Oncol 2015; 33:4120-1. [DOI: 10.1200/jco.2015.63.1382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - A. Michael Peters
- Brighton Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom
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Keramida G, Dizdarevic S, Bush J, Peters AM. Quantification of tumour (18) F-FDG uptake: Normalise to blood glucose or scale to liver uptake? Eur Radiol 2015; 25:2701-8. [PMID: 25899414 DOI: 10.1007/s00330-015-3659-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/07/2015] [Accepted: 02/04/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE To compare normalisation to blood glucose (BG) with scaling to hepatic uptake for quantification of tumour (18) F-FDG uptake using the brain as a surrogate for tumours. METHODS Standardised uptake value (SUV) was measured over the liver, cerebellum, basal ganglia, and frontal cortex in 304 patients undergoing (18) F-FDG PET/CT. The relationship between brain FDG clearance and SUV was theoretically defined. RESULTS Brain SUV decreased exponentially with BG, with similar constants between cerebellum, basal ganglia, and frontal cortex (0.099-0.119 mmol/l(-1)) and similar to values for tumours estimated from the literature. Liver SUV, however, correlated positively with BG. Brain-to-liver SUV ratio therefore showed an inverse correlation with BG, well-fitted with a hyperbolic function (R = 0.83), as theoretically predicted. Brain SUV normalised to BG (nSUV) displayed a nonlinear correlation with BG (R = 0.55); however, as theoretically predicted, brain nSUV/liver SUV showed almost no correlation with BG. Correction of brain SUV using BG raised to an exponential power of 0.099 mmol/l(-1) also eliminated the correlation between brain SUV and BG. CONCLUSION Brain SUV continues to correlate with BG after normalisation to BG. Likewise, liver SUV is unsuitable as a reference for tumour FDG uptake. Brain SUV divided by liver SUV, however, shows minimal dependence on BG. KEY POINTS • FDG standard uptake value in tumours helps clinicians assess response to treatment. • SUV is influenced by blood glucose; normalisation to blood glucose is recommended. • An alternative approach is to scale tumour SUV to liver SUV. • The brain used as a tumour surrogate shows that neither approach is valid. • Applying both approaches, however, appropriately corrects for blood glucose.
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Affiliation(s)
- Georgia Keramida
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, UK,
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