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Combined 18F-FDG PET/CT with Enhanced CT Perform One-Stop Shop Imaging for Assessing Pancreatic Carcinoma  [PDF]
Miao Zhang, Min Zhang, Lihua Wang, Jiajia Hu, Biao Li
Journal of Cancer Therapy (JCT) , 2012, DOI: 10.4236/jct.2012.35070
Abstract: Objective: To evaluate the role of PET/CT with contrast enhanced CT in diagnosing and staging for pancreatic diseases and optimize the use of enhanced PET/CT as one-stop imaging modality. Methods: Fifty-six patients who presented with suspected pancreatic carcinoma underwent whole-body 18F-FDG PET/CT and enhanced CT imaging. Images were interpreted and compared with the histopathology findings. The sensitivity, specificity and accuracy of enhanced CT, PET/CT and combined PET/CT with contrast enhanced CT diagnosis were analyzed. The vascular invasion and distant metastases of pancreatic lesions on different imaging modality were analyzed and compared. Results: Among the fifty-six patients evaluated for primary tumor, thirty-nine patients had malignant diseases and seventeen had benign lesions. Sensitivity, specificity and accuracy of enhanced CT were 87.5%, 75% and 83.9%, those of non-enhanced PET/CT were 89.7%, 88.2% and 89.2%, of PET/CT with enhanced CT were 100%, 94.1% and 98.2%. Combined PET/CT with enhanced CT had highest sensitivity, specificity and accuracy in diagnosing pancreatic carcinoma. Average SUVmax of malignant lesions was 6.72 ± 3.84, compared with 2.56 ± 1.22 for patients with benign disease (P < 0.01). Combined PET/CT with enhanced CT can help to make accurate staging especially in assessing metastases and vascular invasion. Seven patients deemed surgical candidates were changed to non-surgical treatment. SUVmax didn’t correlate with distant metastases and survival time (Pearson = –0.243, P = 0.136). Distant metastases correlate with survival time (Pearson = –0.447, P = 0.004). Conclusion: PET/CT with contrast enhanced CT is of greater value in the diagnosis of pancreatic lesions as well as preoperative staging especially in assessing vascular invasion and distant metastasis. It is feasible to perform one-stop shop imaging by combining PET/CT with enhanced CT, supplying more accurate assessment before operation and help to select optimal therapeutic plan.
The significance of 18F-FDG PET/CT in secondary hemophagocytic lymphohistiocytosis  [cached]
Zhang Li-Juan,Xu Ji,Liu Peng,Ding Chong-Yang
Journal of Hematology & Oncology , 2012, DOI: 10.1186/1756-8722-5-40
Abstract: This study was aimed to investigate the significance of 18F-FDG PET/CT in secondary hemophagocytic lymphohistiocytosis (sHLH) patients. A total of 18 patients received 18F-FDG PET/CT scan at initial diagnosis. All patients (18/18) had at least 3 organs involved, with increased FDG metabolism in different degrees. Fifteen cases (15/18) had definite underlying diseases, including infections (IAHLH), rheumatosis (RAHLH), or malignancy (MAHLH). The SUVmax of patients in MAHLH group was significantly higher than patients in IAHLH group or RAHLH group (P = 0.015, P = 0.045). Furthermore, the SUVmax of patients in IAHLH group was significantly higher than patients of RAHLH group (P = 0.043). Therefore, we concluded that 18F-FDG PET/CT may especially play important role in differential diagnosis of sHLH.
An intense 18F-FDG pulmonary microfocus on PET without detectable abnormality on CT: A manifestation of an iatrogenic FDG pulmonary embolus  [PDF]
AS Fathinul Fikri,WFE Lau
Biomedical Imaging and Intervention Journal , 2010, DOI: 10.2349/biij.6.4.e37
Abstract: An incidental finding of an intense focus of 18F-Fluorodeoxyglucose (FDG) pulmonary uptake on positron emission tomography (PET) without detectable lesions on computed tomography (CT) is highly suggestive of FDG microembolus. Its microscopic nature means it is undetectable on CT. It is an artefact attributable to 18F-FDG-tracer contamination at the injection site. This paper reports a case of a 61 year-old lady with a past history of breast carcinoma, in whom follow-up PET/CT images demonstrated an incidental intense FDG pulmonary abnormality. A follow-up PET/CT seven months later demonstrated complete resolution of the abnormality.
Significance of subcentimetre 18F-FDG PET/CT pulmonary abnormality in patients with known extrapulmonary malignancy  [PDF]
AS Fathinul Fikri,WFE Lau
Biomedical Imaging and Intervention Journal , 2010, DOI: 10.2349/biij.6.4.e34
Abstract: The significance of a subcentimetre 18F-FDG PET/CT pulmonary abnormality in a patient with known extrapulmonary primary malignancy can have a major impact on the clinical management of the patient. The clinician's reliance on the semi-quantitative and qualitative PET/CT analysis of the abnormality has, at times, led to untoward diagnostic problems, given the limited spatial resolution of PET for a small volume lesion performed as part of the standard PET/CT study. This paper highlights a case each of an FDG-positive and an FDG-negative focal pulmonary abnormality in a combined PET/CT study of patients with known extrapulmonary malignancy.
Impact of 18F-FDG PET/CT on target volume delineation in recurrent or residual gynaecologic carcinoma
Vees Hansj?rg,Casanova Nathalie,Zilli Thomas,Imperiano Hestia
Radiation Oncology , 2012, DOI: 10.1186/1748-717x-7-176
Abstract: Background To evaluate the impact of 18F-FDG PET/CT on target volume delineation in gynaecological cancer. Methods F-FDG PET/CT based RT treatment planning was performed in 10 patients with locally recurrent (n = 5) or post-surgical residual gynaecological cancer (n = 5). The gross tumor volume (GTV) was defined by 4 experienced radiation oncologists first using contrast enhanced CT (GTVCT) and secondly using the fused 18F-FDG PET/CT datasets (GTVPET/CT). In addition, the GTV was delineated using the signal-to-background (SBR) ratio-based adaptive thresholding technique (GTVSBR). Overlap analysis were conducted to assess geographic mismatches between the GTVs delineated using the different techniques. Inter- and intra-observer variability were also assessed. Results The mean GTVCT (43.65 cm3) was larger than the mean GTVPET/CT (33.06 cm3), p = 0.02. In 6 patients, GTVPET/CT added substantial tumor extension outside the GTVCT even though 90.4% of the GTVPET/CT was included in the GTVCT and 30.2% of the GTVCT was found outside the GTVPET/CT. The inter- and intra-observer variability was not significantly reduced with the inclusion of 18F-FDG PET imaging (p = 0.23 and p = 0.18, respectively). The GTVSBR was smaller than GTVCT p ≤ 0.005 and GTVPET/CT p ≤ 0.005. Conclusions The use of 18F-FDG PET/CT images for target volume delineation of recurrent or post-surgical residual gynaecological cancer alters the GTV in the majority of patients compared to standard CT-definition. The use of SBR-based auto-delineation showed significantly smaller GTVs. The use of PET/CT based target volume delineation may improve the accuracy of RT treatment planning in gynaecologic cancer.
Utility of 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in combination with ultrasonography for axillary staging in primary breast cancer
Shigeto Ueda, Hitoshi Tsuda, Hideki Asakawa, Jiro Omata, Kazuhiko Fukatsu, Nobuo Kondo, Tadaharu Kondo, Yukihiro Hama, Katsumi Tamura, Jiro Ishida, Yoshiyuki Abe, Hidetaka Mochizuki
BMC Cancer , 2008, DOI: 10.1186/1471-2407-8-165
Abstract: One hundred eighty-three patients with primary operable breast cancer were recruited. All patients underwent 18F-FDG PET/CT and AUS followed by SNB and/or ALN dissection (ALND). Using 18F-FDG PET/CT, we studied both a visual assessment of 18F-FDG uptake and standardized uptake value (SUV) for axillary staging.In a visual assessment of 18F-FDG PET/CT, the diagnostic accuracy of ALN metastasis was 83% with 58% in sensitivity and 95% in specificity, and when cut-off point of SUV was set at 1.8, sensitivity, specificity, and accuracy were 36, 100, and 79%, respectively. On the other hand, the diagnostic accuracy of AUS was 85% with 54% in sensitivity and 99% in specificity. By the combination of 18F-FDG PET/CT and AUS to the axilla, the sensitivity, specificity, and accuracy were 64, 94, and 85%, respectively. If either 18F-FDG PET uptake or AUS was positive in allixa, the probability of axillary metastasis was high; 50% (6 of 12) in 18F-FDG PET uptake only, 80% (4 of 5) in AUS positive only, and 100% (28 of 28) in dual positive. By the combination of AUS and 18F-FDG PET/CT, candidates of SNB were more appropriately selected. The axillary 18F-FDG uptake was correlated with the maximum size and nuclear grade of metastatic foci (p = 0.006 and p = 0.03).The diagnostic accuracy of 18F-FDG PET/CT was shown to be nearly equal to ultrasound, and considering their limited sensitivities, the high radiation exposure by 18F-FDG PET/CT and also costs of the examination, it is likely that AUS will be more cost-effective in detecting massive axillary tumor burden. However, when we cannot judge the axillary staging using AUS alone, metabolic approach of 18F-FDG PET/CT for axillary staging would enable us a much more confident diagnosis.Axillary lymph node (ALN) status is an important predictor regarding recurrence and survival of patients having primary breast cancer. Recently, sentinel node biopsy (SNB) has been introduced as a minimally invasive procedure to evaluate ALN status [1].
Active Shingles Infection as Detected on 18F-FDG PET/CT  [PDF]
Razi Muzaffar,Medhat M. Osman
Frontiers in Oncology , 2013, DOI: 10.3389/fonc.2013.00103
Abstract: We present the case of a 56-year-old male with a history of recurrent follicular lymphoma undergoing chemotherapy with multiple 18F-FDG PET-CT studies at an outside facility. He developed a painful erythematous, pruritic rash in the left back requiring a visit to the emergency room. He was diagnosed and treated for Varicella zoster infection. He then presented to our imaging center 2 months later for a follow up 18F-FDG PET/CT study. Imaging demonstrated a cutaneous band of increased metabolic activity in the upper back following a dermatomal distribution. This was confirmed to be in the same area as the treated Varicella zoster eruption. A subsequent follow up 18F-FDG PET-CT scan 4 months later to confirm tumor resolution demonstrated the abnormal band of uptake in the back had resolved. This case illustrates the significance of being aware of this entity and to distinguish it from metastasis, especially in patients with a known history of malignancy.
The Value of Extra-lung Lesions on 18F-FDG PET/CT in Improving Diagnosis of Lung Cancer  [cached]
Baoming MI,Weixing WAN,Chunjing YU,Xuyang YOU
Chinese Journal of Lung Cancer , 2012, DOI: 10.3779/j.issn.1009-3419.2012.02.03
Abstract: Background and objective 18F-FDG PET/CT has several shortcomings in discriminating between lung carcinoma and pulmonary benign lesions. The aims of the present study is to explore the value of extra-lung lesions on 18F-FDG PET/CT image in the diagnosis of lung cancer. Methods A total of 126 suspected lung cancer patients underwent 18F-FDG PET/CT scan. Preliminary diagnoses were based on the PET characteristics, SUVmean value, and CT characteristics of the lesions in the lung, and the diagnoses were modified based on the detected extra-lung lesions. The difference between the two methods and their disparity were calculated. Results Extra-lung lesions were identified on the PET/CT image in 81 patients; extra-lung metastasis modified 13 probable malignancies to affirmative malignancy and 1 probable malignancy to benign lesion. Non-metastasis modified 2 probable malignancies to affirmative malignancy and 1 probable malignancy to benign lesion. Fifteen were correct, whereas 2 were misdiagnosed. The diagnoses modification rate was 13.5% (17/126), and the modified diagnoses accuracy is 88.2% (15/17). Conclusion Extra-lung lesions demonstrated on 18F-FDG PET/CT improved the diagnostic accuracy of lung cancer. Tuberculosis was identified as the most important reason for false positive diagnoses after modification by extra-lung lesions.
Correlation of Intra-Tumor 18F-FDG Uptake Heterogeneity Indices with Perfusion CT Derived Parameters in Colorectal Cancer  [PDF]
Florent Tixier, Ashley M. Groves, Vicky Goh, Mathieu Hatt, Pierre Ingrand, Catherine Cheze Le Rest, Dimitris Visvikis
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099567
Abstract: Application of textural features analysis to 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) images has been used to characterize intra-tumor uptake heterogeneity and has been shown to reflect disease outcome. A current hypothesis is that 18F-FDG uptake heterogeneity may reflect the physiological tracer uptake related to tumor perfusion. The purpose of our study was to investigate the correlations between intra-tumor uptake heterogeneity and vascular parameters derived from dynamic contrast enhanced (DCE) computed tomography (CT) obtained from an integrated 18F-FDG PET/perfusion CT examination. Methods Thirty patients with proven colorectal cancer prospectively underwent integrated 18F-FDG PET/DCE-CT to assess the metabolic-flow phenotype. Both CT blood flow parametric maps and PET images were analyzed. Correlations between PET heterogeneity and perfusion CT were assessed by Spearman's rank correlation analysis. Results Blood flow visualization provided by DCE-CT images was significantly correlated with 18F-FDG PET metabolically active tumor volume as well as with uptake heterogeneity for patients with stage III/IV tumors (|ρ|:0.66 to 0.78; p-value<0.02). Conclusion The positive correlation found with tumor blood flow indicates that intra-tumor heterogeneity of 18F-FDG PET accumulation reflects to some extent tracer distribution and consequently indicates that 18F-FDG PET intra-tumor heterogeneity may be associated with physiological processes such as tumor vascularization.
11C-choline vs. 18F-FDG PET/CT in assessing bone involvement in patients with multiple myeloma
Cristina Nanni, Elena Zamagni, Michele Cavo, Domenico Rubello, Paola Tacchetti, Cinzia Pettinato, Mohsen Farsad, Paolo Castellucci, Valentina Ambrosini, Gian Montini, Adil Al-Nahhas, Roberto Franchi, Stefano Fanti
World Journal of Surgical Oncology , 2007, DOI: 10.1186/1477-7819-5-68
Abstract: As MM bone lesions may present low 18F-FDG uptake; the aim of this study was to assess the possible added value and limitations of 11C-Choline to that of 18F-FDG PET/CT in patients affected with MM.Ten patients affected with MM underwent a standard 11C-Choline PET/CT and an 18F-FDG PET/CT within one week. The results of the two scans were compared in terms of number, sites and SUVmax of lesions.Four patients (40%) had a negative concordant 11C-Choline and 18F-FDG PET/CT scans. Two patients (20%) had a positive 11C-Choline and 18F-FDG PET/CT scans that identified the same number and sites of bone lesions. The remaining four patients (40%) had a positive 11C-Choline and 18F-FDG PET/CT scan, but the two exams identified different number of lesions. Choline showed a mean SUVmax of 5 while FDG showed a mean SUVmax of 3.8 (P = 0.042). Overall, 11C-Choline PET/CT scans detected 37 bone lesions and 18F-FDG PET/CT scans detected 22 bone lesions but the difference was not significant (P = 0.8).According to these preliminary data, 11C-Choline PET/CT appears to be more sensitive than 18F-FDG PET/CT for the detection of bony myelomatous lesions. If these data are confirmed in larger series of patients, 11C-Choline may be considered a more appropriate functional imaging in association with MRI for MM bone staging.Multiple myeloma (MM) is a B cell neoplasm involving bones in more than 80% of cases. Patients frequently present with a single or multiple lytic bone lesions causing bone pain, pathological fractures and hypercalcaemia [1-5]. Bone abnormalities (lytic or osteopenic) are one of the myeloma related organ dysfunction [6] and are responsible for low quality of life due to severe pain and high incidence of fractures, and this is particularly dangerous if located in the spine. The incidence of vertebral fractures can be reduced with bisphosphonates that are now available in the therapeutic armamentarium of MM.Bone lesions are usually evaluated with a spectrum of imaging techn
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