The prognostic significance of the 18F-fluorodeoxyglucose positron emission tomography/computed tomography in early-stage nonsmall cell lung cancer

Context: The prognostic criteria for early-stage nonsmall cell lung cancer (NSCLC) wait to be explored. Aim: In this study, our aim was to evaluate the prognostic significance of the positron emission tomography/computed tomography (PET/CT) maximum standardized uptake value (SUVmax) value of the primary tumor in patients with a diagnosis of early-stage NSCLC who received surgical treatment. Settings and Design: This was a multicenter retrospective design. Materials and Methods: Patients who had been diagnosed with early-stage NSCLC and who underwent surgery for the condition were included in this study. The preoperative fluorodeoxyglucose (18F-FDG) PET/CT results of the patients were retrospectively accessed from their medical files. The disease-free survival (DFS) rates of patients who had SUVmax values above and below the determined cutoff value were compared. Statistical Analysis Used: SPSS version 22 and Kaplan–Meier method were used for statistical analysis. Results: A total of 92 patients were included in the study. The median age of the patients was 60 years (range: 36–79). The determined cutoff SUVmax value of the primary tumor was 13.6. A comparison of the DFS rates of the patients with an SUVmax value above and below 13.6 revealed a significant difference in patients with Stage I (22.9 months vs. 50.3 months; P = 0.02) and Stage II (28 months vs. 40.4 months; P = 0.04), Stage I + II (43.5 months vs. 26.1 months; P = 0,02), and Stage IIIA (14.7 months vs. 13.6 months; P = 0.92) NSCLC. Conclusions: We found that in early-stage NSCLC patients, the SUVmax value of the primary mass in 18F FDG PET/CT was a prognostic indicator for the DFS rates

Application of / 中南大学学报(医学版)

Small cell lung cancer belongs to neuroendocrine tumors and is the most malignant one in lung cancer. It possesses clinical features such as rapid growth, easy early metastasis, and poor prognosis. PET/CT is a molecular imaging technique that combines morphological and metabolic imaging. It has been widely used in the diagnosis, staging, treatment planning, efficacy and prognosis evaluation of tumors. This article reviews the efficacy, prognostic parameters, evaluation criteria, possible influencial factors, clinical application and value of

Early Onset Polymorphic Post-transplant Lymphoproliferative Disease Mimicking a Solitary Necrotizing Abscess in a Graft Liver

Although post-transplantation lymphoproliferative disease (PTLD) after liver transplantation is very rare, its prognosis is worse than that of PTLD following other types of solid organ transplantation. Here, we report a rare case of early onset polymorphic PTLD in a graft liver occurring five months after deceased-donor liver transplantation due to hepatocellular carcinoma and hepatitis C virus infection. Initially, findings from contrast-enhanced magnetic resonance imaging mistakenly suspected the lesion was a necrotizing abscess with central necrosis. However, ¹⁸F-fluorodeoxyglucose positron emission tomography and biopsy findings confirmed an Epstein-Barr virus (EBV)-associated, B cell type polymorphic PTLD with central necrosis. Our case suggests regular monitoring of EBV serologic status for liver transplant recipients who were initially in an EBV seronegative state. Although early-onset PTLD is very rare after liver transplantation, PTLD should be suspected when recipients show the seroconversion for EBV proteins and the development of new tumors with various clinical presentations.

The 18F-fluorodeoxyglucose positron emission tomograhy in predicting residual retro-peritoneal tumor after chemotherapy of testis germ cell tumors / 中国肿瘤临床

Objective:To determine the value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scans in identify-ing the residual retroperitoneal tumor after chemotherapy of testis germ cell tumors. Methods:Sixteen testis germ cell tumor patients with metastasis of retroperitoneal lymph nodes who were treated in our hospital from February 2014 to December 2016 were select-ed for the study from February 2014 to December 2016. After 4-6 cycles of chemotherapy, their CT scans showed residual masses with diameters greater than 2 cm. The retroperitoneal lymph nodes were dissected after the 18F-FDG PET exam. The post-surgery pathology results were compared with the results of the 18F-FDG PET exam. Results:Residual tumors were found in 5 of 10 patients with 18F-FDG PET positive. Residual tumor was absent in 4 of 6 patients with 18F-FDG PET negative, while residual mature teratoma tumors were found in two patients. The accuracy rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 18F-FDG PET exam were 56.25%(9/16), 71.42%(5/7), 44.44%(4/9), 50.00%(5/10), and 66.67%(4/6), respectively. Conclusion: 18F-FDG PET is highly sensitive. However, many factors influence the result of 18F-FDG PET. Mature teratoma leads to a false negative re-sult, whereas massive tissue inflammation leads to a false positive result. Therefore, more clinical examinations should be made.

Effect of Mild Hypothermia Therapy on Neonatal Bilirubin Encephalopathy:Evaluated with 18F-fluorodeoxyglu-cose Positron Emission Tomography/CT and Amplitude Integrated Electroencephalogram / 中国康复理论与实践

Objective To investigate the clinical effect of mild hypothermia on neonatal bilirubin encephalopathy, and the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT and amplitude integrated electroencephalogram (aEEG) for diagnosis and evaluation of curative effect. Methods From May, 2013 to December, 2014, 29 newborns with bilirubin encephalopathy were divided into conventional group (n=15) and mild hypothermia group (n=14). The conventional group received conventional therapy, and the other group received mild hypothermia in addition. The aEEG and neuron-specific enolase (NSE) were measured before and after treatment, as well as the glucose metabolism rate with 18F-FDG PET/CT after treatment. Results The NSE was lower after treatment in both groups (t>9.670, P2.943, P0.640, P<0.05). Conclusion Mild hypothermia therapy could further promote the energy metabolism of brain cells in neonatal bilirubin encephalopathy. 18F-FDG PET/CT and aEEG can be used for early diagnosis and therapeutic evaluation.

The role of ¹⁸F-fluorodeoxyglucose positron emission tomography in the assessment of disease activity of adult-onset Still’s disease

BACKGROUND/AIMS: ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) has been suggested as a reliable imaging technique for monitoring of disease activity in patients with adult-onset Still’s disease (AOSD). Therefore, we investigated the clinical significance of ¹⁸F-FDG PET/CT in Korean AOSD patients. METHODS: Thirteen AOSD patients were included in the study. The PET/CT images were evaluated with visual and semiquantitative method using standardized uptake values (SUVs). RESULTS: The presence of increased ¹⁸F-FDG uptake was noted in 90% of clinically active AOSD patients. ¹⁸F-FDG uptake was located in the lymph node, spleen, and bone marrow. Visual grade and SUV intensity of lymph node was significantly correlated with the systemic score of AOSD. Visual grade of spleen was significantly correlated with the systemic score, erythrocyte sedimentation rate (ESR), and ferritin. Additionally, visual grade and SUV intensity of bone marrow was significantly correlated with the systemic score, ESR, leukocyte, and neutrophil. CONCLUSIONS: Visual grade and SUV intensity of lymph node, spleen, and bone marrow on ¹⁸F-FDG PET/CT scan showed significant correlations with known disease activity markers. The data suggest that ¹⁸F-FDG PET/CT scan may be a useful imaging technique for evaluation of disease activity in AOSD patients.

Effectiveness of Breast MRI and 18F-FDG PET/CT for the Preoperative Staging of Invasive Lobular Carcinoma versus Ductal Carcinoma / 한국유방암학회지

PURPOSE: We evaluated the utility of magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for the preoperative staging of invasive lobular carcinoma (ILC) of the breast and compared the results with those of invasive ductal carcinoma (IDC). METHODS: The study included pathologically proven 32 ILCs and 73 IDCs. We compared clinical and histopathological characteristics and the diagnostic performances of MRI and 18F-FDG PET/CT for the primary mass, additional ipsilateral and/or contralateral lesion(s), and axillary lymph node metastasis between the ILC and IDC groups. RESULTS: Primary ILCs were greater in size, but demonstrated lower maximum standardized uptake values than IDCs. All primary masses were detected on MRI. The detection rate for ILCs (75.0%) was lower than that for IDCs (83.6%) on 18F-FDG PET/CT, but the difference was not significant. For additional ipsilateral lesion(s), the sensitivities and specificities of MRI were 87.5% and 58.3% for ILC and 100.0% and 66.7% for IDC, respectively; whereas the sensitivities and specificities of 18F-FDG PET/CT were 0% and 91.7% for ILC and 37.5% and 94.7% for IDC, respectively. The sensitivity of 18F-FDG PET/CT for ipsilateral lesion(s) was significantly lower in the ILC group than the IDC group. The sensitivity for ipsilateral lesion(s) was significantly higher with MRI; however, specificity was higher with 18F-FDG PET/CT in both tumor groups. There was no significant difference in the diagnostic performance for additional contralateral lesion(s) or axillary lymph node metastasis on MRI or 18F-FDG PET/CT for ILC versus IDC. CONCLUSION: The MRI and 18F-FDG PET/CT detection rates for the primary cancer do not differ between the ILC and IDC groups. Although 18F-FDG PET/CT demonstrates lower sensitivity for primary and additional ipsilateral lesions, it shows higher specificity for additional ipsilateral lesions, and could play a complementary role in the staging of ILC as well as IDC.

18F-FDG PET/CT for Diagnosis of Osteosclerotic and Osteolytic Vertebral Metastatic Lesions: Comparison with Bone Scintigraphy

STUDY DESIGN: A retrospective study. PURPOSE: The aims of this study were to investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in PET/computed tomography (CT) in the evaluation of spinal metastatic lesions. OVERVIEW OF LITERATURE: Recent studies described limitations regarding how many lesions with abnormal 18F-FDG PET findings in the bone show corresponding morphologic abnormalities. METHODS: The subjects for this retrospective study were 227 patients with primary malignant tumors, who were suspected of having spinal metastases. They underwent combined whole-body 18F-FDG PET/CT scanning for evaluation of known neoplasms in the whole spine. 99mTc-methylene diphosphonate bone scan was performed within 2 weeks following PET/CT examinations. The final diagnosis of spinal metastasis was established by histopathological examination regarding bone biopsy or magnetic resonance imaging (MRI) findings, and follow-up MRI, CT and 18F-FDG PET for extensively wide lesions with subsequent progression. RESULTS: From a total of 504 spinal lesions in 227 patients, 224 lesions showed discordant image findings. For 122 metastatic lesions with confirmed diagnosis, the sensitivity/specificity of bone scan and FDG PET were 84%/21% and 89%/76%, respectively. In 102 true-positive metastatic lesions, the bone scan depicted predominantly osteosclerotic changes in 36% and osteolytic changes in 19%. In 109 true-positive lesions of FDG PET, osteolytic changes were depicted predominantly in 38% while osteosclerotic changes were portrayed in 15%. CONCLUSIONS: 18F-FDG PET in PET/CT could be used as a substitute for bone scan in the evaluation of spinal metastasis, especially for patients with spinal osteolytic lesions on CT.

US Findings of Secondary Breast Lymphoma Detected by PET/CT

Breast lymphomas, either manifesting as a primary extranodal disease or secondary involvement, are a rare form of malignancy. Breast lymphomas can be visualized as hypermetabolic lesions in 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) scans. Here, we describe a case of a secondary breast lymphoma, detected with 18F-FDG PET/CT.

The Clinical Meaning of Benign Colon Uptake in 18F-FDG PET: Comparison with Colonoscopic Findings

BACKGROUND/AIMS: Benign colon 18F-fluorodeoxyglucose (FDG) uptake is frequently observed in asymptomatic individuals. Aims of this study were to investigate the benign colon uptake by whole body FDG-positron emission tomography (PET) in asymptomatic adults and to correlate those results with colonoscopic and histologic findings. METHODS: Among 3,540 subjects who had undergone FDG-PET, 43 subjects who were diagnosed to have benign colon uptake in FDG-PET and underwent colonoscopy were retrospectively reviewed. Subjects were classified as diffuse or focal groups based on their FDG uptake patterns. PET results were analyzed together with colonoscopic and histologic findings. RESULTS: Forty-three subjects showed benign colon uptake in FDG-PET; 28 of them were shown as the diffuse group, while other 15 subjects were classified as the focal group. Five subjects among those showed diffuse uptake were diagnosed as adenoma. Seven among 15 subjects who showed focal uptake were diagnosed as adenocarcinoma (n=2), adenoma (n=3), or non-neoplastic polyp (n=2). Positive predictive values were 25% in the diffuse group and 47% in the focal group. CONCLUSIONS: We recommend that patients showing benign FDG uptake in the colon should be further evaluated by colonoscopy, especially for patients with focal FDG uptake.

The Role of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Treatment of Brain Abscess

OBJECTIVE: The purpose of this study was to evaluate whether 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used to assess the therapeutic response of brain abscess. METHODS: A study was conducted on 10 consecutive patients with brain abscess. Magnetic resonance imaging (MRI) with diffuse-weighted imaging (DWI) was performed at 3 and 6 weeks after surgical treatment and intravenous antibiotics therapy and FDG-PET at 6 weeks after treatment. The extent of the abscess, signal changes on MRI, and FDG-PET standardized uptake values were analyzed and correlated with the response to therapy. RESULTS: Aspiration or craniotomy with excision of the abscess followed by intravenous antibiotics for 6-8 weeks resulted in good recovery with no recurrence. In 10 patients, two had low signal intensity on the DWI; one had no uptake on FDG-PET imaging after 6 weeks antibiotics and discontinued intravenous treatment, but the other patient had diffuse, increased uptake on FDG-PET imaging after 6 weeks antibiotics and underwent an additional 2 weeks of intravenous antibiotics. The remaining eight patients had high signals on the DWI. Four had no uptake on FDG-PET imaging and the treatment period varied from 6 to 8 weeks (mean, 6.75 weeks). Among the other four patients, FDG was accumulated in a diffuse or local area corresponding to a high signal area within the DWI and 2 weeks of intravenous antibiotics was added. CONCLUSION: MRI plus FDG-PET improved the accuracy of assessing therapeutic responses to antibiotics treatment of brain abscess and aided in optimizing therapy.

Clinical significance of diffusely increased 18F-FDG uptake in the thyroid / 中华内分泌代谢杂志

lymphocytic thyroiditis.

Association between Bone Marrow Hypermetabolism on (18)F-Fluorodeoxyglucose Positron Emission Tomography and Response to Chemotherapy in Non-Small Cell Lung Cancer / 결핵및호흡기질환

BACKGROUND: (18)F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used for the diagnosis and staging of non-small cell lung cancer (NSCLC). The aim of this study is to determine whether the bone marrow hypermetabolism seen on FDG-PET predicts a response to chemotherapy in patients with NSCLC. METHODS: We evaluated the patients with advanced NSCLC and who were treated with combination chemotherapy. For determination of the standardized uptake value (SUV) of the bone marrow (BM SUV) on FDG-PET, regions of interest (ROIs) were manually drawn over the lumbar vertebrae (L1, 2, 3). ROIs were also drawn on a homogenous transaxial slice of the liver to obtain the bone marrow/ liver SUV ratio (BM/L SUV ratio). The response to chemotherapy was evaluated according to the Response Evaluation Criteria in Solid Tumor (RECIST) criteria after three cycles of chemotherapy. RESULTS: Fifty-nine NSCLC patients were included in the study. Multivariate analysis was performed using a logistic regression model. The BM SUV and the BM/L SUV ratio on FDG-PET were not associated with a response to chemotherapy in NSCLC patients (p=0.142 and 0.978, respectively). CONCLUSION: The bone marrow hypermetabolism seen on FDG-PET can not predict a response to chemotherapy in NSCLC patients.

Application of FDG-PET in the clinical management of lung cancer / 国际生物医学工程杂志

FDG-PET has played a significant role in the clinical management of lung cancer since it can efficiently visualize the functional metabolic changes of normal and pathological tissues in human body. It has been used more and more widely in many aspects of lung cancer management including diagnosis, staging, target volume delineation for radiotherapy plan, treatment response inspection, and recurrence detection. However, the false positive led by benign and inflammation somehow decreases its diagnostic specificity of lung cancer. The diagnostic methods for lung cancer consist of visual interpretation and semi-quantitative analysis based on static imaging and quantitative analysis based on dynamic imaging. This article briefly reviews the current trends, challenges and foreground of this imaging modality in the field of clinical management of lung cancer.