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1.
Clin Nucl Med ; 38(2): 81-7, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23334119

ABSTRACT

PURPOSE: The aim of this study was to compare various acquisition and processing protocols for noninvasive glioma grading using either static or dynamic (18)F-FDopa PET. METHODS: Dynamic studies were performed in 33 patients. Based on histopathological analysis, 18 patients had a high-grade (HG) tumor and 15 patients had a low-grade (LG) tumor. For static imaging, SUV(mean) and SUV(max) were calculated for different acquisition time ranges after injection. For dynamic imaging, the transport rate constant k1 was calculated according to a compartmental kinetic analysis using an image-derived input function. RESULTS: With the use of a 5-minute static imaging protocol starting at 38 minutes after injection, newly diagnosed HG tumors could be distinguished from LG tumors with a sensitivity of 70% and a specificity of 90% with a threshold of SUV(mean) of 2.5. In recurrent tumors, a sensitivity of 100% and a specificity of 80% for identifying HG tumors were obtained with a threshold set to 1.8. Dynamic imaging only slightly, but nonsignificantly, improved differential diagnosis. CONCLUSIONS: Static and dynamic imaging without blood sampling can discriminate between LG and HG for both newly diagnosed and recurrent gliomas. In dynamic imaging, excellent discrimination was obtained by considering the transport rate constant k1 of tumors. In static imaging, the best discrimination based on SUV was obtained for SUV(mean) calculated from a 5-minute acquisition started at 38 minutes after injection.


Subject(s)
Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Dihydroxyphenylalanine/analogs & derivatives , Glioma/diagnostic imaging , Glioma/pathology , Multimodal Imaging/methods , Positron-Emission Tomography , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Female , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Neoplasm Grading , Neoplasm Invasiveness , Time Factors , Young Adult
3.
Clin Nucl Med ; 37(5): 486-8, 2012 May.
Article in English | MEDLINE | ID: mdl-22475900

ABSTRACT

An 82-year-old woman was followed up for an uterine cervical adenocarcinoma treated by surgery. A whole-body fluorodeoxyglucose positron emission tomography study revealed a pathologic fluorodeoxyglucose uptake located in the umbilicus associated to peritoneal carcinomatosis. Biopsy of the umbilical nodule demonstrated an umbilical metastasis from the uterine adenocarcinoma, the so-called "Sister Mary Joseph's nodule."


Subject(s)
Fluorodeoxyglucose F18 , Multimodal Imaging , Positron-Emission Tomography , Sister Mary Joseph's Nodule/diagnostic imaging , Tomography, X-Ray Computed , Aged, 80 and over , Female , Humans
4.
J Clin Endocrinol Metab ; 94(5): 1713-22, 2009 May.
Article in English | MEDLINE | ID: mdl-19190108

ABSTRACT

CONTEXT: Most adrenal incidentalomas are nonfunctioning adrenocortical adenomas (ACAs). Adrenocortical carcinomas (ACCs) are rare but should be recognized at an early stage. OBJECTIVE: The objective of the study was to evaluate the usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) to predict malignancy in patients without a previous history of cancer. DESIGN: This was a prospective, multicenter study from 2001 to 2006. SETTING: The study was conducted at a network of seven university hospitals in Paris. PATIENTS: Seventy-seven patients were included. All underwent surgery because of hypersecretory and/or growing benign lesions (n = 18), obvious ACCs (n = 21), or radiologically indeterminate lesions (n = 38). MAIN OUTCOME MEASURE: The degree of (18)F-FDG PET uptake [maximum standardized uptake value (maxSUV)] was related to the pathological findings serving as a reference, and its diagnostic value was compared with that of computerized tomography (CT) scan. RESULTS: Pathology eventually diagnosed 43 ACAs, 22 ACCs, and 12 nonadrenocortical lesions. Using a cutoff value above 1.45 for adrenal to liver maxSUV ratio, the sensitivity and specificity to distinguish ACAs from ACCs were, respectively, 1.00 (95% confidence interval 0.85-1.00) and 0.88 (95% confidence interval 0.75-0.96). Among the 38 indeterminate lesions at CT scan, we could analyze a subgroup of 16 adrenocortical tumors with high unenhanced density (>10 HU) and an inappropriate washout: (18)F-FDG PET correctly predicted the benignity in 13 of 15 ACAs. CONCLUSIONS: In a multidisciplinary team approach, (18)F-FDG PET helps to manage suspicious CT scan lesions. An adrenal to liver maxSUV ratio less than 1.45 is highly predictive of a benign lesion.


Subject(s)
Adrenal Cortex Neoplasms/diagnostic imaging , Adrenal Cortex Neoplasms/surgery , Fluorodeoxyglucose F18 , Adrenal Cortex Neoplasms/pathology , Adult , Aged , Blood Glucose/metabolism , Diabetes Complications/diagnostic imaging , Female , Hormones/blood , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Paris , Positron-Emission Tomography , Preoperative Care , Prospective Studies , Tomography, X-Ray Computed
7.
Eur J Nucl Med Mol Imaging ; 35(1): 95-9, 2008 Jan.
Article in English | MEDLINE | ID: mdl-17786437

ABSTRACT

PURPOSE: This prospective and bi-centric study was conducted in order to determine the impact of antidiabetic treatments (AD) on (18)F-FDG bowel uptake in type 2 diabetic patients. METHODS: Fifty-five patients with previously diagnosed and treated type 2 diabetes mellitus (group 1) were divided in two subgroups: AD treatment including metformin (n=32; group 1a) and AD treatment excluding metformin (n=23; group 1b). The 95 patients without diabetes mellitus made up controls (group 2). (18)F-FDG uptake in small intestine and colon was visually graded and semi-quantitatively measured using the maximum standardized uptake value. RESULTS: (18)F-FDG bowel uptake was significantly increased in AD patients (group 1) as compared to controls (group 2) (p<0.001). Bowel uptake was significantly higher in AD patients including metformin (group 1a) as compared to AD patients excluding metformin (group 1b) (p<0.01), whose bowel uptake was not significantly different from controls (group 2). A metformin treatment was predictive of an increased bowel uptake in the small intestine (odds ratio OR=16.9, p<0.0001) and in the colon (OR=95.3, p<0.0001), independently of the other factors considered in the multivariate analysis. Bowel uptake pattern in the patients treated with metformin was typically intense, diffuse and continuous along the bowel, strongly predominant in the colon, in both the digestive wall and lumen. CONCLUSION: This study emphasizes that metformin significantly increases (18)F-FDG uptake in colon and, to a lesser extent, in small intestine. It raises the question of stopping metformin treatment before an (18)F-FDG PET/CT scan is performed for intra-abdominal neoplasic lesion assessment.


Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/metabolism , Fluorodeoxyglucose F18/pharmacokinetics , Hypoglycemic Agents/therapeutic use , Intestinal Mucosa/metabolism , Intestines/drug effects , Metformin/therapeutic use , Case-Control Studies , Colon/drug effects , Colon/metabolism , Humans , Hypoglycemic Agents/pharmacology , Intestine, Small/drug effects , Intestine, Small/metabolism , Metformin/pharmacology , Tissue Distribution/drug effects
8.
Presse Med ; 37(3 Pt 2): 460-9, 2008 Mar.
Article in French | MEDLINE | ID: mdl-17596908

ABSTRACT

FDG-PET is now an established diagnostic tool in oncology. Fluorodeoxyglucose is not a specific tracer for malignant lesions but rather for elevated glucose metabolism, present not only in cancer but also in inflammatory and infectious lesions. FDG-PET has thus been suggested for diagnosis of fevers of unknown origin, deep bone or visceral infectious foci, inflammatory vasculitis or sarcoidosis and unknown primary tumors, all frequent situation in internal medicine. The main characteristics of FDG-PET are its ability to rule out focal inflammation or infection with a high degree of certainty when the examination is negative because of its good negative predictive value and its usefulness as an early marker of therapeutic response, compared with anatomy-based or conventional scintigraphic imaging. Large-scale prospective studies are necessary, however, before FDG-PET is integrated into routine clinical use. It should be compared with different techniques already validated (biology, radiology, conventional scintigraphic imaging) and its cost-effectiveness should be evaluated.


Subject(s)
Internal Medicine/methods , Positron-Emission Tomography , Humans , Infections/diagnostic imaging
9.
Clin Nucl Med ; 32(8): 603-6, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17667431

ABSTRACT

Percutaneous vertebroplasty consists of injection of acrylic cement - polymethylmethacrylate - into a vertebral body to obtain pain relief and increase its mechanical stability. The procedure is indicated for painful hemangiomas and for painful vertebral compression fractures due to osteoporosis or malignancy. Although vertebroplasty is an efficient treatment, it is not free of complications. We present the case of a patient with pulmonary cement embolism after percutaneous vertebroplasty. Because such patients may be completely asymptomatic, but may also present with acute and severe, cardiovascular instability, clinicians and nuclear physicians should be aware that pulmonary embolism of polymethylmethacrylate may occur after percutaneous vertebroplasty.


Subject(s)
Bone Cements/adverse effects , Extravasation of Diagnostic and Therapeutic Materials/complications , Extravasation of Diagnostic and Therapeutic Materials/diagnosis , Methylmethacrylates/adverse effects , Pulmonary Embolism/chemically induced , Pulmonary Embolism/diagnosis , Humans , Male , Middle Aged , Thrombosis/complications
11.
Bull Cancer ; 92(7): 723-32, 2005 Jul.
Article in French | MEDLINE | ID: mdl-16123010

ABSTRACT

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives, the SOR SAVOIR PATIENT program (SSP). The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres, the National League against Cancer, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals, the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The guidelines, "Standards, Options: Recommendations" (SOR) are used as primary information sources. The handbook SOR SAVOIR PATIENT Understanding positron emission tomography (PET) with [18F]-FDG in clinical oncology, integrally published in this issue of the Bulletin du Cancer, is an adapted version of the clinical practice guidelines (CPG) Standards, Options and Recommendations for positron emission tomography (PET) with [18F]-FDG in clinical oncology. The main objectives of this article are to allow persons affected by cancer and their close relatives to better understand this medical imaging technique and its implementation. This document also offers health professionals a synthetic evidence-based patient information source that should help them communicate that information during the physician-patient encounter. Positron emission tomography (PET) is a scintigraphy technique using a radiotracer, [18F]-fluorodeoxyglucose (abbreviated [18F]-FDG), administered intravenously into the patient's arm. This tracer, similar to glucose (sugar), binds to cancer cells and temporarily emits radiations that can be recorded by a special camera in the PET scanner. PET scanning can be used to obtain complementary information at different stages of the disease, whether for assessing diagnosis, treatment evolution or follow-up. By 2007, in the framework of the government plan against cancer, about seventy-five PET scanners are expected to be installed in France. Twenty-four are currently in use; a similar number is under installation. At the end of this process, all French regions should have at least one PET imaging equipment. The SOR SAVOIR PATIENT guide: Understanding positron emission tomography (PET) with [18F]-FDG in clinical oncology and the integral report of CPG SOR 2003: Standards, Options and Recommendations for positron emission tomography (PET) with [18F]-FDG in clinical oncology can be downloaded from the FNCLCC website: http:\\www.fnclcc.fr.


Subject(s)
Fluorodeoxyglucose F18 , Neoplasms/diagnostic imaging , Patient Education as Topic/methods , Positron-Emission Tomography/methods , Radiopharmaceuticals , Decision Making , Documentation , Humans
12.
Ann Otol Rhinol Laryngol ; 113(8): 628-35, 2004 Aug.
Article in English | MEDLINE | ID: mdl-15330142

ABSTRACT

We performed a prospective study to assess the value of positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) in the prediction of local control in irradiated head and neck squamous cell carcinomas (HNSCCs). Forty-two patients with irradiated HNSCCs underwent 49 FDG-PET scans between 3 and 6 months after the end of radiotherapy. The mean follow-up time after the first FDG-PET scan was 17 months. The result of the FDG-PET scan was true-positive in 6 patients, false-positive in 7 patients, and true-negative in 29 patients. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET scanning were 100%, 81%, 46%, and 100%, respectively. We conclude that FDG-PET scanning is useful for prediction of therapy outcome in irradiated HNSCCs. No biopsy is needed for at least 1 year if an FDG-PET scan is negative. If the scan is positive and the biopsy is negative, decreased FDG uptake measured in a follow-up scan indicates that a local recurrence is unlikely.


Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Head and Neck Neoplasms/diagnostic imaging , Tomography, Emission-Computed , Adult , Aged , Carcinoma, Squamous Cell/radiotherapy , Female , Fluorodeoxyglucose F18 , Head and Neck Neoplasms/radiotherapy , Humans , Hypopharyngeal Neoplasms/diagnostic imaging , Hypopharyngeal Neoplasms/radiotherapy , Laryngeal Neoplasms/diagnostic imaging , Laryngeal Neoplasms/radiotherapy , Male , Middle Aged , Oropharyngeal Neoplasms/diagnostic imaging , Oropharyngeal Neoplasms/radiotherapy , Prospective Studies , Radiopharmaceuticals , Sensitivity and Specificity
13.
Eur J Endocrinol ; 150(6): 789-92, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15191348

ABSTRACT

DESIGN: This study is a preliminary report on 18F-fluorodeoxyglucose (18F-FDG) uptake for the characterization of hypersecretory or non-hypersecretory adrenocortical masses in patients without known neoplastic disease, thereby minimizing the presence of adrenal metastases, and without phaeochromocytoma, in comparison with computed tomography (CT) scanning and with iodocholesterol scintigraphy. METHODS: Thirteen consecutive patients with an adrenal mass scheduled to have surgery, underwent hormonal exploration, a CT scan for tumour size measurement and an 18F-FDG positron emission tomography scan. Eleven of these patients also had unenhanced density measurement at CT scan and iodocholesterol scintigraphy. RESULTS: CT-scanned adrenal masses ranged in size from 2.2 to 10 cm; attenuation value was <10 Hounsfield units (HUs) in two cases and >10 HU in nine. All benign lesions demonstrated iodocholesterol uptake. In the case of malignant tumours, results were non-homogeneous: no uptake, uptake and non-informative scintigraphy. All patients with an adrenocortical carcinoma had positive adrenal 18F-FDG uptake (n=3), one had a liver metastasis with positive 18F-FDG uptake, one showed 18F-FDG uptake in an adrenal metastasis from an unknown primary kidney tumour. All patients with a benign adrenocortical lesion had negative 18F-FDG uptake (n=9). Patients' lesions were hypersecretory (n=5), or non-hypersecretory (n=8), regardless of the pathology. CONCLUSION: This short preliminary study indicates that 18F-FDG gave a correct classification of tissue characterization with accurate identification of malignant lesions, as well as the disease stage (metastasis or primary). These promising preliminary results on adrenocortical lesions, seldom studied with 18F-FDG, are to be confirmed in larger series.


Subject(s)
Adrenal Cortex Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18 , Tomography, Emission-Computed , Adrenal Cortex/pathology , Adrenal Cortex Neoplasms/metabolism , Adrenal Cortex Neoplasms/surgery , Adult , Female , History, 18th Century , Humans , Liver/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Male , Middle Aged , Neoplasm Staging , Tomography, X-Ray Computed
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