Clinical Value Of 18F-FDG Research Articles

Clinical value of 18F-FDG PET/CT in patients with newly diagnosed acute leukemia.

To explore the correlation between semi-quantitative parameters of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scans findings and the clinical features of patients with acute leukemia (AL), as well as to evaluate the clinical utility of 18F-FDG PET/CT in the management of AL. A retrospective study was conducted with 44 patients newly diagnosed with acute leukemia (AL) at Zhongnan Hospital of Wuhan University between January 2019 and August 2024. Multivariate analysis revealed that age at diagnosis of AL (odds ratio [OR]: 0.888, P < 0.01) and percentage of blasts in the peripheral blood (PB) (OR: 1.061, P < 0.05) were independent predictors of the appearance of active extramedullary disease (EMD). Kaplan-Meier survival analysis for patients with EMD(+) indicated that those with organ infiltration beyond the lymph nodes experienced markedly reduced overall survival (OS) compared to those without such infiltration (157 days and 806 days, respectively). Furthermore, in the AL subgroup with EMD, the ratio of the maximum standardized uptake value (SUVmax) in the bone marrow (BM) to SUVmax of the liver emerged as an independent prognostic factor for OS (Hazard ratio [HR]: 2.372; 95% confidence interval [CI]: 1.079-5.214, P < 0.05). 18F-FDG PET/CT offers the benefits of being non-invasive and highly sensitive for the thorough evaluation of disease status in patients newly diagnosed with AL. Furthermore, the SUVmax BM/liver ratio is of significant clinical importance for prognosticating outcomes in patients with AL presenting EMD.

Imaging features and clinical value of 18F-FDG PET/CT for predicting airway involvement in patients with relapsing polychondritis

BackgroundThe clinical value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in assessing relapsing polychondritis (RP) with airway involvement remains controversial. This study aimed to investigate PET/CT features of RP with airway involvement and explore its clinical value in predicting disease pattern, severity and prognosis.MethodsRP patients with airway involvement who underwent PET/CT from January 2010 to July 2022 were retrospectively reviewed. PET/CT features were analyzed both visually and semiquantitatively with the maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG). Patterns of airway involvement on PET were summarized. Correlations of SUVmax and TLG of the airway were made with spirometric indicators and serological inflammatory markers (CRP and ESR). In addition, long-term follow-up was conducted through questionnaires in regard to symptom control, subjective feeling, pulmonary function, and quality of life.ResultsFifty-two cases were finally included. 18F-FDG PET showed FDG-avid lesions with increased FDG uptake in the airway among 94.2% of the patients. Three patterns (focal, multifocal and diffuse patterns) were identified. TLG of the whole airway was lower in patients with previous therapy (p = 0.046). Bronchoscopy was more sensitive in detecting tracheal abnormalities (90.7% vs.53.5%, p = 0.039) but less sensitive for peripheral airway lesions (65.1% vs. 79.1%, p = 0.046) compared with PET. SUVmax and TLG of the airway positively correlated with spirometry indicators (FEV1%pred, FEV1/FVC, MEF 50%pred, etc.) and serological inflammatory markers. Five patients died during the follow-up, with two deaths related to airway problems. Higher FDG uptake predicted worse subjective feeling, but not with symptom control or pulmonary function.ConclusionPET/CT is a valuable tool for RP with airway involvement, particularly in assessing peripheral airway lesions, and PET/CT related parameters are significantly associated with disease patterns, severity, and long-term outcomes.

Clinical value of 18F-FDG PET/CT in the management of HIV-associated lymphoma.

HIV is still a major public health problem. At present, HIV-associated lymphoma remains the leading cause of deaths among people living with HIV, whichshouldbepaidmore attentionto. 18F-fluorodeoxglucose (FDG) PET/CT has been recommended in the initial staging, restaging, response assessment and prognostic prediction of lymphomas in general population. HIV-associated lymphoma is, however, a different entity from lymphoma in HIV-negative with a poorer prognosis. The ability to accurately risk-stratify HIV-infected patients with lymphoma will help guide treatment strategy and improve the prognosis. In the review, the current clinical applications of 18F-FDG PET/CT in HIV-associated lymphoma will be discussed, such as diagnosis, initial staging, response evaluation, prognostic prediction, PET-guided radiotherapy decision, and surveillance for recurrence. Moreover, future perspectives will also be presented.

Clinical value of 18F-FDG PET/CT in IgG4-related disease.

To investigate the clinical value of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in IgG4-related disease (IgG4-RD). Seventy two patients diagnosed with IgG4-RD who underwent PET/CT were included. Correlations between clinical variables and PET/CT findings were analyzed by Spearman's correlation test. Conventional radiology was compared to PET/CT to evaluate detection discrepancies. The detection ability of insidious organ involvement by PET/CT at disease onset was investigated. The utility value of PET/CT for the 2019 ACR/EULAR classification criteria was analyzed with the multivariate logistic analysis and ROC curve. SUVmax of main involved organ was positively correlated with IgG4-RD Responder Index (IgG4-RD RI), serum and tissue IgG4 levels and IgG4/IgG ratio, serum eosinophils counts and number of involved organs, while negatively correlated with serum IgM levels. PET/CT was superior in detecting organ/tissue involvements including prostate, gastrointestinal tract and lung compared with conventional imaging. For patients with pancreato-hepato-biliary or head-neck involvements at onset, PET/CT showed superiority in detecting insidious lesions. Multivariate analysis showed that disease duration, multiple-organ involvement, SUVmax of main involved organ and mean SUVmax of all involved organs were significantly associated with the fulfillment of the 2019 ACR/EULAR classification criteria. ROC curves indicated that the cut-off value for SUVmax of main involved organ and mean SUVmax of all involved organs for fulfillment of the 2019 ACR/EULAR classification criteria for IgG4-RD were 4.1 and 3.5, respectively. 18F-FDG PET/CT has potential capacity to monitor disease activity, evaluate organ involvements and assist in the classification criteria in IgG4-RD.

Characteristics and Clinical Value of 18F-FDG PET/CT in the Management of Adult-Onset Still's Disease: 35 Cases.

While the diagnosis of adult-onset Still’s disease (AOSD) involves the exclusion of differential diagnoses, the characteristics and value of 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography coupled with CT (PET/CT) in the management of AOSD remain poorly known. Our retrospective study included patients from four centers, fulfilling Yamaguchi or Fautrel criteria, who underwent a PET/CT during an active AOSD. Thirty-five patients were included. At the time of PET/CT, the Yamaguchi criteria were met in 23 of 29 evaluable cases. PET/CT showed bone marrow (74.3%), lymph node (74.3%), and splenic (48.6%) FDG uptake. Despite arthralgia or arthritis in most patients, joints were rarely the sites of 18F-FDG accumulation. The spatial distribution of 18F-FDG uptake was nonspecific, and its intensity could be similar to malignant disease. Lymph node or bone marrow biopsy was performed after PET/CT in 20 patients (57.1%). The intensity of bone marrow; splenic and lymph node hypermetabolism appeared to be correlated with disease activity. Abnormal PET/CT in the cervical lymph nodes and age ≥ 60 years seemed to be predictive factors for monocyclic evolution. The clinical value of PET/CT is not in direct diagnosis; but as an aid in excluding differential diagnoses by searching for their scintigraphic features and guiding biopsy.

Clinical Value of 18F-FDG PET/CT in Prediction of Visceral Pleural Invasion of Subsolid Nodule Stage I Lung Adenocarcinoma

This study investigated the utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for predicting visceral pleural invasion (VPI) of subsolid nodule (SSN) stage I lung adenocarcinoma. A retrospective analysis of 18F-FDG PET/CT data from 65 postsurgical cases with surgical pathology-confirmed SSN lung adenocarcinoma identified significant VPI predictors using multivariate logistic regression. Nodule and solid component sizes, solid component-to-tumor ratios, pleural indentations, distances between nodules and pleura, and maximum standardized uptake values (SUVmax) differed significantly between VPI-positive (n = 30) and VPI-negative (n = 35) cases on univariate analysis. The distance between the nodule and pleura and SUVmax were significant independent VPI predictors on multivariate analysis. Areas under the curve of the distance between the nodule and pleura and SUVmax on receiver operating characteristic curves were 0.76 and 0.79, respectively; both factors were 0.90. The area under the curve of combined predictors was significantly superior to the distance between the nodule and pleura only but not SUVmax alone. The threshold of the distance between the nodule and pleura, to predict VPI was 4.50 mm, with 96.67% sensitivity, and 57.14% specificity. The threshold of SUVmax to predict VPI was 1.05, with 100% sensitivity and 60% specificity. The sensitivity and specificity of model 2 using the independent predictive factors were 96.67%, and 71.43%, respectively. Distance between the nodule and pleura and SUVmax are independent predictors of VPI in SSN stage I lung adenocarcinoma. Further, combining these factors improves their predictive ability.

Clinical value of 18F-FDG PET/CT imaging in evaluation of antineutrophil cytoplasmic antibody-associated vasculitis

Objective To explore the clinical value of 18F-fluorodeoxyglucose (FDG) PET/CT in assessing antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Methods Fifteen patients(7 males, 8 females, age (66±11) years) with AAV between January 2015 and June 2017 were retrospectively analyzed. There were 6 patients diagnosed as granulomatosis with polyangiitis (GPA), 7 diagnosed as microscopic polyangiitis (MPA) and 2 diagnosed as eosinophilic granulomatosis with polyangiitis (EGPA). All patients underwent 18F-FDG PET/CT and the image features were observed and analyzed. The maximum standardized uptake value (SUVmax) of the positive lesion was measured. The relationship between the SUVmax and C reactive protein (CRP) was analyzed with Pearson correlation. The SUVmax and the number of lesion sites were compared by two-sample t test between the CRP-elevated and CRP-normal patients. Results A total of 56 lesions in the 14 of 15 AAV patients were detected by PET/CT. The positive findings distributed in 15 tissues and organs, including the nasopharynxes (n=9), lungs (n=9), kidneys (n=8), spleen (n=6), lymph nodes (n=6), bone marrow (n=4), skin (n=3), prostate (n=2), aortas (n=2), vertebral soft tissues (n=2), orbita (n=1), parotid gland (n=1), thyroid gland (n=1), liver (n=1) and pancreas (n=1). The 60.7% (34/56) of lesions were clinically unsuspected occult lesions. GPA lesions mainly invaded the nasopharynxes, lungs and kidneys; MPA lesions mainly invaded the kidneys and spleen; EGPA lesions mainly invaded the nasopharynxes, lymph nodes and bone marrow. There was no significant correlation between the level of CRP and the SUVmax of AAV lesions (r=0.462, P>0.05). No differences in the SUVmax were observed between patients with elevated CRP levels and those with normal CRP levels (t=1.451, P>0.05). But more lesion sites were observed in patients with elevated CRP (t=3.456, P<0.05). Conclusions 18F-FDG PET/CT shows positive findings in multiple sites in AAV patients, including clinically unsuspected sites. This imaging technique may be a useful tool for diagnosis and evaluation of AAV. Key words: Anti-neutrophil cytoplasmic antibody-associated vasculitis; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Clinical value of 18F-FDG PET/CT in assessing muscular inflammation of dermatomyositis

Objective To analyze the imaging characteristics and diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT in muscular inflammation in dermatomyositis (DM), as well as the relationship between maximum standardized uptake value (SUVmax) and activity of muscular inflammation. Methods From July 2013 to November 2016, 17 hospitalized DM patients (8 males, 9 females, age range: 35-78 years) who underwent 18F-FDG PET/CT were retrospectively reviewed, including 13 typical DM (TDM) and 4 amyopathic DM (ADM). Seventeen healthy volunteers (8 males, 9 females, age range: 35-78 years) in the same period were enrolled as the control group. The proximal limb muscles of whole body were divided into 7 areas, and the SUVmax of each was measured and recorded. Two-sample t test, one-way analysis of variance, Dunnett-t test and Spearman correlation analysis were used to analyze data. Results Five TDM cases showed diffuse increased FDG uptake in global muscles; 8 TDM cases showed increased FDG uptake in local muscles, mainly in the shoulder and hip. The FDG uptake by muscles of 4 ADM patients was similar with that of controls. The SUVmax was lower and lower in the order of shoulder and back muscles, hip muscles, thoracic vertebra muscles, cervical vertebra muscles, biceps, proximal quadriceps and lumbar vertebra muscles in DM group. The muscle SUVmax of DM, TDM, ADM and the controls were 1.92±0.86, 2.14±0.85, 1.19±0.44 and 0.93±0.26, respectively (F=69.50, P<0.001). Muscle SUVmax of DM group was higher than that of controls, muscle SUVmax of TDM was higher than that of ADM, and muscle SUVmax of ADM was higher than that of controls (t values: 4.102-11.970, all P<0.05). Muscle SUVmax of 9 DM patients with interstitial lung disease (ILD) was lower than that of patients without ILD (1.73±0.09 vs 2.13±0.13; t=5.857, P<0.001). Muscle SUVmax of DM was positive correlated with serum levels of creatine kinase (CK) and creatine kinase isoenzyme composed by M and B subunits (CK-MB) (rs values: 0.814 and 0.751, both P<0.001). Conclusion 18F-FDG PET/CT is helpful to detect muscular inflammation of DM and it can reflect the activity and severity with SUVmax, and meanwhile evaluate the condition of ILD associated with DM. Key words: Dermatomyositis; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

C-reactive protein levels can predict positive 18F-FDG PET/CT findings that lead to management changes in patients with bacteremia.

Bacteremia portends high rates of morbidity and mortality. Although 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) imaging has clinical value in assessing fever of unknown origin, its usefulness in bacteremia has not been entirely elucidated. We therefore designed the current single-center retrospective study to investigate 1) the clinical value of 18F-FDG PET/CT imaging in assessing bacteremia and 2) the association between laboratory data and imaging findings. We examined 102 patients with bacteremia who had undergone 18F-FDG PET/CT imaging. The patients' clinical and laboratory data were reviewed and analyzed in relation to 18F-FDG PET/CT findings. Patients showing positive results underwent quantitative measurements of 18F-FDG uptake. Positive 18F-FDG PET/CT findings were identified in 74 (72.5%) patients, and 40 (54.1%) underwent modified treatment or management because of the imaging results (p=0.003). Positive 18F-FDG PET/CT findings were significantly associated with higher white blood cell (WBC) counts and C-reactive protein (CRP) levels (p=0.012 and<0.001, respectively). Notably, CRP levels accurately predicted (area under curve=0.752; p<0.001) positive 18F-FDG PET/CT findings (optimal cut-off point: 54.025mg/L). A majority (54.1%, n=40) of the patients with positive 18F-FDG PET/CT results underwent treatment modifications; they accounted for most cases (87%) of management changes in our cohort. Leukocytosis and increased CRP levels are significantly associated with positive 18F-FDG PET/CT findings in patients with bacteremia. CRP levels >54.025mg/L were accurate predictors of positive 18F-FDG PET/CT results.

Clinical value of 18F-FDG PET/CT for the prognosis of colorectal cancer

18F-flurodeoxyglucose(FDG) PET/CT plays an important role in early diagnosis, clinical staging, therapeutic efficacy evaluation, and recurrence monitoring of colorectal cancer (CRC). More and more scholars have focused on the value of PET/CT in CRC prognosis, intending to find out whether PET/CT can predict the survival outcomes (disease-free survival, progression-free survival and overall survival) of CRC patients after radical resection, in liver metastasis stage or in multiple metastases stage. This review summarizes the clinical value of 18F-FDG PET/CT for the prognosis of CRC. Key words: Colorectal neoplasms; Prognosis; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

18F-FDG PET/CT for restaging, guiding therapeutic strategy and predicting prognosis in patients with postoperative colorectal cancer

Objective To evaluate the clinical value of 18F-FDG PET/CT for restaging, guiding therapeutic strategy and predicting prognosis in patients with postoperative colorectal cancer (PCC). Methods Records of 91 patients (51 males, 40 females; average age (54.90±11.47) years) in whom PCC were evaluated by 18F-FDG PET/CT imaging from May 2010 to June 2014 were retrospectively reviewed. All patients underwent evaluation at the First Affiliated Hospital of Soochow University. 18F-FDG PET/CT results were compared with the results from pathological examination, clinical long-term follow-up (≥6 months) and conventional imaging. Diagnostic efficiency of 18F-FDG PET/CT in detecting recurrence and metastases of PCC were calculated. The clinical value of 18F-FDG PET/CT in restaging and guiding therapeutic strategy were analyzed in patients with true positive results. Kaplan-Meier survival analysis was conducted based on the results of PET/CT and the alteration of therapeutic strategy after PET/CT. Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 18F-FDG PET/CT were 96.36%(53/55), 83.33%(30/36), 91.21%(83/91), 89.83%(53/59) and 93.75%(30/32), respectively. The median survival time and the 5-year survival rate were 10.00 years and 84% in patients with true negative PET/CT results, and were 6.33 years and 53% in true positive group. Patients with true negative results showed longer OS and PFS than those with true positive results (χ2=7.753, 8.933, both P<0.01). Among the 53 patients with true positive PET/CT results, tumor restaging was up-regulated in 32 patients and down-regulated in 2 patients. Therapeutic strategies were changed in 33 patients, in whom the PFS was longer than those without treatment alteration (χ2=4.905, P<0.05). Conclusion 18F-FDG PET/CT imaging has the high sensitivity and accuracy in detecting recurrence and metastasis of PCC, with the potential for altering clinical restaging and therapeutic strategy timely. Key words: Colorectal neoplasms; Neoplasm staging; Prognosis; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Comparison of 18F-FDG and 68Ga-DOTA-NOC PET/CT on the diagnosis of G3 neuroendocrine neoplasm

Objective To investigate the clinical value of 18F-FDG PET/CT in diagnosing G3 NEN and compare it with 68Ga-DOTA-NOC PET/CT. Methods Twenty-three patients (12 males, 11 females; average age (63±12) years) diagnosed of NEN between January 2006 and November 2016 were retrospectively recruited in this study: 11 patients with gastroenteropancreatic NEN(GEP-NEN), 10 with G3 NEN in lungs, 1 with malignant pheochromocytoma and 1 with G3 NEN of unknown primary site. All patients underwent 18F-FDG PET/CT for staging and evaluation of biological behavior, and 9 of them also underwent 68Ga-DOTA-NOC PET/CT within 1 week. Image interpretation was analyzed by visual and semi-quantitative analysis, and SUVmax was calculated. Results All 23 cases showed positive results on 18F-FDG PET/CT (100%, 23/23), with primary tumor SUVmax 10.56±3.94. Compared with 18F-FDG PET/CT, the positive detection rate of 68Ga-DOTA-NOC PET/CT was lower (6/9 vs 9/9), with primary tumor SUVmax 14.24±10.00. There were 22 patients with distant metastasis. The most frequent metastatic sites associated with G3 NEN in lungs were lymph nodes and bones, while those with GEP-NEN were lymph nodes and the liver. In one patient with non-functional NEN, some metastatic lesions showed negative results on 18F-FDG PET/CT but positive results on 68Ga-DOTA-NOC PET/CT. Conclusions 18F-FDG PET/CT has higher diagnostic ability for G3 NEN and may serve as a useful tool for evaluating biological behavior of G3 NEN. 68Ga-DOTA-NOC PET/CT is valuable as a complementary diagnostic tool in a small proportion of high differentiated G3 NEN. Key words: Carcinoma, neuroendocrine; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose; Octreotide

Value of 18F-FDG PET/CT SUVmax for preoperative assessment of primary tumor infiltration and metastases in patients with endometrial cancer

Objective To evaluate the clinical value of 18F-FDG PET/CT in preoperative assessment for endometrial cancer. Methods A retrospective study was performed in 51 patients (average age (59±12) years) with confirmed or suspicious diagnosis of endometrial cancer from February 2013 to December 2015. Thirty-three patients underwent curettage surgery at least 1 week before PET/CT imaging. With SUVmax as the statistical variable, comparison was made between the pathologically confirmed benign and malignant groups, and in case of the latter, the extent of infiltration, histologic grade and subtype of primary tumor, lymph node and distant metastases were also analyzed. Two-sample t test was used to analyze the data, and diagnostic efficacy of PET/CT for metastasis was calculated. Results There were 43 patients with endometrial cancer and 8 patients with benign uterine tumor. SUVmax was found to significantly correlate with histopathology classification (benign: 3.4±1.2, malignant: 12.8±6.5) and depth of myometrial invasion (≥1/2: 17.7±5.4, 0.05). The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT for the detection of lymph node metastases on a lesion basis were 85.7%(18/21), 98.2%(271/276), 97.3%(289/297), 78.3%(18/23), 98.9%(271/274), respectively, and on a patient basis were 6/6, 97.3%(36/37), 97.7%(42/43), 6/7, 100%(36/36), respectively. The sensitivity and PPV of PET/CT for the detection of other metastases on a lesion basis were both 11/12. Conclusion SUVmax could be a clinically valuable tool for preoperative evaluation of the presence of deep myometrial invasion, lymph node metastases and other metastases in patients with endometrial cancer, particularly in specificity and NPV. Key words: Endometrial neoplasms; Neoplasm metastasis; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Clinical value of 18F-FDG PET/CT in patients with extranodal nasal type natural killer/T-cell lymphoma

Objective To analyze the image characteristics and clinical value of 18F-FDG PET/CT in patients with extranodal nasal type natural killer/T-cell lymphoma (ENKTL). Methods From January 2012 to March 2016, 20 ENKTL patients (12 males, 8 females; median age 53 years) who underwent whole-body 18F-FDG PET/CT were enrolled in this retrospective study. Eleven patients were newly diagnosed, and 9 were previously treated. Clinical data were collected for histopathology and bone marrow biopsy, laboratory results, PET/CT and radiological findings such as CT or MRI. The final diagnosis was based on histopathology and immunohistochemistry. Mann-Whitney u test was used to compare the SUVmax of newly diagnosed patients and patients with recurrence or disease progression after therapy. Spearman correlation analysis was used to explore the relation between diameter of tumor-invaded lymph nodes and SUVmax. Results ENKTL could be found in all parts of the body, but more frequently in the nasal cavity, nasopharynx and skin. All lesions showed high uptake of FDG on PET/CT. The SUVmax of newly diagnosed patients was significantly higher than that of patients (n=7) with recurrence or disease progression: 6.5(4.3, 10.4) vs 5.4(3.4, 8.9); u=6 853.500, z=-2.039, P<0.05). The diameter of tumor-invaded lymph nodes showed weakly positive correlation with SUVmax (rs=0.290, P<0.01), suggesting that invasion of ENKTL might not be accurately evaluated by the size of lymph nodes. The staging by PET/CT was concordant with clinical final staging in 11 newly diagnosed patients, while the staging by CT or MRI was only correct in 6 patients. Conclusions PET/CT is superior to conventional imaging modalities in diagnosis and staging for patients with ENKTL. Since some lesions might be found in the limbs, limbs should be included in the scan field. Key words: Lymphoma, extranodal NK-T-cell; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

The diagnostic value of 18F-FDG PET/CT in cervical cancer

Objective To assess the clinical value of 18F-FDG PET/CT in the diagnosis of primary, suspected recurrent and metastatic cervical cancer. Methods The results of 67 women who were suspected suffering from cervical cancer had undergone Color dopplar ultrasound, HPV, TCT, some of them do CT, MRI and SCC-Ag examination from April 2013 to April 2015 were retrospectively analyzed.Their 18F-FDG PET/CT images with the other test results were compared.The presence or absence of tumor was confirmed by histopathology. Results In the 67 patients, 22 cases were finally diagnosed as primary cervical tumors, and 22 cases of recurrent and metastatic cervical tumors.In all the patients with cervical cancer, 18F-FDG PET/CT found a total of 41 cases, which had contributed to the diagnosis in 94.0%, But 3 cases had not been found.For the detection of primary cervical tumors, 18F-FDG PET/CT was diagnostically wrong in 4.2%, For the detection of recurrent and metastatic cervical tumors, 18F-FDG PET/CT was diagnostically wrong in 7.0%, and 2 cervical adenocarcinoma patients were not diagnosed by 18F-FDG PET/CT. Conclusion The study showed a significantly higher sensitivity of 18F-FDG PET/CT for the detection of primary, recurrent and metastatic cervical cancer than the other auxiliary examination.18F-FDG PET/CT for the diagnosis of cervical cancer can be worth popularization. Key words: Cervical cancer; Tumor metastasis; Diagnosis; Computed tomography; 18F-Fluorodeoxy glucose

Analysis of 18F-FDG PET/CT imaging characteristics in 36 patients with autoimmune pancreatitis

Objective To investigate the imaging characteristics and the clinical value of 18F-FDG PET/CT imaging in autoimmune pancreatitis (AIP). Methods The 18F-FDG PET/CT imaging characteristics of 36 patients (33 males, 3 females; average age 60 years) with AIP proved by histopathology or clinical follow-up from August 2010 to March 2014 were retrospectively analyzed. The morphologic and metabolic abnormalities of pancreatic and extra-pancreatic lesions were analyzed. The early SUVmax and delayed SUVmax were compared by paired t test in 32 patients who underwent dual time point 18F-FDG PET/CT imaging. Results (1)18F-FDG PET/CT showed diffuse uptake of FDG by the pancreas in 17 patients (47.2%, 17/36), localized uptake in 10 patients (27.8%, 10/36), mixed uptake in 7 patients (19.4%, 7/36), and multifocal uptake in 2 patients (5.6%, 2/36). A total of 33 patients (91.7%) had intense FDG uptake in the pancreas with SUVmax of 5.32±1.83, while the others showed mild FDG uptake with SUVmax of 2.13±0.15. Delayed SUVmax was significantly different from early SUVmax (6.11±2.68 vs 5.08±2.03, t=-7.305, P<0.01) in the 32 patients undergoing delayed scan. The average retention index (RI) in those patients were (18.0±16.1)%. (2) Capsule-like rim surrounding the pancreas was found in 10 patients and abnormality of the main pancreatic duct was found in 9 patients. (3) Thirty-four (94.4%, 34/36) patients had extra-pancreatic lesions, including mediastinal and pulmonary hilar lymph nodes, salivary glands, cervical and submandibular lymph nodes, and foci with the invertedVshaped high FDG uptake in the prostate, which were found in 21 of 33 (63.6%) male patients. (4) The case-times of extra-pancreatic organs involved were 4.17±2.15 in the whole pancreas involved group (diffuse uptake + mixed uptake), and 2.64±1.63 in the partial pancreas involved group (localized uptake + multifocal uptake), which were significantly different (t=2.10, P<0.05). Conclusions Various intense uptake of FDG, which is higher on delayed scan, can be shown in the pancreas in patients with AIP. 18F-FDG PET/CT is an effective modality to detect extra-pancreatic lesions, and it could contribute to the diagnosis and evaluation of AIP. Key words: Autoimmune diseases; Pancreatitis; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Performance of 18F-FDG PET/CT in the diagnosis of recurrent and metastatic endometrial cancer

Objective To evaluate the clinical value of 18F-FDG PET/CT in the diagnosis of recurrent and metastatic endometrial cancer. Methods A total of 62 patients with endometrial cancer from October 2004 to February 2014 were retrospectively analyzed. The diagnostic efficiency of 18F-FDG PET/CT for the detection of recurrent and metastatic endometrial cancer was evaluated based on the results of pathological biopsy or clinical follow-up. Results There were 28 endometrial cancer cases with recurrence and metastasis, 9 cases with a second primary cancer and without recurrence and metastasis of endometrial carcinoma. PET/CT imaging had false positive findings in 3 cases, false negative findings in 2 cases. The overall sensitivity, specificity and accuracy of PET/CT for detection of recurrence and metastatic endometrial carcinoma were 93.3%(28/30), 90.6%(29/32), 91.9%(57/62), respectively. The sensitivity and specificity of PET/CT for the diagnosis of vaginal stump recurrence, lymph node metastasis and distant metastasis were 9/10 and 98.1%(51/52), 95.7%(22/23) and 92.3%(36/39), 15/18 and 95.5%(42/44), respectively. Conclusion 18F-FDG PET/CT is a useful diagnostic tool for the detection of recurrent and metastatic endometrial cancer and a second primary cancer. Key words: Endometrial neoplasms; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Value of 18F-FDG PET/CT in patients with cancer of the uterine cervix having elevated serum squamous cell carcinoma antigen after treatment

Objective To evaluate the clinical value of 18F-FDG PET/CT in the detection of residual, recurrent and metastatic diseases in post-treatment uterine cervical cancer patients presenting with elevated serum squamous cell carcinoma (SCC) antigen levels. Methods Between March 2009 and October 2012, 18F-FDG PET/CT was performed in 48 patients(average age (47.5±11.2) years) with suspected residual, recurrent or metastatic uterine cervical cancer because of increased serum SCC antigen level (>1.5 μg/L). The final diagnosis was established by pathology or more than 1 year of clinical follow-up. The diagnostic efficiency of 18F-FDG PET/CT was calculated. Two-sample t test was used for data analysis. Results The serum SCC levels were 1.6-42.5(mean: 8.6±9.4) μg/L. Among the 48 patients, 45 (93.75%) were confirmed of having malignant lesions. 18F-FDG PET/CT along with other imaging detected 174 lesions, of which 169 were proven as residual, recurrent or metastatic diseases. 18F-FDG PET/CT correctly identified 159 lesions, yielding a diagnostic sensitivity and accuracy of 94.08%(159/169) and 91.38%(159/174), respectively. The diagnostic sensitivity and accuracy for residual and recurrent diseases were both 9/10; for lymph node metastasis were 94.59%(105/111) and 92.92%(105/113), respectively; and for other sites of metastasis were 93.75% (45/48) and 88.24%(45/51), respectively. There was no significant difference of SUVmax between the patients with residual/recurrent disease (mean: 6.9±3.8, range: 2.0-13.7) and those with metastasis (mean: 6.3±2.7, range: 2.0-14.4,t=0.629, P>0.05). Conclusion 18F-FDG PET/CT is valuable for the detection of residual, recurrent and metastatic diseases in the uterine cervical cancer patients presenting with elevated serum squamous cell carcinoma antigen after conventional treatment. Key words: Cervix neoplasms; Neoplasm recurrence, local; Neoplasm metastasis; Antigens; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Diagnostic value of 18F-FDG PET/CT in differentiating the cardiac benign from malignant lesions

Objective To explore the clinical value of 18F-FDG PET/CT in differentiating between cardiac benign and malignant lesions. Methods From September 2009 to September 2012, a total of 9 (7 males, 2 females, average age (46±22) years) patients with space-occupying lesions of the heart underwent whole body 18F-FDG PET/CT. 18F-FDG PET/CT diagnosis was made according to morphologic features and SUVmax of lesions. The final diagnoses were confirmed by either histopathology or clinical data and follow-up. Two-sample t test was used for data analysis. Results Among 9 cases of cardiac occupying lesions, 4 cases were malignant tumors, 4 cases were benign tumors (including 2 lipomas, 1 myxoma, and 1 fibroma), 1 case was thrombus. The average SUVmax of malignant tumors was 18.99±14.58, which was significantly higher than that of benign tumors (2.35±1.46, t=-2.58, P<0.05). With a cut-off SUVmax of 4.6, 18F-FDG PET/CT could be used to noninvasively detect malignant tumors with a sensitivity of 4/4, specificity of 4/5, and accuracy of 8/9. Only 1 thrombus was misdiagnosed. Conclusion 18F-FDG PET/CT can aid the noninvasive differential diagnosis of cardiac malignant tumors from benign lesions. Key words: Heart neoplasms; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Prediction of postoperative recurrence and metastasis with 18F-FDG PET/CT in patients with non-small cell lung cancer

Objective To assess the clinical value of 18F-FDG PET/CT for the prediction of postoperative recurrence and metastasis in patients with NSCLC.Methods Eighty-five patients (64 males,21 females; average age:58.0 years) with NSCLC were enrolled.All patients underwent 18 F-FDG PET/CT within one week before surgical operation and 3 months after the operation.The diagnosis of recurrent cancer and metastasis was confirmed by pathologic findings,other imaging modalities and clinical follow-up.The diagnostic efficacy of PET/CT was calculated and the predictors for postoperative recurrence and metastasis were analyzed.x2 test and two-sample t test were used for statistical analysis.Results Among 85 patients,43 had recurrence and metastasis post operation.The postoperative recurrence and metastasis were detected by 18F-FDG PET/CT in 9.3％(4/43) within 6 months,30.2％(13/43) within 1 year,76.7％(33/43) within 2 years and 97.7％(42/43) after 2 years.The sensitivity,specificity,accuracy of 18F-FDG PET/CT for the detection of recurrent tumor and metastasis were 97.7％ (42/43),95.2％ (40/42),96.5％ (82/85) respectively.The preoperative cancer staging,size and SUVmax of primary tumor were significant factors for the prediction of postoperative tumor recurrence and metastasis within 2 years (x2 =12.360,t=3.281 and 2.465,all P＜0.05),but not gender,age or pathological findings (x2 =0.639,0.012 and 3.800,all P＞0.05).Conclusions 18F-FDG PET/CT has an important role for the detection of postoperative recurrence and metastasis in patients with NSCLC.Preoperative cancer staging,size and SUVmax of the primary tumor might be the predictive factors for postoperative tumor recurrence and metastasis within 2 years. Key words: Carcinoma, non-small cell lung; Neoplasm recurrence, local ; Neoplasm metastasis ; Tomography, emission-computed ; Tomography, X-ray computed; Deoxyglucose