Diagnostic Performance Of 18F-FDG Research Articles

Retracted: The Diagnostic Performance of 18F-FDG PET/CT in Recurrent Pancreatic Cancer: A Systematic Review and Meta-analysis.

[This retracts the article DOI: 10.1155/2022/3655225.].

Diagnostic value of 18F-FDG PET/CT and 68Ga-FAPI PET/CT in primary liver cancer: A systematic review and meta-analysis.

To conduct a meta-analysis of the diagnostic efficacy of fluorine-18-fluorodeoxyglucose (18F-FDG) and gallium-68-labeled fibroblast-activation protein inhibitor (68Ga-FAPI) positron emission tomography/computed tomography (PET/CT) for primary liver cancer based on existing clinical evidence. Meta-analysis was carried out according to PRISMA reporting specification. The clinical studies in PubMed/Medline, Embase and the Cochrane Library database were retrieved from the establishment to September 2022. Two researchers independently conducted literature screening and data extraction, evaluated the risk of bias according to QUADAS-2, conducted meta-analysis using Meta Disc 1.4 and Stata15.1 software, and calculated the summarized sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (-LR), and diagnostic odds ratio (DOR). The diagnostic performance of 18F-FDG PET/CT and 68Ga-FAPI PET/CT for primary liver cancer was compared using summarized receiver operating characteristic (SROC) curve and area under curve (AUC). Four original studies on 18F-FDG PET/CT and 68Ga-FAPI PET/CT in the diagnosis of primary liver cancer were included, including 159 intrahepatic lesions in 106 patients. Taking lesions as a unit, in four original studies, the pooled results of 18F-FDG PET/CT diagnosis of primary liver cancer were Sen=0.5 (95% CI:95% CI: 0.41-0.59), Spe=0.87 (95% CI: 0.52-0.98), AUC=0.58 (95% CI:0.53-0.62); The pooled results of 68Ga-FAPI PET/CT in the diagnosis of primary liver cancer, Sen=0.5 (95% CI: 0.41-0.59), Spe=0.87 (95%CI:0.52-0.98), AUC=0.58 (95% CI:0.53-0.62). Besides, the Sen of 68Ga-FAPI PET/CT in the diagnosis of primary liver cancer was higher than that of 18F-FDG PET/CT (Z=2.323, P=0.02), the difference was statistically significant. Gallium-68-FAPI PET/CT is a promising tool. Compared with 18F-FDG, 68Ga-FAPI has higher sensitivity to detect more lesions in primary liver cancer and metastatic lesions, and has high performance in the diagnosis of primary liver cancer.

The diagnostic performance of 18F-FDG PET/CT in recurrent renal cell carcinoma: a systematic review and meta-analysis

The diagnostic performance of 18F-FDG PET/CT in recurrent renal cell carcinoma: a systematic review and meta-analysis

The Diagnostic Performance of 18F-FDG PET/CT in Recurrent Pancreatic Cancer: A Systematic Review and Meta-analysis.

Purpose The CT scan is the best common screening test for pancreatic cancer recurrence after surgery. The goal of our meta-analysis was to assess the diagnostic accuracy of 18F-FDG PET/CT for pancreatic cancer recurrence. Methods We examined PubMed and Embase for suitable papers between 2009 and 2022. The researchers considered studies that looked at the diagnostic usefulness of 18F-FDG PET/CT in identifying local and/or distant disease recurrence throughout the follow-up following pancreatic cancer resection. The Quality Assessment of Diagnostic Performance Studies-2 (QUADAS-2) method was used to evaluate the quality of each study. For each of the publications included, two researchers extracted data independently. The extracted data included general data (authors, year of publication), literature characteristics (country, type of literature, and design of study), characteristics of the patient (patients' number, mean or median age, and treatment regimen), and technical aspects (scanner, injection activity, and image analysis). Results The analysis includes 7 trials with a total of 263 patients. The sensitivity and specificity of 18F-FDG PET/CT in detecting recurrent pancreatic cancer following definitive treatment were 0.89 (95 percent CI: 0.83-0.93) and 0.88 (95 percent CI: 0.72-0.96), respectively, according to the pooled estimates. PET/CT performed well in the diagnosis of recurrent pancreatic cancer, with an AUC of 0.94. (0.91-0.95). Conclusions 18F-FDG PET-CT was found to be a reliable detection method in recurrent pancreatic tumor.

Diagnostic test accuracies of F-18 FDG PET for characterisation of cardiac masses compared to conventional imaging techniques: systematic review and meta-analysis.

The present systematic review and meta-analysis compared the diagnostic performance of F-18 fludeoxyglucose positron emission tomography (18F-FDG PET) and conventional imaging, including MRI, echocardiography, and CT, in characterising cardiac masses. A literature search of the PubMed, Cochrane, and EMBASE databases for studies comparing the diagnostic accuracies of 18F-FDG PET and conventional imaging in characterising cardiac masses, from inception of indexing to 31 July 2020, was performed. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality. Sensitivity and specificity across the studies were determined, positive and negative likelihood ratios (LR+ and LR-, respectively) were calculated, and summary receiver operating characteristic curves were constructed. Of six included studies (n = 212 patients), 18F-FDG PET demonstrated a pooled sensitivity of 0.89 (95% confidence interval [CI] 0.81-0.94) and a pooled specificity of 0.89 (95% CI 0.80-0.94). LR syntheses yielded an overall LR+ of 7.9 (95% CI 4.3-14.6) and LR- of 0.12 (95% CI 0.07-0.22). The calculated pooled diagnostic odds ratio (DOR) was 64 (95% CI 23-181). For conventional imaging, the pooled sensitivity was 0.70 (95% CI 0.57-0.81) and the pooled specificity was 0.96 (95% CI 0.88-0.98). LR syntheses yielded an overall LR+ of 16.1 (95% CI 5.8-44.5) and LR- of 0.31 (95% CI 0.21-0.46). The evaluated pooled DOR was 52 (95% CI 17-155). 18F-FDG PET and conventional imaging demonstrated comparable diagnostic accuracies for the characterisation of cardiac masses. Further large multicentre studies are, however, required to corroborate the diagnostic performances of 18F-FDG PET and conventional imaging for the characterisation of cardiac masses. No previous studies have comprehensively analysed the diagnostic performance of 18F-FDG PET/CT compared with conventional imaging techniques including echocardiography, CT, and MRI. According to the current study, 18F-FDG PET/CT yielded a pooled DOR of 64, whereas other conventional imaging techniques demonstrated a DOR of 52. As such, 18F-FDG PET/CT demonstrated sensitivity and specificity, with a high pooled DOR comparable with other conventional imaging modalities.

Diagnostic value of FDG-PET/CT in fever of unknown origin

BackgroundFever of unknown origin (FUO) is a challenging clinical problem in medicine that needs collaboration of various diagnostic techniques to establish the accurate diagnosis. We evaluated the diagnostic performance of 18F-FDG PET/CT in patients who presented themselves with FUO. Our study included 40 patients with FUO who underwent PET/CT examination and their results were compared to the results of laboratory, histopathological, microbiological investigations and/or response to therapy.ResultsThe final diagnosis included malignancy in 20 patients (50%), infectious causes in 7 patients (17.5%) and non-infectious inflammatory causes in 6 patients (15%). Fever resolved without diagnosis in 4 patients (10%), while no definite diagnosis was reached in 3 patients (7%). PET/CT successfully contributed to diagnosis of 35 out of 40 patients with diagnostic accuracy of 87.5%. The sensitivity, specificity, positive predictive value and negative predictive value of PET/CT in our study were 93.5%, 66.7%, 90.6% and 75%, respectively.ConclusionPET/CT is a useful tool to investigate and diagnose the cause of FUO. It provides information that can guide the treatment strategy of the patients.

18F-FDG PET/CT for early response assessment of jaw osteoradionecrosis after the PENTOCLO protocol: A promising imaging modality

IntroductionThe Pentoxifylline, Tocopherol and Clodronate protocol (PENTOCLO) showed promising results for jaw osteoradionecrosis (ORN) management. However, the clinical and radiological improvements are often delayed, leading to unwanted long-term treatment, with potential loss of opportunity for more radical surgical treatments. Our objective was to assess the diagnosis performance of 18F-FDG PET/CT to early predict ORN response to the PENTOCLO protocol. Materials and methodsAll patients from our center who were treated with the PENTOCLO protocol and with a 18F-FDG PET/CT performed at diagnosis and three months after the end of antibiotherapy were retrospectively included. The PENTOCLO protocol was always combined with prior appropriate antibiotherapy for six weeks. The healing endpoint was divided into healing, stability or worsening, according to the combination of clinical and radiological assessments at the date of last follow-up. For each patient, the difference between the maximal standardized uptake value (ΔSUVmax) of the ORN lesion at three months and baseline were computed. Diagnostic performance of 18F-FDG PET/CT was evaluated by sensitivity, specificity and the area under the receiver operating characteristic curve (ROC-AUC) of ΔSUVmax. Results24 patients were included with an average follow-up of 29.3 months. The healing, stability and worsening rate were 25%, 62.5% and 12.5% respectively. The AUC for discriminating worsening vs stability or healing was 0.92 (IC95 [0.81–1.00]). A ΔSUVmax greater than or equal to 0 was predictive of a worsening with a sensitivity and specificity of 84 and 66% respectively. Conclusion18F-FDG PET/CT imaging could be useful for early prediction of PENTOCLO treatment resistance with appropriate antibiotherapy.

Diagnostic Performance of FDG-PET/CT Scan as Compared to US-Guided FNA in Prediction of Axillary Lymph Node Involvement in Breast Cancer Patients.

PurposeThe aim of this study was to evaluate the diagnostic ability of 2-deoxy-2-[fluorine-18]fluoro-d-glucose (18F-FDG) PET/non-contrast CT compared with those of ultrasound (US)-guided fine needle aspiration (FNA) for axillary lymph node (ALN) staging in breast cancer patients.Patients and MethodsPreoperative 18F-FDG PET/non-contrast CT was performed in 268 women with breast cancer, as well as ALN dissection or sentinel lymph node (SLN) biopsy. One hundred sixty-four patients underwent US-guided FNA in combination with 18F-FDG PET/CT. The diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. The receiver operating characteristic (ROC) curves were compared to evaluate the diagnostic ability of several imaging modalities.ResultsAxillary 18F-FDG uptake was positive in 180 patients, and 125 patients had axillary metastases according to the final pathology obtained by ALN dissection and/or SLN dissection. Of the patients with positive 18F-FDG uptake in the axilla, 21% had false-positive results, whereas 79% were truly positive. Eighty-eight patients had negative 18F-FDG uptake in the axilla, among which 25% were false-negative. 18F-FDG-PET/CT had a sensitivity of 86.59% and a specificity of 63.46% in the assessment of ALN metastasis; on the other hand, US-guided FNA had a sensitivity of 91.67% and a specificity of 87.50%. The mean primary cancer size (p = 0.04) and tumor grade (p = 0.04) in combination were the only factors associated with the accuracy of 18F-FDG PET/CT for detecting metastatic ALNs.ConclusionThe diagnostic performance of 18F-FDG PET/CT for the detection of axillary node metastasis in breast cancer patients was not significantly different from that of US-guided FNA. Combining 18F-FDG PET/CT with US-guided FNA or SLN biopsy could improve the diagnostic performance compared to 18F-FDG PET/CT alone.

Diagnostic performance of 18F-FDG PET/CT in pediatric lymphoma infiltrating bone marrow: a meta-analysis

Diagnostic performance of 18F-FDG PET/CT in pediatric lymphoma infiltrating bone marrow: a meta-analysis

Diagnostic Value of 18F-FDG PET/MRI for Revised 2018 FIGO Staging in Patients with Cervical Cancer.

Purpose: To evaluate the diagnostic potential of PET/MRI with 18F-fluorodeoxyglucose (18F-FDG) in cervical cancer based on the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system. Materials and Methods: Seventy-two patients with biopsy-proven primary cervical cancer underwent pretreatment 18F-FDG PET/MRI, CT, and pelvic MRI. The diagnostic performance of 18F-FDG PET/MRI and MRI for assessing extent of the primary tumor and 18F-FDG PET/MRI and CT for assessing nodal and distant metastases was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. McNemar test was employed for statistical analysis. Results: Accuracy for the invasion of vagina, parametrium, side wall, and adjacent organs was 97.2%, 93.1%, 97.2%, and 100% for 18F-FDG PET/MRI; and 97.2%, 91.7%, 97.2%, and 100% for pelvic MRI, respectively (p > 0.05). Patient-based accuracy for metastasis to pelvic and paraaortic lymph nodes and distant organs was 95.8%, 98.6%, and 100% for 18F-FDG PET/MRI; and 83.3%, 95.8%, and 97.2% for CT, respectively; metastasis to pelvic lymph nodes was statistically significant (p < 0.01). Lesion-based sensitivity, specificity, and accuracy for lymph nodes were 83.3%, 95.9%, and 94.8% for 18F-FDG PET/MRI; and 29.2%, 98.9% and 93.1% for CT, respectively; sensitivity was statistically significant (p < 0.001). After excluding patients diagnosed by conization, accuracy for revised FIGO staging 2018 was significantly better for 18F-FDG PET/MRI (82.1%) than for CT and MRI (60.7%) (p < 0.01). Conclusions: 18F-FDG PET/MRI offers higher diagnostic value for revised 2018 FIGO staging, suggesting that 18F-FDG PET/MRI might provide an optimal diagnostic strategy for preoperative staging.

Role of 18F-FDG PET/CT in diagnosis of cardiovascular infection in patients after cardiac surgery

Abstract Purpose To investigate the diagnostic performance of 18F-FDG PET/CT in patients with suspected prosthetic valve infective endocarditis (IE), prosthetic aortic and intracardiac device infection. Methods The prospective analysis included results of PET/CT examinations performed in 60 patients with fever of unknown origin after cardiac surgery (median time 29 months): valve replacement (n=26), intracardiac device implantation (n=19), both procedures (n=8), Bentall-de-Bono surgery (n=7). According to the Duke criteria most patients – 90% (54/60) – had possible (n=42) and rejected (n=12) diagnosis of IE; 6 patients had definite IE. PET/CT scan was performed 90 min after intravenous injection of 18F-FDG (175–200MBq). All patients underwent strict carbohydrate-free diet and fasted for at least 15–18 hours. Final diagnosis was based on clinical, laboratory, instrumental and intraoperative (n=41) data: confirmed in 40 and ruled out in 20 patients. Results PET/CT results correctly confirmed the infectious process in the prosthetic valve area, aortic prosthesis or along the intracardiac device in 93% (37/40) and ruled it out in 75% (15/20) patients. False results were obtained in 13% (8/60) – positive (n=5) and negative (n=3). Thus, in the analyzed group of patients (n=60), the sensitivity, specificity and diagnostic accuracy of PET/CT with 18F-FDG in the diagnosis of IE were 93%, 75% and 83%, respectively; positive and negative predictive value – 88% and 83%. In patients with possible IE according to the Duke criteria, true PET/CT results were obtained in 86% (36/42) – positive (n=28) and negative (n=8). In 7% (4/60) of patients – the diagnosis was based only on PET/CT, while initially, according to the Duke criteria, it was rejected. In addition, in 40% (24/60) of patients of the analyzed group, whole body PET/CT revealed other than valve and device, previously unknown foci of inflammation: in the lungs (n=6), in the sternum (n=6), in the area of the native valve (n=3), in the mediastinum (n=4), other (n=13). Conclusions 18F-FDG PET/CT proved to be highly informative for the diagnosis of infectious processes in the heart and vessels in patients after cardiac surgery. The inclusion of PET/CT in the diagnostic algorithm for this category of patients reduces the number of patients with possible IE according to the Duke criteria. Funding Acknowledgement Type of funding source: None

Diagnostic value of 18F-FDG PET/MRI for staging in patients with endometrial cancer

BackgroundPreoperative accurate assessment of endometrial cancer can assist in the planning of additional surgical options, and in predicting the prognosis. The aim of the present study was to evaluate the diagnostic potential of non-contrast PET/MRI with 18F-fluorodeoxyglucose (18F-FDG) for assessment in preoperative staging of endometrial cancer.MethodsThirty-six patients with biopsy-proven endometrial cancer underwent preoperative 18F-FDG PET/MRI, contrast-enhanced CT (ceCT) and pelvic dynamic contrast-enhanced MRI (ceMRI) for initial staging. The diagnostic performance of 18F-FDG PET/MRI and ceMRI for assessing the extent of the primary tumor (T stage), and 18F-FDG PET/MRI and ceCT for assessing nodal (N stage) and distant (M stage) metastasis, was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis.ResultsAccuracy for T status was 77.8 and 75.0% for 18F-FDG PET/MRI and ceMRI, respectively. Patient-based accuracy for detecting regional nodal and distant metastasis was 91.3 and 81.8% for 18F-FDG PET/MRI, and 87.0 and 81.8% for ceCT. None of these parameters was statistically significant (p > 0.05). Lesion-based sensitivity, specificity and accuracy for detecting regional nodal metastasis were 100, 96.9 and 97.0% for 18F-FDG PET/MRI, and 14.3, 97.6 and 93.3% for ceCT; sensitivity was statistically significant (p < 0.05).ConclusionsNon-contrast 18F-FDG PET/MRI, which combines the individual advantages of PET and MRI, offers a high diagnostic value equivalent to that of ceMRI for assessment of the primary tumor, and equivalent to that of ceCT for the assessment of nodal and distant metastatic staging, in patients with endometrial cancer. These findings suggest that 18F-FDG PET/MRI might provide an alternative diagnostic strategy to conventional imaging modalities in the preoperative staging of endometrial cancer.

Diagnostic value of sentinel lymph node scintigraphy and 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in the detection of metastatic lymph nodes in patients with early-stage cervical cancer.

Cervical cancer is staged clinically using the International Federation of Gynaecology and Obstetrics staging system. Although lymph node status does not form part of the staging, it has important prognostic and potential therapeutic implications. The aim of the study was to evaluate the role of sentinel lymph node (SLN) scintigraphy and 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting lymph node metastases in patients with early-stage cervical cancer. Thirty-six patients with early-stage cervical cancer underwent SLN detection during primary operation. Of the 36 patients, 28 patients underwent 18F-FDG PET/CT before surgery. The 18F-FDG PET/CT images were analyzed with the histopathological findings as the reference standard. The diagnostic performance of 18F-FDG PET/CT in the detection of nodal disease was reported in terms of accuracy value. The SLN detection rate was the highest (91.7%) using the combined method (lymphoscintigraphy, intraoperative gamma probe, and blue dye). Seven of the thirty-six patients had lymph node involvement (19.4%), of which five had preoperative 18F-FDG PET/CT imaging. On overall patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of 18F-FDG PET/CT were 40.0%, 78.3%, 28.6%, 85.7%, and 71.4%, respectively. The combination of radiolabeled nanocolloid with blue dye is safe and reliable and allows successful detection of SLNs in patients with early-stage cervical cancer in a population with high prevalence of human immunodeficiency virus. The specificity and NPV of 18F-FDG PET/CT are high and can be used in conjunction with SLN biopsy.

Diagnosis of Infective Endocarditis by Subtype Using 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Contemporary Meta-Analysis.

Background Infective endocarditis (IE) remains a difficult to diagnose condition associated with high mortality. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently emerged as another IE imaging modality, although diagnostic accuracy varies across observational studies and types of IE. This meta-analysis assessed the diagnostic performance of 18F-FDG PET/CT for IE and its subtypes. Methods We searched Pubmed, Cochrane, and Embase from January 1980 to September 2019 for studies reporting both sensitivity and specificity of 18F-FDG PET/CT for IE. Meta-Disc 1.4 was used to pool data for all cases of IE and its subgroups of native valve IE, prosthetic valve IE, and cardiac implantable electronic devices IE. Results We screened 2566 records from the search, assessed 52 full-text articles, and included 26 studies totaling 1358 patients (509 IE cases). Pooled sensitivity and specificity (95% CI, inconsistency I-square statistic) were 0.74 (0.70-0.77, 71.5%) and 0.88 (0.86-0.91, 78.5%) for all cases of endocarditis. Corresponding parameters for native valve IE were sensitivity 0.31 (0.21-0.41, 29.4%) and specificity 0.98 (0.95-0.99, 34.4%); for prosthetic valve IE: sensitivity 0.86 (0.81-0.89, 60.0%) and specificity 0.84 (0.79-0.88, 75.2%); and for cardiac implantable electronic devices IE: sensitivity 0.72 (0.61-0.81, 76.2%) and specificity 0.83 (0.75-0.89, 83.6%). Pooled sensitivities and specificities were higher for the 17 studies since 2015 than the 9 studies published before 2015. Conclusions 18F-FDG PET/CT had high specificity for all IE subtypes; however, sensitivity was markedly lower for native valve IE than prosthetic valve IE and cardiac implantable electronic devices IE. It is, therefore, a useful adjunct modality for assessing endocarditis, especially in the challenging scenarios of prosthetic valve IE and cardiac implantable electronic devices IE, with improving performance over time, related to advances in 18F-FDG PET/CT techniques.

Diagnostic Value of Whole-Body DWI With Background Body Suppression Plus Calculation of Apparent Diffusion Coefficient at 3 T Versus 18F-FDG PET/CT for Detection of Bone Metastases.

OBJECTIVE. The purpose of this study is to evaluate the diagnostic performance of whole-body (WB) DWI with background body suppression (DWIBS) combined with calculation of the apparent diffusion coefficient (ADC) value at 3 T compared with the diagnostic performance of 18F-FDG PET/CT for detecting bone metastases in patients with malignant tumors. SUBJECTS AND METHODS. Thirty-nine consecutive patients with suspected bone metastases underwent both WB DWIBS and FDG PET/CT. Imaging findings were independently interpreted using qualitative and quantitative analyses. Pathologic findings or clinical or radiologic follow-up data were used as the diagnostic reference standard. The sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of both modalities were calculated. The ADCs of benign lesions and metastases were compared. RESULTS. A total of 213 metastatic bone segments were confirmed among 39 patients. The sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value were 93.0%, 87.8%, 89.6%, 79.8%, and 96.0%, respectively, for WB DWIBS and 92.5%, 92.0%, 92.1%, 85.7% and 95.9%, respectively, for FDG PET/CT. The specificity of WB DWIBS in detecting bone metastases was significantly lower than that of FDG PET/CT (p < 0.05), whereas the sensitivity, overall accuracy, positive predictive value, and negative predictive value in detecting bone metastases were not significantly different between WB DWIBS and FDG PET/CT (p > 0.05). The ADCs for benign lesions were significantly higher than those for metastases (p < 0.001). In ROC curve analysis, the AUC value was 0.901. A cutoff ADC value of 920.5 × 10-6 mm2s-1 distinguished benign lesions from bone metastases with a sensitivity of 92.9% and a specificity of 73.4%. CONCLUSION. WB DWIBS coupled with ADC analysis at 3 T is effective for detecting bone metastases.

Diagnostic Performance of 18F-FDG PET/CT in Infectious and Inflammatory Diseases according to Published Meta-Analyses.

Purpose To date, several meta-analyses have reported data about the diagnostic performance of 18F-FDG PET/CT in infectious and inflammatory diseases. This article aims to summarize the published evidence-based data about the diagnostic performance of 18F-FDG PET/CT in this setting. Methods A comprehensive computer literature search of meta-analyses published in PubMed/MEDLINE and Cochrane library database from January 2009 through December 2018 and regarding the diagnostic performance of 18F-FDG PET/CT in infectious and inflammatory diseases was carried out. This combination of key words was used: (i) “PET” OR “positron emission tomography” OR “FDG” OR “fluorodeoxyglucose” AND (ii) meta-analysis. Only records on inflammatory or infectious diseases were selected. Results The diagnostic performance of 18F-FDG PET/CT in detecting inflammatory and infectious diseases has been summarized taking into account 36 meta-analyses published in the literature. Evidence-based data demonstrated good diagnostic performance of 18F-FDG PET/CT for several inflammatory and infectious diseases, in particular cardiovascular infectious and inflammatory diseases and some musculoskeletal infections. Conclusions Evidence-based data about the diagnostic performance of 18F-FDG PET/CT in infectious and inflammatory diseases are increasing, with good diagnostic performance of this imaging method for some indications. More prospective multicenter studies and cost-effective analyses are warranted.

Diagnostic performance of 18F-FDG PET/CT and whole-body MRI before and early after treatment of multiple myeloma: a prospective comparative study

To determine the diagnostic accuracy of WB-MRI and 18F-FDG PET/CT in detecting infiltration pattern, disease activity, and response to treatment in patients with multiple myeloma (MM). Fifty-six patients with confirmed MM were included in the present study for pre-treatment evaluation. Among these individuals, 22 patients were available for the post-treatment evaluation of response to therapy. All patients were imaged with both WB-MRI and 18F-FDG PET/CT. All radiographic findings of infiltration pattern, disease activity, and response to therapy were compared. The diagnostic performance of both modalities was estimated using bone marrow aspirate and biopsy as the reference test. For detection of active myelomatous tissue at diagnosis, WB-MRI achieved higher sensitivity (94%) than 18F-FDG PET/CT (75%) (p = 0.0039), whereas both modalities achieved the same specificity (80%). For detection of residual myelomatous tissue after treatment, 18F-FDG PET/CT achieved higher specificity (86%) than WB-MRI (43%) (p = 0.0081), whereas both modalities achieved the same sensitivity (75%). WB-MRI is more sensitive than 18F-FDG PET/CT in the diagnosis of MM before treatment; however, 18F-FDG PET/CT is more specific than WB-MRI in detecting residual involvement in treated patients.

Diagnostic performance of 18F-FDG PET/CT and whole-body diffusion-weighted imaging with background body suppression (DWIBS) in detection of lymph node and bone metastases from pediatric neuroblastoma

ObjectiveRecent many studies have shown that whole body “diffusion-weighted imaging with background body signal suppression” (DWIBS) seems a beneficial tool having higher tumor detection sensitivity without ionizing radiation exposure for pediatric tumors. In this study, we evaluated the diagnostic performance of whole body DWIBS and 18F-FDG PET/CT for detecting lymph node and bone metastases in pediatric patients with neuroblastoma.MethodsSubjects in this retrospective study comprised 13 consecutive pediatric patients with neuroblastoma (7 males, 6 females; mean age, 2.9 ± 2.0 years old) who underwent both 18F-FDG PET/CT and whole-body DWIBS. All patients were diagnosed as neuroblastoma on the basis of pathological findings. Eight regions of lymph nodes and 17 segments of skeletons in all patients were evaluated. The images of 123I-MIBG scintigraphy/SPECT-CT, bone scintigraphy/SPECT, and CT were used to confirm the presence of lymph node and bone metastases. Two radiologists trained in nuclear medicine evaluated independently the uptake of lesions in 18F-FDG PET/CT and the signal-intensity of lesions in whole-body DWIBS visually. Interobserver difference was overcome through discussion to reach a consensus. The sensitivities, specificities, and overall accuracies of 18F-FDG PET/CT and whole-body DWIBS were compared using McNemer’s test. Positive predictive values (PPVs) and negative predictive values (NPVs) of both modalities were compared using Fisher’s exact test.ResultsThe total numbers of lymph node regions and bone segments which were confirmed to have metastasis in the total 13 patients were 19 and 75, respectively. The sensitivity, specificity, overall accuracy, PPV, and NPV of 18F-FDG PET/CT for detecting lymph node metastasis from pediatric neuroblastoma were 100, 98.7, 98.9, 95.0, and 100%, respectively, and those for detecting bone metastasis were 90.7, 73.1, 80.3, 70.1, and 91.9%, respectively. In contrast, the sensitivity, specificity, overall accuracy, PPV, and NPV of whole-body DWIBS for detecting bone metastasis from pediatric neuroblastoma were 94.7, 24.0, 53.0, 46.4 and 86.7%, respectively, whereas those for detecting lymph node metastasis were 94.7, 85.3, 87.2, 62.1, and 98.5%, respectively. The low specificity, overall accuracy, and PPV of whole-body DWIBS for detecting bone metastasis were due to a high incidence of false-positive findings (82/108, 75.9%). The specificity, overall accuracy, and PPV of whole-body DWIBS for detecting lymph node metastasis were also significantly lower than those of 18F-FDG PET/CT for detecting lymph node metastasis, although the difference between these 2 modalities was less than that for detecting bone metastasis.ConclusionThe specificity, overall accuracy, and PPV of whole-body DWIBS are significantly lower than those of 18F-FDG PET/CT because of a high incidence of false-positive findings particularly for detecting bone metastasis, whereas whole-body DWIBS shows a similar level of sensitivities for detecting lymph node and bone metastases to those of 18F-FDG PET/CT. DWIBS should be carefully used for cancer staging in children because of its high incidence of false-positive findings in skeletons.

Diagnostic performance of 18F-FDG PET/CT using point spread function reconstruction on initial staging of rectal cancer: a comparison study with conventional PET/CT and pelvic MRI

BackgroundAccurate staging is crucial for treatment selection and prognosis prediction in patients with rectal cancer. Point spread function (PSF) reconstruction can improve spatial resolution and signal-to-noise ratio of PET imaging. The aim of this study was to evaluate the effectiveness of 18F-FDG PET/CT with PSF reconstruction for initial staging in rectal cancer compared with conventional PET/CT and pelvic MRI.MethodsA total of 59 patients with rectal cancer underwent preoperative 18F-FDG PET/CT and pelvic MRI. The maximum standardized uptake value (SUVmax) and lesion to background (L/B) ratio of possible metastatic lymph nodes, and metabolic tumor volumes (MTVs) of primary tumors were calculated. For N and T (T1-2 vs T3-4) staging, sensitivities, specificities, positive predictive values, negative predictive values, and accuracies were compared between conventional PET/CT [reconstructed with ordered subset expectation maximization (OSEM)], PSF-PET/CT (reconstructed with OSEM+PSF), and pelvic MRI. Histopathologic analysis was the reference standard.ResultsFor N staging, PSF-PET/CT provided higher sensitivity (78.6%) than conventional PET/CT (64.3%), and pelvic MRI (57.1%), and all techniques showed high specificity (PSF-PET: 95.4%, conventional PET: 96.7%, pelvic MRI: 93.5%). SUVmax and L/B ratio were significantly higher in PSF-PET/CT than conventional-PET/CT (p < 0.001). The accuracy for T staging in PSF-PET/CT (69.4%) was not significantly different to conventional PET/CT (73.5%) and pelvic MRI (73.5%). MTVs of PSF and conventional PET showed a significant difference among T stages (p < 0.001), with higher values in advanced stages. In M staging, both PSF and conventional PET/CT diagnosed all distant metastases correctly.ConclusionsPSF-PET/CT produced images with higher lesion-to-background contrast than conventional PET/CT, which allowed improved detection of lymph node metastasis without compromising specificity, and showed comparable diagnostic value to MRI in local staging. PSF-PET/CT is likely to have a great value for initial staging in rectal cancer.

Using 18F-fluorodeoxyglucose positron emission tomography/computed tomography to estimate the length of gross tumor and involvement of lymph nodes in esophagogastric junction carcinoma.

To determine the optimal approach for estimating the length of gross tumor and involvement of the lymph nodes with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in esophagogastric junction carcinoma (EGJC). The result was verified with pathologic examination. Twenty patients with diagnosed and untreated EGJC were enrolled. The length of the gross tumor was measured using different approaches with PET/CT: Standardized uptake value (SUV) 1.5-5.5 in intervals of 1.0 and 10%-50% of maximum SUV (SUVmax) on 18F-FDG PET/CT in intervals of 10%. The results were expressed as L1.0-L5.0, and L10%-L50%, respectively. The pathological length of gross tumor (Lpath) was calculated based on the shrinkage ratio of primary tumor. The measurable lymph nodes were measured on PET/CT preoperatively, labeled during operation, and examined for pathology. Lpath was 6.87 ± 2.25 cm, L30% and L2.5 were 6.61 ± 1.76 cm and 7.56 ± 1.89 cm, respectively. L30% was closer to Lpath than other % SUVmax, L2.5 was closer to Lpath than other absolute SUV thresholds. The diagnostic performance of 18F-FDG PET/CT for lymph nodes was best at the cutoff SUV of 2.7, providing sensitivity of 70% and a specificity of 83.7% for detecting lymph node metastases. The tumor length with 30% SUVmax as the threshold was closest to the actual pathological length of EGJC. The diagnostic efficiency of 18F-FDG PET/CT was best at the cutoff SUVmax of 2.7 for detecting lymph node metastases in EGJC.