18F-fluorodeoxyglucose Positron Emission Tomography-computed Tomography Research Articles

Impact of 18F-fluorodeoxyglucose positron emission tomography computed tomography imaging in a case of pericardial cavernous hemangioma

Hemangiomas are extremely rare tumors of the heart that may present with pericardial effusion, dyspnea, chest discomfort, palpitations, or syncope. Few published reports have highlighted the utility of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) in the evaluation of cardiac lesions. We report a case demonstrating the utility of 18F-FDG PET-CT in a young man who presented with gross pericardial effusion and suspicion of metastatic carcinoma on fluid cytology.

Evaluation of CYFRA 21.1 as a dedifferentiation marker of advanced thyroid cancer

Purpose of the Study:Well-differentiated thyroid carcinomas have good prognosis, but as it de-differentiates, the survival rates go down. Early identification of such patients needs a marker which indicates the dedifferentiation process. CYFRA 21.1 has also shown to be increased in patients with 131I refractory thyroid cancer. We tested whether CYFRA 21.1 can differentiate between 131I avid and refractory tumors.Methodology:Well-differentiated thyroid cancer patients with known distant metastases were accrued and tested for stimulated and unstimulated thyroglobulin and CYFRA 21.1. All patients underwent 131I whole-body scan, 131I post therapy scan, and 18F-Fluorodeoxyglucose positron emission tomography-computed tomography. Those with even a single 131I nonavid lesion were considered 131I refractory disease. CYFRA 21.1 of both 131I avid and nonavid was compared, and CYFRA 21.1 levels against disease extent were analyzed.Results:CYFRA 21.1 levels were significantly elevated in 131I refractory group. A cutoff value of 2.07 ng/ml distinguished between 131I avid and refractory disease with high sensitivity and specificity (88% and 89. 7%, respectively). However, CYFRA 21.1 levels were similar in patients when analyzed based on disease sites.Conclusion:CYFRA 21.1 can be utilized to differentiate between 131I avid and refractory diseases. Further long-term studies are required to use it as a predictive and prognostic marker.

A Case of Metachronous Triple Carcinoma with Synchronous Double Primary Carcinoma on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography.

Multiple primary malignancies in a single patient are exceedingly rare, but their prevalence has increased in recent decades due to prolonged survival rates supported by the advent of newer and better generation of chemotherapeutic agents as well as advances in cancer detectability facilitated by sophisticated modalities such as positron emission tomography-computed tomography. Here, we discuss a case of a 66-year-old male who recovered completely from lung carcinoma but subsequently developed synchronous gall bladder and gastric carcinoma after 1 year.

18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Malignant Transformation of Paget's Disease of Bone.

Malignant transformation Paget's disease of bone to sarcoma is relatively rare, occurring in approximately 1% of these patients. Although few clinical and imaging findings may help in prediction of malignant transformation, most of them are nonspecific. We describe a case of carcinoma vocal cord and Paget's disease of bone with sarcomatous transformation, where 18F-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography was helpful in accurate diagnosis by demonstrating differential intense FDG uptake in transformed areas of pagetic bone and also FDG-avid osteoblastic pulmonary metastasis.

Prognostic value of metabolic parameters measured by 18F-fluorodeoxyglucose positron emission tomography-computed tomography in surgically resected non-small cell lung cancer patients.

18F-fluorodeoxyglucose positron emission tomography-computed tomography-derived metabolic parameters can play a role in prognostication. We investigated the prognostic value of various metabolic parameters such as maximum standardized uptake value (SUVmax), mean SUV (SUVmean), whole-body metabolic tumor volume (WBMTV), and whole-body total lesion glycolysis (WBTLG) in surgically resected non-small cell lung cancer (NSCLC) patients. We retrospectively reviewed 153 patients with NSCLC who underwent surgical resection. The SUVmax, SUVmean, WBMTV, and WBTLG of the tumor were measured. Continuous PET parameters were stratified by receiver operating characteristic curve analysis. Prognostic factors were estimated using the Kaplan–Meier method and Cox proportional hazards model. The median follow-up was 36.9 months. Fifty-six patients died and 78 patients had recurrence. On univariate analysis, tumor-node-metastasis (TNM) stage; male sex; no adjuvant treatment; and higher SUVmax, SUVmean, WBMTV, and WBTLG were statistically significant and were associated with poor overall survival (OS). TNM stage; no adjuvant treatment; and higher SUVmax, SUV mean, WBMTV, and WBTLG were statistically significant and were associated with poor disease-free survival (DFS). On multivariate analysis, higher WBTLG (hazard ratio [HR] = 3.08, P = 0.007) for DFS and higher WBTLG (HR = 2.70, P = 0.041) and TNM staging (HR = 1.63, P = 0.035) for OS were statistically significant. Whole-body tumor burden assessment with TLG has independent prognostic value in patients with operated lung cancer. Incorporation of TLG into clinical practice can identify patients benefitted from additional therapy.

18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Initial Diagnosis and Treatment Response Evaluation of New Onset Refractory Status Epilepticus.

New onset refractory status epilepticus (NORSE), is a rare, neurological condition characterised by prolonged periods of refractory epileptic seizure with no readily identifiable cause in otherwise healthy individuals. Anatomical imaging like MRI and serology is usually unremarkable. In patients who have underlying etiology as auto-immune encephalitis without any evidence of auto-antibodies FDG PET may help in early diagnosis and treatment response as it tends to accumulate in the neuronal tissue whenever there is increased blood flow, metabolic demand or increased electrical activity which reverts back with clinical recovery.

Rare Case of Cardiac Metastasis in a Patient with Cutaneous Squamous Cell Carcinoma of Foot Detected on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography.

Cutaneous squamous cell carcinoma (SCC) metastasizes most commonly to the regional lymph nodes and lungs. Metastasis to heart, although described in literature, is a very rare phenomenon. We present the 18F-fluorodeoxyglucose positron emission tomography–computed tomography findings in a 50-year-old woman who was a biopsy-proven case of SCC left foot, showing cardiac metastasis in addition to lymph nodes, lungs, and skeletal metastases.

18F-fluorodeoxyglucose positron emission tomography-computed tomography in response assessment of perivascular epithelioid cell tumor of the pelvic cavity to irinotecan and temozolomide

Perivascular epithelioid cell tumors (PEComas) are a rare variety of mesenchymal tumors composed of distinctive cells that show a focal association with blood vessel walls and usually express melanocytic and smooth muscle markers. We present a case of 38-year-old male, diagnosed with PEComa of the pelvic cavity who underwent serial 18F-fluorodeoxyglucose positron emission tomography-computed tomography scans for the assessment of response to the chemotherapeutic combination of irinotecan and temozolomide.

Recurrent Cavitary Pulmonary Metastasis from Osteosarcoma: Findings on 18F-Fluorodeoxyglucose Positron Emission Tomography.

Spontaneous cavitation in primary lung malignancies although common, but is rare in secondary metastatic lung tumors. We present a case of 20-year-old male who presented with cavitary left lung lesion 1-year postexcision of the left tibia osteosarcoma on 18F-fluorodeoxyglucose positron emission tomography-computed tomography which on histopathology confirmed as metastatic lesion secondary to the sarcomatous primary.

Unusual Gastric Metastasis in Triple-Negative (Estrogen Receptor/Progesterone Receptor/HER2neu Negative) GATA-Binding Protein 3-Positive Breast Cancer.

Triple-negative breast cancer (TNBC) accounts for 20%–25% of breast cancer cases. Around 10%–15% of patients with breast cancer present with upfront metastasis. Lymph node, bone, and liver are common sites of metastasis in hormone-positive breast cancer while brain, lungs, and liver in TNBC. Although visceral metastasis is common in TNBC, metastasis to stomach is unusual. Morphological similarity of primary gastric carcinoma and lobular invasive breast carcinoma often leads to misdiagnosis. Meticulous review of histopathology and immunohistochemistry is essential for diagnosis. We present a case of carcinoma breast with unusual gastric nodular metastasis detected on 18F-fluorodeoxyglucose positron emission tomography–computed tomography.

18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Large Vessel Vasculitis: Standardization is the Way Forward.

18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Large Vessel Vasculitis: Standardization is the Way Forward.

Predictive Value of the Standardized Uptake Value of 18F-fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Assessing Axillary Lymph Node Metastasis in Different Subtypes of Breast Cancer

Predictive Value of the Standardized Uptake Value of 18F-fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Assessing Axillary Lymph Node Metastasis in Different Subtypes of Breast Cancer

Posterior Reversible Encephalopathy Syndrome: Pattern on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Correlated with Magnetic Resonance Imaging in Pediatric Hypertensive Encephalopathy.

Posterior reversible encephalopathy syndrome (PRES) is characterized clinically by headache, seizures, vomiting, altered mental status, and blurred vision. However, with overlapping and atypical clinical symptoms, PRES becomes a diagnostic challenge. We describe the imaging findings of PRES in magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography-computed tomography in an 11-year-old child who presented with features of hypertensive encephalopathy.

Hypoxia-induced modulation of glucose transporter expression impacts 18F-fluorodeoxyglucose PET-CT imaging in hepatocellular carcinoma.

To investigate the molecular mechanisms underlying the variable standard uptake value (SUV) of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) imaging in hepatocellular carcinoma(HCC) and whether hypoxia-induced glucose transporter expression contributes to the progression of HCC and the rate of glycolysis in HCC cells. Sixteen HCC specimens obtained from patients who underwent pre-treatment staging with 18F-FDG PET-CT imaging were divided into high maximum SUV (SUVmax > 8) and low SUVmax (SUVmax < 5) groups and employed for whole-genome gene expression profiling using GeneChip Human Genome U133 Plus 2.0 Arrays. The relationship between SUVmax and the expression of glucose transporters 1 and 3 (GLUT1 and GLUT3) was further validated using immunohistochemical analysis. The expression of GLUT1 and GLUT3 in different HCC cells under hypoxia and normoxia conditions were monitored by quantitative reverse transcription PCR (RT-qPCR). Glycolysis and FDG uptake by HCC cells were measured using the Seahorse XF glycolysis stress test and 18F-FDG PET-CT imaging. The effect of GLUT1 and GLUT3 on glucose uptake in HCC cells was examined using the fluorescent D-glucose analog 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl) amino]-2-deoxy-d-glucose (2-NBDG) followed by detection of fluorescence produced by the cells using flow cytometry. Glucose transporters are differentially expressed between samples from HCC patients with high and low SUVmax. In particular, over-expression of GLUT1 and GLUT3 in high SUVmax patients was correlated with high glucose uptake and overall survival. The expression of GLUT1 and GLUT3 was significantly induced by hypoxia in different HCC cells. High expression of GLUT1 and GLUT3 in HCC cells were correlated with high rates of glycolysis and 18F-FDG uptake. Therefore, our data suggested that hypoxia-induced glucose transporters expression could result in the variations of 18F-FDG PET-CT imaging and progression of HCC, contributing to more aggressive disease phenotypes like large tumor size, recurrence, and poor survival. Over-expression of GLUT1 and GLUT3 significantly increase glucose uptake in HCC cells. Hypoxia-induced glucose transporters expression may therefore be a contributing variable in 18F-FDG PET-CT imaging and progression in HCC.

Image analysis in posttreatment non-small cell lung cancer surveillance: specialists’ interpretations reviewed by the thoracic multidisciplinary tumor board

Background: Data show that the initial specialist’s image interpretation and final multidisciplinary tumor board (MTB) assessment can vary substantially in the pretherapeutic cancer setting. The aim of this post hoc analysis was to investigate the concordance of the specialist’s and MTB’s image interpretations in patients undergoing systematic posttreatment lung cancer image surveillance.&#x0D; Methods: In the initial prospective study, lung cancer patients who had received curative-intent treatment were randomly assigned to undergo either contrast-enhanced computed tomography (CE-CT) or integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Imaging was performed every 6months for 2 years, and all imaging studies were finally assessed by our MTB. This post hoc analysis assessed differences between the initial specialist’s image interpretation and the final MTB’s image interpretation.&#x0D; Results: In 89 patients, 266 imaging studies (129 PET-CT, 137 CE-CT) were analyzed. In 87.2% (88.4, 86.1%) of the studies, complete concordance was found. Out of the 12.8% (11.6, 13.9%) with discordant results, 7.5% (6.9, 8.0%) had implications for alterations in patient management (major disagreements). Twenty major disagreements were detected in 17 study patients. Retrospectively, in eight out of these 17 (47%) patients, in contrast to the MTB’s view, the specialist’s interpretation was more appropriate, whereas in nine out of 17 patients (53%), the MTB’s interpretation was more accurate.&#x0D; Conclusions: In an experienced MTB, the agreement between imaging specialists and the rest of the MTB with regard to the interpretation of images is high in a setting of posttreatment lung cancer image surveillance. It seems that in cases of disagreements, the rates of more accurate interpretation are well balanced between imaging specialists and the MTB.&#x0D; Trial registration: ISRCTN16281786, Date 23. February 2017.

Image analysis in posttreatment non-small cell lung cancer surveillance: specialists\u2019 interpretations reviewed by the thoracic multidisciplinary tumor board

BackgroundData show that the initial specialist’s image interpretation and final multidisciplinary tumor board (MTB) assessment can vary substantially in the pretherapeutic cancer setting. The aim of this post hoc analysis was to investigate the concordance of the specialist’s and MTB’s image interpretations in patients undergoing systematic posttreatment lung cancer image surveillance.MethodsIn the initial prospective study, lung cancer patients who had received curative-intent treatment were randomly assigned to undergo either contrast-enhanced computed tomography (CE-CT) or integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Imaging was performed every 6 months for 2 years, and all imaging studies were finally assessed by our MTB. This post hoc analysis assessed differences between the initial specialist’s image interpretation and the final MTB’s image interpretation.ResultsIn 89 patients, 266 imaging studies (129 PET-CT, 137 CE-CT) were analyzed. In 87.2% (88.4, 86.1%) of the studies, complete concordance was found. Out of the 12.8% (11.6, 13.9%) with discordant results, 7.5% (6.9, 8.0%) had implications for alterations in patient management (major disagreements).Twenty major disagreements were detected in 17 study patients. Retrospectively, in eight out of these 17 (47%) patients, in contrast to the MTB’s view, the specialist’s interpretation was more appropriate, whereas in nine out of 17 patients (53%), the MTB’s interpretation was more accurate.ConclusionsIn an experienced MTB, the agreement between imaging specialists and the rest of the MTB with regard to the interpretation of images is high in a setting of posttreatment lung cancer image surveillance. It seems that in cases of disagreements, the rates of more accurate interpretation are well balanced between imaging specialists and the MTB.Trial registrationISRCTN16281786, Date 23. February 2017.

8P - Comparison of standard uptake value of 18F-FDG-PET-CT with tumour-infiltrating lymphocytes in breast cancer ≥1cm

BackgroundTumor metabolism and tumor-specific immune responses are one of integral compartments consisting of tumor niche. Several lines of evidence showed that tumor cells and tumor-infiltrating lymphocytes (TILs) compete for glucose in tumor microenvironment and that tumor metabolic parameter correlates with localized immune markers in several solid tumors. With this background, we compared standardized uptake value (SUV) of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG-PET-CT) and stromal TILs in breast cancer (1≥cm). MethodsTwo hundred two patients were identified among those who underwent preoperative 18F-FDG-PET-CT and had tumor size equal to or larger than 1cm. Maximum SUV was obtained from 18F-FDG-PET-CT. Stromal TILs was evaluated according to standardized methodology proposed by the international TIL Working Group. We identified factors related with high TILs (≥40%) using multiple logistic-regression. All tumors were treatment-naïve. ResultsThere was a significant but weak correlation between continuous SUV and continuous TILs (p = 0.002, R = 0.215). Mean TILs was significantly high in Ki-67 labeling index ≥14%, nuclear/histologic grade 3, and HER2-positive or triple-negative breast cancer (TNBC). In multivariable analysis, aggressive subtypes as HER2-positive or TNBC and continuous SUV were significantly associated with high TILs ≥40%. ConclusionsWe found that SUV was associated with TILs in breast cancer and provide clinical evidence that elevated glucose uptake of breast tumors may be affected by TILs in tumor micromileu. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

The prognostic value of PET/CT evaluation with Deauville score on the recurrence and survival in diffuse large B-cell lymphoma: a multi-institutional study of KROG 17-02.

The Korean Radiation Oncology Group (KROG) assessed the value of Deauville score (DS) on 18F-fluorodeoxyglucose Positron emission tomography-computed tomography (FDG PET/CT) as a predictor of recurrence and survival after rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy in diffuse large B-cell lymphoma (DLBCL). A total of 512 patients with stage I-III DLBCL who received six cycles of R-CHOP with or without radiation therapy (RT) and obtained treatment responses according to PET-CT imagings after R-CHOP ± RT were included. Patients were sorted into two arms; DS 4-5 arm (n = 24) was matched at a 1:2 ratio with DS 1-3 arm (n = 48) using propensity score matching method. After a median follow-up time of 37.2 months, the recurrence-free survival rate (86.6% vs. 66.8%, P = 0.041) and overall survival rate (86.9% vs. 62.2%, P = 0.009) at 5years were significantly different between the DS 1-3 and DS 4-5 arms. DS 4-5 arm showed higher 5-years locoregional recurrence-free survival (88.8% vs. 74.3%, P = 0.155) and distant failure-free survival (91.1% vs. 84.3%, P = 0.333) than DS 1-3 arm. In the multivariate analysis, DS was still a significant factor for recurrence-free survival [hazard ratio (HR), 3.840 and confidence interval (CI), 1.068-13.806; P = 0.039] and overall survival rates (HR 4.453 and CI 1.274-15.562; P = 0.019). This study showed and validated that Deauville score of 4-5 of PET-CT imaging taken after full-course of R-CHOP chemotherapy with or without RT could predict recurrence-free survival and overall survival in DLBCL patients.

Diagnosis of giant cell arteritis by head-contrast three-dimensional computed tomography angiography: two case reports

IntroductionTemporal artery biopsy is essential for the diagnosis of giant cell arteritis. It has been shown that 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance angiography, and ultrasonography are useful for the diagnosis of giant cell arteritis. However, there are only a few reports on the usefulness of three-dimensional computed tomography angiography in the diagnosis of giant cell arteritis. We describe two cases in which giant cell arteritis was difficult to diagnose using positron emission tomography-computed tomography and magnetic resonance angiography but was diagnosed using three-dimensional computed tomography angiography, thus showing the importance of three-dimensional computed tomography angiography in the diagnosis of giant cell arteritis.Case presentationCase 1: An 81-year-old Japanese man. Laboratory investigations revealed normocytic anemia and raised inflammatory marker levels. Slight bleeding in the right posterior pole of his eyeball and leukoma of his left cornea were observed on fundus examination. Stenosis and stoppage of the temporal artery were detected on three-dimensional computed tomography angiography. A diagnosis of giant cell arteritis was made, and he was started on orally administered prednisolone. His headache and C-reactive protein levels improved. Four weeks after glucocorticoid steroid treatment, three-dimensional computed tomography angiography revealed improvement in stenosis and stoppage of temporal artery.Case 2: A 74-year-old Japanese woman. A dose of 20 mg of prednisolone was administered and her polymyalgia and polyarthritis improved; however, her headache and ear occlusion persisted. Although vasculitis was not detected on positron emission tomography-computed tomography, stenosis and stoppage of the temporal artery were detected on computed tomography angiography. She was diagnosed as having giant cell arteritis and started on orally administered prednisolone treatment (60 mg daily). Her headache and C-reactive protein levels improved. Four weeks after glucocorticoid treatment, three-dimensional computed tomography angiography showed improvement in stenosis and stoppage of temporal artery.ConclusionsIn both patients with giant cell arteritis, three-dimensional computed tomography angiography revealed improvement in stenosis and stoppage of temporal artery after glucocorticoid treatment. We conclude that computed tomography angiography along with magnetic resonance angiography, positron emission tomography-computed tomography, and ultrasonography are important for the diagnosis of giant cell arteritis.

The Utility of Whole Body 18F-FDG PET-CT in Diagnosing Isolated Cardiac Sarcoidosis: The Western Australian Cardiac Sarcoid Study

It is reported that up to 29-52% of patients with cardiac sarcoidosis (CS) may have isolated cardiac sarcoidosis (ICS). The wide variation in prevalence may be related to the diagnostic methods for assessing extracardiac involvement. Whole-body 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) imaging is a useful and increasingly used technique for screening for extracardiac involvement in cases of suspected ICS. This study aims to determine the rate of isolated cardiac involvement with clinically manifest CS using cardiac 18F-FDG PET-CT. We performed a retrospective analysis of data in the West Australian Cardiac Sarcoid (WACaS) Database. After cardiologist review and workup, all cases of proven or probable CS, based on either current Heart Rhythm Society criteria for the diagnosis of CS or local expert consensus were included. Only patients who underwent whole body 18F-FDG PET-CT were included in the final analysis. Fifty-two (52) cases of CS were identified. Data on symptoms, imaging findings, treatment and outcomes were collected. Of the 42 patients who underwent diagnostic 18F-FDG PET-CT, 32 demonstrated changes consistent with CS. Of the 32, 69% were male, mean age 50 years at diagnosis. Only 3/32 (9.4%) patients had ICS. Pulmonary involvement occurred in 91% with varied involvement in other organs. The mean number of extracardiac sites at diagnosis was 2.2. This study demonstrates the utility of 18F-FDG PET-CT in diagnosing extracardiac organ involvement in cases of CS. With the use of this modality, ICS may be rarer than previously reported.