Node SUV Research Articles

Relationships Between Systemic Inflammatory Markers and 18F-FDG PET/CT Imaging and Clinical Findings in Pulmonary Sarcoidosis.

Background and aim Sarcoidosis is a multisystem inflammatory disease of unknown aetiology. This study aimed to evaluate the relationship between systemic inflammatory parameters, the systemic immune-inflammation index (SII) and the lymphocyte-to-monocyte ratio (LMR), and disease stage, clinical findings, and 18F-fluoro-2-deoxy-D-glucose (18F-FDG) tomography/computed tomography (PET/CT) uptake. Materials and methods Our study included 73 patients. The general characteristics, radiological features, spirometric tests, PET/CT findings, and laboratory parameters of the patients were recorded. Results Relapse and parenchymal fibrosis were not associated with metabolic parameters, such as LMR and SII. Serum angiotensin-converting enzyme (ACE) levels were lower in the relapsed group than in the non-relapse group. However, the patients' PET/CT images indicated that 18F-FDG parenchym maximum standard uptake value (SUV max), lymph node SUV max, lymph node short axis dimension, SII, and LMR were similar between all patients, relapsed or not. Conclusion Although found to be significant in other inflammatory diseases, we found that SII and LMR alone did not indicate disease prognosis in sarcoidosis due to the small number of patients and the lack of homogeneity between the groups in our study. The usefulness of these markers for clinical use should be investigated by studies that include those with extrapulmonary sarcoidosis, and that calculate these markers at the time of disease diagnosis and during the post-treatment period.

Predictors of Lymph Node Involvement in Rectal Cancer Patients Treated with Neoadjuvant Chemoradiotherapy

<h3>Purpose/Objective(s)</h3> Following neoadjuvant chemoradiotherapy (NART), some rectal cancer patients may have pathologic lymph node involvement (ypN+) despite complete response in the primary tumor, and should not be candidates for non-operative management. The aim of this study was to determine risk factors for ypN+ in rectal cancer patients treated with NART. <h3>Materials/Methods</h3> Data of rectal cancer patients treated with NART followed by surgery were evaluated. Patients with synchronous colon cancer, radiotherapy to surgery interval longer than 13 weeks, and those without lymph node (LN) dissection were excluded from the analysis. 92 patients were included. Median age was 59 (30-83). Female/male ratio was 35/57. Tumor location was proximal, mid- and distal rectum in 3, 45 and 44 patients, respectively. Tumor histology was adenocarcinoma in 79 patients, signet ring cell in 6 and mucinous carcinoma in 7. Clinical T stage was T2, T3 and T4 in 3, 81 and 8 patients, respectively. 90 patients had clinical LNs larger than 4 mm (10-34 mm: n=46). Median tumor and LNs SUV_max were 15 (3.9-46) and 2 (0.5-17.6), respectively. Median tumor GTV was 73 (28.9-370) ml. Median tumor length and thickness were 6 (3-14) cm and 16.5 (7-30) mm, respectively. All patients received 56 Gy to the primary tumor and 50.4 Gy to the lymph node regions, simultaneously in 28 fractions, and concurrent capecitabine. 27 patients had ypN+. Clinical and radiological features at initial presentation were analyzed to predict ypN+ using Chi-square or Mann-Whitney U tests. Logistic regression analysis was performed to determine the factors affecting ypN+. ROC analysis was performed to determine the cutoff values. <h3>Results</h3> Age (p=0.027), tumor SUV_max (p=0.001), largest clinical LN size (p=0.007) and number of LNs ≥10 mm in diameter (p=0.033) were significantly different between ypN0 and ypN+ patients in univariate analysis (Table). Only tumor SUV_max (HR (%95 CI): 0.828 (0.731-0.937), p=0.003) and largest clinical LN size (HR (%95 CI): 1.338 (1.023-1.750), p=0.033) were significant in multivariate analysis. Area under the ROC analysis curve (AUC) to determine ypN+ was 68.8% for LN size and 79.3% for tumor SUV_max. Cutoff values of LN size and tumor SUV_max for ypN+ were 10.5 mm (p=0.005) and 12.57 (p<0.001), respectively. Although ypN+ rates were higher in patients with signet ring cell (83%) and mucinous (43%) histology compared to adeno carcinoma (24%), it was not statistically significant. <h3>Conclusion</h3> Rectal cancer patients with lower tumor SUV_max and larger clinical lymph nodes at initial presentation are more likely to have pathologic lymph node involvement following neoadjuvant chemoradiotherapy.

Evaluation of changes in lymph node size and metabolism by PET CT in patients with cancer who have been immunized against COVID 19: A Mexican study.

e13647 Background: The risk of developing COVID-19 in patients with cancer has increased, directly influenced by age and the magnitude of comorbidities. In this population, the estimated mortality is 10.9%. With this, the urgent need for patients with cancer to get vaccinated against SARS COV 2 has generated an international response. With the ongoing vaccination campaign, experts in nuclear medicine have observed an increment in lymph node uptake in PET CT with 18 FDG. Increased uptake in lymph nodes in patients with a neoplastic diagnosis on PET CT 18 FDG must be closely followed and well-studied to differentiate disease progression from an inflammatory, fleeting reaction. Methods: Amongst the inclusion criteria were patients over 18 years of age with solid tumors, including lymphomas, who were on active oncologic treatment with chemotherapy, immune therapy, radiotherapy or under surveillance between April 2021 and July 2021 who underwent a PET CT scan and had at least one dose of a COVID 19 vaccine, and a prior PET CT to the vaccine for comparison. Patients were excluded who showed evidence of progression or disease recurrence of the primary tumor. We evaluated lymph node size and metabolism measured by SUV max in the PET CT scan prior to being vaccinated and posterior to, as well as patients’ clinical characteristics. Results: A total of 92 patients who met inclusion criteria were included in the study. Amongst those, 54.3% were women, the median age was 68 years (27 - 95 years), the most common neoplastic diagnoses were breast cancer (19.6%), gastrointestinal tumors (17.4%), urothelial tumors (9.8%), lymphomas (9.8%) and ovarian cancer (8.7%). 52.2% of patients were under surveillance and 47.8% were under active treatment. 79% of patients had at least 2 vaccine doses. 59% had received Pfizer vaccines and the measurable adenopathies were axillary in 32.7% and mediastinal in 27%. The medium size of the measured lymph nodes prior to receiving the vaccine was 2.86 mm with an SUV max of 1.24, while after vaccination were 6.01 and 2.27 respectively. A Kruskal Wallis test was conducted to compare median results according to histopathologic reports, with no statistical difference. A Mann Whitney U test was conducted to compare breast cancer to other cancer histologies, where a statistical difference was found for SUV max, p = 0.003 and size with p = 0.033. Conclusions: This work details significant differences between lymph node size and SUV max in oncologic patients pre and post vaccination for COVID 19, showing a statistical difference in patients with breast cancer. This increment in lymph node uptake in patients with a neoplastic diagnosis PET CT 18 FDG must be closely followed and well-studied to differentiate disease progression from an inflammatory reaction.

The Relation Between Tumor and Axillary Lymph Node SUV Values with the Presence of Distant Metastases in Staging F18 FDG PET/CT in Breast Cancer

The Relation Between Tumor and Axillary Lymph Node SUV Values with the Presence of Distant Metastases in Staging F18 FDG PET/CT in Breast Cancer

Comparative Evaluation of Lymph Node SUV max Values and Density Measurements in the Differentiation of Patients with Lung CA and Covid-19 Pneumonia showing Mediastinal Lymph Node involvement

Comparative Evaluation of Lymph Node SUV max Values and Density Measurements in the Differentiation of Patients with Lung CA and Covid-19 Pneumonia showing Mediastinal Lymph Node involvement

The Impact of Primary Tumor and Locoregional Metastatic Lymph Node SUVmax on Predicting Survival in Patients with Rectal Cancer.

Objectives:The aim of this study was to evaluate the impact of maximum standard uptake value (SUVmax) of the primary tumor and locoregional metastatic lymph node in predicting survival in patients with the preoperative rectal adenocarcinoma.Methods:One hundred and fifteen patients [mean age ± standard deviation (SD): 58.7±11.4 years] with biopsy-proven rectal adenocarcinoma underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging for the staging were included in this study. All patients were followed-up for a minimum of 12 months (mean ± SD: 29.7±13.5 months). Tumor-node-metastasis 2017 clinical staging, SUVmax of the primary rectal tumor and locoregional lymph nodes on the PET/CT studies were evaluated.Results:All patients had increased FDG activity of the primary tumor. The mean ± SD SUVmax of the primary tumor and locoregional metastatic lymph node were 21.0±9.1 and 4.6±2.8, respectively. Primary tumor SUVmax did not have an effect on predicting survival (p=0.525) however locoregional metastatic lymph node SUVmax had an effect (p<0.05) on predicting survival. Clinical stage of the disease was a factor predicting survival (p<0.001).Conclusion:18F-FDG PET/CT is an effective imaging modality for detecting primary tumors and metastases in rectal adenocarcinoma and clinical stage assessment with PET/CT had an effect on predicting survival. Furthermore, in our study locoregional lymph node SUVmaks was defined as a factor in predicting survival.

New PET/CT criterion for nodal staging in non-small cell lung cancer: measurement of the ratio of section area of standard uptake values ≥2.5/lymph node section area.

The aim of the present study was to use surgical and histological results to develop a simple noninvasive technique for improving nodal staging using preoperative PET/CT in patients with resectable non-small cell lung cancer (NSCLC). Preoperative PET/CT findings (163 patients) and pathological diagnoses after surgical resection were evaluated. Using PET/CT images, lymph node section area (SA), the maximum standardized uptake value (SUVmax), SA of SUV ≥2.5 and ≥3.0 were drawn freehand and measured using caliper software. Receiver operating characteristic (ROC) curves were then used to analyze those data. Based on ROC analyses, the cut-off values for SA of SUV ≥2.5, SA of SUV ≥3.0, SUV ≥2.5 SA/node SA and SUV ≥3.0 SA/node SA for diagnosis of lymph node metastasis were 200mm2, 30mm2, 1.0 and 0.4. SUV ≥2.5 SA/node SA ≥1.0 had the highest negative predictive value, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of nodal staging were 61.1, 73.4, 36.7, 88.2 and 70.9%. When diagnosing nodal staging based a lymph node SUV ≥2.5 SA/node SA ratio of ≥1.0, it can be an effective criterion for use to determine surgical indications.

Ratio of Mediastinal Lymph Node SUV to Primary Tumor SUV in 18F-FDG PET/CT for Nodal Staging in Non-Small-Cell Lung Cancer.

Following determination of the maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes (SUV-LN) and of the primary tumor (SUV-T) on 18F-FDG PET/CT in patients with non-small-cell lung cancer (NSCLC), the aim of the study was to determine the value of the SUV-LN/SUV-T ratio in lymph node staging in comparison with that of SUV-LN. We retrospectively reviewed a total of 289 mediastinal lymph node stations from 98 patients with NSCLC who were examined preoperatively for staging and subsequently underwent pathologic studies of the mediastinal lymph nodes. We determined SUV-LN and SUV-R for each lymph node station on 18F-FDG PET/CT and then classified each station into one of three groups based on SUV-T (low, medium and high SUV-T groups). Diagnostic performance was assessed based on receiver operating characteristic (ROC) curve analysis, and the optimal cut-off values that would best discriminate metastatic from benign lymph nodes were determined for each method. The average of SUV-R of malignant lymph nodes was significantly higher than that of benign lymph nodes (0.79 ± 0.45 vs. 0.36 ± 0.23, P < 0.0001). In the ROC curve analysis, the area under the curve (AUC) of SUV-R was significantly higher than that of SUV-LN in the low SUV-T group (0.885 vs. 0.810, P = 0.019). There were no significant differences between the AUCs of SUV-LN and of SUV-R in the medium and high SUV-T groups. The optimal cut-off value for SUV-R in the low SUV-T group was 0.71 (sensitivity 87.5%, specificity 85.9%). The SUV-R performed well in distinguishing between metastatic and benign lymph nodes. In particular, SUV-R was found to have a better diagnostic performance than SUV-LN in the low SUV-T group.

Lymph Node SUV at Pretreatment FDG-PET as A Valuable Prognostic Factor for Distant Metastasis in Nasopharyngeal Cancer

Lymph Node SUV at Pretreatment FDG-PET as A Valuable Prognostic Factor for Distant Metastasis in Nasopharyngeal Cancer

P218 Nodal Staging In Lung Cancer: A Risk Stratification Model For Lymph Nodes Classified As Negative By Ebus-tbna

Background Over the last 10 years, EBUS-TBNA has become established as the first line nodal staging procedure of choice for lung cancer patients. However, the pathway for patients following a negative EBUS-TBNA has not been clearly defined. Aims and objectives The primary aim of this study was to develop and validate a risk stratification model to categorise lymph nodes deemed negative by EBUS-TBNA into ‘low risk’ and ‘high risk’ groups, where ‘risk’ refers to the risk of false negative sampling. Materials and methods A retrospective analysis of a prospectively maintained database at a UK tertiary EBUS-TBNA centre. Only patients with primary lung cancer and only negative lymph nodes by EBUS-TBNA were included in the analysis. A risk stratification model was built from a derivation set using independent predictors of malignancy and the validation set used to evaluate the constructed model. The study period was March 2010 to August 2013. Results 329 lymph nodes were included in the analysis (derivation set n = 196, validation set n = 133). Lymph node SUV, the SUV ratio between the lymph node and primary tumour and heterogeneous echogenicity during sonographic assessment were the only independent predictors of malignancy. Using a simplified scoring system based on the natural logs of the odds ratios from the multivariable analysis on the derivation sample, lymph nodes can be stratified into ‘low risk’ (score ≤1) and ‘high risk’ (score ≥2). 141/142 and 94/96 lymph nodes classified as ‘low risk’ in the derivation and validation set respectively were ultimately proven to be benign and 35/54 and 24/37 lymph nodes classified as ‘high risk’ were proven malignant. The negative predictive value of the risk stratification model for the derivation set and validation set was 99.3% (95% CI 96.1–99.6) and 97.9% (95% CI 92–99.6%) respectively. Discussion This risk stratification model may assist lung cancer MDTs in deciding which patients need further staging procedures and which may proceed directly to treatment after a negative EBUS.

SU‐E‐J‐124: FDG PET Metrics Analysis in the Context of An Adaptive PET Protocol for Node Positive Gynecologic Cancer Patients

Purpose:To compare PET extracted metrics and investigate the role of a gradient‐based PET segmentation tool, PET Edge (MIM Software Inc., Cleveland, OH), in the context of an adaptive PET protocol for node positive gynecologic cancer patients.Methods:An IRB approved protocol enrolled women with gynecological, PET visible malignancies. A PET‐CT was obtained for treatment planning prescribed to 45–50.4Gy with a 55– 70Gy boost to the PET positive nodes. An intra‐treatment PET‐CT was obtained between 30–36Gy, and all volumes re‐contoured. Standard uptake values (SUVmax, SUVmean, SUVmedian) and GTV volumes were extracted from the clinician contoured GTVs on the pre‐ and intra‐treament PET‐CT for primaries and nodes and compared with a two tailed Wilcoxon signed‐rank test. The differences between primary and node GTV volumes contoured in the treatment planning system and those volumes generated using PET Edge were also investigated. Bland‐Altman plots were used to describe significant differences between the two contouring methods.Results:Thirteen women were enrolled in this study. The median baseline/intra‐treatment primary (SUVmax, mean, median) were (30.5, 9.09, 7.83)/(16.6, 4.35, 3.74), and nodes were (20.1, 4.64, 3.93)/(6.78, 3.13, 3.26). The p values were all &lt; 0.001. The clinical contours were all larger than the PET Edge generated ones, with mean difference of +20.6 ml for primary, and +23.5 ml for nodes. The Bland‐Altman revealed changes between clinician/PET Edge contours to be mostly within the margins of the coefficient of variability. However, there was a proportional trend, i.e. the larger the GTV, the larger the clinical contours as compared to PET Edge contours.Conclusion:Primary and node SUV values taken from the intratreament PET‐CT can be used to assess the disease response and to design an adaptive plan. The PET Edge tool can streamline the contouring process and lead to smaller, less user‐dependent contours.

Increasing the accuracy of 18F-FDG PET/CT interpretation of “mildly positive” mediastinal nodes in the staging of non-small cell lung cancer

IntroductionThe aim of this study was to identify radiological factors that may reduce false-positive results and increase diagnostic accuracy when staging the mediastinum of patients with non-small cell lung carcinoma (NSCLC). MethodsThis was a retrospective, interdisciplinary, per-node analysis study. We included patients with NSCLC and mediastinal nodes with an SUV max in the range of 2.5–4.0 on PET-CT. We hypothesized that the greatest number of false positive cases would occur in this cohort of patients. ResultsA total of 92 mediastinal lymph nodes were analyzed in 44 patients. Mediastinal disease (N2/N3) was histologically confirmed in 15 of 44 patients and in 34 of 92 lymph nodes; positive predictive value of 37% and false positive rate of 63%. Lymph node SUV max, tumor size, ratio of node SUV max to tumor SUV max (SUVn/SUVp), and ratio of node SUV max to node size (SUV n/SADn) were significantly higher in true positive cases. Using a threshold of 0.3 for SUV node/tumor and 3 for SUV node/size yielded sensitivities of 91% and 71% and specificities of 71% and 69% respectively for the detection of mediastinal disease. Using both ratios in combination resulted in a sensitivity of 65% and a specificity of 88%. Concurrent benign lung disease was observed significantly more frequently in false-positive cases. ConclusionSUVn/SUVpt and SUVn/SADn may be complimentary to conventional visual interpretation and SUV max measurement in the assessment of mediastinal disease in patients with NSCLC.

The Ratio of Lymph Node SUV to Primary Tumor SUV on PET/CT Predicts Nodal Pathology in Patients With Non-small Cell Lung Cancer (NSCLC)

The Ratio of Lymph Node SUV to Primary Tumor SUV on PET/CT Predicts Nodal Pathology in Patients With Non-small Cell Lung Cancer (NSCLC)

Prediction of survival and cancer recurrence using F-18 FDG PET/CT in patients with surgically resected early stage (Stage I and II) non-small cell lung cancer

The aim of the current study was to investigate the prognostic value of SUV(max) in patients with completely resected early stage (stage I and II) NSCLC. A retrospective review identified 76 patients with surgically resected early (stage I and II) NSCLC who received F-18 FDG PET/CT at diagnosis of cancer. Survival analysis was conducted using Kaplan-Meier analysis, and survival curves stratified by age, sex, mediastinal lymph node involvement, SUV(max), and TNM staging were generated for estimation of overall survival and disease free survival (DFS). Independent predictive factors for survival were determined using Cox proportional hazard model. For overall survival, the median survival of the patients with tumor SUV(max)≤ 6.7 was 48.9 months and was significantly longer than the patients with tumor SUV(max)>6.7 (Log rank test, Χ²=18.01, p5.9. The median survival of the patients with tumor SUV(max)≤ 5.9 was 31.7 months (Log rank test, Χ²=16, p=0.0001). In conclusion, high FDG uptake measured by F-18 FDG PET/CT might have a prognostic value for overall survival and DFS in surgically resected early stage (stage I and II) NSCLC even after stratified by pathologic stages.

FDG-PET staging and importance of lymph node SUV in head and neck cancer

ObjectivesThe role of positron emission tomography (PET) with fluoro-deoxy-glucose (FDG) in the staging of head and neck cancer (HNC) is unclear. The NCCN guidelines do not recommend FDG-PET as a part of standard workup. The purpose of this report is to examine the role of FDG-PET imaging in altering management and providing prognostic information for HNC.MethodsRetrospective review of HNC patients who had a staging FDG-PET scan performed at either Thomas Jefferson University or University of Kansas Medical Center between the years 2001 and 2007. A total of 212 PET scans were performed in patients who went on to receive radiotherapy.ResultsThe median follow-up time for all patients was 469 days. The PPV and NPV of PET imaging to correctly identify lymph node status was 94% and 89% respectively. Lymph nodes with extracapsular extension (ECE) had higher SUVs than nodes without ECE, 11.0 vs. 5.0 (p < 0.0007). Maximum SUV for the primary tumor > 8.0 was predictive of worse overall survival (p < 0.045), while the SUV of the lymph nodes was predictive for distant recurrence at one year--with a mean SUV value of 10.4 for patients with distant failure vs. 7.0 without (p < 0.05).ConclusionsFDG-PET staging in head and neck cancer has good positive and negative predictive values in determining lymph node status. The maximum SUV of the primary tumor is predictive of overall survival. This is the first report to find that the SUV of a lymph node is predictive for ECE and also for distant recurrence.

Prognostic value of fluorodeoxyglucose positron emission tomography-computed tomography before and after radiotherapy in locally advanced nasopharyngeal carcinoma

Objective To evaluate the prognostic value of maximal standard uptake values ( SUV max ) of flnorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) in pa-tients with locally advanced nasopharyngeal carcinoma (NPC). Methods From October 2002 to January 2004, 58 patients with locally advanced NPC who had undergone FDG PET-CT scan before and after radio-therapy were reviewed retrospectively, FDG uptake of primary tumors and neck nodes represented by SUV max was measured. All patients received intensity-modulated radiotherapy using 6 MV X-rays combined with plat-inum-based chemotherapy. The relation between the change of the SUV max before and after radiotherapy and treatment outcomes was analyzed. Results The median follow-up was 61 (9-69) months. The 5-year over-all survival (OS) and disease-free survival (DFS) were 62% and 53%. The patients with tumor SUV max <8.0 before radiation had a significantly better 5-year OS (80% vs. 49%, χ2 = 5.36 ,P = 0.021 ) and DFS (68% vs. 42% ,χ2 =4.23 ,P =0.040) than those with tumor SU max ≥8.0. The patients who achieved a metabolic complete response (MCR) had significantly higher 5-year OS (74% vs. 46% ,χ2 =5.12,P =0.024) and DFS (65% vs. 38% ,χ2 =5.54,P =0.019) than those who only achieved metabolic partial re-sponse (MPR). Poor prognosis was found in patients with the neck lymph node SUV max higher than that of the primary tumor before radiotherapy ( SUV max-N SUV max-P ) ( χ2 = 4.06, P=0.044 ). Conclusions The SUV max before radiotherapy and metabolic response to radiotherapy may predict the prognosis of paitents with locally advanced NPC. The prognosis is poor for patients with high FDG uptake before and after radiotherapy or SUV max-N SUV max-P . Key words: Nasopharyngeal neoplasms/radiotherapy; Tomography; positron-emission; Fluorodeoxyglucose; Prognosis

18F-choline PET/CT imaging of RECIST measurable lesions in hormone refractory prostate cancer

Apply measurability criteria based on the response evaluation criteria in solid tumors (RECIST) to lesions found on (18)F-choline positron emission tomography (PET)/computerized tomography (CT) in patients with hormone refractory prostate cancer. Whole-body PET followed by CT or in-line PET/CT using 3.3-4 MBq/kg of (18)F-choline was performed prospectively on 30 patients with prostate cancer, castrate testosterone levels, and rising post-treatment prostate specific antigen (PSA) levels. Lesions demonstrating increased (18)F-choline uptake were classified as measurable or non-measureable based on RECIST. Three patients were known previously to have RECIST measurable lesions, 10 patients had metastatic findings on radionuclide bone scan, and 17 patients had elevated serum PSA level as the only evidence of disease. Lesions demonstrating increased (18)F-choline uptake were found in 28 (93%) patients. Thirty-eight PET/CT lesions from 14 patients were measurable by RECIST. Lymph node maximum standardized uptake value (SUV(max)) correlated with lymph node diameter (Pearson r = 0.44, p < 0. 001). RECIST measurable lymph node SUV(max) was significantly higher than that of non-measurable nodes (8.1 vs. 3.7, p < 0.0001). Detection of skeletal, prostatic, or RECIST-compatible lesions was more likely with a PSA level greater than 4.0 ng/ml (Fisher exact p = 0.0005). Lesions detected with (18)F-choline PET/CT are frequently measurable by RECIST at baseline. Therefore, it may be feasible to include comparisons to RECIST in evaluations of (18)F-choline as a therapeutic response marker for hormone refractory prostate cancer.

Idiopathic Pulmonary Fibrosis and Diffuse Parenchymal Lung Disease: Implications from Initial Experience with18F-FDG PET/CT

The purpose of this study was to evaluate integrated (18)F-FDG PET/CT in patients with idiopathic pulmonary fibrosis (IPF) and diffuse parenchymal lung disease (DPLD). Thirty-six consecutive patients (31 men and 5 women; mean age +/- SD, 68.7 +/- 9.4 y) with IPF (n = 18) or other forms of DPLD (n = 18) were recruited for PET/CT and high-resolution CT (HRCT), acquired on the same instrument. The maximal pulmonary (18)F-FDG metabolism was measured as a standardized uptake value (SUV(max)). At this site, the predominant lung parenchyma HRCT pattern was defined for each patient: ground-glass or reticulation/honeycombing. Patients underwent a global health assessment and pulmonary function tests. Raised pulmonary (18)F-FDG metabolism in 36 of 36 patients was observed. The parenchymal pattern on HRCT at the site of maximal (18)F-FDG metabolism was predominantly ground-glass (7/36), reticulation/honeycombing (26/36), and mixed (3/36). The mean SUV(max) in patients with ground-glass and mixed patterns was 2.0 +/- 0.4, and in reticulation/honeycombing it was 3.0 +/- 1.0 (Mann-Whitney U test, P = 0.007). The mean SUV(max) in patients with IPF was 2.9 +/- 1.1, and in other DPLD it was 2.7 +/- 0.9 (Mann-Whitney U test, P = 0.862). The mean mediastinal lymph node SUV(max) (2.7 +/- 1.3) correlated with pulmonary SUV(max) (r = 0.63, P < 0.001). Pulmonary (18)F-FDG uptake correlated with the global health score (r = 0.50, P = 0.004), forced vital capacity (r = 0.41, P = 0.014), and transfer factor (r = 0.37, P = 0.042). Increased pulmonary (18)F-FDG metabolism in all patients with IPF and other forms of DPLD was observed. Pulmonary (18)F-FDG uptake predicts measurements of health and lung physiology in these patients. (18)F-FDG metabolism was higher when the site of maximal uptake corresponded to areas of reticulation/honeycomb on HRCT than to those with ground-glass patterns.

FDG PET in the Staging and Management of Cutaneous T Cell Lymphoma

We aimed to assess the usefulness of 18F-FDG PET in siting lymphoma involvement for CTCL patients. We retrospectively analyzed CTCL patients who had received a lymph node biopsy within approximately one month of a PET scan. Between 2003 and 2007, 19 CTCL patients (7 males, 12 females, age range: 4 – 70, median: 55) underwent a combined 56 PET scans. All studies were performed on GE Discovery LS 8 slice MDCT PET CT scanner or GE Discovery DST 16 slice MDCT PET CT scanner (Milwaukee, WI) and the images were interpreted on a GE AW or Xeleris workstation. The patients underwent whole body imaging from the head to foot at 4 minutes per bed position. Of these 19 patients, eight patients (four men, four women, mean age: 56.6, range: 49 – 70) received a lymph node biopsy following a PET scan that demonstrated elevated focal uptake (SUVs ranging from 2.2 to 9.9) in at least one lymph node. In four of the cases, the biopsied lymph node directly confirmed CTCL involvement sited in that node by PET scan (SUV 2.2 to 6.1). Three cases represented false-positive PET scans which were attributed to category 1 dermatopic lymphadenopathy and post radiation change. Despite these lack in correlations, in one case, PET sited adenopathy (SUV 9.9) in an inguinal node that biopsy pronounced benign. Further studies proved that a sampling error produced a false-negative biopsy. Despite the small sample, the study demonstrates the importance of PET imaging in staging patients with CTCL. Findings suggest that lymph node SUV values ranging from 2.2 – 9.9 often correlate with definite involvement of the nodes, and consequentially progression of the disease. It was found that false-positive PET scans may result from post radiation change or dermatopathic lymphadenopathy, category 1. The sample size was too small to detect differences in SUV and correlation in lymph node involvement. Our study demonstrates the need for improvement in the specificity of FDG-PET scans possibly by two point imaging and accurate localization of lymph nodes by use of an intraoperative probe to further enhance its usefulness in the staging of CTCL. Further prospective study is needed to determine correlation with SUV and lymph node involvement.

The standardized uptake value for F‐18 fluorodeoxyglucose is a sensitive predictive biomarker for cervical cancer treatment response and survival

The objective of this study was to evaluate cervical tumor uptake of F-18 fluorodeoxyglucose (FDG) measured as the maximal standardized uptake value (SUV(max)) by positron emission tomography (PET) and its association with treatment response and prognosis in patients with cervical cancer. The study population consisted of 287 patients with stage IA2 through IVB cervical cancer who underwent pretreatment FDG-PET studies. SUV(max), tumor volume, and sites of lymph node metastasis were recorded. Therapy included surgery, chemoradiation, or palliation. The mean SUV(max) was 11.4 (range, 1-50.4). The mean tumor volume by stage was 42.1 cm(3) for stage I tumors (using International Federation of Gynecology and Obstetrics [FIGO] staging criteria), 63.7 cm(3) for stage II tumors, 129.2 cm(3) for stage III tumors, and 166.2 cm(3) for stage IV tumors. There was no correlation between tumor volume and SUV(max) (correlation coefficient [R(2)] = 0.01). No significant difference in SUV(max) was observed between squamous histology (n = 247 patients) and nonsquamous histology (n = 40 patients; P = .089). Higher SUV(max) was associated with an increased risk of lymph node metastasis at diagnosis (P = .0009). A Cox proportional-hazards model for death from cervical cancer was used to evaluate tumor histology, lymph node metastasis, tumor volume, and SUV(max). The results indicated that SUV(max) was the only significant independent factor (P = .0027). Three prognostic groups were established using SUV(max). The overall survival rates at 5 years were 95% for an SUV(max) </= 5.2, 70% for an SUV(max) > 5.2 and </=13.3, and 44% for an SUV(max) > 13.3 (P < .0001). Increasing SUV(max) was associated with persistent abnormal FDG uptake in the cervix on 3-month FDG-PET studies in 238 patients who received curative chemoradiation (P = .04). The SUV(max) of the cervical tumor at diagnosis was a sensitive biomarker of treatment response and prognosis for patients with cervical cancer.