Role Of Positron Emission Tomography Research Articles

Role of Positron Emission Tomography in Staging Lymph Nodes in Non-small Cell Lung Cancer

Role of Positron Emission Tomography in Staging Lymph Nodes in Non-small Cell Lung Cancer

Diagnostic performance of positron emission tomography in the staging of pseudomyxoma peritonei

BackgroundPseudomyxoma peritonei (PMP) is a rare clinical entity, commonly derived from a mucin-producing tumour of the appendix. International consensus is unclear on the role of positron emission tomography (PET) in preoperative staging. This study aimed to assess the ability of preoperative PET in predicting the histological grade of PMP. MethodsAll patients scheduled for cytoreductive surgery (CRS) +/− hyperthermic intraperitoneal chemotherapy (HIPEC) for PMP who underwent preoperative PET at a single centre between June 2007 and June 2020 were included. A nuclear medicine physician, blinded to patient outcomes, retrospectively reviewed imaging studies to assess for maximum tumour standardised uptake value (SUV) to mean liver SUV ratio (SUVTLR) and maximum porta hepatis SUV to mean liver SUV ratio (SUVPLR). ResultsBetween April 2007 and December 2020, a total of 204 patients underwent surgical intervention for PMP. Of these, 124 (60.8%) met the inclusion criteria. Median peritoneal carcinomatosis index for the entire cohort was 9 and complete cytoreduction (CC0/1) was achieved in 109 (88%) patients. Patients with high-grade PMP were more likely to have diffuse peritoneal disease (p < 0.001) and higher SUVTLR (p<0.001). The area under the ROC curve (AUC) of SUVTLR in predicting high-grade pathology was 71% (p = 0.003). Patients with a SUVTLR ≤ 0.78 had improved disease-free survival (p = 0.042). ConclusionPreoperative PET showed positive correlation with high-grade PMP and acceptable sensitivity and specificity as a diagnostic tool. PET should be considered a useful adjunct to standard imaging for predicting histological grade in the staging of patients with PMP.

The role of positron emission tomography in the diagnosis and treatment of oncological diseases of the hepatobiliary system

The article highlights the role of PET and SIRT in the diagnosis and treatment of cholangiocarcinoma and HCR. In HCR, PET can be useful in detecting distant metastases, assessing overall and recurrence-free survival. In the case of cholangiocarcinoma, PET is more diagnostically informative than CT when detecting distant metastases and plays an important role in predicting recurrence after surgical resection. Data on the use of various types of radiopharmaceuticals and their combinations are provided. A comparison of their sensitivity and specificity is presented, which showed the best results when using the combination of FDG + choline. The effectiveness of PET in the selection of patients before transplantation, the ability to assess the distribution of activity and to quantify the absorbed dose in SIRT, which in turn allows to predict the therapeutic response and outcome, has been demonstrated. Different types of microspheres for SIRT are considered, in particular, 90Y-resin, 90Y-glass, and 166Ho-poly-L-lactic acid (PLLA). Among them, the most interesting are 166Ho microspheres, which have the advantage of being able to perform diagnostics and treatment with the same radiological label, i.e., to be used in a theranostic approach, theoretically reducing discrepancies between the planning and treatment procedure. SIRT can be used both alone and in combination with other types of treatment at different stages of tumor disease.

The Role of Positron Emission Tomography/ Computed Tomography (PET/CT) in Staging of Lung Cancer

Background Lung cancer is the leading cause of cancer-related death. The accurate staging of lung cancer is important in determining the optimal treatment strategy and predicting the prognosis. Positron emission tomography (PET)/computed tomography (CT), which has the advantages of PET and CT and minimizes their limitations, is a potential tool for the staging of lung cancer. Objective This study aimed to evaluate the role of PET/CT in the staging of lung cancer. Patients and methods This study was carried out on 40 patients with pathologically confirmed lung cancer referred to the Nuclear Medicine Unit affiliated to the Department of Radiodiagnosis at Sharq El Madina Hospital, Ministry of Health, Alexandria, between November 2017 and December 2019 for initial staging of lung cancer with PET/CT or restaging after therapy. Combined PET/CT imaging was performed using the Siemens biograph 64 PET/CT scanner. Results (a) Initial staging: PET/CT was able to assess the stage of ten patients (25%), whose stage could not be assessed by CECT. Both PET/CT and CECT disagreed in the staging of six patients. PET/CT staged 10 (25%) patients that could not be assessed by contrast enhanced computed tomography (CECT) and they disagreed in staging of six patients (15%). T staging was predicted by PET/CT in the 40 patients (100%) and by CECT in 30 patients (75%), with disagreement in two patients (5%). PET/CT disagreed with CECT in N staging of 10 patients (25%). PET/CT detected distant metastasis (M) in 18 patients (45%), while CECT detected it in 14 patients (35%). (b) Restaging after neoadjuvant therapy: staging was concordant in six out of eight patients (75%) and dissimilar in two patients (25%). Conclusion PET/CT is an essential component in the initial staging of lung cancer for its better locoregional and distant staging abilities. It is also more reliable in restaging after neoadjuvant therapy, being more related to the functional activity of the residual tumor rather than its size.

The role of positron emission tomography in the diagnosis of non-small cell lung cancer

This clinical lecture demonstrates the current and future role of 18-F FDG PET/CT in the diagnosis of NSCLC (non-small cell lung cancer) (usefulness/limitations) and prognosis in lung cancer treatment. PET-CT combines metabolic and morphological data, which makes it possible to offer better possibilities for diagnosing malignant pulmonary nodules compared to conventional CT. Integrated PET-CT combines the advantages of PET and CT, minimizing their limitations in the diagnosis, staging and treatment of NSCLC. PET-CT offers a better assessment of lymph node involvement and the presence of local or distant metastatic disease than can be done with conventional imaging alone, and is often used to interpret suspicious lesions detected by such imaging techniques.

Role of Positron Emission Tomography with 2-Deoxy-2-[fluorine-18]fluoro-D-glucose Integrated with Computed Tomography in the Evaluation of Hepatic Metabolic Activity due to Steatosis in Lymphoma Patients and its Impact on Deauville Score

BACKGROUND: Liver uptake of 2-Deoxy-2-[fluorine-18]fluoro-D-glucose integrated (18F-FDG) is taken as the reference tissue in interpretation of Deauville score (DS), which is considered a response assessment. AIM: This study was conducted to evaluate the prevalence of hepatic steatosis in patients with lymphoma and the impact of hepatic metabolic activity due to steatosis on 18F-FDG liver uptake and its effect on DS. MATERIAL AND METHODS: This prospective study was conducted on 77 cases. Seventy-seven patients had baseline positron emission tomography/computed tomography (PET/CT), 69 patients had interim PET/CT, 31 patients had end of treatment (EOT) PET/CT, and 3 patients had follow-up (FU) PET/CT after EOT. The study included 49 female patients (63.6%) and 28 male patients (36.4%). The mean age = 39.5 + 13. Forty-one patients (53.2%) diagnosed as non-Hodgkin lymphoma [HL] while 36 patients (46.8%) diagnosed as HL. Steatosis was diagnosed on the unenhanced CT part of PET/CT examinations using a cutoff value of 42 Hounsfield units. Both maximum standardized uptake value (SUVmax) and SULmax were recorded on the liver and the tumor target lesion. DS was then computed. RESULTS: Among 77 cases, prevalence of steatosis in baseline (10/77, 12.9%), interim (13/69, 18.8%), and EOT/FU (4/31, 12.9%), there was no significant difference in hepatic steatosis during their time course of their treatment. There was correlation between Liver SUVmax with body mass index (BMI) in each of interim and EOT PET/CT. Regarding SULmax, there was no correlation with BMI. There was no change in interpretation of DS using either SUVmax or SULmax. CONCLUSION: Steatosis has no practical issue regarding liver metabolic activity (either SUVmax or SULmax) in interpretation of DS. Liver SUVmax is affected by body weight. Unlike, SULmax is not affected by body weight.

Assessment of therapeutic response of lymphoma patients by PET/CT

Abstract Background Lymphoma compromises а histologically heterogeneous group of cancers derived from the cells of the immune system. The hallmark of the disease is the enlargement and proliferation of lymph nodes or secondary lymphoid tissues. Aim of the Work to evaluate the role of Positron emission tomography in the assessment of response to therapy in lymphoma patients: in particular, a five-point scale (Deauville criteria), which can be employed for early- and late-therapeutic response assessment. Patients and Methods This cross sectional study was conducted on 20 Patients with different types of lymphoma recruited and enrolled from Ain Shams university hospital. Results PET/CT and Contrast enhanced computed tomography were concurrent in results in 55% of cases during treatment and 75 % at the end of treatment with CT sensitivity of 61.1%, specificity of 92.2% and accuracy of 76.2% during treatment in comparison to 100 % sensitivity and specificity of PET/CT.While sensitivity of CT at end of treatment is 57.5% with specificity of 86.7% and accuracy of 71.6%. Conclusion PET/СT using 2-deoxy-2[18F]fluoro-D-glucose is considered one of the best oncologic imaging modality at the time being with valuable applications in lymphoma.It is very efficient with least possible pitfalls and false results compared to either of its components alone and to side by side reading of separately acquired PET and СT. It is becoming а standard modality for lymphoma providing а new vision to management and treatment plan.

Обследование пациентов с раком предстательной железы высокого риска: реальная практика в России

Introduction. Approaches to the diagnosis and staging of localized and locally advanced high-risk prostate cancer (PCa-НR) continue to be actively researched and improved. Materials and methods. In order to understand some of the controversial and controversial issues regarding the diagnosis of PCа-НR, a survey was conducted, in which 250 specialists took part – oncourologists, urologists, andrologists, specializing in the treatment / observation of patients with prostate cancer (PCа). The survey was conducted within the urological information portal Uroweb.ru by filling out a questionnaire. Results. The results obtained indicate that the most significant differences were obtained in views on the role of positron emission tomography combined with computed tomography (PET/CT) in the primary diagnosis of non-metastatic PCа and the importance of local prevalence in determining the risk of progression, while the attitude to genetic testing, primary local staging and prognosis criteria after radical prostatectomy in the majority respondents were similar. Conclusions. Most Russian oncourologists specialists involved in the treatment of PCа do not recommend that patients with PCа-HR perform PET/CT with prostate specific membrane antigen (68Ga-PSMA) and do not prescribe geneticist consultation and genetic counseling for non-metastatic PCа. To assess the local prevalence of the process in prostate cancer, based on the results of MRI, digital rectal examination and the percentage of tumor tissue in the biopsy sample. Most specialists determine the prognosis of a patient after RP by summing up the pathomorphological (PSA + radiological diagnostics + the result of histological examination) and clinical (PSA + radiological diagnostics + biopsy) indicators, which quite correlates with the global data.

The Role of Positron Emission Tomography - Computed Tomography (PET - CT) Scan in the Assessment and Management of Carcinoma of the Prostate Gland: A Review and Update

Background: PET CT Scan has been used on numerous occasions in the assessment and management of various malignancies but it is only occasionally used in the assessment management of carcinoma of the prostate gland globally. There is the need to establish whether or not PET/CT scan is a useful imaging technique which should be used more often in the investigation of biochemical failure following treatment of carcinoma of prostate gland with curative intent Aim: To investigate the suggestion that PET/CT scan would be a useful and reliable imaging option for the investigation of biochemical recurrence resulting following the treatment of prostate cancer with curative intent by reviewing the literature relating to the use of PET / CT scan in carcinoma of the prostate gland. Method: Various internet data bases were searched including: Google, Google Scholar, Yahoo, and PUBMED. The search words that were used included: PET/CT Scan in carcinoma of the prostate, PET/CT scan in prostate cancer, PET/CT scan and prostate cancer, PET/CT scan and carcinoma of the prostate. Results: Fifty two manuscripts that have been published relating to the use of a form of PET/CT scan in relationship to investigation of carcinoma of the prostate gland were utilized to write the article. One of the articles published in Dutch was a review article. Another paper reported the use of PET CT scan in the diagnosis of Hurtle tumour (a benign tumour) in association with carcinoma of the prostate gland. The remaining manuscripts contained case reports and studies regarding the use of various types of PET/CT scan in the investigation of biochemical failure as well as in the treatment and follow-up of some cases of metastasis. On the whole almost all of the papers had confirmed the high sensitivity and high specificity of PET/CT scan in detecting localized and distant metastatic lesions in the scenario of slight elevations of serum PSA. There have been reports of PET/CT scan being able to detect localized and distant metastasis when conventional computed tomography scan and isotope bone scan failed to detect metastases. In one case when the serum PSA level was high isotope bone scan and CT scan failed to detect bone metastases but PET/CT scan detected bone metastases. Conclusions: PET/CT Scan is a very useful imaging modality that detects localized and distant metastases in biochemical recurrence of prostate cancer and this modality of imaging should be used more often from now onwards. CT scan would usually detect nodes/lesions that measure 1 cm or larger but PET/CT scan would detect smaller sized lesions at slightly raised levels of serum PSA. The detection of small localized metastasis at a slightly elevated serum PSA values would make it easier for the undertaking of a second-line treatment of curative intent in the form of salvage lymphadenectomy or salvage radiotherapy targeted at the lesion. Perhaps PET/CT scan should be the first-line imaging modality which should be used in investigating biochemical recurrence and this should be done when the serum PSA is slightly elevated.

The Role of Positron Emission Tomography in Bariatric Surgery Research: a Review.

Bariatric surgery, initially understood as restricting or bypassing the amount of food that reaches the stomach to reduce food intake and/or increase malabsorption of food to promote weight loss, is now recognized to also affect incretin signaling in the gut and promote improvements in system-wide metabolism. Positron emission tomography (PET) is an imaging technique whereby patients are injected with picomolar concentrations of radioactive molecules, below the threshold of having physiological effects, to measure spatial distributions of blood flow, metabolism, receptor, and enzyme pharmacology. Recent advances in both whole-body PET imaging and radioligand development will allow for novel research that may help clarify the roles of peripheral and central receptor/enzyme systems in treating obesity with bariatric surgery.

Prognostic significance of bone marrow and spleen 18F-FDG uptake in patients with colorectal cancer

Serum inflammatory markers are used in the prognostication of colorectal cancer (CRC); however, the corresponding role of positron emission tomography (PET)-derived inflammatory markers remains unclear. This study aimed to investigate the prognostic value of 18F-fluorodeoxyglucose (FDG) uptake in the bone marrow and spleen of patients with CRC and evaluate the relationship between FDG uptake estimates in these organs and serum inflammatory markers. In total, 411 patients who underwent preoperative FDG PET/computed tomography (CT) within 1 month of surgery were enrolled. The mean standardized uptake values of the bone marrow and spleen were normalized to the value of the liver, thereby generating bone marrow-to-liver uptake ratio (BLR) and spleen-to-liver uptake ratio (SLR) estimates. The value of BLR and SLR in predicting overall survival (OS) was assessed using the Cox proportional hazards model. The correlation between BLR or SLR and neutrophil-to-lymphocyte ratio (NLR) was evaluated. The predictive accuracy of BLR alone and in combination with SLR was compared using the integrated area under the receiver operating characteristic curves (iAUC). In the univariate analysis, BLR (> 1.06) and SLR (> 0.93) were significant predictors of OS. In the multivariate analysis, BLR was an independent predictor of OS (hazard ratio = 5.279; p < 0.001). Both BLR and SLR were correlated with NLR (p < 0.001). A combination of BLR and SLR was better than BLR alone at CRC prognostication (iAUC, 0.561 vs. 0.542). FDG uptake estimates in the bone marrow and spleen may be useful imaging-derived biomarkers of systemic inflammation, supporting CRC prognostication.

The role of positron emission tomography in different types of malignant lymphomas: the results of 2020

The review presents the results of studies published in 2020 concerning the role of positron emission tomography (PET) in the diagnosis of different types of malignant lymphomas. The authors tried to highlight the current trends in the development of the PET method in case of Hodgkin lymphoma, diffuse large B-cell lymphoma, follicular lymphoma and multiple myeloma. The topic concerning the use of PET in immunotherapy is highlighted separately. There was also an emphasis on the interpretation of quantitative imaging biomarkers used in PET. The concept of PET-adapted approach in Hodgkin lymphoma, the predictive significance of PET before high-dose chemotherapy and autologous hematopoietic stem cell transplantation in patients with diffuse large B-cell lymphoma, predictive value of intermediate PET in case of follicular lymphoma, the application of methionine as PET tracer to diagnose tumor burden and to measure minimal residual disease in case of multiple myeloma, the variants of atypical tumor response to the immune checkpoint inhibitors therapy, PET in diagnosing immune-mediated adverse events are currently relevant for oncologists, hematologists, radiologists and discussed in this article. In the context of the topics the authors showed the results of PET imaging of Russian patients who had PET examination in the Bakulev National Medical Research Center for Cardiovascular Surgery.

Supplemental 18F-FDG-PET/CT for Detection of Malignant Transformation of IPMN-A Model-Based Cost-Effectiveness Analysis.

Simple SummaryThe incidence of IPMN is increasing, mainly attributed to the expanded application of radiological cross-sectional imaging and improvements in image quality. IPMN are the cause of approximately 10% of all pancreatectomies in the USA. A significant number of surgically treated IPMNs do not show high-grade dysplasia or invasive cancer, raising the question of overtreatment, and the need for better diagnostic accuracy. 18F-FDG-PET/CT demonstrated promising diagnostic performance in the detection of malignant transformation of IPMN in comparison to CT and MRI. In this study, the authors analyze whether a supplemental 18F-FDG-PET/CT to the current diagnostic pathway of IPMN could be cost-effective. Results suggest that implementation of 18F-FDG-PET/CT in a preoperative setting could be beneficial from a health care system perspective. It also encourages the research community to investigate if 18F-FDG-PET/CT could be a useful addition in other diagnostic settings within IPMN management.Accurate detection of malignant transformation and risk-stratification of intraductal papillary mucinous neoplasms (IPMN) has remained a diagnostic challenge. Preliminary findings have indicated a promising role of positron emission tomography combined with computed tomography and 18F-fluorodeoxyglucose (18F-FDG-PET/CT) in detecting malignant IPMN. Therefore, the aim of this model-based economic evaluation was to analyze whether supplemental FDG-PET/CT could be cost-effective in patients with IPMN. Decision analysis and Markov modeling were applied to simulate patients’ health states across a time frame of 15 years. CT/MRI based imaging was compared to a strategy with supplemental 18F-FDG-PET/CT. Cumulative costs in US-$ and outcomes in quality-adjusted life years (QALY) were computed based on input parameters extracted from recent literature. The stability of the model was evaluated by deterministic sensitivity analyses. In the base-case scenario, the CT/MRI-strategy resulted in cumulative discounted costs of USD $106,424 and 8.37 QALYs, while the strategy with supplemental FDG-PET/CT resulted in costs of USD $104,842 and a cumulative effectiveness of 8.48 QALYs and hence was cost-saving. A minimum specificity of FDG-PET/CT of 71.5% was required for the model to yield superior net monetary benefits compared to CT/MRI. This model-based economic evaluation indicates that supplemental 18F-FDG-PET/CT could have a favorable economic value in the management of IPMN and could be cost-saving in the chosen setting. Prospective studies with standardized protocols for FDG-PET/CT could help to better determine the value of FDG-PET/CT.

Role of positron emission tomography in predicting early tumor response to neoadjuvant chemotherapy for breast cancer

Background. Neoadjuvant chemotherapy (NACT) is an important stage in the treatment of patients with breast cancer. Positron emission tomography/computed tomography (PET/СT) with fluorodeoxyglucose labeled with 18F (18F-FDG) is widely used as an effective method of metabolic tumor imaging at the stages of treatment. The aim of this study was to evaluate the possibility of using PET/CT with 18F-FDG to determine the early tumor response to NACT.Materials and methods. The results of PET/CT with 18F-FDG in 27 patients with breast cancer were retrospectively analyzed. The study was performed before the start of NACT, after the 2nd cycle of chemotherapy and after completion of all courses, the maximum accumulation of 18F-FDG in the tumor tissue (SUVmax), as well as the dynamics of changes in SUVmax after NACT (SUV(%)) were assessed. According to the results of postoperative morphological examination, the patients were divided into two groups: with complete tumor regression (pCR) and with no complete tumor regression (non-pCR).Results. The results of the study showed that the SUV(%) between the primary and interim examination, as well as between the intermediate and preoperative PET/CT scans, was 66.6 ± 13.3 % and 31.6 ± 17.5 %, respectively. The dynamics of SUV(%) between the primary and intermediate scans in the pCR and non-pCR groups was 79.04 ± 4.1 % and 63.8 ± 13.1 %, respectively (p = 0.02). The SUVmax value in the pCR and non-pCR groups during the primary PET/CT scan was 8.5 ± 0.78 and 8.2 ± 0.78, respectively (p = 0.5), while the intermediate scan was 1.8 ± 0.35 and 3.0 ± 0.14 (p = 0.03). Based on the research results, an ROC analysis was carried out, which showed that the optimal value of SUV(%) is 73.55 %, which showed the highest sensitivity and specificity.Discussion. Given that the change in SUVmax between primary and intermediate PET/CT was more pronounced than between intermediate and preoperative scans, it can be assumed that metabolic changes in the background of NACT are observed already in the early stages of treatment and persist until the end of therapy, thus, the ineffectiveness of the chemotherapy regimen can be determined using an intermediate PET/CT scan and a timely change in the treatment plan.Conclusions. We consider 73.55 % to be the optimal value of SUV(%) for intermediate PET/CT scanning; for this indicator and above, it is expected to expect a complete morphological response of the tumor to NACT. We believe that PET/CT with 18F-FDG at an intermediate stage of observation during NACT is a valuable method for predicting early tumor response to therapy.

Diagnostic role of positron emission tomography in patients with ovarian cancer

The review deals with the effectiveness of the use of positron emission tomography (PET) with 18F-fluorodeoxyglucose in the diagnosis, staging, assessment of treatment results, prognosis and monitoring of ovarian cancer. It is shown that the adequate use of PET in diagnostic algorithms can improve the accuracy of complex diagnostics, optimize the tactics of examination and treatment of patients. The opinions of researchers on the limitations of the method are presented, leading to false positive and false negative conclusions. Key words: ovarian cancer, positron emission tomography, 18F- fluorodeoxyglucose.

Role of positron emission tomography/computed tomography for the staging of primary colorectal cancers

ObjectiveThe aim of this paper was to evaluate the role of positron emission tomography (PET) combined with contrast-enhanced computed tomography (CECT) in staging patients with primary colorectal cancer (CRC).BackgroundCRC is the second leading cause of cancer-related deaths and the fourth most common malignancy worldwide. Cross-sectional imaging studies such as CT and MRI have evolved as the best modalities for staging rectal cancer. PET combined with CT is widely used not only for preoperative staging, but also for assessing the outcomes of rectal carcinoma.Patients and methodsThis prospective study was carried out on 50 patients: 30 (60%) men and 20 (40%) women in the age range from 27 to 74 years, who were diagnosed or suspected to have cancer colon by other radiological imaging.ResultsOur results showed that PET-CT had equal sensitivity (95.4%) and specificity (82%), positive predictive value (PPV) (80.7%), negative predictive value (NPV) (95.8%), and accuracy (88%) for the detection of regional lymph node metastasis compared to CECT. But PET-CT and CECT had higher sensitivity and higher specificity, PPV, NPV, and accuracy more than PET for detection of metastatic lymph nodes and PET-CT had equal sensitivity (92.8%) and specificity (86.2%), PPV (72.2%), NPV (96.8%), and accuracy (88%) for detection of lung metastasis compared to PET. But PET-CT and PET had higher sensitivity and higher specificity, PPV, NPV, and accuracy more than CECT for detection of pulmonary deposits.ConclusionAccording to our results, fluorine-18 fluorodeoxyglucose PET/CT has contributed positively to the staging of primary CRC patients.

The role of pet in the treatment of B-cell lymphoproliferative disorders in a real-world clinical setting in Russia

Objective. Assessment of the role of positron emission tomography (PET) in the diagnosis and treatment of B‑cell lymphoproliferative disorders (B-LPD) in Russian real‑world clinical practice from 2014 to 2017.Materials and Methods. The EQUILIBRIUM, a post marketing multicenter study, included 1000 patients aged 21 to 91 years with a verified diagnosis of B‑cell non‑Hodgkin»s lymphoma (B-NHL) or chronic lymphocytic leukemia (CLL) who received at least 4 cycles of rituximab‑containing therapy with Acellbia®. The main method for the assessment of the disease dissemination, the size and location of the lesions was computed tomography, which was used in 76.2 % of patients. PET was performed in 324 (32.4 %) patients: in 152 (47 %) cases during initial diagnosis, PET during treatment in 102 (31 %) patients and — in the vast majority, i. e. 310 (96 %) patients — after completion of induction chemo‑immunotherapy. Results. According to the results of interim PET, complete remission was achieved in 44 (43 %) of 102 patients, partial remission — in 53 (52 %) cases, stabilization of the disease was observed in 5 (5 %) patients, and no cases of progression among patients who underwent interim PET was detected. The main evidence of the final PET assessment efficacy was the achievement of complete remission (CR) in 235 (75.8 %) cases; partial remission (PR) was observed in only 61 (19.7 %) patients, and disease progression was reported in 14 (4.5 %) of cases. The median follow‑up was 15 months (range from 1 to 42 months). As expected, the median overall survival (OS) as well as the median event‑free survival (EFS) has not been reached for this period of time. There was a statistically significant effect of the results of interim PET on event‑free survival (p = 0.07661) without a significant effect on overall survival (p = 0.69868). The depth of response recorded during the final PET scan turned out to be a prognostically significant factor for both EFS and OS (p = 0.00000).Conclusion. Positron emission tomography is a modern and effective method for diagnosing and assessing the efficacy of therapy in B‑cell lymphoproliferative disorders, which is used for only 1 / 3 of patients in a real‑world clinical practice. Nevertheless, the role of this method in assessing the effectiveness of therapy is beyond doubt.

Abstract IA24: Imaging cancer metabolism in patients: Beyond FDG PET

Abstract Molecular imaging is a tool that can visualize and quantify biological processes at the molecular and cellular levels in living systems1, and it is therefore ideally suited to the study of cancer metabolism in patients2. In the clinic, molecular imaging of cancer metabolism has been most widely exploited using the elevated rate of glycolysis observed in most tumors as a target for cancer detection and staging using positron emission tomography (PET) and the glucose analog 18F-fluordeoxyglucose (FDG)3. FDG PET, now combined with anatomic imaging in the form of PET/CT, has become an important tool for cancer detection, staging, and response assessment, widely used in oncologic clinical practices around the world. Clinical use of FDG PET has increased our appreciation of aberrant glycolysis as a feature of more aggressive, less differentiated tumors4. At the same time, the variability of tumor FDG uptake seen in clinical imaging has highlighted some of the limitations of imaging tumor glycolysis and has spurred the development of new imaging probes and novel imaging modalities designed to image other facets of cancer energy metabolism. In addition, the use of therapeutics that are targeted to and/or influenced by cancer metabolic phenotype5 drive applications of cancer metabolic imaging to clinical challenges beyond detection that include predicting and monitoring response to targeted therapy6. This talk will briefly review the underpinnings of the current use of FDG PET/CT for cancer staging and response evaluation. The talk will beyond FDG PET and discuss alternative PET probes targeted to other metabolic substrates such as amino acids, lipids, and TCA intermediates7, as well as new instrumentation that offers unique capabilities for imaging whole-body cancer metabolism imaging8. The talk will also highlight other methods for imaging cancer metabolism in patients, especially hyperpolarized 13C-labeled metabolic substrates such as pyruvate9. Unique features and advantages of each modality will be highlighted, as will approaches to image analysis common across modalities, including quantitative imaging and kinetic analysis. Finally, the talk will emphasize benefit of multi-modality imaging as an approach to fully characterize cancer metabolism, using glutaminolysis imaging as an example of active investigation. Supported in part by Komen SAC130060, NIH P30-CA016520, and NIH R01-CA211337.

Prognostic role of positron emission tomography in patients with known or suspected cardiac sarcoidosis. a systematic review and meta-analysis

Abstract Background Sarcoidosis is a chronic inflammatory disorder of unclear etiology, characterized by the presence of non-caseating granulomas. Cardiac involvement occurs in upto 27 percent of patients, manifesting as atrioventricular blocks, ventricular arrhythmia or sudden cardiac death. Current guidelines cite insufficient evidence for the prognostic utility of positron emission tomography (PET) in patients with cardiac sarcoidosis. Thus, we performed a systematic review and meta-analysis of published studies to ascertain the prognostic significance of PET imaging in patients with suspected or diagnosed cardiac sarcoidosis. Purpose To review current literature and determine if PET has prognostic utility in patients with known or suspected cardiac sarcoidosis Methods We performed a comprehensive literature search of electronic databases (Embase, Medline and Web of Science) using MeSH terms and keywords for sarcoidosis and PET from inception through December 2019. Studies were eligible if they included patients with known and/or suspected cardiac sarcoidosis undergoing evaluation by PET with or without perfusion imaging and reported clinical events of interest. An abnormal PET study was defined as the presence of focal or focal-on-diffuse uptake of 18- fluorodeoxyglucose (18-FDG) by visual analysis. In studies with perfusion imaging, patients with only perfusion defects were excluded. The primary outcome of interest was a composite of major adverse cardiac events (MACE), including sustained ventricular tachycardia, sudden cardiac death. Secondary analysis studied association of MACE with focal right ventricular (RV) uptake in patients with an abnormal PET study. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Heterogeneity of results among the studies was assessed using the Higgins I2 value. Results Out of a total of 1645 citations, 40 were selected for full-text review. Five studies were included in the final analysis with a total of 465 patients. mean follow-up was 2.3 years. Three of the five studies also reported frequency of abnormal RV uptake of 18-FDG. Patients with abnormal 18-FDG uptake on visual assessment had higher odds of MACE (OR 3.12, CI 1.9–5.01, p&amp;lt;0.00001), compared to known or suspected cardiac sarcoid patients with normal PET studies. Heterogeneity among studies was low (I2 = 0). In patients with an abnormal PET study, abnormal focal RV uptake of 18-FDG was associated with higher odds of MACE (OR 5.24, CI 1.1–25.1, p=0.04), with moderate heterogeneity among studies (I2=41). Conclusion In patients undergoing PET imaging for known or suspected cardiac sarcoidosis, abnormal metabolism on visual analysis is associated with increased risk of MACE. Furthermore, focal RV uptake further increases the risk of MACE in patients with abnormal PET imaging. Thus, PET imaging can serve as a tool to risk stratify patients with known or suspected cardiac sarcoidosis. Forrest Plots Funding Acknowledgement Type of funding source: None

Usefulness of Brain Positron Emission Tomography with Different Tracers in the Evaluation of Patients with Idiopathic Normal Pressure Hydrocephalous.

Idiopathic normal pressure hydrocephalus (iNPH) is the only form of dementia that can be cured by surgery. Its diagnosis relies on clinical and radiological criteria. Identifying patients who can benefit from surgery is challenging, as other neurological diseases can be concomitant or mimic iNPH. We performed a systematic review on the role of positron emission tomography (PET) in iNPH. We retrieved 35 papers evaluating four main functional aspects with different PET radiotracers: (1) PET with amyloid tracers, revealing Alzheimer’s disease (AD) pathology in 20–57% of suspected iNPH patients, could be useful in predictions of surgical outcome. (2) PET with radiolabeled water as perfusion tracer showed a global decreased cerebral blood flow (CBF) and regional reduction of CBF in basal ganglia in iNPH; preoperative perfusion parameters could predict surgical outcome. (3) PET with 2-Deoxy-2-[18F]fluoroglucose ([18F]FDG ) showed a global reduction of glucose metabolism without a specific cortical pattern and a hypometabolism in basal ganglia; [18F]FDG PET may identify a coexisting neurodegenerative disease, helping in patient selection for surgery; postsurgery increase in glucose metabolism was associated with clinical improvement. (4) Dopaminergic PET imaging showed a postsynaptic D2 receptor reduction and striatal upregulation of D2 receptor after treatment, associated with clinical improvement. Overall, PET imaging could be a useful tool in iNPH diagnoses and treatment response.