Sensitivity Of 18F-FDG Research Articles

Role of 18F-FDG PET/CT in Guiding Surgical Management of Clinically Node Negative Neck (cN0) in Carcinoma Oral Cavity.

Conventional staging paradigm with clinical examination or imaging invariably leads to underestimation of occult metastatic neck disease in oral cavity carcinoma. The advantage of 18F-FDG PET/CT is in its ability to identify lymph nodes without morphological changes yet harboring occult metastases. We present findings of our study to evaluate diagnostic accuracy of 18F-FDG PET/CT, in detecting occult cervical lymph node metastasis in carcinoma oral cavity. In a single institution prospective study, 51 consecutive patients with histologically proven (cT1/T2) oral cavity carcinoma and clinically node negative neck (cNo), underwent 18F-FDG PET/CT before elective neck dissection of 58 neck sides. 18F-FDG PET/CT findings were compared with histopathology of dissected nodes, to calculate diagnostic accuracy. 18F-FDG PET/CT correctly characterized the occult lymph node metastasis status (true positive + true negative) in 51 of 58 neck sides, yielding diagnostic accuracy of 87.93%. Sensitivity of 18F-FDG PET/CT was 90% and specificity was 87.5%. While a positive 18F-FDG PET/CT accurately predicted the disease in only 60% (positive predictive value), a negative 18F-FDG PET/CT reasonably ruled out occult metastases in 97.67% (negative predictive value). If a decision regarding the need for neck dissection had been based solely on 18F-FDG PET/CT, the number of neck dissections would have been reduced by 74.13%. Based on diagnostic accuracy and high negative predictive value, incorporating 18F-FDG PET/CT in preoperative staging paradigm of cT1/T2 carcinoma oral cavity will guide in selection of patients in which cN0 neck can be safely observed.

Hibridne dijagnostičke procedure u evaluaciji melanoma

Aim: To evaluate the usefulness of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) in patients with advanced melanoma. Method: This study included 264 consecutive patients with melanoma who were sent for the 18F-FDG PET/CT. The inclusion criteria were as follows: histopathologically verified melanoma stage III or IV, the absence of other malignancy/infection; glycemia ≤ 11 mmol/l. The final study population consisted of 220 patients. After the first 18F-FDG PET/CT, the follow-up examination was performed after 11.81±7.99 months, for therapy response evaluation. Results: Pathological 18F-FDG PET/CT was present in 154 patients. Sensitivity of 18F-FDG PET/CT was estimated as 99%, specificity as 47%. There was no statistically significant difference between 18F-FDG PET/CT findings and gender (p> 0.05), and MDCT examination (p = 0.678). However, 18F-FDG PET/CT upstaged 45% patients, especially these with widespread disease. SUV max and inguinal disease localization (in patients who had lower extremities as primary localization of disease) were associated with progression free survival (PFS) (p < 0.05). SUV max (HR 1.03, CI 1.00-1.12, p=0.05) and locally advanced disease (HR 12.02, CI 1.13-148.00, p=0.04) were independent predictors of PFS. A follow up 18F-FDG PET/CT revealed active disease in 22/26 patients. Therapy type (immunotherapy or target therapy) did not correlate significantly with the 18F-FDG PET/CT follow up result (p=0.760, r=-0.354). Conclusion: 18F-FDG PET/CT has good sensitivity in the evaluation of advanced melanoma. Small lesions and brain localization reduce specificity of the examination, then MDCT, Mr are advised. Predictive factors SUV max and locally advanced disease, are more important than the timing of follow-up 18F-FDG PET/CT, since they were predictors of PFS. Follow up 18F-FDG PET/CT should be done at least in 6 months, only if there is suspicion of the presence of active disease.

Uloga 18F-FDG PET/CT u praćenju pacijenata sa laringealnim skvamocelularnim karcinomom nakon terapije

Introduction: The aim of this investigation was to estimate the diagnostic performance of positron emission tomography/computed tomography using fluorine-18 fluoro-deoxyglucose (18F-FDG PET/CT) in the follow-up of post-treatment laryngeal squamous cell carcinoma (SCC) and the survival rate. Material and methods: Fifty seven patients (50 males, 7 females), mean age (68.3±6.7), with post-treatment laryngeal SCC were investigated. Indications for 18F-FDG PET/CT were: post-surgery staging, post-therapy restaging with positive/uncertain CT, follow-up, suspected recurrence on CT. 18F-FDG PET/CT findings were compared to the clinical follow-up of up to 10 years after imaging. The degree of metabolic activity was analyzed visually and semi-quantitatively using the maximum standardized uptake value (SUVmax). Results: A high accumulation of radiopharmaceutical was found in 41 (71.9%) patients who were considered true positive, physiological in 14 patients (24.5%) and only two males (3.5%) were false positive. Overall sensitivity of 18F-FDG PET/CT was 95.3%, specificity 100.0%, positive predictive value 100.0%, negative predictive value 87.5% and accuracy 96.5%. In 19 cases (33.3%) PET/CT findings significantly influenced further management of the patients. Progression-free survival (PFS) in the 18F-FDG positive group was 41.1±12.7 months. Statistically significant correlation between SUVmax and PFS was not observed (p>0.05). Conclusion: 18F-FDG PET/CT is a valuable tool for the follow-up of laryngeal SCC due to its high sensitivity, specificity, PPV, NPV and accuracy. It can influence the patients' management in a significant number of cases. Patients with negative 18F-FDG PET/CT findings had longer PFS than those with positive ones, but without statistical significance. SUVmax was not proven to be a strong predictor of patients' disease-free survival.

Intérêt diagnostique de la TEP-TDM au 18F-FDG dans le diagnostic d’endocardite infectieuse sur valve native

BackgroundNative valve endocarditis (NVE) is a rare but serious disease. The prognosis depends on the rapidity of diagnosis, and is currently based on modified Duke criteria, where echocardiography has a key role but may lack sensitivity if valves are calcified. For prosthetic valves, the European Society of Cardiology 2015 recommendations added 18F-FDG PET/CT as a major imaging criterion as well as for extension assessment. This study evaluated the diagnostic accuracy of 18F-FDG PET/CT in NVE and in extension assessment. MethodsThis retrospective study involved 59 patients suspected of NVE at Bordeaux university hospital between 2011 and 2019 and received 18F-FDG PET/CT. The final diagnosis was established according to Duke criteria after 3 months of management. Infective endocarditis (IE) was assessed in the initial phase according to the Duke criteria. All PET/CTs were blindly reviewed jointly by a junior and senior nuclear-medicine physician. ResultsIn total, 59 patients were included. At 3 months, 26 patients had definite IE, 22 had rejected IE, and 11 possible IE. Twelve patients had positive PET/CT results. The sensitivity of the modified Duke criteria in the initial phase was 77% and the specificity was 81%. When combined with 18F-FDG PET/CT, the sensitivity of the Duke criteria increased to 96% and the specificity was 81%. The sensitivity of 18F-FDG PET/CT alone was 46%. All three patients with perivalvular abscess had positive PET/CT results. Of the 22 patients with NVE definite at 3 months, fourteen (54%) had at least one septic embolism diagnosed on PET/CT. ConclusionsThe implementation of 18F-FDG PET/CT with modified Duke criteria increased the sensitivity for NVE diagnosis in the initial phase and contributed to IE extension assessment. It may contribute to making the diagnosis of a local cardiac complication.

18F-FDG PET/CT and circulating tumor cells in treatment-naive patients with non-small-cell lung cancer.

This study retrospectively investigated the clinical utility of 2-deoxy-18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and circulating tumor cells (CTCs) in the diagnosis and prognosis of treatment-naive patients with non-small-cell lung cancer (NSCLC). The blood samples of treatment-naive patients with NSCLC were collected for CTCs detection, and the tumor metabolic parameters of 18F-FDG PET/CT, including maximum standard uptake value (SUVmax), metabolic tumor volume of primary lesion (MTV-P) and combination of primary lesion and metastases (MTV-C), and total lesion glycolysis of primary lesion (TLG-P) and combination of primary lesion and metastases (TLG-C), were analyzed. Age, sex, smoking, serum tumor markers, tumor size, location, TNM stage, and genetic mutations were also reviewed. Moreover, progression-free survival (PFS) and overall survival (OS) of these patients were analyzed. A total of 309 patients with NSCLC (200 men, 109 women; mean age: 61 ± 9years) were enrolled in this study, including 217 patients with adenocarcinoma and 92 with squamous cell carcinoma. Of the 309 cases, 11 were misdiagnosed with benign diseases by 18F-FDG PET/CT. CTCs positivity was detected in 234 cases. The sensitivity of 18F-FDG PET/CT and CTCs in NSCLC were 96.4% and 75.7%, respectively. SUVmax, MTV-P, TLG-P, MTV-C, TLG-C, tumor size, and serum CYFRA211 levels were significantly higher in CTCs positive group than negative group; and advanced TNM stage, squamous cell carcinoma, and EGFR wild type presented higher CTCs positivity. Multivariate logistic regression analysis revealed that SUVmax was significantly associated with CTCs positivity. Multivariate cox regression analysis showed that TLG-P, TLG-C, and CTCs were independent predictors of PFS in patients with NSCLC, and TLG-C and CTCs were independent predictors of OS. 18F-FDG PET/CT was superior to CTCs in the diagnosis of treatment-naive patients with NSCLC. The levels of CTCs in the peripheral blood were associated with tumor glucose metabolism in NSCLC. Metabolic parameters of 18F-FDG PET/CT and CTCs could separately predict the outcomes of treatment-naive patients with NSCLC.

The Evaluation of Short-Term Outcome of Neuroblastoma in Children by 18F-FDG PET/CT Imaging and Ultrasonography

Objective: By exploring and analyzing the evaluation of the short-term outcome of neuroblastoma (NB) in children by fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging and ultrasonography, the detailed values of 18F-FDG PET/CT imaging and ultrasonography in diagnosing and treating NB in children were discussed. The effectiveness and superiority of the two evaluation methods were verified, providing a theoretical basis for clinical applications. Methods: Child patients with NB diagnosis were included as research objects. Except for child patients in the IVs stage, other included child patients received the same surgical therapeutic plan. The clinical materials included child patients were collected, such as 18F-FDG PET/CT results, ultrasonography results, and serum neuron specific enolase (NSE) results. The data information was input into the database and statistically analyzed by SPSS 22.0 software. The specificity as well as sensitivity of 18F-FDG PET/CT imaging, ultrasonography, and serum NSE in the clinical evaluation were comparatively analyzed. The detection rates of 8F-FDG PET/CT imaging, ultrasonography, as well as other diagnostic ways were comparatively analyzed. Results: Consequently, 10 patients had no recurrence or metastasis of NB; 2 patients had recurrence as well as metastasis of NB but survived, but the remaining 2 patients died eventually. Besides, in terms of specificity, the NSE detection was the lowest, while the specificity of 18F-FDG PET/CT and ultrasonography was the same, which was 100%. In addition, 18F-FDG PET/CT and NSE were found to be statistically significant (P < 0.05). Conclusion: The research results showed that image of the 18F-FDG PET/CT and ultrasonography were useful to diagnosis and treat NB in children, which could effectively predict the survival periods of patients. In certain aspects, these two methods were better than other traditional diagnostic methods. However, traditional diagnostic methods also had certain advantages. In the future, the clinical diagnosis and treatment of NB should value the joint application of various diagnostic methods to foster the strengths and avoid the weaknesses. The research results have provided the direction and guidance for clinical diagnosis and treatment of NB in children.

Application of 18F-FDG PET/CT in evaluation of curative effect and prognosis for small cell lung cancer.

Small cell lung cancer belongs to neuroendocrine tumors and is the most malignant one in lung cancer. It possesses clinical features such as rapid growth, easy early metastasis, and poor prognosis. PET/CT is a molecular imaging technique that combines morphological and metabolic imaging. It has been widely used in the diagnosis, staging, treatment planning, efficacy and prognosis evaluation of tumors. This article reviews the efficacy, prognostic parameters, evaluation criteria, possible influencial factors, clinical application and value of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in small cell lung cancer. The accuracy and sensitivity of 18F-FDG PET/CT in small cell lung cancer stage, efficacy and prognosis evaluation are significantly higher than those of traditional imaging methods. Maximal standardized uptake, metabolic tumor volume, and total lesion glycolysis have been applied in efficacy and prognosis prediction, which have important value in developing the personalized treatment and improving the survival for small cell lung cancer patient.

Abstract 761: Comparison of 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (18F-FDG PET/CT) and conventional imaging (CI) for locally advanced breast cancer staging: A prospective study from a tertiary hospital cancer centre in the Western Cape South Africa

Abstract Background Breast cancer is the second most common cancer in adults, second to lung cancer, and is the most frequently diagnosed cancer in women globally. In South Africa, breast cancer is the commonest type of cancer affecting women and accounts for 26% of all female cancers, excluding non-melanoma skin cancers. Approximately 40% of patients with locally advanced breast cancer (LABC) will develop metastasis within five years after treatment. The presence or absence of distant metastases is the single most important prognostic factor in these patients, and plays a critical role in determination of appropriate therapy. A limited number of studies conducted in LMICs comparing 18F-FDG PET/CT with conventional imaging (CI) have shown superior accuracy of 18F-FDG PET/CT in the detection of distant metastasis in LABC. However, there remains some uncertainty regarding the diagnostic superiority of 18F-FDG PET/CT compared to CI in LABC in South Africa. Results Forty-eight participants were recruited; however, 6 were excluded; 2 because of poor quality 18F-FDG PET/CT scans, 1 because of metaplastic histology, and 3 because they did not complete the investigations for analysis. The final analysed sample consisted of 42 participants. The mean (±SD) age of the participants was 51.5 (±12.71) years, (Range: 27 to 77 years). The stage at presentation was mainly stage IIIB (54.8), with the majority (52.38%), having clinical T4b disease (skin ulceration, peau d'orange or satellite nodules; or palpable nodal disease (90.48%). The study aimed to assess the difference in the sensitivity of 18F-FDG PET/CT and CI in detecting metastases in patients with locally advanced invasive ductal carcinoma (IDC) of the breast. 18F-FDG PET/CT was superior to the selected CI (CXR, USG, bone scan) in the detection of distant metastases(p=0.0077), resulting in the upstaging of disease in 21.4% of patients from clinical stage IIIa to stage IIIc, and changed management in 54 % of patients. Of the 5 suspected metastatic sites that were biopsied, only one was positive for malignancy. 18F-FDG PET/CT detected ipsilateral supraclavicular lymphadenopathy in 10 (23.8%) patients, which was clinically detected in only 5 (11.9%) patients. 18F-FDG PET/CT detected internal mammary lymphadenopathy (IMN) in 11 (26.1%) patients, 4 (9.5%) of whom had bilateral IMN. Three of the patients with supraclavicular nodal disease detected on 18F-FDG PET/CT were subjected to a biopsy by multi-disciplinary team (MDT) recommendation, and 2 of these were found to be negative on histopathology and/or cytology. The use of 18F-FDG PET/CT for breast cancer staging is recommended in LABC, with a better accuracy if biopsy of isolated suspected metastatic lesions, to avoid the danger of false positive rates, as this has an impact on treatment decisions. Conclusion 18F-FDG PET/CT is more accurate than CI for the initial staging of LABC, frequently upstaging clinical disease, and requiring modification of loco-regional management. It provides the convenience of examining the whole body in a single session. Larger multi-centred prospective studies are required to ascertain the significance of isolated solitary lesions on 18F-FDG PET/CT. Citation Format: Paul Mambwe Chilwesa. Comparison of 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (18F-FDG PET/CT) and conventional imaging (CI) for locally advanced breast cancer staging: A prospective study from a tertiary hospital cancer centre in the Western Cape South Africa [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 761.

Value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of pulmonary artery activity in patients with Takayasu's arteritis.

To explore the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the detection of active pulmonary artery (PA) lesions in patients with Takayasu's arteritis (TA). Consecutive TA patients with PA involvement were prospectively recruited. Clinical activity was assessed according to the National Institutes of Health (NIH) criteria. CT pulmonary angiography (CTPA) or magnetic resonance pulmonary angiography was performed for evaluation of vascular structural characteristics, and mural thickening was considered as radiologically active. A vascular segment with 18F-FDG uptake ≥ liver was considered as PET-active. A total of 38 18F-FDG PET/CT scans were performed in 29 patients. In terms of disease activity, the sensitivity of 18F-FDG PET/CT did not significantly differ from radiological imaging (71.4% vs. 92.9%, P = 0.250), but 18F-FDG PET/CT had higher specificity (91.7% vs. 37.5%, P = 0.001) and accuracy (84.2% vs. 57.9%, P = 0.022). Although the majority of PET-active PA segments (54.9%) showed mural thickening, 14 PA segments with normal structure were also PET-active. 18F-FDG activity did not significantly differ between the PA and aorta in clinically active patients. In addition, 18F-FDG activity of the PA was positively correlated with inflammatory markers. Changes in 18F-FDG activity in PA during follow-up reflected therapeutic effects. 18F-FDG PET/CT can effectively evaluate PA activity in TA patients, and its diagnostic performance is superior to radiological imaging. The 18F-FDG activity of PA shows a good correlation with clinical disease status and inflammatory markers and can be used to monitor therapeutic effects.

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

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

Prospective evaluation of whole-body MRI and 18F-FDG PET/MRI in N and M staging of primary breast cancer patients

ObjectivesTo evaluate and compare the diagnostic potential of whole-body MRI and whole-body 18F-FDG PET/MRI for N and M staging in newly diagnosed, histopathologically proven breast cancer.Material and methodsA total of 104 patients (age 53.4 ± 12.5) with newly diagnosed, histopathologically proven breast cancer were enrolled in this study prospectively. All patients underwent a whole-body 18F-FDG PET/MRI. MRI and 18F-FDG PET/MRI datasets were evaluated separately regarding lesion count, lesion localization, and lesion characterization (malignant/benign) as well as the diagnostic confidence (5-point ordinal scale, 1–5). The N and M stages were assessed according to the eighth edition of the American Joint Committee on Cancer staging manual in MRI datasets alone and in 18F-FDG PET/MRI datasets, respectively. In the majority of lesions histopathology served as the reference standard. The remaining lesions were followed-up by imaging and clinical examination. Separately for nodal-positive and nodal-negative women, a McNemar chi2 test was performed to compare sensitivity and specificity of the N and M stages between 18F-FDG PET/MRI and MRI. Differences in diagnostic confidence scores were assessed by Wilcoxon signed rank test.ResultsMRI determined the N stage correctly in 78 of 104 (75%) patients with a sensitivity of 62.3% (95% CI: 0.48–0.75), a specificity of 88.2% (95% CI: 0.76–0.96), a PPV (positive predictive value) of 84.6% % (95% CI: 69.5–0.94), and a NPV (negative predictive value) of 69.2% (95% CI: 0.57–0.8). Corresponding results for 18F-FDG PET/MRI were 87/104 (83.7%), 75.5% (95% CI: 0.62–0.86), 92.2% (0.81–0.98), 90% (0.78–0.97), and 78.3% (0.66–0.88), showing a significantly better sensitivity of 18F-FDG PET/MRI determining malignant lymph nodes (p = 0.008). The M stage was identified correctly in MRI and 18F-FDG PET/MRI in 100 of 104 patients (96.2%). Both modalities correctly staged all 7 patients with distant metastases, leading to false-positive findings in 4 patients in each modality (3.8%). In a lesion-based analysis, 18F-FDG PET/MRI showed a significantly better performance in correctly determining malignant lesions (85.8% vs. 67.1%, difference 18.7% (95% CI: 0.13–0.26), p < 0.0001) and offered a superior diagnostic confidence compared with MRI alone (4.1 ± 0.7 vs. 3.4 ± 0.7, p < 0.0001).Conclusion18F-FDG PET/MRI has a better diagnostic accuracy for N staging in primary breast cancer patients and provides a significantly higher diagnostic confidence in lesion characterization than MRI alone. But both modalities bear the risk to overestimate the M stage.

POSITRON EMISION TOMOGRAPHY FOR DETECTION OF DISTANT METASTASES IN PATIENTS WITH BREAST CANCER

Background . Standard imaging techniques, including chest x-ray, ultrasonography, magnetic resonance imaging and computed tomography have some limitations in terms of their ability to detect distant metastases. The purpose of the study was to search for additional diagnostic techniques for breast cancer detection. M aterial and methods. Results of 18 F-FDG PET/scans were retrospectively analyzed in 50 breast cancer patients. R esults. Traditional imaging techniques showed suspicion for distant metastases in 29 patients. Of them, metastatic disease was histologically confirmed in 16 patients. Sensitivity and specificity of traditional imaging techniques were 80 % and 67.5 %, respectively. Distant metastases were not detected by 18 F-FDG PET/CT in 29 patients, however in one of these patients, both CT and cytological examination performed during the follow-up period revealed pleural metastases. 18 F-FDG PET/CT detected distant metastases in 21 patients. Of these patients, two had no evidence of metastases confirmed by biopsy and other diagnostic imaging methods as well as during follow-up period. The sensitivity and specificity of 18 F-FDG PET/CT in detection of distant metastases were 95 % and 93.3 %, respectively. Conclusion. Sensitivity of 18F-FDG PET/CT in the detection of breast cancer distant metastasis was significantly higher than that of the traditional imaging techniques.

The role of 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT in the follow-up of patients with medullary thyroid cancer.

Medullary thyroid cancer (MTC) is an aggressive form of thyroid malignancy with local metastasis in 30%-50% of the cases and distant metastasis predominantly to lung, liver and skeleton in 13%-15% of patients. Identification of the lesion using imaging modalities is of crucial importance for disease management in the recurrent or metastatic MTC. In this study, we aimed to determine the efficacy of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and gallium-68 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid tyrosine-3-octreotate (68Ga-DOTATATE) PET/CT imaging in patients with MTC and to evaluate the relationship between imaging findings and serum tumor markers. The records of MTC patients, who were treated and followed-up in our department between the years 2005 and 2018 were retrospectively analyzed. Seventy-three patients with MTC, who underwent either 68Ga-DOTATATE PET/CT (n=61) and/or 18F-FDG PET/CT (n=59) together with serum calcitonin (Ctn) and/or carcinoembryogenic antigen (CEA) measurement within 6 months period were included in the study. Gallium-68-DOTATATE PET/CT and 18F-FDG PET/CT scans performed within 6 months on the same patient (n=38) were analyzed separately for comparison of the efficacy of both modalities. The overall sensitivity of 18F-FDG PET/CT and 68Ga-DOTATATE PET/CT were 72.4% and 88.1%, respectively in detecting recurrent or metastatic disease. In the group of patients, who had both 18F-FDG PET/CT and 68Ga-DOTATATE PET/CT within 6 months interval (median: 1.14 months; range: 0.03 - 5.7 months), no significant difference was found in the overall sensitivity of both imaging modalities, however 68Ga-DOTATATE PET/CT was found to be more sensitive in detection of bone lesions compared to 18F-FDG PET/CT (P=0.005). Both 18F-FDG PET/CT and 68Ga-DOTATATE PET/CT are efficient imaging modalities in detection of recurrent or metastatic disease in MTC patients. Gallium-68-DOTATATE PET/CT could be more beneficial in detection of bone metastases with respect to 18F-FDG PET/CT.

Diagnostic value of 18F-FDG PET/CT and tumor markers (CEA, CA19-9, CA24-2) in recurrence and metastasis of postoperative colorectal moderately differentiated adenocarcinoma

Objective To evaluate the diagnostic value of 18F-FDG PET/CT and tumor markers (CEA,CA19-9,CA24-2) in detection for recurrence and metastasis of postoperative colorectal moderately differentiated adenocarcinoma. Methods Fifty-five patients were enrolled in this study. All of the patients were tested with serum CEA within 2 weeks when they underwent 18F-FDG PET/CT scan, and some patients were tested with serum CA19-9 and CA24-2 simultaneously. According to the pathology and clinical results of their follow-up, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT and tumor markers were calculated based on different divided groups, respectively. Results According to the pathology and the results of their clinical follow-up, the sensitivity of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 95.74%, 68.09%, 28.57%, 40.00% and 74.47%, respectively. The specificity of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 75.00%, 50.00%, 66.67%, 71.43% and 50.00%, respectively. The positive predictive valueof 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 95.74%, 88.89%, 85.71%, 88.89% and 89.74%, respectively. The negative predictive value of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 75.00%, 26.67%, 11.42%, 17.24%, 25.00%, respectively. The accuracy of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 92.73%, 65.47%, 32.65%, 44.68% and 70.91%, respectively. There were 2 cases of false positive and 2 cases of false negative in 18F-FDG PET/CT. Conclusion 18F-FDG PET/CT has high value in detecting recurrence and metastasis of postoperative colorectal carcinoma. Tumor markers have the positive value to imply the recurrence and metastasis of postoperative colorectal carcinoma and are useful to indicate when to perform the 18F-FDG PET/CT. The combination of tumor markers could improve the diagnostic efficiency to some extent.

Value of 18F-FDG PET/CT in the diagnosis of portal vein tumor thrombus in patients with hepatocellular carcinoma.

The aim of this study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for the diagnosis of a portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma (HCC). One hundred fifty-four patients with histologically proven HCC underwent 18F-FDG PET/CT imaging. The maximum standardized uptake value (SUVmax) was calculated, and the change in SUVmax (retention index, RI) was defined as the ratio of the increase in SUVmax between early and delayed scans to the SUVmax in the early scan. The circular region of interest was placed on the transaxial images according to the corresponding CT images. The final diagnoses of a PVTT were confirmed by histopathology. Of the patients examined, 101 (65.6%) had no confirmed instances of a PVTT, whereas 53 (34.4%) had a confirmed PVTT. The sensitivity of 18F-FDG PET/CT imaging was 62.3%, the specificity was 97.0%, the accuracy was 85.1%, the positive predictive value was 91.7%, and the negative predictive value was 83.1%. The SUVmax of the PVTT was 4.32 ± 1.96 and the SUVmax of the HCC lesions for these patients was 5.38 ± 2.79, but these differences were insignificant (t = 1.78, p = 0.08). For dual-time-point imaging, the SUV1 of the PVTT lesions was 3.75 ± 1.48, and SUV2 was 3.63 ± 1.41, but these differences were insignificant (t = 0.82, p = 0.42). The SUV1 of the HCC lesions was 4.47 ± 2.03, and the SUV2 was 4.90 ± 2.07, which were both also insignificant (t = - 1.81, p = 0.09). The RI of the PVTT lesions was - 2.05 ± 19.96%, and the RI of the HCC lesions was 11.87 ± 26.20%, with no significant differences between them (t = 1.58, p = 0.13). 18F-FDG PET/CT may potentially improve the accurate diagnoses of a PVTT in patients with HCC.

Is it sufficient to evaluate bone marrow involvement in newly diagnosed lymphomas using 18F-FDG PET/CT and/or routine iliac crest biopsy? A new approach of PET/CT-guided targeted bone marrow biopsy

BackgroundTo investigate whether PET/CT-guided bone marrow biopsy adds complementary information for evaluation of bone marrow involvement (BMI) in newly diagnosed lymphomas.MethodsPatients with newly diagnosed lymphomas that received both 18F-FDG PET/CT and bone marrow biopsy (BMB) were included in this retrospective study. PET/CT classification of bone lesions was classified as isolated, multifocal (2 lesions or more), diffuse (homogeneous uptake of the entire axial skeleton), or negative. BMBs included PET/CT-guided targeted BMB and/or the routine unilateral iliac crest biopsy. Of 34 patients with focal lesions on PET/CT scan, 30 received both PET/CT-guided targeted BMB and iliac crest biopsy, and 4 patients received targeted biopsy without iliac crest biopsy. The final diagnosis of BMI depends on BMB results.ResultsA total of 299 patients with lymphomas were included. PET/CT classification of bone lesions was isolated (16/5.4%), multifocal (67/22.4%), diffuse (52/17.4%), and negative (164/54.8%). If only positive iliac crest biopsy was considered as the reference standard, the sensitivity of 18F-FDG PET/CT for identifying focal and diffuse BMI was 48 and 56%, respectively, and the respective specificities were 70 and 83%. Three of 30 patients (10.0%) with focal lesions on PET/CT were confirmed to be false-positive by targeted BMB, and 25 of 30 patients (83.3%) with focal lesions on PET/CT were confirmed as false-negative by iliac crest biopsy.ConclusionIt is insufficient to evaluate BMI in newly diagnosed lymphomas using both 18F-FDG PET/CT and routine iliac crest biopsy. 18F-FDG PET/CT imaging should be performed before BMB. In focal bone lesions, PET/CT-guided targeted BMB may complement the results of possible false-positive PET/CT and false-negative iliac crest biopsy findings. However, in diffuse and negative lesions, iliac crest biopsy cannot be safely omitted.

The Utility of 18F-FDG PET/CT for Monitoring Response and Predicting Prognosis after Glucocorticoids Therapy for Sarcoidosis.

Sarcoidosis has significant heterogeneity involving multiple organs; treatment of the disease is a significant therapeutic challenge due to the difficulties in accurately monitoring disease activity and estimating prognosis. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) plays an important role in assessing the metabolic activity. However, there is not enough evidence about the influence of this method in the clinical management and prognosis prediction for sarcoidosis. This study aims to investigate the clinical utility of 18F-FDG PET/CT for therapeutic evaluation and prognostic prediction in sarcoidosis. We had retrospectively enrolled 23 patients with sarcoidosis assigned to receive systemic glucocorticoids. All patients underwent baseline 18F-FDG PET/CT before initiating therapy and follow-up 18F-FDG PET/CT within 3 months after the therapy. The metabolic and clinical responses were classified. The baseline 18F-FDG PET/CT showed increased uptake in all patients. Based solely on biopsy-proven sites, the sensitivity of 18F-FDG PET/CT was 91.7%, and the sensitivity improved to 100% after excluding skin involvement. In the subsequent follow-up PET scans within 3 months after glucocorticoids therapy, the SUVmax were variously decreased except one; there are significant differences in the clinical remission rates and the relapse rates between patients with a favorable response and cases with no response on follow-up PET scan, the increasing metabolic response was associated with the increase in clinical remission rates and the reduction in recurrence rates. In conclusion, the present study shows that 18F-FDG PET/CT is an effective way to monitor the early therapeutic reaction and is helpful in predicting the long-term prognosis of sarcoidosis.

Cervical ultrasonography has no additional value over negative 18F-FDG PET/CT scans for diagnosing cervical lymph node metastases in patients with oesophageal cancer

ObjectivesTo investigate the additional value of cervical ultrasonography over 18F-FDG PET/CT for diagnosing cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.MethodsBetween January 2013 and January 2016, 163 patients with newly diagnosed oesophageal cancer underwent both cervical ultrasonography and 18F-FDG PET/CT at a tertiary referral centre in the Netherlands. Retrospective clinical data analysis was performed to assess the diagnostic value of cervical ultrasonography and 18F-FDG PET/CT for the detection of cervical lymph node metastases. Fine needle aspiration or clinical follow-up was used as reference standard.ResultsThe overall incidence of patients with cervical lymph node metastases was 14%. The sensitivity of 18F-FDG PET/CT to detect cervical lymph node metastases was 82% (95% CI 59–94%) and specificity was 91% (95% CI 85–95%). The sensitivity and specificity of cervical ultrasonography were 73% (95% CI 50–88%) and 84% (95% CI 77–90%), respectively. In patients with a negative 18F-FDG PET/CT, 12 of 133 (9%) patients had suspicious nodes on cervical ultrasonography. In all these 12 patients the nodes were confirmed benign.ConclusionsCervical ultrasonography has no additional diagnostic value to a negative integrated 18F-FDG PET/CT for the detection of cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.Key Points• Cervical ultrasonography has no value over PET/CT in evaluating cervical node metastases.• PET/CT provides greater diagnostic confidence compared to cervical ultrasonography.• Cervical ultrasonography during standard diagnostic work-up may be considered unnecessary.• Cervical lesions on PET/CT require cytopathological confirmation by FNA.

Diagnostic accuracy of 18F-FDG PET/CT for detection of peritoneal carcinomatosis; a systematic review and meta-analysis.

The current review aimed to investigate the performance of the diagnostic accuracy of 18F- fludeoxyglucose positron emission tomography/CT (PET/CT) in detecting peritoneal carcinomatosis (PC) through a systematic review and meta-analysis. The MEDLINE via PubMed and EMBASE from the earliest available date of indexing to 31 March 2017, were searched for studies evaluating the diagnostic performance of 18F-FDG PET/CT in detecting PC. We evaluated the pooled sensitivities and specificities across included studies, calculated positive and negative likelihood ratios (LR+ and LR-), and plotted summary receiver operating characteristic curves. Deek's funnel plot asymmetry tests were used to assess the possible underlying publication bias. The current meta-analysis demonstrated no significant publication bias (p = 0.21). Across 14 studies (671 patients), the overall sensitivity of 18F-FDG PET/CT was 0.87 [95% CI (0.77-0.93)] with heterogeneity (χ2 = 94.2, p = 0.00) and a pooled specificity of 0.92 [95% CI; (0.89-0.94)] with heterogeneity (χ2 = 20.6, p = 0.08). LR syntheses gave an overall LR+ of 10.4 [95% CI (7.5-14.5)] and LR- of 0.14 [95% CI (0.08-0.26)]. The pooled diagnostic odds ratio was 73 [95% CI (34-159)]. In univariate meta-regression analysis, publication year and cohort homogeneity were the potent sources of heterogeneity. However, in multivariate meta-regression, no definite variable was the source of the study heterogeneity. 18F-FDG PET/CT demonstrated good sensitivity and specificity for the detection of PC. Further large multicentre studies would be necessary to substantiate the diagnostic accuracy of 18F-FDG PET/CT for the diagnosis of PC in various cancers. Advances in knowledge: 18F-FDG PET/CT showed good diagnostic performance in the evaluation of PC and could provide additional information for that purpose in various cancers.

Comparative evaluation of 18F-FLT and 18F-FDG for detecting cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis

Background18F-FDG PET has been used in sarcoidosis for diagnosis and determination of the extent of the disease. However, assessing inflammatory lesions in cardiac sarcoidosis using 18F-FDG can be challenging because it accumulates physiologically in normal myocardium. Another radiotracer, 3′-deoxy-3′-18F-fluorothymidine (18F-FLT), has been investigated as a promising PET tracer for evaluating tumor proliferative activity. In contrast to 18F-FDG, 18F-FLT uptake in the normal myocardium is low. The purpose of this retrospective study was to compare the uptake of 18F-FLT and 18F-FDG in the evaluation of cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis.Data for 20 patients with newly diagnosed sarcoidosis were examined. 18F-FLT and 18F-FDG PET/CT studies had been performed at 1 h after each radiotracer injection. The patients had fasted for at least 18 h before 18F-FDG PET/CT but were given no special dietary instructions regarding the period before 18F-FLT PET/CT. Uptake of 18F-FLT and 18F-FDG was examined visually and semiquantitatively using maximal standardized uptake value (SUVmax).ResultsTwo patients had cardiac sarcoidosis, 7 had extra-cardiac thoracic sarcoidosis, and 11 had both cardiac and extra-cardiac thoracic sarcoidosis. On visual analysis for diagnosis of cardiac sarcoidosis, 4/20 18F-FDG scans were rated as inconclusive because the 18F-FDG pattern was diffuse, whereas no FLT scans were rated as inconclusive. The sensitivity of 18F-FDG PET/CT for detection of cardiac sarcoidosis was 85%; specificity, 100%; and accuracy, 90%. The corresponding values for 18F-FLT PET/CT were 92, 100, and 95%, respectively. Using semiquantitative analysis of cardiac sarcoidosis, the mean 18F-FDG SUVmax was significantly higher than the mean 18F-FLT SUVmax (P < 0.005). Both 18F-FDG and 18F-FLT PET/CT studies detected all 24 extra-cardiac lesions. Using semiquantitative analysis of extra-cardiac sarcoidosis, the mean 18F-FDG SUVmax was significantly higher than the mean 18F-FLT SUVmax (P < 0.001).ConclusionsThe results of this preliminary study suggest that 18F-FLT PET/CT can detect cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis as well as 18F-FDG PET/CT, although uptake of 18F-FLT in lesions was significantly lower than that of 18F-FDG. However, 18F-FLT PET/CT may be easier to perform since it requires neither prolonged fasting nor a special diet prior to imaging.