Tomography-computed Tomography In Patients Research Articles

Positron emission tomography-computed tomography in patients with Staphylococcus aureus bacteraemia: worth the wait?

Positron emission tomography-computed tomography in patients with Staphylococcus aureus bacteraemia: worth the wait?

Use of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients affected by polymyalgia rheumatica and persistent increase of acute phase reactants.

Polymyalgia rheumatica (PMR) is an inflammatory disease affecting older adults characterized by aching pain and morning stiffness of the shoulder and pelvic girdles. Moreover, PMR can be associated with giant cell arteritis (GCA). Generally, PMR is highly responsive to steroids, reaching complete remission in the majority of cases. However, the possibility of occult diseases, including extra-cranial GCA, should be excluded. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is able to detect the presence of peri-/articular or vascular inflammation, which may be both present in PMR, thus representing a useful diagnostic tool, mainly in presence of extra-cranial GCA. We retrospectively evaluated all consecutive patients who received the diagnosis of PMR in our rheumatology clinic, classified according to the 2012 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria, in the period between April 2020 and May 2022. Among this case series, we selected the patients who underwent 18F-FDG-positron emission tomography (PET) because of the persistent increase of acute phase reactants (APR) besides the steroid therapy. Eighty patients were diagnosed with PMR. Nine out of them also presented arthritis of the wrists during the follow-up, whereas none showed signs of cranial GCA at the diagnosis. Seventeen out of eighty subjects (mean age 71.5 ± 7.5 years; M/F 2/15) presented persistent increase of erythrocyte sedimentation rate (mean ESR 44.2 ± 20.8 mm/h) and/or C-reactive protein (mean CRP 25.1 ± 17 mg/l), thus they underwent total body 18F-FDG-PET/CT. Large vessel 18F-FDG uptake indicating an occult GCA was found in 5/17 (29.4%) cases. Twelve out of seventeen (70.6%) patients showed persistence of peri-/articular inflammation, suggesting a scarce control of PMR or the presence of chronic arthritis. Finally, in 2 cases, other inflammatory disorders were found, namely an acute thyroiditis and a hip prosthesis occult infection. 18F-FDG-PET/CT in PMR patients with persistent increase of APR is a useful diagnostic technique in order to detect occult GCA, persistence of active PMR or other misdiagnosed inflammatory diseases.

Prognostic Relevance of Medullary Abnormalities in the Appendicular Skeleton Detected By Positron Emission Tomography-Computed Tomography in Patients with Newly Diagnosed Multiple Myeloma

Background: Positron emission tomography-computed tomography (PET-CT) is a valuable tool in the initial evaluation of myeloma and related disorders. However, the prognostic value of PET-CT has not been fully elucidated. We recently reported the prognostic significance of medullary abnormalities in the appendicular skeleton (AS) detected by multidetector computed tomography (MDCT) in patients with multiple myeloma (MM) [Blood Adv, 2018. 2(9): p.1032-39].The study reported that medullary abnormalities in AS detected by MDCT showed different fluourodeoxyglucose-avidity ranging from entirely negative to diffusely positive on concurrently performed PET-CT, despite the presence of unequivocal infiltration of abnormal lesions in AS on MDCT. We further investigate the prognostic relevance of medullary abnormalities in AS by PET-CT in symptomatic MM.Methods: We identified a total of 211 consecutive patients with newly diagnosed, symptomatic MM diagnosed and treated between April 2008 and February 2018 at Kameda Medical Center, Kamogowa-shi, Japan. They were evaluated with pretreatment whole-body PET-CT. We included only patients who had been treated with novel agents. PET-CT imaging was performed as previously reported [Blood, 2011. 118(23): p.5989-95]. PET-CT positivity and negativity were also defined as previously described.Results: Median age of the patients was 73.5 years [interquartile range (IQR): 66.3-80.3 years). There were 129 (61.1%) patients who showed abnormal findings on PET-CT. Consistent with previous reports, known high-risk PET-CT findings including the presence of >3 systemic focal lesions (FLs), maximum standardized uptake value (SUVmax) >4.2, and extramedullary disease were observed in 91 (43.1%), 97 (46.0%), and 11 (5.2%) patients, respectively. Receiver operating characteristic analysis determined the optimal cutoff value of AS focal lesions (AS-FLs) on PET-CT as 3. We then divided patients into two groups with ≤3 or >3 AS-FLs (Fig. 1). There were 35 (16.6%) patients with >3 AS-FLs, and their levels of clonal circulating plasma cells and prevalence of del(17p) and t(14;16) were higher than those in patients without AS-FLs. Patients with >3 AS-FLs showed significantly shorter progression-free survival (PFS) and overall survival (OS) than those without [median PFS: 12.8 and 35.6 months, respectively; P < 0.001, and median OS: 33.4 months and not reached (NR), respectively; P < 0.001]. Patients with 1-3 AS-FLs did not show significant differences in PFS and OS compared to patients with no AS-FL (Fig. 2). In addition, this finding retained its prognostic value for PFS and OS in multivariate analysis [hazard ratio (HR); 2.35, 95% confidence interval (CI); 1.42-3.88; P < 0.001 for PFS, and HR; 2.86, 95% CI; 1.60-5.09; P < 0.001 for OS] (Table 1). As previously described, we observed that the known high-risk PET findings including the presence of >3 systemic FLs and SUVmax> 4.2 had an unfavorable prognostic impact. Patients with >3 AS-FLs showed significantly shorter PFS and OS than those without, even among patients with >3 systemic FLs (Fig. 3) or SUVmax> 4.2 (Fig. 4). Furthermore, we identified 108 and 42 patients with focal/scattered and diffuse marrow pattern on MDCT, respectively. There were 16 (14.8%) and 19 (45.2%) patients with >3 AS-FLs observed on PET-CT with focal/scattered and diffuse marrow pattern on MDCT, respectively. These patients showed shorter PFS and OS than those without AS-FLs among patients with the same AS marrow pattern on MDCT.Conclusions: To the best of our knowledge, ours is the first study to demonstrate that the presence of >3 FLs in AS detected by pretreatment PET-CT was robustly predictive of unfavorable survival independent of known risk factors, including existing high-risk PET-CT findings in patients with newly diagnosed MM. The findings in AS may potentially complement and improve the prognostic performance of PET-CT. Further systematic studies are warranted for the validation of our results and development of more accurate prognostic systems incorporating cross-sectional imaging. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Prognostic value of lower limb perfusion single-photon emission computed tomography-computed tomography in patients with lower limb atherosclerotic peripheral artery disease.

The purpose of this study was to estimate the severity of the participants' lower limb ischemia by calculating the lower limb muscle-to-background ratio (LMBR) using lower limb perfusion single-photon emission computed tomography-computed tomography (SPECT/CT) and to evaluate the prognostic value of LMBR in peripheral artery disease (PAD) patients. This retrospective study consists of 38 patients with PAD (70±12years) and observed over 1 year who were included in the analysis. All participants underwent lower limb perfusion SPECT/CT. LMBR was calculated by dividing counts/volume in lower limb muscle by mean counts/volume of background. All patients were divided into two groups based on their LMBR value and observed for the occurrence of a major adverse event (MAE). The high and low LMBR groups consisted of 26 and 12 patients, respectively. The median LMBR in the high group was 9.59 (6.11-11.87) while that in the low group was 4.35 (3.85-4.99). A significantly higher number of patients in the low LMBR group experienced MAE than in the high LMBR group (7 of 12 vs. 1 of 26, p<0.001). This study demonstrated that the LMBR derived from lower limb perfusion SPECT/CT may have a high prognostic value in patients with PAD.

Association between survival and maximum standardized uptake value of liver metastases detected by 18-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography in patients with adenocarcinoma of unknown primary origin.

The objective of this retrospective study is to investigate the association between survival and maximum standardized uptake values (SUVmax) of liver metastases detected by pre-treatment positron emission tomography-computed tomography (PET-CT) in patients with adenocarcinoma of unknown primary origin (ACUP). A total of 58 patients with ACUP and liver metastases confirmed histopathologically by liver biopsy and pre-treatment PET-CT were included in this study. SUVmax values of the liver lesions were measured and their association with survival was investigated. The median age was 62years; 63.8% of the patients were males and 36.2% were females. The median overall survival was calculated as 10.7months (OS). The median SUVmax of the liver metastases was 8.6. Accordingly, two groups were established: one with values <8.6 and the other with ones ≥8.6. No differences were detected between the two groups with respect to general characteristics. Median OS was 13.2months in the group with SUVmax <8.6 compared to 7.4months in the group with SUVmax ≥8.6. This difference was statistically significant (p=0.033). SUVmax (HR 1.104, 95% CI 1.013-1.204, p=0.025), age (HR 1.033, 95% CI 1.002-1.064, p=0.034), presence of chemotherapy (HR 2.296, 95% CI 1.136-4.641, p=0.021) and LDH level (HR 1.002, 95% CI 1.001-1.003, p=0.007) were identified as independent prognostic factors affecting survival in the multivariable analysis. This is the first report evaluating the impact of SUVmax for liver metastases on ACUP patient survival. The SUVmax of liver metastases evaluated by PET-CT is a prognostic factor influencing survival of patients with ACUP.

The Association Between Survival and Maximum Standardized Uptake Value of Liver Metastases Detected By 18-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography-Computed Tomography in Patients with Adenocarcinoma of Unknown Primary Origin

Objective The objective of this retrospective study is to investigate the association between survival and maximum standardized uptake values (SUVmax) of liver metastases detected by pre-treatment positron emission tomography-computed tomography (PET-CT) in patients with adenocarcinoma of unknown primary origin (ACUP).

Lung nodule detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography in patients with papillary thyroid cancer, negative 131I whole body scan, and undetectable serum-stimulated thyroglobulin levels: two case reports

IntroductionWhen a pulmonary nodular lesion is detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography in a patient with post-surgical papillary thyroid carcinoma with undetectable serum-stimulated thyroglobulin levels and negative 131I whole body scan, diagnosis and management of the nodule may be confusing.Case presentationWe describe two post-surgical patients with papillary thyroid carcinoma who showed pulmonary nodular lesions detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography. In both cases serum-stimulated thyroglobulin levels were undetectable and nodular lesions were not detected by 131I whole body scan. In the first case, a 64-year-old Asian woman showed one focal increased fluorodeoxyglucose uptake lesion in the right lower lobe of one of her lungs. Based on the histologic study, the pulmonary nodular lesion was diagnosed as a solitary pulmonary metastasis from papillary thyroid carcinoma. In the second case, a 59-year-old Asian woman showed a new pulmonary nodule in the right lower lobe. The computed tomography scan of her chest revealed a 9mm nodule in the anterior basal segment and another tiny nodule in the posterior basal segment of the right lower lobe. Six months later, both nodules had increased in size and miliary disseminated nodules were also seen in both lungs. Based on their histology, the pulmonary nodular lesions were considered to be primary lung adenocarcinoma.ConclusionsThe present cases emphasize that physicians should be cautious and make efforts for an accurate diagnosis of pulmonary nodules detected on F-18 fluorodeoxyglucose positron emission tomography-computed tomography in patients with papillary thyroid carcinoma with no evidence of metastasis such as negative 131I whole body scan and undetectable stimulated serum thyroglobulin levels.

Baseline SUVmax at PET-CT in Stage IIIA Non-small-cell Lung Cancer Patients Undergoing Surgery after Neoadjuvant Therapy: Prognostic Implication Focused on Histopathologic Subtypes

To evaluate the prognostic significance of maximum standardized uptake value (SUVmax) at (18)F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography in patients with stage IIIA non-small-cell lung cancer (NSCLC) who underwent surgical resection after neoadjuvant chemoradiotherapy, focused on the relationship between SUVmax values and tumor histology. We retrospectively evaluated the initial SUVmax of 205 patients (112 adenocarcinomas, 82 squamous cell carcinomas [SCCs], and 11 of other histology) with a stage IIIA NSCLC who underwent surgical resection after neoadjuvant chemoradiotherapy, and who were followed for up to 6 years. Clinical data, including histologic type, pathologic response, and treatment, were reviewed, and the relationship between the SUVmax and patient overall survival was examined. Overall, the 2-year survival rate was 68%. Between the two histologic subtypes of adenocarcinoma and SCC, we noted significant differences in all variables of gender (male predominance in SCC), initial SUVmax (greater in SCC), pathologic response (more complete remission in SCC), and overall survival (better in SCC) (all P values, < .05). SUVmax remained as a sole independent factor for survival in multivariate analysis in whole series (SUVmax cutoff, 13; median survival, 3.0 years vs. 4.0 years; P = .016) and in adenocarcinomas (SUVmax cutoff, 11.5; median survival, 2.6 years vs. 3.6 years; P = .045), but not in SCCs. The initial SUVmax is a sole significant prognostic factor in patients with a surgically resected NSCLC after neoadjuvant chemoradiotherapy, particularly in patients with an adenocarcinoma.

Clinical value of F18-fluorodeoxyglucose positron emission tomography-computed tomography in patients with non-small cell lung cancer after potentially curative surgery: experience with 241 patients

F18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT), which allows differentiation between malignant and benign lesions based on difference in tissue glucose metabolism, has become increasingly important in lung cancer diagnosis. This study examined the clinical value of FDG-PET/CT in a large number of patients with non-small cell lung cancer (NSCLC) after potentially curative surgery. Four hundred and ninety FDG-PET/CT of 241 patients (143 males and 98 females; age range 38-87 years; mean 68.0 years) between May 2006 and February 2008 were retrospectively evaluated. All the 241 patients had undergone potentially curative surgery for NSCLC >6 months before FDG-PET/CT and their pathologic stages were stage I and II according to the tumor-node-metastasis (TNM) classification. A final diagnosis of recurrence was confirmed by histologic or cytologic examination of the disease or by clinical and radiologic follow-up image analysis. Confirmation of recurrence-free status was based on a clinical and radiologic image analysis follow-up period of at least 12 months with no evidence of active malignancy. The diagnostic performance of FDG-PET/CT was evaluated. Details of false results and incidental detection of diseases other than recurrent lung cancer by FDG-PET/CT was also analyzed. Recurrences were confirmed in 35 (15%) patients, and 206 patients (85%) had no evidence of recurrence. FDG-PET/CT correctly diagnosed recurrence in 34 of 35 patients and provided true negative findings in 198 of 206 patients who had no evidence of recurrence (sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 97%, 96%, 96%, 81%, and 99%, respectively), indicating a high diagnostic performance. However, one patient had false negative studies and eight patients had false positive studies; misdiagnosis was more frequently in intrathoracic sites associated with postoperative changes. Malignancies other than recurrence were detected in nine of all 241 patients (4%) including five second primary lung cancers. The present study demonstrated the high diagnostic performance of FDG-PET/CT in detecting recurrences in a large group of patients with NSCLC after potentially curative surgery. FDG-PET/CT is useful not only for diagnosis of recurrence but also for detection of other diseases.