Usefulness Of 18F-FDG Research Articles

Usefulness of 18F-FDG PET/CT in Patients with Cardiac Implantable Electronic Device Suspected of Late Infection.

The presence of a cardiovascular implantable electronic device (CIED) can be burdened by complications such as late infections that are associated with significant morbidity and mortality and require immediate and effective treatment. The aim of this study was to evaluate the role of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in patients with suspected CIED infection. Fifteen patients who performed a 18F-FDG PET/CT for suspicion of CIED infection were retrospectively analyzed; 15 patients, with CIED, that underwent 18F-FDG PET/CT for oncological reasons, were also evaluated. Visual qualitative analysis and semi-quantitative analysis were performed. All patients underwent standard clinical management regardless 18F-FDG PET/CT results. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) resulted as 90.91%, 75%, 86.67%, 90.91% and 75% respectively. Maximum standardized uptake values (SUVmax) and semi-quantitative ratio (SQR) were collected and showed differences statistically significant between CIED infected patients and those who were not. Exploratory cut-off values were derived from receiver operating characteristic (ROC) curves for SUVmax (2.56) and SQR (4.15). This study suggests the clinical usefulness of 18F-FDG PET/CT in patients with CIED infection due to its high sensitivity, repeatability and non-invasiveness. It can help the clinicians in decision making, especially in patients with doubtful clinical presentation. Future large-scale and multicentric studies should be conducted to establish precise protocols about 18F-FDG PET/CT performance.

Usefulness of [18F]fluorodeoxyglucose PET/CT for evaluating the PD-L1 status in nasopharyngeal carcinoma.

To explore the relationship between [18F]fluorodeoxyglucose (18F-FDG uptake) and PD-L1 expression and determine the usefulness of 18F-FDG PET/CT for evaluating the PD-L1 status in tumour cells (TCs) and tumour-infiltrating immune cells (TIICs) in patients with nasopharyngeal carcinoma (NPC). We retrospectively evaluated the records of 84 eligible patients who received an initial histopathological diagnosis of NPC between December 2016 and March 2019. All tissue specimens and PET/CT images were collected prior to treatment. High PD-L1 expression in TCs and TIICs was defined as ≥ 50% of stained cells. There was a significant difference in 18F-FDG uptake according to the PD-L1 status in TCs and TIICs. Univariate analysis showed that PD-L1 expression in TCs was associated with tumour maximum standardized uptake value (SUVmax) (P < 0.001), primary tumour total lesion glycolysis (TLG; P < 0.001), and T stage (P = 0.044), but not with plasma Epstein-Barr virus (EBV) load (P = 0.816), whereas PD-L1 expression in TIICs was related to SUVmax (P = 0.011), TLG (P = 0.001), T stage (P = 0.028), and plasma EBV load (P = 0.003). In multivariate logistic regression, PD-L1 expression in TCs was positively associated with SUVmax (P = 0.003) and TLG (P = 0.001), and in TIICs, negatively associated with SUVmax (P = 0.038) and plasma EBV load (P = 0.025). 18F-FDG uptake in NPC lesions was positively correlated with PD-L1 expression in TCs and negatively correlated with PD-L1 expression in TIICs. Thus, 18F-FDG PET/CT may be useful for evaluating the PD-L1 status in patients with NPC.

Benign differentiation of treated neuroblastoma as a cause of false positive by 123I-MIBG SPECT/CT. Usefulness of 18F-FDG PET/CT

Benign differentiation of treated neuroblastoma as a cause of false positive by 123I-MIBG SPECT/CT. Usefulness of 18F-FDG PET/CT

Maximum standardized uptake value on 18F-fluorodeoxyglucose positron emission tomography/computed tomography improves outcome prediction in retroperitoneal liposarcoma

While 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been investigated in extremity sarcomas, there is no evidence on its usefulness in retroperitoneal sarcoma. This study was designed to evaluate the usefulness of 18F-FDG PET/CT in predicting aggressiveness of retroperitoneal liposarcoma. Patients experienced surgery for retroperitoneal liposarcoma from November 2007 to February 2018 and underwent preoperative 18F-FDG PET/CT were included. Preoperative maximum standardized uptake value (SUVmax) was calculated. To evaluate the predictability of SUVmax for Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade 3, receiver operating characteristics (ROC) curve analysis was performed. To analyze whether SUVmax can be a risk factor for prognosis, multivariable Cox regression was performed including potential risk factors regarding operation and histopathology. A total of 133 patients were included. ROC curve showed area under the curve of 0.877 (P < 0.001), with a cut-off point of 4.5 SUVmax showing 85.7% sensitivity and 78.3% specificity. Cox analyses showed that SUVmax > 4.5 was a significant factor for recurrence-free survival (HR = 2.148, CI 1.301–3.546, P = 0.003) and overall survival (HR = 5.052, CI 1.854–13.766, P = 0.002). SUVmax is highly predictive of FNCLCC grade 3 and SUVmax > 4.5 can be used as a prognostic factor before obtaining the histopathology.

Diagnostic Performance of 18F-FDG PET/CT Semiquantitative Analysis in the Management of Sarcoidosis.

Sarcoidosis is a multisystem granulomatous disorder of unknown origin characterized by nonspecific clinical symptomatology. 18F-FDG PET/CT can visualize activated inflammatory cells of sarcoidosis and simultaneously provide whole-body images. To evaluate the clinical usefulness of 18F-FDG PET/CT and its semiquantitative parameters for the assessment of treatment efficacy in patients with sarcoidosis. Thirty-one consecutive patients who performed 18F-FDG PET/CT for sarcoidosis assessment were selected. All subjects performed 18F-FDG PET/CT before any treatment (PET1) and after 6-12 months (PET2). SUVmax and SUVmean on PET1 and PET2 were collected. SUVs values were employed to evaluate the ratios with the liver (R-LIVERmax, R-LIVERmean) and the blood (R-BLOODmax, R-BLOODmean). The difference between the PET1 and PET2 values was evaluated (ΔSUVmax, ΔSUVmean, ΔR-LIVERmax, ΔR-LIVERmean, ΔR-BLOODmax, ΔR-BLOODmean). Patients were classified as Responders (R), Partial-Responders (PR) and Non- Responders (NR). Seventeen patients (54.8%) had a complete metabolic response (R), 4 (12.9%) were PR while 10 (32.3%) had no Metabolic Response (NR). The chi-square test showed that response groups were related neither to the stage of disease (p=0.59) nor to therapy performed (p<0.079). The comparison between each Δ semiquantitative parameter showed a statistically significant decrease from PET1 to PET2 (0.0001 < p < 0.002). The comparison between Δ mean values in relation to response groups showed to be statistically significant (0.001 < p < 0.005). Conversely, they did not show statistical significance in relation to the clinical stage groups and to the kind of therapy performed (p>0.05). Pearson's coefficient demonstrated a reverse correlation between a number of sites still involved in disease after therapy and each Δ semiquantitative parameters (p≤0.0001). 18F-FDG PET/CT should be considered a useful technique for the evaluation of sarcoidosis and semiquantitative parameters. Further studies are needed to determine the long-term impact of 18F-FDG PET/CT on clinical outcomes.

Usefulness of 18F-FDG PET/CT in Cutaneous Melanoma Patients with Negative Sentinel Lymph Nodes and High Clark Levels.

Objective:We investigated the utility of PET/CT in cutaneous melanoma (CM) patients with pathological negative sentinel lymph nodes (SLN), within the first year.Methods:The results of PET/CTs and SLN biopsy (SLNB) in 65 patients (39 male and 26 female, mean age 53.8) with a PET/CT in the first postoperative year were evaluated. Within this cohort, the utility of early PET/CT imaging was assessed in patients with negative SLNB. McNemar test was used to compare PET/CT findings with SLNB results.Results:Out of 43 patients with pathologically positive SLNs, 23 patients (53.5%) had positive and 20 patients (46.5%) had negative findings on PET/CT within the first postoperative year. On the other hand, PET/CT results of 22 patients with negative SLNBs were found to be negative in 19 patients (86.4%) and positive in 3 patients (13.6%). For the patients with negative SLNB results, the detection rate of distant metastasis with PET/CT was significantly lower (p<0.001) than that in patients with positive SLNBs.Conclusion:Our results showed that 18F-FDG PET/CT will most likely (86.4%) be negative during the first postoperative year in patients with a negative SLNB. Therefore, it is concluded that this modality would not provide any significant clinical contribution within this time frame.

Clinical Usefulness of 18F-FDG PET/CT for Staging Cancer of the External Auditory Canal.

Our objective was to evaluate the clinical usefulness of positron emission tomography/computed tomography using 2-deoxy-2-[F-18]fluoro-D-glucose (FDG-PET/CT) for staging cancer of the external auditory canal (EAC). Retrospective case review. Tertiary referral center. Twenty-three patients (seven men, 16 women, mean age of 59.6-year-old) who underwent FDG-PET/CT and high-resolution CT within 1 month for staging cancer of the EAC between July 2006 and December 2014 were enrolled in this study. FDG-PET/CT, high-resolution CT. Sensitivity, specificity, and accuracy for diagnosing nodal metastases. Most primary tumors were FDG-avid and maximum standardized uptake values were 7.72 ± 3.04 and 9.06 ± 3.94 for the early (60 min) and delayed (120 min) phases of FDG-PET/CT, respectively. FDG-PET/CT was capable of detecting small nodal metastases (short axis <10 mm), and patient-based sensitivity, specificity, and accuracy of FDG-PET/CT for the N staging were 71.4, 81.3, and 78.3%, respectively. There were no patients with distant metastases in our cohort. Compared with the combination of clinical examination and conventional imaging methods, additional FDG-PET/CT resulted in a change in the surgical strategy in five patients (21.7%). Most primary cancers of the EAC are FDG-avid, and FDG-PET/CT is useful for detecting small nodal metastases, followed by the change in the surgical strategy.

The additional role of 18F-FDG PET/CT in prosthetic valve endocarditis.

The purpose of the present review is an update on the diagnosis of prosthetic valve endocarditis (PVE), evaluating the additional value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to the standard modified DUKE criteria on which for a long time is based the diagnostic strategy of the disease. We did a comprehensive research on the studies reported in the literature and regarding the employment of 18F-FDG PET/CT in the early diagnosis of PVE in patients with suspected disease. Scientific databases have been examined such as Medline and PubMed, followed by a review of citations and reference lists. The research included the following terms: infective endocarditis, prosthetic heart valve and cardiac valve replacement infections, 18F-FDG PET/CT and endocarditis. The recent studies reported in the literature on the PVE diagnostic approaches showed elevated sensitivity and specificity values of 18F-FDG PET/CT ranging from 73 to 96.6% and from 80 to 94%, respectively, reducing the number of misdiagnosed patients. The usefulness of the radioisotopic procedure is even more important when the other diagnostic conventional diagnostic tools, such as echocardiography, are inconclusive or negative in patients in whom the diagnosis of PVE is definitively ascertained. However, false negative and positive results of 18F-FDG PET/CT were also ascertained in some studies interfering with image interpretation even if such limitation can be reduced with an adequate patient preparation, with a better knowledge of clinical course of the disease, of the treatment in progress and of the different technical aspects of the method. In different studies reported in the literature, 18F-FDG PET/CT proved to improve the diagnostic accuracy of the conventional modified DUKE criteria in patients with suspected IE, and in particular with PVE, giving the highest diagnostic performance and providing additional diagnostic benefits. Thus, the radioisotopic hybrid procedure should be included in the diagnostic protocol of PVE as complementary tool to modified DUKE criteria. Finally, the usefulness of 18F-FDG PET/CT in monitoring the response to antibiotic therapy, although the few data reported in the literature are encouraging, needs more numerous studies and with a major number of cases.

Role of 18F-FDG PET/CT in primary brain lymphoma.

To study the usefulness of 18F-FDG PET/CT in the initial evaluation and in the response assessment in primary brain lymphoma. A retrospective analysis was carried out on 18 patients diagnosed with primary brain lymphoma, a histological subtype of diffuse large B-cell lymphoma, on whom an initial 18F-FDG PET/CT and MRI was performed, with 7 of the cases being analysed after the completion of treatment in order to assess response and clinical follow up. Initial 18F-FDG PET/CT showed 26 hypermetabolic foci, whereas 46 lesions were detected by MRI. The average SUV maximum of the lesions was 17.56 with T/N 3.55. The concordance of both tests for identifying the same number of lesions was moderate, obtaining a kappa index of 0.395 (P<.001). In the evaluation of treatment, MRI identified 16 lesions compared to 7 pathological accumulations observed by 18F-FDG PET/CT. The concordance of both tests to assess type of response to treatment was moderate (kappa index 0.41) (P=.04). In both the initial evaluation and the assessment of the response to treatment, PET/CT led to a change strategy in 22% of patients who had lesions outside the cerebral parenchyma. MRI appears to be the method of choice for detecting brain disease in patients with primary brain lymphoma, whereas 18F-FDG PET/CT seems to play a relevant role in the assessment of extra-cerebral disease.

Role of 18F-FDG PET/CT in primary brain lymphoma

ObjectiveTo study the usefulness of 18F-FDG PET/CT in the initial evaluation and in the response assessment in primary brain lymphoma. Material and methodsA retrospective analysis was carried out on 18 patients diagnosed with primary brain lymphoma, a histological subtype of diffuse large B-cell lymphoma, on whom an initial 18F-FDG PET/CT and MRI was performed, with 7 of the cases being analyzed after the completion of treatment in order to assess response and clinical follow up. ResultsInitial 18F-FDG PET/CT showed 26 hypermetabolic foci, whereas 46 lesions were detected by MRI. The average SUV maximum of the lesions was 17.56 with T/N 3.55. The concordance of both tests for identifying the same number of lesions was moderate, obtaining a kappa index of 0.395 (p<0.001). In the evaluation of treatment, MRI identified 16 lesions compared to 7 pathological accumulations observed by 18F-FDG PET/CT. The concordance of both tests to assess type of response to treatment was moderate (kappa index 0.41) (p=0.04). In both the initial evaluation and the assessment of the response to treatment, PET/CT led to a change strategy in 22% of patients who had lesions outside the cerebral parenchyma. ConclusionsMRI appears to be the method of choice for detecting brain disease in patients with primary brain lymphoma, whereas 18F-FDG PET/CT seems to play a relevant role in the assessment of extra-cerebral disease.

PD-031 - Usefulness of 18F-FDG PET/CT, LDH and tumor markers in the prognosis and evaluation of tumor response after RMB therapy in advanced, metastatic colorectal cancer (mCRC)

PD-031 - Usefulness of 18F-FDG PET/CT, LDH and tumor markers in the prognosis and evaluation of tumor response after RMB therapy in advanced, metastatic colorectal cancer (mCRC)

Usefulness of 18F-FDG PET/CT for the Diagnosis of Tuberculous Pericarditis

Usefulness of 18F-FDG PET/CT for the Diagnosis of Tuberculous Pericarditis

Usefulness of 18F-FDG PET/CT in thyroid carcinoma

Usefulness of 18F-FDG PET/CT in thyroid carcinoma

First case report of usefulness of 18F-FDG PET/CT in diagnosing typhlitis (an oncological emergency)

Methods A 35-year-old lady was admitted with febrile neutropenia complaining of shortness of breath, productive cough and chest tightness. Having been diagnosed with acute myeloid leukaemia nine months ago, her disease had relapsed soon after allogeneic stem cell transplant from matched donor. A few diagnostic CECTs during her hospital stay showed findings in chest only confirmed to be due to invasive fungal and viral infections. Following some improvement, she was prescribed palliative subcutaneous cytarabine. The patient developed backache and neck pain with no findings on MRI. Due to continued fever and sepsis despite maximum treatment, PET/CT was requested by infectious disease team.

Role of 18F-FDG PET/CT in predicting the outcomes of spinal metastasis treated with Cyberknife radiosurgery in patients with sarcoma.

e21503 Background: The aim of this study was to evaluate the usefulness of 18F-FDG PET/CT (PET) in predicting infield tumor recurrence after Cyberknife radiosurgery (CKS) in patients with metastati...

Clinical Usefulness of ¹⁸F-FDG PET/CT for the Detection of Infections of Unknown Origin in Patients Undergoing Maintenance Hemodialysis.

Patients with end-stage renal disease undergoing maintenance hemodialysis (MHD) are highly prone to infections. The potential clinical usefulness of (18)F-FDG PET/CT for the detection of infections of unknown origin in this patient population remains unclear. This study was designed to investigate this issue. Between October 2011 and July 2014, a total of 104 adult MHD patients with sepsis underwent (18)F-FDG PET/CT for the detection of unknown infection foci. Follow-up was continued until October 2014. Positive (18)F-FDG PET/CT findings and mortality served as the main outcome measures. Of the 104 study patients, 73 (70.2%) had positive (18)F-FDG PET/CT findings, and a total of 95 major infection foci were identified. Eighteen patients (24.6%) had at least 2 infection foci on (18)F-FDG PET/CT scans. Seven (53.8%) of the 13 patients with primary vascular access-related infections had concurrent metastatic foci. Twenty-eight patients (26.9%) had their treatments modified by (18)F-FDG PET/CT results. Multivariate logistic regression analysis demonstrated that low hemoglobin and high C-reactive protein levels at diagnosis were the independent predictors of positive (18)F-FDG PET/CT results. Twenty-seven patients (26.0%) died during their hospital stay, and 24 of them had positive (18)F-FDG PET/CT findings (P = 0.014). Positive (18)F-FDG PET/CT results were an independent predictor of mortality (hazard ratio, 3.896; 95% confidence interval, 1.039-14.613; P = 0.044). Our results suggest that (18)F-FDG PET/CT may be clinically useful for detecting occult infection foci in end-stage renal disease patients undergoing MHD. In this population, positive (18)F-FDG PET/CT findings may lead to a significant change in clinical management and independently predict mortality.

Positron Emission Tomography for the Response Evaluation following Treatment with Chemotherapy in Patients Affected by Colorectal Liver Metastases: A Selected Review.

The aim of the present paper is to review the scientific literature concerning the usefulness of 18F-FDG PET/CT in the evaluation of response to chemotherapy in patients affected by liver metastases from colorectal cancer. Material and Methods. Studies were identified by searching PubMed electronic databases. Both prospective and retrospective studies were included. Information regarding the figure of merit of PET for the evaluation of therapy response was extracted and analyzed. Results. Existing data suggests that 18F-FDG PET/CT may have an outstanding role in evaluating the response. The sensitivity of PET in detecting therapy response seems to be greater than conventional imaging (CT and MRI). PET/CT response is strictly related to better overall survival and progression-free survival. Conclusions. PET/CT is more than a promising technique to assess the response to chemotherapy in colorectal and liver metastases. However, to be fully validated, this examination needs further studies by recruiting more patients.

(18)F-FDG PET/CT for Detection of Metachronous Hodgkin's Disease in Patients with Myelofibrosis.

A 66-year-old man with a history of JAK2+ myelofibrosis and newly diagnosed space-occupying liver lesions, fever and weight loss underwent whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for further evaluation. Myelofibrosis had been diagnosed 4 years before, after the patient had suffered from polycythemia vera for 18 years. He had received an allogeneic stem cell transplantation from an unrelated donor 3 years before. 18F-FDG PET/CT detected increased inhomogeneous tracer uptake throughout the skeleton and in multiple space-occupying liver lesions (Fig. 1a–d). Histopathological evaluation revealed Hodgkin’s lymphoma with hepatic and osseous involvement (Fig. 1e–j). Fig. 1 Whole-body maximum intensity projection FDG PET image (a) demonstrating increased inhomogeneous tracer uptake throughout the skeleton (arrowheads) and in the liver (arrows). Corresponding transversal CT (b), PET (c) and fused PET/CT images (d) showing ... Primary myelofibrosis and the clinically indistinguishable secondary forms of myelofibrosis (post-essential thrombocythemia and polycythemia vera myelofibrosis, post-ET/PV myelofibrosis) are BCR-ABL1-negative hematopoietic stem cell diseases characterized by chronic myeloproliferation [1, 2]. Myelofibrosis is characterized by progressive bone marrow fibrosis, which reduces medullary erythropoietic sites and causes peripheral pancytopenia. Reduction of medullary hematopoiesis leads to extramedullary hematopoiesis, mainly observed as splenomegaly [2, 3]. Patients may present with a variety of symptoms including night sweats, fatigue and thrombotic events [3]. Average life expectancy is 5 to 7 years. Leukemic transformation into secondary acute myeloid leukemia may be observed to occur in 8 % to 23 % of patients [4, 5]. In addition, metachronous occurrence of other hematologic malignancies including non-Hodgkin lymphoma can be observed [6]. Although such an association of myeloproliferative and lymphoproliferative disorders may occur after cytotoxic drug or radiation exposure, the combination of Hodgkin’s lymphoma and post-PV myelofibrosis is exceedingly rare. This report highlights the potential usefulness of 18F-FDG PET/CT to correctly identify other more aggressive hematologic malignancies in the context of pre-existing myelofibrosis. In recent years, PET/CT using 18F-FDG has been increasingly used as a morphofunctional imaging modality for both initial assessment and therapy monitoring in various hematalogic malignancies [7–9]. Moreover, 18F-FDG PET/CT is a highly sensitive technique for detection of extramedullary involvement [10]. Bone marrow uptake of 18F-FDG in myelofibrosis is usually homogeneous [11], and any lesion with focally increased and inhomogeneous uptake should undergo biopsy for exclusion of leukemic transformation or synchronous lymphoma. This is a case of Hodgkin’s lymphoma in the context of myelofibrosis initially detected on 18F-FDG PET/CT.

Usefulness of 18F-FDG PET/CT in the detection of neurolymphomatosis.

Neurolymphomatosis (NL) is an uncommon complication of lymphoma and leukemia. Few data have been reported regarding the utilization of fluorine-18 fluorodeoxyglucose PET/computed tomography (F-FDG PET/CT) in this disease. The aim of this study was to assess the role of F-FDG PET/CT in the diagnosis of NL. Eight patients who suffered from NL due to lymphoma or leukemia were studied. The diagnosis of NL lesions was established according to ;the combination of neurologic symptoms, and imaging techniques including MRI and PET/CT, and/or analysis of cerebrospinal fluid, pathology, and clinical follow-up. Eight patients with lymphoma or leukemia were diagnosed with NL during or after treatment. F-FDG PET/CT was positive in all eight patients. A total of 19 NL lesions were detected by F-FDG PET/CT. Morphological abnormality was seen in seven of 19 lesions on the syn-modality CT. However, all lesions were F-FDG avid with a maximum standardized uptake value of 6.42 ± 3.02, and presented with linear and nodular hypermetabolic patterns. There was a significant difference in the detection of NL lesions between PET and syn-modality CT [100% (19/19) vs. 36.8% (7/19), χ=14.74, P<0.001]. The NL lesions were located predominantly in the nerve root of the thoracic and lumbar segments (63.2%). In four patients, PET/CT was performed after treatment and was useful for assessing the treatment response. F-FDG PET/CT is a sensitive imaging modality for the detection of NL lesions. Further research involving more patients is needed to confirm our findings.

The potential usefulness of 18F-FDG PET/CT for detecting colorectal carcinoma and adenoma in asymptomatic adults

The aim of this study was to evaluate the potential usefulness of (18)F-FDG PET/CT for detecting colorectal carcinoma and adenoma in asymptomatic adults. 614 subjects were enrolled in this retrospective study. They underwent both (18)F-FDG PET/CT and colonoscopy in the same day as part of a cancer-screening program. Small focal FDG accumulation along the colorectum on (18)F-FDG PET/CT images were compared with colonoscopy findings. Size of lesion was measured on colonoscopy and histology was determined by biopsy or polypectomy. In 614 (18)F-FDG PET/CT images, 27 foci of FDG uptakes were observed in the colorectal area in 25 subjects. The overall sensitivity and specificity of (18)F-FDG PET/CT were 5.6 and 96.8 %, respectively, but sensitivity to detect lesions larger than or equal to 1 cm was 25.8 %. On the ROC analysis, the optimal cut-off value for differentiating premalignant and malignant lesions from other benign conditions was 5.0 (sensitivity = 50 %, specificity = 88 %, AUC = 0.643). Colonoscopic evaluation could be recommended by presence of focal colonic FDG uptake on (18)F-FDG PET/CT, especially when SUVmax is over 5.