Usefulness Of FDG-PET Research Articles

702 PROGNOSTIC ROLE OF MYOCARDIAL VIABILITY ASSESSMENT BY 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY IN STEMI PATIENTS WITH LATE PRESENTATION

Abstract Background ST-segment elevation myocardial infarction (STEMI) is one of the world's leading causes of disability and death. The incidence of late-onset STEMI (i.e. after at least 12 hours from symptom onset to medical observation) accounts up to 10% of overall STEMI events and optimal management in this setting is still debated due to the lack of randomized data. The aim of the present study is to explore the usefulness of FDG-PET to improve late-onset STEMI treatment. Methods We conducted a single-center retrospective observational study that included patients admitted for late-onset STEMI who underwent coronary angiography and FDG-PET to evaluate myocardial viability (MV). Follow-up by telephone interview and / or clinical follow-up at 6, 12, 24, 36, 48 and 60 months was performed in all patients. The prevalence of myocardial viability (MV) related to infarct-related artery (IRA) by FDG-PET study (using a semi-quantitative visual scoring method), the study of clinical and angiographic predictors of viability and the association of myocardial viability evaluated with FDG-PET with the improvement of the left ventricular ejection fraction (LVEF) were investigated. Results A total of 27 patients with mean age 64.7 ± 11.1 years, predominantly men (n=25, 92,6%), were enrolled in the study. Compared to patients without MV (n=12), MV-patients (n=15) presented more frequently dyslipidemia (100.0% vs 66.7%, p=0.015) and diabetes (53.3% vs 16.5%, p=0.050) but showed no difference in inflammatory biomarkers and echocardiographic parameters. Multivessel disease (MVD 86.7% vs 33.3%, p=0.004) and high-grade collateral-connection (hg-CC 80.0% vs 33.3%, p=0.027) were more frequent in MV-patients compared to patients without MV. The presence of angiographically visible hg-CC (OR=8.00, 95%CI 1.40-45.76, p=0.019) and MVD (OR=13.00, 95%CI 1.92-88.00, p<0.001) were positive predictors of FDG-PET MV related to IRA and remained independent positive predictors of FDG-PET MV related to IRA at multivariable logistic regression analysis (p<0.05). No significant differences were recorded between patients without MV and MV-patients in the incidence of MACEs (20.0% vs 50.0%, p=0.100). Of note, as compared to patients without MV, MV-patients displayed a significant improvement in LVEF (86.7% vs 50.0%, p = 0.036), with a higher mean value of LVEF at follow-up (39.4 ± 10.9 vs 29.6 ± 8.0, p = 0.013) and of LVEF change from baseline to follow-up (6.1 ± 7.2 vs -1.1 ± 9.1, p = 0.027). Conclusions This study could be of great help in clinical practice in order to provide a personalized approach in patients with late-STEMI, suggesting the potential benefit of a routine assessment IRA-related viability by FDG-PET in all asymptomatic late-STEMI subjects and providing further evidence in favor of a revascularization of occluded IRA in those with documented myocardial viability.

The Role of FDG PET for Evaluation of Bone Marrow Status and Prognosis in T Cell Lymphomas

Objective: We investigated clinical value of FDG PET for evaluation of bone marrow (BM) tumor involvement status in peripheral T cell lymphoma (PTCL) or extranodal NK/T cell lymphoma (NKTCL).Methods: Patients with PTCL or NKTCL, who underwent initial staging with FDG PET and BM biopsy were analyzed. PET BM uptake was analyzed visually and quantitatively (bone marrow-to-liver ratio; MLR). Receiver-operating-characteristic (ROC) analysis was performed to evaluate the usefulness of FDG PET for predicting BM tumor involvement. Prognostic implication of FDG PET finding was also assessed.Results: A total of 109 (63 PTCL and 46 NKTCL) patients were analyzed. BM biopsy revealed tumor involvement in 64.2% of cases. In the ROC curve analysis for determining visually positive BM involvement by MLR, the area under curve (AUC) was 0.948 with sensitivity 90.2% and specificity 91.2%. The AUC using visual analysis was 0.76 (sensitivity 82.1% and specificity 38.6%). Predicting power of FDG PET for BM involvement was not different across lymphoma subtypes. Multivariate survival analysis revealed that BM FDG PET finding was an independent prognostic factor for survival in PTCL and NKTCL. Moreover, MLR was a significant prognostic factor for both PFS and OS (P = 0.001 and 0.005) in BM involvement-negative patients by BM biopsy.Conclusion: Although FDG PET findings fairly correlates with BM biopsy findings, FDG PET could not replace BM biopsy in PTCL and NKTCL. Rather, BM finding on FDG PET is an independent prognostic factor in these tumors, suggesting further biologic relevance of FDG PET findings. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Clustering Analysis of FDG-PET Imaging in Primary Progressive Aphasia.

Background: Primary progressive aphasia (PPA) is a clinical syndrome characterized by the neurodegeneration of language brain systems. Three main clinical forms (non-fluent, semantic, and logopenic PPA) have been recognized, but applicability of the classification and the capacity to predict the underlying pathology is controversial. We aimed to study FDG-PET imaging data in a large consecutive case series of patients with PPA to cluster them into different subtypes according to regional brain metabolism.Methods: 122 FDG-PET imaging studies belonging to 91 PPA patients and 28 healthy controls were included. We developed a hierarchical agglomerative cluster analysis with Ward's linkage method, an unsupervised clustering algorithm. We conducted voxel-based brain mapping analysis to evaluate the patterns of hypometabolism of each identified cluster.Results: Cluster analysis confirmed the three current PPA variants, but the optimal number of clusters according to Davies-Bouldin index was 6 subtypes of PPA. This classification resulted from splitting non-fluent variant into three subtypes, while logopenic PPA was split into two subtypes. Voxel-brain mapping analysis displayed different patterns of hypometabolism for each PPA group. New subtypes also showed a different clinical course and were predictive of amyloid imaging results.Conclusion: Our study found that there are more than the three already recognized subtypes of PPA. These new subtypes were more predictive of clinical course and showed different neuroimaging patterns. Our results support the usefulness of FDG-PET in evaluating PPA, and the applicability of computational methods in the analysis of brain metabolism for improving the classification of neurodegenerative disorders.

Value of FDG-PET/CT for treatment response in tuberculosis: a systematic review and meta-analysis

Tuberculosis (TB) is an infectious disease with a high global incidence and substantial disease burden. Monitoring disease activity and evaluating treatment response with conventional methods such as culture or chest x-ray is time-consuming and non-specific. Active TB lesions are typically highly FDG-avid and may be assessed on whole-body 18-fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). We hypothesized that FDG-PET or FDG-PET/CT is useful for evaluation of treatment response and outcome in TB-infected patients undergoing anti-tuberculosis therapy (ATT). PubMed and Embase databases were searched and original studies with humans infected with Mycobacterium tuberculosis receiving ATT and a minimum of one FDGPET/CT or FDG-PET scan were included. Percentage change in maximum standardized uptake value (SUVmax) from baseline was assessed with a fixed-effects model using the inverse variance method supplemented by a Forest Plot. Publication bias and heterogeneity between studies was assessed with a Funnel plot and the I squared statistic, respectively. A total of 2048 articles were identified and nine were included in the review. Four studies were included in the meta-analysis. The estimated overall percentage change in SUVmax was − 54.38% (95% confidence interval − 57.81 to − 50.96) and the heterogeneity between studies was high (I 2 = 90.1%). Study design, protocol, sample size and ATT varied between studies. Despite high heterogeneity there was a trend towards the usefulness of FDG-PET or FDG-PET/CT for evaluation of ATT response. Impending research is needed to further clarify the predictive value of FDG-PET/CT in tuberculous disease.

P1.17-017 Usefulness of FDG-PET for Differentiating Thymic Epithelial Tumors from Malignant Lymphomas

It is difficult to diagnose the tumor in the anterior mediastinum by computed tomography. Distinguishing between thymic epithelial tumors and malignant lymphoma is important, because therapeutic strategy is difficult in each disease. The objective of this study was to clarify the usefulness of positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) for distinguishing thymic epithelial tumors and malignant lymphoma. We retrospectively reviewed FDG PET-CT scans of 62 patients pathologically diagnosed by surgery or biopsy as thymic epithelial tumors or malignant lymphoma. FDG uptake was measured as the maximum standard uptake value (SUVmax). Student t tests were used to assess association between SUVmax and pathological diagnosis. Among the 62 patients, 36 patients had a pathological diagnosis of thymoma: WHO classification type A in 3 patients (11%), type AB in 9 patients (19%), type B1 in 6 patients (19%), type B2 in 15 patients (42%), and type B3 in 3 patients (7%). Eleven patients had the thymic carcinoma. Fifteen patients had the malignant lymphoma. The SUVmax in malignant lymphoma (14.9 ± 6.4) was significantly higher than that in the thymic epithelial tumors (5.1 ± 2.5) (p＜0.001). The SUVmax in thymic carcinoma (7.8 ± 3.2) was higher than that in the thymoma (4.0 ± 1.5) (p=0.002). The ROC curve of SUVmax for predicting malignant lymphoma indicated that the optimal cutoff value was 7.3. This value had a sensitivity of 0.89 and a specificity of 0.87. FDG PET-CT is helpful for distinguishing malignant lymphoma from thymic epithelial tumors with cut off value of 7.3.

Emerging clinical issues and multivariate analyses in PET investigations.

PET using 18F-2-fluoro-2-deoxy-D-glucose (FDG-PET) has been gradually introduced in the diagnostic clinical criteria of the most prevalent neurodegenerative diseases. Moreover, an increasing amount of literature has shown that the information provided by FDG-PET enhances the sensitivity of standard imaging biomarkers in less frequent disorders in which an early differential diagnosis can be of paramount relevance for patient management and outcome. Therefore emerging uses of FDG-PET may be important in prion diseases, autoimmune encephalitis (AE) and amyotrophic lateral sclerosis. Interestingly, FDG-PET findings can also be observed in the early phases of these conditions, even in the presence of normal magnetic resonance imaging scans. Thalamic hypometabolism is a common finding in sporadic Creutzfeldt-Jacob disease and fatal familiar insomnia patients, with further cortical synaptic dysfunction in the former. Limbic and extra-limbic metabolic abnormalities (more often hypermetabolism) can be observed in AE, although specific patterns may be seen within different syndromes associated with antibodies that target neuronal surface or synaptic antigens. FDG-PET shows its usefulness by discriminating patients with amyotrophic lateral sclerosis associated to upper motor neuron onset that evolve to frontotemporal dementia. Besides visual and voxel based image analysis, multivariate analysis as interregional correlation analysis and independent/principal component analysis have been successfully implemented to PET images increasing the accuracy of the discrimination of neurodegenerative diseases. The clinical presentation and current diagnostic criteria of these neurologic disorders as well as the emerging usefulness of FDG-PET in the diagnostic workup are presented and discussed in this review.

Preoperative High Maximum Standardized Uptake Value in Association with Glucose Transporter 1 Predicts Poor Prognosis in Pancreatic Cancer.

The diagnosis of malignant diseases worldwide has been determined using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). Glucose transporter type 1 (Glut-1) is a key protein associated with the accumulation of FDG in cancer cells. This study evaluated the relationship between Glut-1 expression and FDG accumulation to determine the usefulness of FDG-PET for prediction of long-term outcomes of pancreatic cancer. The expression of Glut-1 was immunohistochemically examined in 138 surgically resected pancreatic cancer specimens. The Glut-1-positive and Glut-1-negative groups were analyzed with respect to their clinicopathologic characteristics and prognosis. Before surgery, 93 patients underwent FDG-PET and measurement of the corrected maximum standardized uptake value (cSUVmax). The relationship between Glut-1 expression and cSUVmax were examined, and prognostic factors were identified using uni- and multivariate analyses. Glut-1 was positive in 69 patients (50%). The median relapse-free and overall survival times were significantly shorter in the Glut-1-positive group (11 vs. 22months, respectively) than in the Glut-1-negative group (23 vs. 42months, respectively). The cSUVmax was significantly associated with long-term survival. The relapse-free and overall survival rates were significantly poorer in the high-cSUVmax group than in the low-cSUVmax group. Glut-1 expression was associated with cSUVmax accumulation. In the multivariate Cox regression analysis using forward stepwise selection, male gender, positive lymph node metastases, high CA19-9, and high cSUVmax were identified as independent prognostic factors for pancreatic cancer. A significant relationship exists between high preoperative cSUVmax and Glut-1 expression. High cSUVmax is one of the prognostic factors for overall survival after resection of pancreatic cancer.

Clinical usefulness of FDG-PET in patients with hepatocellular carcinoma undergoing surgical resection.

Backgrounds/AimsDiagnosis and staging of hepatocellular carcinoma (HCC) is critical because of the variety of treatment methods and prognosis. [18F]fludeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) has been suggested as a diagnostic modality in HCC. The purpose of this study is to evaluate the accuracy of FDG-PET for staging of HCC after surgical resection and histological confirmation.MethodsWe retrospectively collected data of 56 patients that underwent FDG-PET before surgical resection for HCC March 2011–May 2017, all of whom were suitable for resection by conventional HCC staging. Results of the maximal standardized uptake value (SUVmax) were compared with histological confirmation.ResultsA larger tumor size was related with higher SUVmax (≥4.9). The serum alpha-feto protein was associated with SUVmax. Recurrence rate was higher in patients with higher SUVmax and patients with lower SUVmax had a better survival rate.ConclusionsThe SUVmax correlates well with tumor size and factors associated with biological behavior of HCC such as alpha-feto protein, and it could be a beneficial modality in providing prognostic information for HCC.

食道癌の早期診断におけるFDG-PETの有用性

食道癌の早期診断におけるFDG-PETの有用性

Phase II study for determining usefulness of FDG-PET as imaging biomarker in regorafenib treatment for metastatic colorectal cancer (JACCRO CC-12).

TPS772 Background: Regorafenib (rego) is a novel multikinase inhibitor. A clinical, placebo-controlled phase III study (CORRECT) showed a 1.4-month improvement in Overall Survival (OS) as compared to the placebo group (HR 0.77, p = 0.0052) for metastatic colorectal cancer (mCRC). In the CORRECT trial, the Progression Free Survival (PFS) curve showed that half of the patients in the rego group showed a similar tendency to the placebo group. The finding suggested that patients might be divided into responders and non-responders, and there might be a biomarker to predict them. Although various studies including the CORRECT trial have searched for the biomarker of rego, it still has not been established. On the other hand, tumor metabolic analysis using FDG-PET has been reported to be more sensitive than the change of tumor size using CT to predict the response of molecular targeting therapies. We conducted a prospective multicenter phase II trial to identify the usefulness of FDG-PET as an imaging biomarker for rego. Methods: The main eligibility criteria are as follows; pathologically proven mCRC, sufficient organ functions, failure of standard therapies (fluorouracil, oxaliplatin, irinotecan and any biologic agents), with tumors detected by FDG-PET. The treatment schedule consists of 160mg once-daily oral administration of rego for 3 weeks, followed by 1 week of rest. On day 28, FDG-PET is re-taken and the change of the maximum standardized uptake value (SUVmax) from that of the pre-treatment examination is evaluated. The primary endpoint is the change of SUVmax in the region with the highest value in pretreatment FDG-PET. Secondary endpoints are changes of SUVmax in top 5 regions (maximum 2 regions in one organ), OS, PFS, response rate, disease control rate, adverse events, and correlation of their clinical parameters and changes of SUVmax. Because there has been no data about early change in SUVmax when rego was used, we set the threshold value and estimate value as 0% and 10%, respectively. Assuming a one-sided alpha of 2.5% and a power of ≥ 90%, 16 subjects are required, and a target sample size of 20 patients was determined. Ten of the planned 20 patients have been enrolled. Clinical trial information: UMIN000015563.

The usefulness of FDG-PET for monitoring hyperbaric oxygen therapy in treatment of bisphosphonate-related osteonecrosis of jaws (BRONJ)

The usefulness of FDG-PET for monitoring hyperbaric oxygen therapy in treatment of bisphosphonate-related osteonecrosis of jaws (BRONJ)

The pathological features of FDG-PET negativity in patients with pancreatic ductal carcinoma

Introduction: Usefulness of FDG-PET in pancreatic cancer various studies have been carried out. Aims: In this study, we clarified the pathological features of pancreatic ductal carcinoma with negative positron emission tomography(PET) findings and determined the factors that might affect fluorodexyglucose(FDG) accumulation by the pancreatic ductal carcinoma. Patients & methods: Eighteen patients with pancreatic ductal carcinoma and negative findings on PET preoperatively enrolled. Pathological findings (proliferation type and extent of fibrosis) and reproductive activity were examined. Proliferation was classified into 3 types: equal, extended, and collective. Reproductive activity was assessed using the Ki67 index; the Ki-67 indexes for 11 patients with positive PET findings were used as controls. Results: There were 10, 3, and 5 patients with equal, extended, and collective proliferation, respectively. Patients with equal and extended proliferation generally had massive fibrosis. The difference in proliferation type could not be determined by the Ki-67 index, which ranged from 2.7 to 12.6(average, 6.8). The average Ki-67 index of patients with PET positivity was 26.1(p<0.01) Conclusion: PET negativity can be defined by proliferation type; patients with equal and extended proliferation accounted for 72%(13/18) of the patients. These results suggest that low cell density, fibrosis, and extension cancer gland indicate a decrease in the amount of localized cancer cells. The decrease in the number cancer cells caused a reduction in FDG accumulation, which possibly lead to PET negativity. Patients with PET negativity had a lower rate of Ki-67 positivity than patients with PET positivity. It was hypothesized that the reproductive activity of the cancer cells also contributes to PET negativity.

Usefulness of FDG-PET in the evaluation of tumor response to proton beam therapy for locally advanced pancreatic ductal adenocarcinoma.

271 Background: Evaluation of tumor response to radiation therapy in pancreatic ductal adenocarcinoma (PDA) using conventional radiological tests is difficult due to generally small size and inflammatory or fibrotic changes of radiated tissue. Although increasing evidence has shown that 18-F-fluorodeoxyglucose-positoron emission tomography (FDG-PET) can assess functional changes in various tumors, available data in PDA with radiation therapy is scarce. In this study, we investigated the role of FDG-PET in long-term monitoring tumor response to proton beam therapy (PBT) for PDA. Methods: Thirty-four locally advanced PDA patients with pre- and post-PBT FDG-PET data were included in this study. Local tumor responses by computed tomography (CT) and FDG-PET were defined as below: response group in CT (complete response: CR, partial response: PR, stable disease: SD, progressive disease: PD) was defined according to Response Evaluation Criteria in Solid Tumors, but only evaluation of primary tumor; and in FDG-PET, CR was defined as disappearance of FDG uptake, PR as decrease, SD as unchange, and PD as increase, compared to pre-PBT data. We evaluated tumor response at three different time points: 0-3, 3-6, and 6-12 months after PBT. Also serum CA19-9 values were evaluated. Results: Radiation doses were 50.4-70.2 GyE and 28 (82%) patients received concomitant chemotherapy. During the follow-up period (median 19 months), a total of 90 FDG-PET tests were performed. At the first time point, SD was noted in 90% (9/10) of patients by CT, whereas CR or PR in all by FDG-PET. At the second point, 39% (7/18) of patients demonstrated PR by CT, whereas 91% CR or PR by FDG-PET. Two patients with PD by FDG-PET were diagnosed as SD by CT, while one patient with PD by CT was diagnosed as PR by FDG-PET. At the third point, four patients with PD by FDG-PET were diagnosed as PR or SD by CT. Serum CA19-9 values supported FDG-PET findings. In four of 14 patients with serial FDG-PET, the maximum effects were noted at the second point. Conclusions: Serial FDG-PET can detect changes in local tumor response to PBT for PDA earlier and more sensitively than CT. Of note, there is the risk for false positive in early post-PBT FDG-PET.

The role of fluorine-18-fluorodeoxyglucose positron emission tomography in aggressive histological subtypes of thyroid cancer: an overview.

Aggressive histological subtypes of thyroid cancer are rare and have a poor prognosis. The most important aggressive subtypes of thyroid cancer are Hürthle cell carcinoma (HCTC) and anaplastic and poorly differentiated carcinoma (ATC and PDTC). The American Thyroid Association recently published guidelines for the management of patients with ATC, but no specific guidelines have been done about HCTC. We performed an overview of the literature about the role of Fluorine-18-Fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography (FDG-PET or PET/CT) in aggressive histological subtypes of thyroid cancer. Only few original studies about the role of FDG-PET or PET/CT in HCTC, PDTC, and ATC have been published in the literature. FDG-PET or PET/CT seems to be useful in staging or followup of invasive and metastatic HCTC. FDG-PET or PET/CT should be used in patients with ATC in initial staging and in the followup after surgery to evaluate metastatic disease. Some authors suggest the use of FDG-PET/CT in staging of PDTC, but more studies are needed to define the diagnostic use of FDG-PET/CT in this setting. Limited experience suggests the usefulness of FDG-PET or PET/CT in patients with more aggressive histological subtypes of DTC. However, DTC presenting as radioiodine refractory and FDG-PET positive should be considered aggressive tumours with poor prognosis.

Emerging role of Fluorine-18-fluorodeoxyglucose positron emission tomography in patients with retroperitoneal fibrosis: a systematic review

To systematically review the literature data on the role of Fluorine-18-fluorodeoxyglucose positron emission tomography and positron emission tomography/computed tomography (FDG-PET and PET/CT) in patients with retroperitoneal fibrosis (RF), PubMed/MEDLINE, Embase and Scopus databases were searched for articles that evaluated the usefulness of FDG-PET and PET/CT in patients with RF from inception to March 31, 2012. Review articles or editorials, articles not in the field of interest of this review, case reports and preclinical studies were excluded. Only studies including FDG-PET or PET/CT scans performed in at least three patients with RF were included. Ten studies comprising a total of 101 patients with RF were found. The main findings of the included studies are described. FDG-PET and PET/CT are feasible and suitable imaging methods for evaluating patients with RF. These functional imaging techniques seem to be useful both in the diagnosis (mainly in the assessment of activity and extent of the disease) and in evaluating the treatment response in patients with RF. Given the heterogeneity among the various studies for PET analysis and diagnostic criteria, a standardization of the technique is required in order to achieve reproducible and inter-observer independent results. Moreover, further studies are needed to substantiate the role of FDG-PET and PET/CT in patients with RF.

Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in Assessing Retroperitoneal Fibrosis: A Literature Review

Background and Purpose. Several studies have evaluated the role of fluorine-18-fluorodeoxyglucose positron emission tomography and positron emission tomography/computed tomography (FDG-PET and PET/CT) in diagnosing and assessing disease activity in patients with retroperitoneal fibrosis (RF). The aim of our paper is to perform a literature review on this topic. Methods. Scientific articles that evaluated the usefulness of FDG-PET and PET/CT in patients with RF were searched and discussed. Results. Eleven studies were found, and the main findings of these articles were described. Conclusion. FDG-PET and PET/CT are useful functional imaging methods for assessing patients with RF both in the diagnosis and in the treatment response evaluation. Moreover, further studies are needed to substantiate the role of FDG-PET and PET/CT in patients with RF.

Assessment of Chemotherapy Response Using FDG-PET in Pediatric Bone Tumors: A Single Institution Experience

PurposeResponse to neo-adjuvant chemotherapy is an important prognostic factor for osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT). [F-18]-fluorodeoxy-D-glucose (FDG)-positron emission tomography (PET) is a non-invasive imaging modality that predicts histologic response to chemotherapy of various malignancies; however, limited data exist about the usefulness of FDG-PET in predicting the histologic response of pediatric bone tumors to chemotherapy. We analyzed the FDG-PET imaging characteristics of pediatric bone tumors and determined the association with response to chemotherapy.Materials and MethodsPediatric patients with OS (n=19) or ESFT (n=17) were evaluated for FDG-PET standard uptake values before (SUV1) and after (SUV2) chemotherapy. The relationship to the chemotherapy response was assessed by histopathology in surgically-excised tumors. A complete data set (SUV1, SUV2, and histologic response) was available in 23 patients.ResultsWhile the mean SUV1s were not different between patients with OSs and ESFTs (9.44 vs. 6.07, p=0.24), the SUV2s were greater in the patients with OSs than ESFTs (4.55 vs. 1.66, p=0.01). The ratios of SUV2-to-SUV1 (SUV2 : SUV1) were 0.65 and 0.35 for OS and ESFT, respectively (p=0.08). All of the patients with ESFTs and 47% of the patients with OS had a favorable histologic response to chemotherapy. The SUV2 : 1 [(SUV1-SUV2)/SUV1]≥0.5 and SUV2≤2.5 were related to favorable histologic responses to chemotherapy; the sensitivity and specificity of SUV2 : 1 at 0.5 and SUV2 at 2.5 were 93% and 88%, and 88% and 78%, respectively.ConclusionFDG-PET can be used as a non-invasive surrogate to predict response to chemotherapy in children with bone tumors.

Clinical value of FDG-PET for preoperative evaluation of endometrial cancer

Whole body positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) has been widely used in various malignancies, but the clinical value of FDG-PET for endometrial cancer has not been fully investigated. The purpose of this study was to evaluate the usefulness of FDG-PET for preoperative evaluation of endometrial cancer. Forty female patients suspected of having endometrial cancer were included in this study. All patients underwent an FDG-PET or PET/CT scan, and images were interpreted visually. The diagnostic performance in detecting the primary tumor, regional nodal status, and distant metastasis was determined. In addition, the usefulness of PET was assessed in terms of additional information and clinical impact for therapeutic management. Of 40 patients, 30 were histologically confirmed to have endometrial cancer. The patient-based sensitivity and specificity of FDG-PET for primary tumors were 83 and 100%, respectively, and 100 and 100%, respectively, for nodal metastases. There were 12 distant metastases in 6 patients and two second primary cancers in two patients, which were all accurately diagnosed by PET on a patient-basis. PET yielded 12 additional findings in 10 patients, and had a bearing on the therapeutic management of four patients, including one patient with recurrent breast cancer. FDG-PET had a reasonably high diagnostic accuracy in endometrial cancer. Although the number of cases with clinical impact was limited, additional information by PET was obtained in one-third of the cases.

Clinical usefulness of FDG-PET for biliary cancer

Clinical usefulness of FDG-PET for biliary cancer

Usefulness of 18F-fluorodeoxyglucose positron emission tomography for diagnosis of asymptomatic giant cell arteritis in a patient with Alzheimer's disease

It is often difficult to diagnose disease in elderly patients, in particular those with dementia, who do not present with typical symptoms. This report describes our experience of an elderly patient (an 83-year-old woman) who presented with a chief complaint of memory loss, showed a marked inflammatory response, and was diagnosed with large-vessel giant cell arteritis (GCA) on the basis of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) findings. She had no symptoms typical of GCA including jaw claudication, visual field defect and heavy headed feeling. Corticosteroid therapy resulted in a trend toward improvement in the inflammatory response and then she first recognized that she might have experienced slight dull headache before treatment of GCA. This was probably because this patient had large-vessel GCA, which produces a few symptoms in the head and neck, and because she had Alzheimer's disease and could not accurately describe her symptoms. Our experience suggests the usefulness of FDG-PET for the diagnosis of GCA, particularly in elderly patients without typical symptoms.