Usefulness Of FDG-PET Research Articles

Usefulness of FDG PET in Primary Bone Tumors~!2009-05-15~!2009-12-18~!2010-03-25~!

Usefulness of FDG PET in Primary Bone Tumors~!2009-05-15~!2009-12-18~!2010-03-25~!

18F-Fluorodeoxyglucose positron emission tomography for diagnosis and monitoring of idiopathic retroperitoneal fibrosis associated with mediastinal fibrosis

A 68-year-old man was admitted to our hospital with left intermittent claudication. Computed tomography showed soft tissue masses surrounding the left iliac artery and in the bilateral pulmonary hilum, and the first FDG PET showed increased FDG uptake by the lesions. Retroperitoneal fibrosis associated with mediastinal fibrosis was most suspected. An open biopsy of the left peri-iliac masses revealed retroperitoneal fibrosis. Corticosteroid treatment was initiated. The second FDG PET under corticosteroid treatment showed no pathological FDG uptake. The third FDG PET after cessation of corticosteroid treatment showed increased FDG uptake in the mediastinum, and so Sairei-to treatment was initiated. The fourth FDG PET under Sairei-to treatment showed no improvement of the pathological FDG uptake, and so low-dose corticosteroid was re-started in combination with Sairei-to treatment. The fifth FDG PET under Sairei-to and corticosteroid treatment showed no pathological FDG uptake. These FDG PET findings suggest the usefulness of FDG PET for the diagnosis and monitoring of retroperitoneal fibrosis associated with mediastinal fibrosis.

Early distant relapse in early stage triple-negative breast cancer: usefulness of FDG-PET for diagnosis of distant metastases

Triple-negative breast cancer is extremely aggressive and more likely to metastasize than other subtypes of breast cancer. Better understanding of the distinct patterns of relapse and early detection will help identify patients who need aggressive treatment. Here we report a case of early stage triple-negative breast cancer with no lymph node metastasis at the time of breast-conserving surgery in a 46-year-old woman. She developed distant metastases immediately after completing adjuvant chemotherapy following surgery, which were detected by an [18F] 2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan. Although routine use of FDG-PET is not recommended for early stage breast cancer, FDG-PET might be useful for the early detection of distant metastasis among patients with triple-negative breast cancer.

A Case of Malignant Lymphoma That Presented with Characteristic Brain Imaging: Usefulness of FDG-PET and <sup>123</sup>I-IMP SPECT to Detect the CNS Spread of the Disease.

A Case of Malignant Lymphoma That Presented with Characteristic Brain Imaging: Usefulness of FDG-PET and <sup>123</sup>I-IMP SPECT to Detect the CNS Spread of the Disease.

Early evaluation of the effects of chemotherapy with longitudinal FDG small-animal PET in human testicular cancer xenografts: early flare response does not reflect refractory disease

We aimed to evaluate the usefulness of FDG PET in the early prediction of the effects of chemotherapy on human testicular cancer xenografts. Nude rats bearing subcutaneous human embryonal carcinoma xenografts received either cisplatin (5 mg/kg) or saline serum. Small-animal PET studies were performed on days 0, 2, 4 and 7 and compared to immunochemistry studies, flow cytometry studies and hexokinase assays. Cisplatin treatment resulted in biphasic FDG uptake evolution: a peak was observed on day 2, followed by a marked decrease on day 7 despite an insignificant change in tumour volume. Similarly, a peak in cyclin A immunostaining was observed on days 2 and 4), followed by a significant decrease on day 7. Flow cytometry showed that the cyclin A peak was not related to increased cell proliferation but was due to a transient S and G(2)/M cell cycle arrest. A marked increase in cell apoptosis was observed from day 2 to day 7. GLUT-1 showed a significant decrease on day 7. Macrophagic infiltrate remained stable except for an increase observed on day 7. In control tumours, continuous growth was observed, all immunostaining markers remaining stable over time. Hexokinase activity was significantly lower on day 7 in treated tumours than in controls. FDG PET may be useful in the early evaluation of treatment in patients with testicular cancer. In our model, a very early increased [(18)F]-FDG uptake was related to a transient cell cycle arrest and early stage apoptosis but did not reveal refractory disease.

Usefulness of FDG-PET in the management of carcinoma of unknown primary

FDG-PET has proven to be a valuable diagnostic tool in patients with a carcinoma of unknown primary. In patients presenting with cervical metastases of unknown primary, FDG-PET makes it possible to locate a primary in 36% of the patients and induces therapeutic modification in 39%. This examination should be carried out prior to upper endoscopy, guiding the biopsies when possible. In patients presenting with non-cervical metastases, FDG-PET localize the primary in 37% of cases, with an impact on the therapeutic management in 42% of the patients. Recent results from coupled PETCT-scanning examinations seem to improve the diagnostic performances this assessment modality, especially its specificity. The prognostic value of FDG-PET still needs to be evaluated.

Utility of FDG-PET in Post Transplant Lymphoproliferative Disorders: An Update from a Single Center Experience

Backgrounds Positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) is a well known imaging technique that has been proven being useful in staging and response to treatment assessment of Hodgkin and non-Hodgkin lymphomas, providing information about the metabolic behaviour of tissues independently of morphological criteria. At the moment its role in Post Transplant Lymphoproliferative Disorders (PTLDs) remains unclear, because large series of patients evaluated with FDG-PET and compared with conventional imaging still lack.Aims To establish the usefulness of FDG-PET in staging, remission assesment and follow-up of PTLD in comparison to the conventional imaging (CT) findings in terms of sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV).Methods Between February 2003 and July 2008, 79 FDG-PET were performed in 31 patients who developed PTLD after solid organ transplantation. According to WHO classifications, patients could be divided as follow: 1 Plasmacytic Hyperplasia, 9 Polymorphic Lymphoproliferative Disorder, 20 Malignant Lymphoma; in one case histological diagnosis was not obtained. We retrospectively compared results from 46/79 FDG-PET to findings obtained from conventional imaging performed at the same time. Thirty-three/79 more FDG-PET scans were performed as follow up assesment and results were compared according to disease status as defined on the basis of clinical signs and symptoms, biochemical markers and imaging technique.Results When compared to conventional imaging (46 scans), FDG-PET showed the same results as CT in 34/46 cases, while discordant results were found in 12/46 cases (data are reported in the table). No differences in FDG-PET sensitivity were observed in the different histological subtypes of PTLD. According to disease status FDG-PET showed good sensitivity, specificity and accuracy; when compared to CT, FDG-PET had lower sensitivity (81% vs 97%), but higher specificity (96% vs 78%) and accuracy (92% vs 85%). Moreover, this technique provided a high PPV (90%) and NPV (93%)Conclusions: Our data support the role of FDG-PET as diagnostic tool in PTLD as well as other FDG-avid lymphomas. The histological PTLD subtype doesn't seem to have any impact on FDG avidity, even though in our analysis ML were the prevalent forms. In the majority of cases FDG-PET can well identify all disease areas seen at standard imaging modalities. Moreover, avoiding contrast medium related nephrotoxicity, this imaging modality can even be considered as a safe procedure in the setting of frail PTLD patients whose renal function is often impaired. In our analysis FDG-PET has higher PPV when compared to CT (90% vs 72%): the absence of metabolic activity at FDG-PET can rule out a supposed residual disease revealed at CT on the basis of morphological criteria. So while CT can still be considered the gold standard in staging assessment, due to its higher sensitivity, FDGPET may be better employed in the follow up, due to its capacity to detect the persistence of active disease in residual lesions described by conventional imaging.CONCORDANT (34/46)DISCORDANT (12/46)Disease presentDisease absentDisease presentDisease absentPET posPET negPET negPET posPET negCT posCT negCT posCT negCT pos1519426

クローン病に対するＰＥＴ検査の有用性の検討

クローン病(以下CD）に対するFDG-PET検査の有用性について検討した．吻合部狭窄を含めた狭窄病変はFDG-PET検査で比較的明瞭に表現されたが，成人例では造影検査がFDG-PET検査よりも特異性が高く，有用性は否定的であった．癌合併症例のFDG-PET検査の陽性率は50%であり，陽性率が低い原因としてはCDに合併する癌に粘液癌が多いことも関与している可能性があると思われた．局所再発に関してはFDG-PETよりもMRIの方が周囲臓器との位置関係，浸潤範囲の診断に有用であると思われた．直腸肛門病変に対するFDG-PET検査は，低侵襲に瘻孔の走行および一次口の検索が可能である症例もあるが，サーベイランスに関しては診断の精度，費用等を考慮すると，サーベイランスプログラムに組み込む検査としては適切ではないものと思われた．

FDG-PET in the Serial Assessment of Patients with Lymphoma in Complete Remission.

FDG-PET role in the assessment of lymphoma patients is well established but only few papers evaluated the usefulness of FDG-PET during follow up.Aim: to prospectively investigate the value of serial FDG-PET scans in the follow up of lymphoma patients in complete remission. All lymphoma patients who achieved a complete remission were prospectively enrolled in the study and scheduled for serial FDG-PET scans at 6, 12, 18 and 24 months; further scans were then carried out on annual basis (overall 421 pts, 160 pts with Hodgkin's Disease (HD) and 261 pts with non-Hodgkin Lymphoma (NHL) were studied). All patients had a final assessment using other imaging procedures and/or biopsy and/or clinical evolution. FDG-PET findings were reported as positive, indeterminate or negative for relapse; after comparison with all available data, PET results were categorized as true positive (TP), true negative (TN), false positive (FP), indeterminate turned out to be relapse (I+) and indeterminate turned out to be complete remission (I-).Results: PET documented relapse in 42 cases at 6 mo (14 HD (8.8%) and 28 NHL (10.7%); in 31 cases at 12 mo (14 HD (9.5%) and 17 NHL (7.3%); in 27 cases at 18 mo (6 HD (4.5%) and 21 NHL (3.2%); in 9 cases at 24 mo (3 HD (2.4%) and 6 NHL (3.2%); and in 5 cases at > 36 mo (2 HD (2.8%) and 3 NHL (6.5%). Out of 125 scans reported as positive for relapse, 109 turned out to be TP (PPV of 87%); no false negative scan was recorded, and in the great majority of cases PET detected the presence of relapse before clinical evidence. Our results confirm that FDG-PET is a valid tool for lymphoma patients follow-up. The higher incidence of relapse occurred in both HD and NHL quite early after complete remission (at 6 and 12 months for HD and at 6, 12 and 18 months for NHD), thus confirming the usefulness of performing FDG-PET scans at these times in order to identify recurrence. The role of serial PET at later times (after 18 months for HD and 24 months for NHL) was found less relevant.

Usefulness of FDG-PET for early prediction of the response to gefitinib in non-small cell lung cancer

Increased tumor uptake of (18)F-fluorodeoxyglucose (FDG) measured by positron emission tomography (PET) reflects glucose metabolism and proliferative activity of tumor cells. We conducted a study to assess the usefulness of FDG-PET for early prediction of the response to gefitinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), in advanced non-small cell lung cancer (NSCLC). Five NSCLC patients underwent FDG-PET to evaluate changes in FDG uptake at day 2 and 4 weeks after the initiation of gefitinib therapy compared with FDG-PET prior to therapy. FDG uptake was evaluated as the maximum standardized uptake value (SUVmax) of the target lesions, which were assessable by conventional CT. Based on the CT evaluation, two patients exhibited a partial response (PR), two patients had stable disease (SD) with a minor response, and one patient had progressive disease (PD). In patients with PR and SD, SUVmax decreased by 61+/-18% (standard deviation) and 59+/-12%, respectively, on day 2, and by 26+/-6 and 43+/-10%, respectively, at 4 weeks after the initiation of gefitinib. Two patients with SD had decreased FDG uptake within 2 days of initiation of therapy, and achieved progression-free survival (PFS) of more than 12 months. In contrast, SUVmax increased up to 153+/-21% at 2 days and 232+/-73% at 4 weeks in a patient with PD. The present preliminary study suggests that FDG-PET may be able to predict response to gefitinib in the early stage of therapy in patients with advanced NSCLC and may have a potential prognostic role.

Clinical usefulness of FDG-PET in sarcomas of the head and neck

Clinical usefulness of FDG-PET in sarcomas of the head and neck

1002 POSTER The usefulness of FDG-PET in predicting response to neoadjuvant chemotherapy (NCT) in patients with locally-advanced breast cancer (LABC)

A novel class of nitroimidazole alkylsulfonamides have been prepared and evaluated as hypoxia-selective cytotoxins and radiosensitisers. The sulfonamide side chain markedly influences the physicochemical properties of the analogues: lowering aqueous solubility and raising the electron affinity of the nitroimidazole group. The addition of hydroxyl or basic amine groups increased aqueous solubility, with charged amine groups contributing to increased electron affinity. The analogues covered the range of electron affinity for effective radiosensitisation with one-electron reduction potentials ranging from −503 to −342 mV. Cytotoxicity under normoxia or anoxia against a panel of human tumour cell lines was determined using a proliferation assay. 2-Nitroimidazole sulfonamides displayed significant hypoxia-selective cytotoxicity (6 to 64-fold), while 4- and 5-nitroimidazole analogues did not display hypoxia-selective cytotoxicity. All analogues sensitised anoxic HCT-116 human colorectal cells to radiation at non-toxic concentrations. 2-Nitroimidazole analogues provided modest sensitisation due to the relatively low concentrations used while several 5-nitroimidazole analogues provided equivalent sensitisation to misonidazole and etanidazole at similar molar concentrations.

1022 POSTER The usefulness of FDG-PET in diagnosis and management of peritoneal seeding patients with colorectal cancer

1022 POSTER The usefulness of FDG-PET in diagnosis and management of peritoneal seeding patients with colorectal cancer

Poster 042: Usefulness of FDG-PET in the Management of Oral Squamous Cell Carcinoma

Poster 042: Usefulness of FDG-PET in the Management of Oral Squamous Cell Carcinoma

Potential role of FDG PET in the setting of diabetic neuro-osteoarthropathy: can it differentiate uncomplicated Charcot's neuroarthropathy from osteomyelitis and soft-tissue infection?

This paper is based on the results from an ongoing prospective trial designed to investigate the usefulness of FDG PET in the complicated diabetic foot. To investigate the potential utility of FDG PET imaging in the setting of acute neuropathic osteoarthropathy (Charcot's foot). A total of 63 patients, in four groups, were evaluated. The groups were: (A) 17 patients with a clinical diagnosis of Charcot's neuroarthropathy (11 men, six women; mean age: 59.4+/-8.6 years); (B) 21 patients with uncomplicated diabetic foot (16 men, five women; mean age: 63+/-10 years); (C) 20 non-diabetic patients with normal lower extremities (12 men, eight women; mean age 54+/-19 years); and (D) five patients with proven osteomyelitis secondary to complicated diabetic foot (three men, two women; mean age: 61.2+/-13.9 years). Five patients in group A had foot ulcer and intermediate to high degree of suspicion for superimposed osteomyelitis. Each subject underwent FDG PET imaging of the lower extremities in addition to MRI and the findings were compared with the final diagnostic outcome based on histopathology and clinical follow-up. The images were examined visually for focal abnormalities. Regions of interest were assigned to the sites of abnormal FDG uptake for calculating maximum standardized uptake value (SUVmax). Two important clinical decision-making issues were explored: (1) whether FDG PET shows a definitive uptake pattern in Charcot's neuroarthropathy and if so whether that could be utilized to differentiate it from other complicated forms of diabetic foot like osteomyelitis and cellulitis, which is frequently a diagnostic challenge in this clinical setting; and (2) how accurate FDG PET is in detection soft tissue infection in patients with Charcot's foot. These issues were examined by utilizing FDG PET findings along with MRI results in the same patient. We observed a low degree of diffuse FDG uptake in the Charcot's joints. This was clearly distinguishable from the normal joints. The SUVmax in the Charcot's lesions varied from 0.7 to 2.4 (mean, 1.3+/-0.4) while those of midfoot of the normal control subjects and the uncomplicated diabetic foot ranged from 0.2 to 0.7 (mean 0.42+/-0.12) and from 0.2 to 0.8 (mean 0.5+/-0.16), respectively. The only patient with Charcot's foot with superimposed osteomyelitis had an SUVmax of 6.5. The SUVmax of the sites of osteomyelitis as a complication of diabetic foot was 2.9-6.2 (mean: 4.38+/-1.39). Unifactorial analysis of variance test yielded a statistical significance in the SUVmax between the four groups (P<0.01). The SUVmax between the normal control groups and the uncomplicated diabetic foot was not statistically significant by the Student's t-test (P>0.05). In the setting of concomitant foot ulcer FDG PET accurately ruled out osteomyelitis. Overall sensitivity and accuracy of FDG PET in the diagnosis of Charcot's foot was 100 and 93.8%, respectively; and for MRI were 76.9 and 75%, respectively. FDG PET showed foci of abnormally enhanced uptake in the soft tissue which was suggestive of inflammation in seven cases (43.75%) which were proven pathologically to be secondary to infection. In only two of these cases the features of soft tissue infection were noted on the magnetic resonance images. The results support a valuable role of FDG PET in the setting of Charcot's neuroarthropathy by reliably differentiating it from osteomyelitis both in general and when foot ulcer is present.

Non-resected solid papillary epithelial tumor of the pancreas: 18F-FDG PET/CT evaluation at 5 years after diagnosis

Solid and papillary epithelial neoplasm of the pancreas (SPEN) is an encapsulated, slowly enlarging abdominal mass that generally shows no evidence of capsular invasion, regional lymph node involvement, or distal metastases. We present a 68 years old Hispanic male diagnosed with SPEN 5 years earlier that refused surgical excision. Presently he underwent a whole-body 18F-FDG PET/CT. Although tumor size, location and CT features did not seem to depict significant changes, FDG-PET was useful showing persistent tumoral activity. A brief review of the differential diagnosis as well as the usefulness of FDG-PET in SPEN (a slow growing pancreatic neoplasm) is presented.

FDG PET and PET/CT Monitoring of Autoimmune Pancreatitis Associated With Extrapancreatic Autoimmune Disease

We report a series of FDG PET findings of a 69-year-old male patient with autoimmune pancreatitis (AIP) associated with extrapancreatic disease. The first FDG PET revealed diffuse uptake of FDG in AIP and retroperitoneal fibrosis (RF). The second FDG PET after cessation of steroid treatment indicated subsiding of disease activity in AIP, continuous disease activity in RF, and new extrapancreatic lesions, including enlargement of a right salivary gland, nephritis, and lymphadenopathy. The last FDG PET under steroid treatment revealed reduced FDG uptake in the above abnormal FDG uptake lesions. A series of these FDG PET findings suggest the usefulness of FDG PET for the diagnosis and monitoring of AIP associated with extrapancreatic autoimmune diseases.

FDG-PET and FDG-PET/CT for Diagnosing Infection in Patients with Multiple Vascular Bypass Grafts: A Report of Two Cases

2-Deoxy-2-[ 18 F]fluoro- d -glucose (FDG) positron emission tomography (PET) is an established imaging modality in the fields of clinical oncology, cardiology and neurology, and could be useful for the diagnosis of vascular prosthetic graft infection. The technology of combining FDG-PET and computed tomography (CT) images, acquired in a single session, is gaining popularity. Several reports proposed the application of both FDG-PET and FDG-PET/CT in the diagnosis and management of vascular prosthetic graft infection. This case report highlights the usefulness of FDG-PET and FDG-PET/CT as noninvasive diagnostic modalities for patients with multiple vascular prosthetic bypass grafts susceptible for infection.

ＦＤＧ‐ＰＥＴにより原発巣が判明した原発不明癌例

18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a powerful tool for the detection of malignant tumors. We herein reported a case of cervical metastasis from unknown primary. Primary tumor was successfully diagnosed by FDG-PET. A 70-year-old man presented with a right-sided cervical lymph node swelling. Fine needle aspiration cytology in the previous hospital showed class III atypia, however, the primary tumor was not found by physical examination, fiberscopy, computed tomography (CT), or magnetic resonance imaging. Open biopsy of the neck demonstrated that the lesion was metastatic squamous cell carcinoma, and he subsequently underwent neck dissection on the affected side. FDG-PET and PET/CT after surgery revealed demonstrated uptake in the right piriform recess of the hypopharynx. The patient was eventually referred to our department, and underwent biopsy of the piriform recess via direct endoscopy. Histopathological diagnosis was the poorly-differentiated squamous cell carcinoma, and then he received radical radiotherapy of 72Gy to the whole neck. There was no evidence of recurrence on FDG-PET performed four months after radiation. The literature on the clinical usefulness of FDG-PET for the diagnosis of head and neck cancers were reviewed.

Utility of FDG-PET and Comparison of FDG-PET and Ga-67 Scintigraphy in Evaluation of B-Cell Indolent Lymphoma.

18Fluoro-2-deoxyglucose positron emission tomography (FDG-PET) has emerged as an important tool for the management of lymphoma patients, but little information has been reported about its usefulness in indolent lymphoma. The aim of this study was to retrospectively assess the usefulness of FDG-PET, and to compare the sensitivity of FDG-PET with gallium 67 citrated scintigraphy (Ga-67), in identifying disease involvement in patients with indolent lymphoma. We also investigated the relationship between FDG-PET and pathologic diagnosis according to the World Health Organization (WHO) classification system.A total of 118 cases contemporaneously underwent FDG-PET and CT and/or MRI prior to treatment. The histological diagnoses included follicular lymphoma (FL; n=43), MALT-lymphoma (n=52), splenic marginal zone lymphoma (SMZL; n=10), small lymphocytic lymphoma (SLL; n=5) and mantle cell lymphoma (MCL; n=8). In 88 of these 118 cases, Ga-67 was also performed. The involved disease sites were divided into lymph node regions and extranodal regions. The former group was further divided into four lymph node regions:head and neck,chest,abdomen andpelvis.Among the 118 patients, 401 disease sites were included in the analysis. FDG-PET identified disease sites in 171/189 (90%) FLs, 107/126 (86%) MALTs, 7/16 (44%) SMZLs, 10/19 (53%) SLLs and 51/51 (100%) MCLs. In addition, FDG-PET detected more involvement sites than Ga-67 for all disease sites, except for one region each in the MALTs and SMZLs, namely the eyelid and spleen. Ga-67 was able to detect disease sites assessed by FDG-PET in 48/127 (38%) FLs, 44/78 (56%) MALTs, 3/5 (60%) SMZLs, 1/2 (50%) SLLs and 8/27 (30%) MCLs. There were no anatomical differences in the not-detected disease sites between FDG-PET and Ga-67.In imaging lymphomas before therapy, FDG-PET was informative for FL, MALT, and MCL, but less reliable for SMZL and SLL. Ga-67 was not suitable for indolent lymphoma, in particular FL and MCL. Given the high sensitivity of FDG-PET, this modality is highly recommended for indolent lymphoma. However, for SMZL and SLL, different anatomical imaging modalities such as CT and MRI should be used.Sensitivity of FDG-PETHistologyNo.of sitesFDG-PET positive%FL18917190MZL/MALT12610786MCL5151100SMZL16744SLL191053Total401346Comparison of FDG-PET with Ga-67HistologyPET positiveGa-67 positiveGa/PET(%)FL1274839MZL/MALT784456MCL27830SMZL5360SLL2150Total239104