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Sample records for 18f-fdg pet-ct scan

  1. Utility of 18 F-FDG PET/CT scan to diagnose the etiology of fever of unknown origin in patients on dialysis.

    PubMed

    Tek Chand, Kalawat; Chennu, Krishna Kishore; Amancharla Yadagiri, Lakshmi; Manthri Gupta, Ranadheer; Rapur, Ram; Vishnubotla, Siva Kumar

    2016-09-12

    Introduction Studies on fever of unknown origin (FUO) in patients of chronic kidney disease and end stage renal disease patients on dialysis were not many. In this study, we used 18 F-FDG PET/CT scan whole body survey for detection of hidden infection, in patients on dialysis, labelled as FUO. Methods In this retrospective study, 20 patients of end stage renal disease on dialysis were investigated for the cause of FUO using 18F-FDG PET/CT scan. All these patients satisfied the definition of FUO as defined by Petersdorf and Beeson. Any focal abnormal site of increased FDG concentration detected by PET/CT, either a solitary or multiple lesions was documented and at least one of the detected abnormal sites of radio tracer concentration was further examined for histopathology. Findings All patients were on renal replacement therapy. Of these, 18 were on hemodialysis and two were on peritoneal dialysis. 18F-FDG PET/CT scan showed metabolically active lesions in 15 patients and metabolically quiescent in five patients. After 18F-FDG PET/CT scan all, but one patient had a change in treatment for fever. Anti-tuberculous treatment was given in 15 patients, antibiotics in four patients and anti-malaria treatment in one patient. Discussion The present study is first study of 18F-FDG PET/CT scan in patients of end stage renal disease on dialysis with FUO. The study showed that the 18 F FDG PET/CT scan may present an opportunity to attain the diagnosis in end stage renal disease patients on dialysis with FUO.

  2. A rare adult renal neuroblastoma better imaged by (18)F-FDG than by (68)Ga-dotanoc in the PET/CT scan.

    PubMed

    Jain, Tarun Kumar; Singh, Sharwan Kumar; Sood, Ashwani; Ashwathanarayama, Abhiram Gj; Basher, Rajender Kumar; Shukla, Jaya; Mittal, Bhagwant Rai

    2017-03-20

    Primary renal neuroblastoma is an uncommon tumor in children and extremely rare in adults. We present a case of a middle aged female having a large retroperitoneal mass involving the right kidney with features of neuroblastoma on pre-operative histopathology. Whole-body fluorine-18-fluoro-deoxyglucose positron emission tomography ((18)F-FDG PET/CT) and (68)Ga-dotanoc PET/CT scans performed for staging and therapeutic potential revealed a tracer avid mass replacing the right kidney and also pelvic lymph nodes. The (18)F-FDG PET/CT scan showed better both the primary lesion and the metastases in the pelvic lymph nodes than the (68)Ga-dotanoc scan supporting diagnosis and treatment planning.

  3. (18)F-FDG-PET/CT, (123)I-MIBG and (99m)Tc-MDP whole-body scans, in detecting recurrence of an adult adrenal neuroblastoma.

    PubMed

    Skoura, Evangelia; Oikonomopoulos, Georgios; Vasileiou, Spyridon; Kyprianou, Diogenis; Koumakis, Georgios; Datseris, Ioannis E

    2014-01-01

    Neuroblastoma is the most common extracranial solid malignancy in children, but is rare in adults. We report the case of a 33 year old man with recurrence of neuroblastoma, 2 years after the excision of the primary tumor in the right adrenal gland. The iodine-123-radioiodinated metaiodobenzylguanidine ((123)I-MIBG) and (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) bone scans and the fluorine-18-fluorodeoxyglucose-positron computed tomography ((18)F-FDG PET/CT) findings in this patient are presented. First, we applied (123)I-MIBG scintigraphy that detected increased uptake at the right adrenal gland region and probably at liver lesions and in several bones. Then, the (99m)Tc-MDP bone scan revealed also increased uptake of the radiopharmaceutical in bones, but there was a discrepancy between these two studies concerning the number and location of the lesions. Then, (18)F-FDG PET/CT scan was performed, which showed increased uptake of (18)F-FDG at the right adrenal gland region with extension to the liver and also in multiple bones. Additionally, an aortocaval lymph node was detected. In conclusion, this case indicated that (18)F-FDG PET/CT has defined the extent of the recurrence of neuroblastoma in a better way than (123)I-MIBG and (99m)Tc-MDP together.

  4. Candida Esophagitis Incidentally Detected by 18F-FDG PET/CT in Metastatic Lung Adenocarcinoma

    PubMed Central

    Martínez-Amador, N; Martínez-Rodríguez, I; Quirce, R; Jiménez-Bonilla, J; Banzo, I

    2017-01-01

    The diagnostic significance of esophageal 18F-FDG uptake in oncologic patient is challenging. It may represent normal physiological uptake, inflammation, infection, or neoplasia. We present a patient with a recent diagnosis of non-small cell lung cancer stage IV and esophageal mild uptake on 18F-FDG PET/CT scan. Biopsy of esophageal mucosa demonstrated Candida esophagitis.

  5. Combined 18F-FDG and 11C-Methionine PET/CT scans in a case of metastatic hepatocellular carcinoma

    PubMed Central

    D’souza, Maria M.; Sharma, Rajnish; Jaimini, Abhinav; Saw, Sanjiv Kumar; Singh, Dinesh; Mondal, Anupam

    2014-01-01

    A 37-year-old male who underwent a central hepatectomy of the liver for hepatocellular carcinoma (HCC) was referred for an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) study to rule out tumor recurrence or metastases. The scan showed a recurrent hepatic mass at the operative site, along with low-grade uptake in bilateral pulmonary metastases, mediastinal and hilar lymph nodes, and few skeletal sites. A non-FDG avid intracranial extradural mass was visualized in the right frontal lobe. The 11C-methionine PET/CT scan performed subsequently revealed a larger area of involvement at the primary site, along with widespread metastases to the lungs, mediastinal, hilar, and abdominal lymph nodes, and multiple skeletal sites. Further, dural metastasis with high tracer uptake was noted in the frontal region. To the best of our knowledge, this is the first case documented in the literature, wherein 11C-methionine PET/CT played a significant role in delineating the widespread dissemination, including the extremely rare dural involvement in a case of HCC. This report highlights the potential value of 11C-methionine PET/CT in assessing the hepatic and extrahepatic tumor burden in cases of HCC, especially in clinically unexpected locations. PMID:25210286

  6. PET/CT in giant cell arteritis: High (18)F-FDG uptake in the temporal, occipital and vertebral arteries.

    PubMed

    Rehak, Z; Vasina, J; Ptacek, J; Kazda, T; Fojtik, Z; Nemec, P

    (18)F-FDG PET/CT imaging is useful in patients with fever of unknown origin and can detect giant cell arteritis in extracranial large arteries. However, it is usually assumed that temporal arteries cannot be visualized with a PET/CT scanner due to their small diameter. Three patients with clinical symptoms of temporal arteritis were examined using a standard whole body PET/CT protocol (skull base - mid thighs) followed by a head PET/CT scan using the brain protocol. High (18)F-FDG uptake in the aorta and some arterial branches were detected in all 3 patients with the whole body protocol. Using the brain protocol, head imaging led to detection of high (18)F-FDG uptake in temporal arteries as well as in their branches (3 patients), in occipital arteries (2 patients) and also in vertebral arteries (3 patients).

  7. Normal variations and benign findings in pediatric 18F-FDG-PET/CT.

    PubMed

    Grant, Frederick D

    2014-04-01

    (18)F-FDG PET and PET/CT have a wide variety of indications in children and young adults. Oncologic indications are the most common, but others include neurology, sports medicine, cardiology, and infection imaging. Accurate interpretation of pediatric (18)F-FDG PET and PET/CT requires a technically adequate study and knowledgeable interpretation of the images. A successful pediatric (18)F-FDG PET requires age-appropriate patient preparation and consideration of patient age and developmental stage. Accurate interpretation of the study requires familiarity with normal patterns of physiologic (18)F-FDG uptake in children at all stages of development.

  8. The role of early 18F-FDG PET/CT in therapeutic management and ongoing risk stratification of high/intermediate-risk thyroid carcinoma.

    PubMed

    Triviño Ibáñez, E M; Muros, M A; Torres Vela, E; Llamas Elvira, J M

    2016-03-01

    Little is known about the role in ongoing risk stratification of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) performed early after radioactive iodine (RAI) ablation in differentiated thyroid carcinoma (DTC). The aim of the study is to investigate whether 18F-FDG PET/CT performed early after RAI ablation is useful to detect disease and to influence therapy and ongoing risk stratification. Patients with high/intermediate risk of recurrent DTC were included. 18F-FDG PET/CT scan was performed within 6 months after RAI ablation. We confirmed results with other imaging techniques, pathology reports, or follow-up. We classified the patient response as excellent, acceptable, or incomplete. Modified Hicks criteria were used to evaluate clinical impact. We included 81 patients with high/intermediate risk of recurrent DTC. Forty-one (50.6%) had positive uptake in 18F-FDG PET/CT, with negative (131)I whole-body scan ((131)I WBS). Sensitivity, specificity, and diagnostic accuracy of 18F-FDG PET/CT were 92.5, 90.2, and 91.4%, respectively. 18F-FDG PET/CT results had an impact on therapy in 38.3% of patients. One year after initial therapy, 45.7% showed excellent response, 8.6% acceptable response, and 45.7% incomplete response. A statistically significant relationship was found between negative 18F-FDG PET/CT and excellent response (80 vs. 12.2%, p < 0.001; OR 52.8). 18F-FDG PET/CT scan performed early in surveillance of patients with high/intermediate-risk thyroid carcinoma provides important additional information not available with conventional follow-up methods and had a high impact on therapy. A negative 18F-FDG PET/CT predicts an excellent response to therapy in the new ongoing risk stratification.

  9. 18F-FDG PET/CT in Bladder Cancer.

    PubMed

    Tagliabue, Luca; Russo, Giovanna; Lucignani, Giovanni

    2016-12-01

    Urinary clearance of F-FDG and variability in bladder wall FDG uptake may hamper the interpretation and limit the use of FDG-PET/CT for imaging bladder tumors. Nevertheless, careful combined evaluation of both CT and FDG-PET images of the urinary tract can provide useful findings. We present 2 cases of bladder cancer detected by FDG-PET/CT. These cases suggest that FDG uptake can be indicative of malignancy in bladder cancer when viewed in conjunction with CT scans and that whole-body FDG-PET/CT scans should always be reviewed with particular attention to the urinary tract because abnormalities suggestive of bladder cancer can be found unexpectedly.

  10. Cervix carcinoma and incidental finding of medullary thyroid carcinoma by 18F-FDG PET/CT--clinical case.

    PubMed

    Chaushev, Borislav; Bochev, Pavel; Klisarova, Anelia; Yordanov, Kaloyan; Encheva, Elitsa; Dancheva, Jivka; Yordanova, Cvetelina; Hristozov, Kiril; Krasnaliev, Ivan; Radev, Radoslav; Nenkov, Rumen

    2014-01-01

    Thyroid nodules are encountered in clinical practice during the diagnostic procedures or patients' follow-up due to other diseases quite far from the thyroid gland with prevalence 4-50% in general population, depending on age, diagnostic method and race. The prevalence of thyroid nodules increases with age and their clarification should be done for their adequate treatment. An 18F-FDG PET/CT was done with a PET/CT scanner (Philips Gemini TF), consisting of dedicated lutetium orthosilicate full ring PET scanner and 16 slice CT. The PET/CT scan of the whole-body revealed on the CT portion a hypodense nodular lesion in the left lobe of the thyroid gland with increased uptake of 18F-FDG on the PET with SUVmax 10.3 and demonstrated a complete response to the induction therapy of the main oncological disease of the patient--squamous cell carcinoma. This clinical case demonstrates that whole-body 18F-FDG-PET/CT has an increasingly important role in the early evaluation of thyroid cancer as a second independent malignant localization. Focal thyroid lesion with high risk of thyroid malignancy was incidentally found on 18F-FDG PET/CT.

  11. Incidental Detection of Femoral Pseudoaneurysm at 18F-FDG PET/CT

    PubMed Central

    Nougaret, Stephanie; Ragucci, Monica; Bach, Ariadne M.; Carollo, Gabriella; Mannelli, Lorenzo

    2016-01-01

    A 72-year-old man with history of lung cancer and melanoma was referred for routine follow-up with 18F-FDG PET/CT. CT images showed a new mass in the right groin associated with mild FDG activity on 18F-FDG PET images. Subsequent ultrasound obtained the same day demonstrated flow within the lesion to be a pseudoaneurysm of the right femoral artery. PMID:26462043

  12. Early detection of encephalitis with (18)F-FDG PET/CT.

    PubMed

    Gaeta, M C; Godani, M; Nunziata, R; Capellini, C; Ciarmiello, A

    2015-01-01

    Encephalitis is a relatively rare condition for which making an accurate diagnosis can be challenging. In fact, clinical features are not specific and structural imaging can be normal in a considerable number of cases. However, an early diagnosis is important as many forms of treatment are effective if started promptly. Even though recent guidelines do not recommend (18)F-FDG PET/CT for patients with suspected encephalitis, the case presented suggests that (18)F-FDG PET/CT may play a relevant role for the early diagnosis of this clinical condition.

  13. Anxiety in Cancer Patients during 18F-FDG PET/CT Low Dose: A Comparison of Anxiety Levels before and after Imaging Studies

    PubMed Central

    Vieira, Lina; Carolino, Elisabete; Oliveira, Cátia; Pacheco, Carolina; Castro, Maria; Alonso, Juan

    2017-01-01

    Objective. Assessing the level of anxiety in oncology patients who underwent 18F-FDG PET/CT low dose scan and identifying the main reasons that generate anxiety. Material and Method. The study included 81 cancer patients submitted to the 18F-FDG PET/CT low dose scan. Patients filled in the Scan Experience Questionnaire and the State-Trait Anxiety Inventory (STAI) before and after 18F-FDG PET/CT low dose scan. Results. Substantial levels of anxiety were detected both before and after 18F-FDG PET/CT low dose scan (STAI mean > 30), with a significant increase in the state of anxiety after scan performance (p < 0.0001, Medianpre = 31.1, and Medianpos = 33.0). 18F-FDG PET/CT low dose results are the main cause of anxiety both before (79.1%) and after (86.9%) the scan. The information provided by staff both before and on the 18F-FDG PET/CT low dose day was classified mostly as completely understandable (70.5% and 75.3%, resp.) and as very useful (70.5% and 72.6%, resp.) and correlated positively with patients' overall satisfaction with NM Department (rS = 0.372, p = 0.004 and rS = 0.528, p = 0.000, resp.), but not with anxiety levels. Conclusions. Patients perceive high levels of anxiety during the 18F-FDG PET/CT low dose scan and the concern with scan results was pointed out as the main factor for that emotional reaction. PMID:28392942

  14. Assessment of outcomes with delayed 18F-FDG PET-CT response assessment in head and neck squamous cell carcinoma

    PubMed Central

    Slevin, F; Subesinghe, M; Ramasamy, S; Sen, M; Scarsbrook, A F

    2015-01-01

    Objective: To assess the accuracy of a 4-month post-(chemo)radiotherapy 18-fludeoxyglucose (18F-FDG) positron emission tomography (PET)-CT for head and neck squamous cell carcinoma (HNSCC). Methods: 105 patients who underwent a baseline and response assessment 18F-FDG PET-CT scan between 2008 and April 2013 were identified. 18F-FDG PET-CT outcomes were analysed with reference to clinicopathological outcomes. Results: 79 of 105 (75%) 18F-FDG PET-CT scans demonstrated a complete metabolic response; 19 of 101 (19%) for assessable primary tumours were positive; and 19 of 93 (20%) for patients with nodal disease were equivocal (n = 10) or positive (n = 9). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for primary and nodal disease were 90%, 89%, 47%, 99% and 91%, 89%, 53% and 99%, respectively. Eight of nine patients with a positive nodal response scan had clinicopathological evidence of residual nodal disease (PPV, 89%). 2 of 10 patients with equivocal nodal responses had clinicopathological evidence of residual nodal disease (PPV, 20%). Conclusion: 18F-FDG PET-CT 4 months post treatment has a very high NPV. A positive 18F-FDG PET-CT has a high PPV for residual nodal disease. By contrast, patients who have an equivocal nodal response have a low PPV. Advances in knowledge: Response assessment 18F-FDG PET-CT is a valuable tool in guiding the selective use of neck dissection following (chemo)radiotherapy for HNSCC. An equivocal lymph node response has a limited predictive value for persistent disease, and optimal management remains a clinical challenge. PMID:26081447

  15. Plasmacytoma of the ovary: additional role of 18F-FDG PET/CT.

    PubMed

    Santhosh, Sampath; Mittal, Bhagwant Rai; Raveendran, Ainharan; Jain, Vanita; Nijhawan, Raje; Kumar, Ritesh; Bhattacharya, Anish; Sharma, Suresh C

    2013-05-01

    We report a case of ovarian plasmacytomas where 18F-FDG PET/CT helped in staging by demonstrating increased FDG uptake limited to the ovary, and hence, surgical treatment was carried out as the disease was localized to the ovary.

  16. PET/CT imaging in polymyalgia rheumatica: praepubic 18F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis

    PubMed Central

    Sprlakova-Pukova, Andrea; Bortlicek, Zbynek; Fojtik, Zdenek; Kazda, Tomas; Joukal, Marek; Koukalova, Renata; Vasina, Jiri; Eremiasova, Jana; Nemec, Petr

    2017-01-01

    Abstract Background The role of 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) is increasing in the diagnosis of polymyalgia rheumatica (PMR), one of the most common inflammatory rheumatic diseases. In addition to other locations, increased 18F-FDG accumulation has been detected in the praepubic region in some patients. However, a deeper description and pathophysiological explanation of this increased praepubic accumulation has been lacking. The aim of the presented study is to confirm a decrease in praepubic 18F-FDG accumulation in response to therapy and to describe potential correlations to other 18F-FDG PET/CT scan characteristics during the course of disease. As a secondary objective, we describe the pathological aspects of the observed praepubic 18F-FDG uptake. Patients and methods A retrospective review of patients with newly suspected PMR undergoing baseline and follow up 18F-FDG PET/CT between February 2010 and March 2016 is given. Those with a visually detected presence of praepubic 18F-FDG accumulation were further analysed. The uptake was assessed visually and also semi-quantitatively in the defined region of interest by calculation of target-to-liver ratios. Other regions typical for PMR were systematically described as well (shoulders, hips, sternoclavicular joints, ischiogluteal bursae, spinous interspaces). Results Twenty-three out of 89 screened patients (26%) presented with initial praepubic 18F-FDG PET/CT positivity, 15 of whom also underwent follow up 18F-FDG PET/CT examination. Five out of 15 patients presented with increased 18F-FDG accumulation in large arteries as a sign of giant cell arteritis. During follow up examination, decrease in 18F-FDG accumulation caused by therapeutic intervention was observed in all evaluated locations in all analysed patients and no new positivity was indicated, including periarticular, extraarticular tissues or target large vessels. Praepubical accumulation of 18F-FDG was

  17. Granulocytic sarcoma of the pancreas on 18F-FDG PET/CT

    PubMed Central

    Ishii, Akira; Kondo, Tadakazu; Oka, Tomomi; Nakamoto, Yuji; Takaori-Kondo, Akifumi

    2016-01-01

    Abstract Rationale: Granulocytic sarcoma (GS) is defined as leukemia infiltration in any organ other than the bone marrow. GS rarely occurs in the pancreas. Here, we present the first report of GS in the pancreas on 18F-fluorodexyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Patient concerns: A 19-year-old male patient with acute myeloid leukemia received a human leukocyte antigen-haploidentical stem cell transplant as a second transplant while in second complete remission. Interventions: After a second stem cell transplant, obstructive pancreatitis accompanied by a mass in the pancreatic head was observed. FDG-PET/CT revealed abnormal activity in the head of the pancreas and the skin in the patient's left breast area. Diagnoses: Pathological examination demonstrated relapsed acute myeloid leukemia in both the lesions. Outcomes: This is the first report showing the 18F-FDG PET/CT findings of GS in the pancreas. Lessons: 18F-FDG PET/CT may help determine the stage of GS. PMID:27930567

  18. The Role of 18F-FDG PET/CT Integrated Imaging in Distinguishing Malignant from Benign Pleural Effusion

    PubMed Central

    Sun, Yajuan; Yu, Hongjuan; Ma, Jingquan

    2016-01-01

    Objective The aim of our study was to evaluate the role of 18F-FDG PET/CT integrated imaging in differentiating malignant from benign pleural effusion. Methods A total of 176 patients with pleural effusion who underwent 18F-FDG PET/CT examination to differentiate malignancy from benignancy were retrospectively researched. The images of CT imaging, 18F-FDG PET imaging and 18F-FDG PET/CT integrated imaging were visually analyzed. The suspected malignant effusion was characterized by the presence of nodular or irregular pleural thickening on CT imaging. Whereas on PET imaging, pleural 18F-FDG uptake higher than mediastinal activity was interpreted as malignant effusion. Images of 18F-FDG PET/CT integrated imaging were interpreted by combining the morphologic feature of pleura on CT imaging with the degree and form of pleural 18F-FDG uptake on PET imaging. Results One hundred and eight patients had malignant effusion, including 86 with pleural metastasis and 22 with pleural mesothelioma, whereas 68 patients had benign effusion. The sensitivities of CT imaging, 18F-FDG PET imaging and 18F-FDG PET/CT integrated imaging in detecting malignant effusion were 75.0%, 91.7% and 93.5%, respectively, which were 69.8%, 91.9% and 93.0% in distinguishing metastatic effusion. The sensitivity of 18F-FDG PET/CT integrated imaging in detecting malignant effusion was higher than that of CT imaging (p = 0.000). For metastatic effusion, 18F-FDG PET imaging had higher sensitivity (p = 0.000) and better diagnostic consistency with 18F-FDG PET/CT integrated imaging compared with CT imaging (Kappa = 0.917 and Kappa = 0.295, respectively). The specificities of CT imaging, 18F-FDG PET imaging and 18F-FDG PET/CT integrated imaging were 94.1%, 63.2% and 92.6% in detecting benign effusion. The specificities of CT imaging and 18F-FDG PET/CT integrated imaging were higher than that of 18F-FDG PET imaging (p = 0.000 and p = 0.000, respectively), and CT imaging had better diagnostic consistency with

  19. 18F-FDG PET/CT in the diagnosis of prosthetic valve endocarditis.

    PubMed

    Fagman, Erika; van Essen, Martijn; Fredén Lindqvist, Johan; Snygg-Martin, Ulrika; Bech-Hanssen, Odd; Svensson, Gunnar

    2016-04-01

    Recent studies have shown promising results using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the diagnosis of prosthetic valve endocarditis (PVE). However, previous studies did not include negative controls. The aim of this study was to compare (18)F-FDG-uptake around prosthetic aortic valves in patients with and without PVE and to determine the diagnostic performance of (18)F-FDG PET/CT in the diagnosis of PVE. (18)F-FDG PET/CT examinations in patients with a prosthetic aortic valve performed 2008-2014 were retrieved. Eight patients with a final diagnosis of definite PVE were included in the analysis of the diagnostic performance of (18)F-FDG PET/CT. Examinations performed on suspicion of malignancy in patients without PVE (n = 19) were used as negative controls. Visual and semi-quantitative analysis was performed. Maximal standardized uptake value (SUVmax) in the valve area was measured and SUVratio was calculated by dividing valve SUVmax by SUVmax in the descending aorta. The sensitivity was 75 %, specificity 84 %, positive likelihood ratio [LR(+)] 4.8 and negative likelihood ratio [LR(-)] 0.3 on visual analysis. Both SUVmax and SUVratio were significantly higher in PVE patients [5.8 (IQR 3.5-6.5) and 2.4 (IQR 1.7-3.0)] compared to non-PVE patients [3.2 (IQR 2.8-3.8) and 1.5 (IQR 1.3-1.6)] (p < 0.001). ROC-curve analysis of SUVratio yielded an area under the curve of 0.90 (95 % CI 0.74-1.0). (18)F-FDG-uptake around non-infected aortic prosthetic valves was low. The level of (18)F-FDG-uptake in the prosthetic valve area showed a good diagnostic performance in the diagnosis of PVE.

  20. [18F-FDG PET/CT diagnosis of liver cyst infection in a patient with autosomal dominant polycystic kidney disease and fever of unknown origin].

    PubMed

    Banzo, J; Ubieto, M A; Gil, D; Prats, E; Razola, P; Tardín, L; Andrés, A; Rambalde, E F; Ayala, S M; Cáncer, L; Velilla, J

    2013-01-01

    The diagnosis, localization and treatment of infected cysts in the kidney or liver of patients with autosomal dominant polycystic kidney disease (ADPKD) remain a clinical challenge. We report the findings of (18)F-FDG PET-CT in an ADPKD diagnosed patient who required renal transplantation five years before and in his follow up presented repeated episodes of bacteriemia without known focus on radiological tests performed. The (18)F-FDG PET-CT scan showed numerous hypermetabolic images with focal or ring-shaped morphology related to the content and the wall of some hepatic cysts. The increased metabolic activity was localized on segments VI and VII. We proceeded to drainage of one cyst in segment VI, removing 110 cc of purulent fluid which grew E. Coli BLEE. The (18)F-FDG PET/CT scan should be included in the diagnostic algorithm for detecting infected liver cysts in patients with ADPKD and fever of unknown origin.

  1. The Role of 18F-FDG PET/CT in the Evaluation of Gastric Cancer Recurrence

    PubMed Central

    Cayvarlı, Hakan; Bekiş, Recep; Akman, Tülay; Altun, Deniz

    2014-01-01

    Objective: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been widely used for staging, re-staging and for monitoring therapy-induced changes and response to therapy in patients with various types of cancer, but its utilization for gastric cancer has been limited. This study aimed to assess the diagnostic performance of 18F-FDG PET/CT for detecting recurrence in gastric cancer patients with radiologic or clinical suspicion of recurrence and its clinical impact on making decision. Methods: We performed a retrospective review of 130 consecutive patients who underwent PET/CT scans for post-treatment surveillance of gastric cancer between January 2008 and March 2012. The mean time between the initial diagnosis of gastric cancer and PET/CT studies was 44 weeks with a median of 18 weeks. The number and site of positive FDG uptake were analyzed and correlated with the final diagnosis by calculating the diagnostic values. We evaluated the diagnostic accuracy of PET/CT for detecting the recurrence in terms of whether or not histology had been SRC/musinous adenocarcinoma. The changes in the clinical management of patients were also evaluated according to the results of PET/CT. Results: Of all 130 patients, 91 patients were confirmed to have true recurrence. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of PET/CT for diagnosing true recurrence on a per-person basis were 91.2%, 61.5%, 84.6%, 75.0% and 82.3% respectively. Final diagnoses were confirmed histopathologically in 59 (45.4%) of 130 patients and by clinical and radiological follow-up in the remaining 71 (54.6%) patients. In the subgroup with SRC/mucinous adenocarcinoma differentiation of the primary tumor, there was no statistically significant difference in terms of diagnostic accuracy of PET/CT on a per-person basis. In addition, PET/CT results changed the patients’ management in 20 (15%) cases. Conclusions: 18F-FDG

  2. (18)F-FDG PET/CT findings in a case with HIV (-) Kaposi sarcoma.

    PubMed

    Ozdemir, E; Poyraz, N Y; Keskin, M; Kandemir, Z; Turkolmez, S

    2014-01-01

    Although mucocutaneous sites are the most frequently encountered sites of involvement, Kaposi Sarcoma (KS) may also occasionally involve the breast and the skeletal, endocrine, urinary and nervous systems.. Various imaging modalities may be used to delineate the extent of the disease by detecting unexpected sites of involvement. Herein, we report a case of classical type KS, in whom staging with (18)F-FDG PET/CT imaging disclosed widespread disease and unexpected findings of bone and salivary gland involvement.

  3. Evaluation of the dependence of the exposure dose on the attenuation correction in brain PET/CT scans using 18F-FDG

    NASA Astrophysics Data System (ADS)

    Choi, Eun-Jin; Jeong, Moon-Taeg; Jang, Seong-Joo; Choi, Nam-Gil; Han, Jae-Bok; Yang, Nam-Hee; Dong, Kyung-Rae; Chung, Woon-Kwan; Lee, Yun-Jong; Ryu, Young-Hwan; Choi, Sung-Hyun; Seong, Kyeong-Jeong

    2014-01-01

    This study examined whether scanning could be performed with minimum dose and minimum exposure to the patient after an attenuation correction. A Hoffman 3D Brain Phantom was used in BIO_40 and D_690 PET/CT scanners, and the CT dose for the equipment was classified as a low dose (minimum dose), medium dose (general dose for scanning) and high dose (dose with use of contrast medium) before obtaining the image at a fixed kilo-voltage-peak (kVp) and milliampere (mA) that were adjusted gradually in 17-20 stages. A PET image was then obtained to perform an attenuation correction based on an attenuation map before analyzing the dose difference. Depending on tube current in the range of 33-190 milliampere-second (mAs) when BIO_40 was used, a significant difference in the effective dose was observed between the minimum and the maximum mAs (p < 0.05). According to a Scheffe post-hoc test, the ratio of the minimum to the maximum of the effective dose was increased by approximately 5.26-fold. Depending on the change in the tube current in the range of 10-200 mA when D_690 was used, a significant difference in the effective dose was observed between the minimum and the maximum of mA (p < 0.05). The Scheffe posthoc test revealed a 20.5-fold difference. In conclusion, because effective exposure dose increases with increasing operating current, it is possible to reduce the exposure limit in a brain scan can be reduced if the CT dose can be minimized for a transmission scan.

  4. Uterine leiomyosarcoma metastatic to thyroid shown by (18)F-FDG PET/CT imaging.

    PubMed

    Gauthé, M; Testart Dardel, N; Nascimento, C; Trassard, M; Banal, A; Alberini, J-L

    About one third of focal thyroid uptakes in a fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) study are malignant, the most frequent histological type being papillary carcinoma. Metastases to the thyroid account for approximately 7.5% of thyroid malignancies and come mainly from kidney, lung, head and neck, and breast cancers. We report the case of a 64-year-old woman presenting a fast growing thyroid nodule whose primitive or metastatic origin was not obvious, for which (18)F-FDG PET/CT helped in the diagnostic process and in the later management of the patient. Histopathologic findings finally revealed a metastasis of uterine leiomyosarcoma.

  5. 18F-FDG PET/CT in Neurolymphomatosis: Report of 3 Cases

    PubMed Central

    Canh, Nguyen Xuan; Tan, Ngo Van; Tung, Tran Thanh; Son, Nguyen Truong; Maurea, Simone

    2014-01-01

    Neurolymphomatosis is a rare manifestation of non-Hodgkin lymphoma characterized by infiltration of peripheral nerves, nerve roots, plexus and cranial nerves by malignant lymphocytes. This report presents positron emission tomography/computed tomography (PET/CT)imaging with 2-deoxy-2-18F-fluoro-D-glucose (18F-FDG) in 3 cases of non-Hodgkin lymphoma with nerve infiltration, including one newly diagnosed lymphoma, one recurrent lymphoma in previous nerve lesions and one newly recurrent lymphoma. PET/CT could reveal the affected neural structures including cranial nerves, spinal nerve roots, brachial plexus, cervicothoracic ganglion, intercostal nerves, branches of the vagus nerve, lumbosacral plexus and sciatic nerves. There was relative concordance between PET/CT and MRI in detection of affected cranial nerves. PET/CT seemed to be better than MRI in detection of affected peripheral nerves. 18F-FDG PET/CT was a whole-body imaging technique with the ability to reveal the affected cranial nerves, peripheral nerves, nerve roots and plexus in non-Hodgkin lymphoma. A thorough understanding of disease and use of advanced imaging modalities will increasingly detect neurolymphomatosis. PMID:27408859

  6. Spectrum of the Breast Lesions With Increased 18F-FDG Uptake on PET/CT

    PubMed Central

    Dong, Aisheng; Wang, Yang; Lu, Jianping; Zuo, Changjing

    2016-01-01

    Abstract Interpretation of 18F-FDG PET/CT studies in breast is challenging owing to nonspecific FDG uptake in various benign and malignant conditions. Benign conditions include breast changes in pregnancy and lactation, gynecomastia, mastitis, fat necrosis, fibroadenoma, intraductal papilloma, and atypical ductal hyperplasia. Among malignancies, invasive ductal carcinoma and invasive lobular carcinoma are common histological types of breast carcinoma. Rarely, other unusual histological types of breast carcinomas (eg, intraductal papillary carcinoma, invasive micropapillary carcinoma, medullary carcinoma, mucinous carcinoma, and metaplastic carcinoma), lymphoma, and metastasis can be the causes. Knowledge of a wide spectrum of hypermetabolic breast lesions on FDG PET/CT is essential in accurate reading of FDG PET/CT. The purpose of this atlas article is to demonstrate features of various breast lesions encountered at our institution, both benign and malignant, which can result in hypermetabolism on FDG PET/CT imaging. PMID:26975010

  7. Adrenal tuberculosis masquerading as disseminated malignancy: A pitfall of (18)F-FDG PET/CT Imaging.

    PubMed

    Gorla, A K R; Gupta, K; Sood, A; Biswal, C K; Bhansali, A; Mittal, B R

    2016-01-01

    Non-invasive characterization of adrenal lesions is a commonly encountered diagnostic challenge. Characteristic clinical and correlative imaging findings may assist in only arriving at a probable diagnosis. Currently, (18)F-FDG PET/CT is considered to provide the most comprehensive imaging information. We here present a case of bilateral adrenal tuberculosis that highlights the need for caution during the interpretation of (18)F-FDG PET/CT and also the need to suggest histopathological correlation.

  8. 18F-FDG PET/CT and extragastric MALT lymphoma: role of Ki-67 score and plasmacytic differentiation.

    PubMed

    Albano, Domenico; Bosio, Giovanni; Giubbini, Raffaele; Bertagna, Francesco

    2017-03-07

    The detection rate of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in extragastric mucosa associated lymphoid tissue (MALT) lymphoma is under debate and the reason is not clear. Our aim was to investigate the metabolic behavior of extragastric MALT lymphoma and whether the histological features (Ki-67 index and plasmacytic differentiation, PD) might explain it. PET/CT images were analyzed visually and semi-quantitatively and compared with Ki-67 index and PD. Seventy-two patients were included. Twelve of 18 patients with PD showed intense 18F-FDG uptake; on the contrary, 42 of 54 patients without PD had positive 18F-FDG PET/CT. Twenty-six of 27 patients with Ki-67 > 15% had 18F-FDG-avid lesions; 28 of 45 patients with Ki-67 ≤ 15% had positive 18F-FDG PET/CT. 18F-FDG avidity was significantly associated with Ki-67 index (p < .001) and not correlated with PD (p = .352). Maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio and lesion-to-blood pool SUVmax ratio were not correlated with Ki-67 index or PD. 18F-FDG avidity was noted in 75% and is correlated only with Ki-67.

  9. A Comparison between 18F-FDG PET/CT Imaging and Biological and Radiological Findings in Restaging of Hepatoblastoma Patients

    PubMed Central

    Treglia, Giorgio; Pagano, Manuela; Fania, Piercarlo; Basso, Maria Eleonora; Fagioli, Franca; Ficola, Umberto

    2013-01-01

    Background. In this study we retrospectively evaluated if 18F-FDG-PET/CT provided incremental diagnostic information over CI in a group of hepatoblastoma patients performing restaging. Procedure. Nine patients (mean age: 5.9 years; range: 3.1–12 years) surgically treated for hepatoblastoma were followed up by clinical examination, serum α-FP monitoring, and US. CI (CT or MRI) and PET/CT were performed in case of suspicion of relapse. Fine-needle aspiration biopsies (FNAB) were carried out for final confirmation if the results of CI, PET/CT, and/or α-FP levels were suggestive of relapse. PET/CT and CI findings were analyzed for comparison purposes, using FNAB as reference standard. Results. α-FP level was suggestive of disease recurrence in 8/9 patients. Biopsy was performed in 8/9 cases. CI and PET/CT resulted to be concordant in 5/9 patients (CI identified recurrence of disease, but 18F-FDG-PET/CT provided a better definition of disease extent); in 4/9 cases, CI diagnostic information resulted in negative findings, whereas PET/CT correctly detected recurrence of disease. 18F-FDG-PET/CT showed an agreement of 100% (8/8) with FNAB results. Conclusions. 18F-FDG-PET/CT scan seems to better assess HB patients with respect to CI and may provide incremental diagnostic value in the restaging of this group of patients. PMID:24063012

  10. Effectiveness of [(124)I]-PET/CT and [(18)F]-FDG-PET/CT for localizing recurrence in patients with differentiated thyroid carcinoma.

    PubMed

    Lee, Jandee; Nah, Kuk Young; Kim, Ra Mi; Oh, Yeon-Ju; An, Young-Sil; Yoon, Joon-Kee; An, Gwang Il; Choi, Tae Hyun; Cheon, Gi Jeong; Soh, Euy-Young; Chung, Woong Youn

    2012-09-01

    Although the prognosis of patients with differentiated thyroid carcinoma (DTC) is generally encouraging, a diagnostic dilemma is posed when an increasing level of serum thyroglobulin (Tg) is noted, without detection of a recurrent tumor using conventional imaging tools such as the iodine-131 whole-body scanning (the [(131)I] scan) or neck ultrasonography (US). The objective of the present study was to evaluate the diagnostic value of [(124)I]-PET/CT and [(18)F]-FDG-PET/CT in terms of accurate detection of both iodine- and non-iodine-avid recurrence, compared with that of conventional imaging such as the [(131)I] scan or neck ultrasonography (US). Between July 2009 and June 2010, we prospectively studied 19 DTC patients with elevated thyroglobulin levels but who do not show pathological lesions when conventional imaging modalities are used. All involved patients had undergone total thyroidectomy and radioiodine (RI) treatment, and who had been followed-up for a mean of 13 months (range, 6-21 months) after the last RI session. Combined [(18)F]-FDG-PET/CT and [(124)I]-PET/CT data were evaluated for detecting recurrent DTC lesions in study patients and compared with those of other radiological and/or cytological investigations. Nine of 19 patients (47.4%) showed pathological [(18)F]-FDG (5/19, 26.3%) or [(124)I]-PET (4/19, 21.1%) uptake, and were classed as true-positives. Among such patients, disease management was modified in six (66.7%) and disease was restaged in seven (77.8%). In particular, the use of the described imaging combination optimized planning of surgical resection to deal with locoregional recurrence in 21.1% (4/19) of patients, who were shown to be disease-free during follow-up after surgery. Our results indicate that combination of [(18)F]-FDG-PET/CT and [(124)I]-PET/CT affords a valuable diagnostic method that can be used to make therapeutic decisions in patients with DTC who are tumor-free on conventional imaging studies but who have high Tg levels.

  11. Fireworks-induced chest wall granulomatous disease: 18F-FDG PET/CT imaging.

    PubMed

    Le, Stephanie T; Nguyen, Ba Duong

    2014-04-01

    The authors present a case of 18F-FDG-avid granulomatous reaction induced by fireworks injury of the chest wall in a patient with esophageal adenocarcinoma. This hypermetabolic lesion, involving the right pectoralis muscles, appeared slightly more prominent on restaging PET/CT imaging following chemotherapy and radiation therapy. Excisional biopsy of the lesion established the diagnosis of foreign-body granulomatous-type inflammation with surrounding foci of non-polarizable black foreign material and ruled out malignancy. The patient recalled accidentally shooting himself in the chest with a Roman candle at the age of 3.

  12. (99m)Tc-DMSA (V) in Evaluation of Osteosarcoma: Comparative Studies with (18)F-FDG PET/CT in Detection of Primary and Malignant Lesions.

    PubMed

    Bandopadhyaya, G P; Gupta, Priyanka; Singh, Archana; Shukla, Jaya; Rastogi, S; Kumar, Rakesh; Malhotra, Arun

    2012-01-01

    To evaluate the role of (99m)Tc-DMSA (V) and [(18)F]FDG PET-CT in management of patients with osteosarcoma, 22 patients were included in our study. All patients underwent both (99m)Tc-DMSA (V) and whole-body [(18)F]FDG PET-CT scans within an interval of 1 week. 555-740 MBq of (99m)Tc-DMSA (V) was injected i.v. the whole-body planar, SPECT images of primary site and chest were performed after 3-4 hours. [(18)F]FDG PET-CT images were obtained 60 minutes after i.v. injection of 370 MBq of F-18 FDG. Both FDG PET-CT (mean SUV(max) = 7.1) and DMSA (V) scans showed abnormal uptake at primary site in all the 22 patients (100% sensitivity for both). Whole-body PET-CT detected metastasis in 11 pts (lung mets in 10 and lung + bone mets in 1 patient). Whole-body planar DMSA (V) and SPECT detected bone metastasis in one patient, lung mets in 7 patients and LN in 1 patient. HRCT of chest confirmed lung mets in 10 patients and inflammatory lesion in one patient. 7 patients positive for mets on DMSA (V) scan had higher uptake in lung lesions as compared to FDG uptake on PET-CT. Three patients who did not show any DMSA uptake had subcentimeter lung nodule. Resuts of both (99m)Tc-DMSA (V) (whole-body planar and SPECT imaging) and [(18)F]FDG PET-CT were comparable in evaluation of primary site lesions and metastatic lesions greater than 1 cm. Though (99m)Tc-DMSA (V) had higher uptake in the lesions as compared to [(18)F]FDG PET-CT, the only advantage [(18)F]FDG PET-CT had was that it could also detect subcentimeter lesions.

  13. Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies.

    PubMed

    Uslu, Lebriz; Donig, Jessica; Link, Michael; Rosenberg, Jarrett; Quon, Andrew; Daldrup-Link, Heike E

    2015-02-01

    Successful management of solid tumors in children requires imaging tests for accurate disease detection, characterization, and treatment monitoring. Technologic developments aim toward the creation of integrated imaging approaches that provide a comprehensive diagnosis with a single visit. These integrated diagnostic tests not only are convenient for young patients but also save direct and indirect health-care costs by streamlining procedures, minimizing hospitalizations, and minimizing lost school or work time for children and their parents. (18)F-FDG PET/CT is a highly sensitive and specific imaging modality for whole-body evaluation of pediatric malignancies. However, recent concerns about ionizing radiation exposure have led to a search for alternative imaging methods, such as whole-body MR imaging and PET/MR. As we develop new approaches for tumor staging, it is important to understand current benchmarks. This review article will synthesize the current literature on (18)F-FDG PET/CT for tumor staging in children, summarizing questions that have been solved and providing an outlook on unsolved avenues.

  14. (18) F-FDG PET/CT vs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors.

    PubMed

    Cheol Park, Gi; Roh, Jong-Lyel; Cho, Kyung-Ja; Seung Kim, Jae; Hyeon Jin, Mi; Choi, Seung-Ho; Yuhl Nam, Soon; Yoon Kim, Sang

    2017-03-15

    Squamous cell carcinoma of unknown primary of the head and neck (SCCUP) is a heterogeneous disease entity that requires careful examination to locate the occult primary. We examined the diagnostic value of expression of biomarkers, such as human papillomavirus (HPV), p16 and Epstein-Barr virus (EBV), in metastatic lymph nodes vs. (18) F-fluorodeoxyglucose ((18) F-FDG) positron emission tomography/computed tomography (PET/CT). We prospectively enrolled 54 consecutive SCCUP patients who received HPV, p16 and EBV analyses of lymph node fine-needle aspirates and (18) F-FDG PET/CT scans and subsequently underwent examinations and biopsies under general anesthesia to detect primary tumors. The diagnostic performance of the biomarkers and (18) F-FDG PET/CT were compared by using receiver operating characteristics (ROC) curve analyses with histopathological results for identification of primary tumors. Primary tumors were identified in 28 (51.9%) of 54 patients: the palatine tonsil in 24, base of the tongue in 1, nasopharynx in 2, and hypopharynx in 1. The sensitivity of p16 (85.7%) and accuracy of HPV (85.2%) were higher than those (42.9% and 68.5%) of (18) F-FDG PET/CT (p < 0.05). The area under the ROC curve of HPV was higher than that of (18) F-FDG PET/CT (0.857 vs. 0.666, p = 0.007). The disease-free survival rates were higher in the patients with primary tumor detection or p16 nodal immunopositivity than in the other patients (p < 0.05). The results showed that HPV and p16 detection in metastatic lymph nodes can help locate hidden primary tumors, guide definitive treatment and predict patient survival.

  15. 18F-FDG PET and PET/CT in diagnosis and treatment monitoring of pyrexia of unknown origin due to tuberculosis with prominent hepatosplenic involvement.

    PubMed

    Shejul, Yogesh; Chhajed, Prashant N; Basu, Sandip

    2014-09-01

    The potential of (18)F-FDG PET/CT in the diagnosis and treatment response monitoring of fever of unknown origin (resulting from hepatosplenic tuberculosis) is demonstrated in this report. The patient was a 32-y-old woman who had presented to us with a history of pyrexia of unknown origin for the past 2 mo. On investigation, she was found to have hepatic and splenic granulomas, with whole-body (18)F-FDG PET demonstrating abnormal (18)F-FDG-avid foci in the liver and spleen. Ultrasonography-guided liver biopsy was suggestive of granulomatous hepatitis. The patient was clinically nonresponsive to first-line antitubercular drugs, and second-line antitubercular medications were added subsequently in view of clinical nonresponse. The patient responded well to the treatment. The repeated CT scan at 11 mo demonstrated persistence of the splenic granulomas; however, follow-up (18)F-FDG PET/CT at the same time showed resolution of (18)F-FDG-concentrating active disease foci with suggestion of complete metabolic response, commensurate with the patient's clinical improvement.

  16. 18F-FDG PET-CT Findings Before and After Laparoscopic Cryoablation of Small Renal Mass: An Initial Report

    PubMed Central

    Sivro, Ferida; van der Zee, Johan A.; Baars, Phillippe C.

    2015-01-01

    The aim of this study was to describe the characteristics of positron emission tomography (PET) molecular imaging combined with low-dose computed tomography (CT) in small renal mass (SRM) treated with cryoablation (CA). Currently, treatment success is defined by the absence of contrast enhancement at CT. However, the use of contrast is relatively contraindicated in patients with renal function impairment, mandating alternative follow-up strategies. Several reasons were identified as criteria for performing PET-CT before and/or after SRM-CA in 9 patients, and the results were retrospectively studied. The histology revealed renal cell carcinoma in 7 patients and oncocytoma in 2 patients. In 6 patients, a PET-CT was performed before and after CA. In one patient, the PET-CT was performed only before CA and in 2 patients only after CA. Before CA, clearly there was metabolic uptake of fluorine-18 fluorodeoxyglucose (18F-FDG) in the SRM in all patients. Following CA, the absence of 18F-FDG uptakes in the SRM could clearly be noticed. However, the tracer cannot always be distinguished from focal recurrence or reactive inflammatory tissue. In one patient, asymptomatic metastatic bone lesions were noticed when performing PET-CT at follow-up. This pilot study with 18F-FDG PET-CT for the follow-up of SRM cryosurgery showed that 18F-FDG PET-CT imaging could be used to characterize cryoablative tissue injury at different times after CA. PMID:28326272

  17. Optimization of oncological {sup 18}F-FDG PET/CT imaging based on a multiparameter analysis

    SciTech Connect

    Menezes, Vinicius O.; D’Errico, Francesco; Namías, Mauro; Larocca, Ticiana F.; Soares, Milena B. P.

    2016-02-15

    Purpose: This paper describes a method to achieve consistent clinical image quality in {sup 18}F-FDG scans accounting for patient habitus, dose regimen, image acquisition, and processing techniques. Methods: Oncological PET/CT scan data for 58 subjects were evaluated retrospectively to derive analytical curves that predict image quality. Patient noise equivalent count rate and coefficient of variation (CV) were used as metrics in their analysis. Optimized acquisition protocols were identified and prospectively applied to 179 subjects. Results: The adoption of different schemes for three body mass ranges (<60 kg, 60–90 kg, >90 kg) allows improved image quality with both point spread function and ordered-subsets expectation maximization-3D reconstruction methods. The application of this methodology showed that CV improved significantly (p < 0.0001) in clinical practice. Conclusions: Consistent oncological PET/CT image quality on a high-performance scanner was achieved from an analysis of the relations existing between dose regimen, patient habitus, acquisition, and processing techniques. The proposed methodology may be used by PET/CT centers to develop protocols to standardize PET/CT imaging procedures and achieve better patient management and cost-effective operations.

  18. Diagnostic Value of (18)F-FDG PET/CT versus MRI in the Setting of Antibody Specific Autoimmune Encephalitis.

    PubMed

    Solnes, Lilja B; Jones, Krystyna M; Rowe, Steven P; Pattanayak, Puskar; Nalluri, Abhinav; Venkatesan, Arun; Probasco, John C; Javadi, Mehrbod Som

    2017-02-16

    Introduction: Diagnosis of autoimmune encephalitis presents some challenges in the clinical setting due to varied clinical presentations and delay in obtaining antibody panel results. We examined the role of neuroimaging in the setting of autoimmune encephalitides comparing the utility (18)F-FDG PET/CT versus conventional brain imaging with MRI. Methods: A retrospective study was performed assessing the positivity rate of MRI versus (18)F-FDG PET/CT during the initial work-up of 23 patients proven to have antibody positive autoimmune encephalitis. (18)F-FDG PET/CT studies were analyzed qualitatively and using Cortex ID (GE Health systems). Areas of cortical lobar hypo (hyper) metabolism in the cerebrum that were 2 standard deviations from the mean were recorded as abnormal. Results: On visual inspection, all patients were identified to have abnormal pattern of (18)F-FDG uptake. In semi-quantitative analysis at least one region of interest with metabolic change was identified in 22/23 (95.6%) patients using discriminating Z-score of 2. Overall, (18)F-FDG PET/CT was more often abnormal during the diagnostic period than MRI (10/23, 43% of patients). The predominant finding on brain (18)F-FDG PET/CT imaging was lobar hypometabolism, being observed in 21/23 (91.3%) of patients. Hypometabolism were most commonly observed in parietal lobe following by occipital lobe. An entire subset of antibody positive patients, anti-NMDAR (5 patients), had normal MRIs and abnormal (18)F-FDG PET/CT while other subsets demonstrated a greater heterogeneity. Conclusion: Brain (18)F-FDG PET/CT may play a significant role in initial evaluation of patients with clinically suspected antibody-mediated autoimmune encephalitis. Given that it is more often abnormal when compared with MRI in the acute setting, this molecular imaging technique may be better positioned as an early biomarker of disease so that treatment may be initiated earlier resulting in improved patient outcomes.

  19. Multiple myeloma: 18F-FDG-PET/CT and diagnostic imaging.

    PubMed

    Mihailovic, Jasna; Goldsmith, Stanley J

    2015-01-01

    Multiple myeloma (MM) is a relatively rare hematologic disorder characterized by proliferation of plasma cells, primarily involving the bone marrow. Extramedullary involvement also occurs with poor prognosis. Asymptomatic plasma cell disorders, monoclonal gammopathy of uncertain significance, and smoldering MM, which do not require therapy, should be distinguished from symptomatic MM, which requires treatment. MM may present with CRAB, elevated Calcium levels, Renal insufficiency, Anemia, and Bone lesions (including lytic lesions and osteopenia), as well as elevated levels of serum M protein or urine M protein or both. Nonsecretory myeloma in which serum and urine M proteins are absent occurs rarely, accounting for 1%-5% of patients with myeloma, but low levels of abnormal immunoglobulins are often present. Staging of patients with MM is done according to the Durie and Salmon criteria based on laboratory testing (determination of hemoglobin, serum calcium, and serum and urine M proteins) and conventional radiography. A variety of diagnostic imaging procedures have been employed to assess the extent of disease in MM and to evaluate the response to treatment as well as provide surveillance for the detection of recurrent disease. These include whole-body x-ray, which despite its limitations is regularly used to detect lytic bone lesions; CT radiography; MRI; and a variety of radionuclide imaging procedures, with (18)F-FDG-PET/CT emerging as the radionuclide procedure of choice. Recently, the Durie-Salmon criteria have been upgrade to the Durie-Salmon PLUS system, which includes (18)F-FDG-PET/CT and MRI of the spine and pelvis.

  20. Homeopathic mistletoe adverse reaction mimics nodal involvement in (18)F-FDG PET/CT performed for evaluation of response to chemotherapy in lymphoma.

    PubMed

    Abreu, P; Sánchez, R; Mut, T; Balaguer, D; Latorre, I; Rodríguez, H

    Some patients use complementary medicine. We present a patient with Hodgkin's lymphoma, scanned with (18)F-FDG PET/CT for evaluation of response after chemotherapy, who was self-administering mistletoe as a homeopathic medicine product. The careful review of the images of the entire scan and patient collaboration in anamnesis were crucial to avoid a false positive result. A review of the published scientific data on the effects of mistletoe is also presented.

  1. (18)F-FDG PET/CT versus bone scintigraphy in the follow-up of gastric cancer.

    PubMed

    Sollini, M; Calabrese, L; Zangheri, B; Erba, P A; Gramaglia, A; Gasparini, M

    2016-01-01

    A 53-year-old patient underwent a positron emission tomography/computed tomography with 2-fluoro-2-deoxy-d-glucose ((18)F-FDG PET/CT) in the suspicious of gastric tumor recurrence (mediastinal and abdominal lymph nodes). PET/CT identified only an area of (18)F-FDGuptake in the twelfth thoracic vertebrae. Unexpectedly, a bone scintigraphy revealed many "hot" spots changing the diagnosis (single metastasis versus plurimetastatic disease) and impacting on patient's management.

  2. Herniation pit mimicking osseous metastasis on 18F-FDG PET/CT in patient with lung cancer.

    PubMed

    Yoo, Su Woong; Song, Ho-Chun; Oh, Jong-Ryool; Kim, Jahae; Kang, Sae-Ryung; Chong, Ari; Byun, Byung Hyun; Hong, Sun-Pyo; Min, Jung-Joon; Bom, Hee-Seung

    2012-07-01

    Herniation pits are small subcortical osseous defects located typically at the proximal anterosuperior quadrant of the femoral neck that are most frequently seen in the young, athletic adult population. We report a case with herniation pit showing focal 18F-FDG uptake on PET/CT images mimicking osseous metastasis in a 69-year-old patient with lung cancer.

  3. Ferret thoracic anatomy by 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (18F-FDG PET/CT) imaging.

    PubMed

    Wu, Albert; Zheng, Huaiyu; Kraenzle, Jennifer; Biller, Ashley; Vanover, Carol D; Proctor, Mary; Sherwood, Leslie; Steffen, Marlene; Ng, Chin; Mollura, Daniel J; Jonsson, Colleen B

    2012-01-01

    The domestic ferret (Mustela putorius furo) has been a long-standing animal model used in the evaluation and treatment of human diseases. Molecular imaging techniques such as 2-deoxy-2-((18)F)fluoro-D-glucose ((18)F-FDG) positron emission tomography (PET) would be an invaluable method of tracking disease in vivo, but this technique has not been reported in the literature. Thus, the aim of this study was to establish baseline imaging characteristics of PET/computed tomography (CT) with (18)F-FDG in the ferret model. Twelve healthy female ferrets were anesthetized and underwent combined PET/CT scanning. After the images were fused, volumes of interest (VOIs) were generated in the liver, heart, thymus, and bilateral lung fields. For each VOI, standardized uptake values (SUVs) were calculated. Additional comparisons were made between radiotracer uptake periods (60, 90, and >90 minutes), intravenous and intraperitoneal injections of (18)F-FDG, and respiratory gated and ungated acquisitions. Pulmonary structures and the surrounding thoracic and upper abdominal anatomy were readily identified on the CT scans of all ferrets and were successfully fused with PET. VOIs were created in various tissues with the following SUV calculations: heart (maximum standardized uptake value [SUV(Max)] 8.60, mean standardized uptake value [SUV(Mean)] 5.42), thymus (SUV(Max) 3.86, SUV(Mean) 2.59), liver (SUV(Max) 1.37, SUV(Mean) 0.99), right lung (SUV(Max) 0.92, SUV(Mean) 0.56), and left lung (SUV(Max) 0.88, SUV(Mean) 0.51). Sixty- to 90-minute uptake periods were sufficient to separate tissues based on background SUV activity. No gross differences in image quality were seen between intraperitoneal and intravenous injections of (18)F-FDG. Respiratory gating also did not have a significant impact on image quality of lung parenchyma. The authors concluded that (18)F-FDG PET and CT imaging can be performed successfully in normal healthy ferrets with the parameters identified in this study. They

  4. Ferret Thoracic Anatomy by 2-Deoxy-2-(18F)Fluoro-D-Glucose (18F-FDG) Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging

    PubMed Central

    Wu, Albert; Zheng, Huaiyu; Kraenzle, Jennifer; Biller, Ashley; Vanover, Carol D.; Proctor, Mary; Sherwood, Leslie; Steffen, Marlene; Ng, Chin; Mollura, Daniel J.; Jonsson, Colleen B.

    2013-01-01

    The domestic ferret (Mustela putorius furo) has been a long-standing animal model used in the evaluation and treatment of human diseases. Molecular imaging techniques such as 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography (PET) would be an invaluable method of tracking disease in vivo, but this technique has not been reported in the literature. Thus, the aim of this study was to establish baseline imaging characteristics of PET/computed tomography (CT) with 18F-FDG in the ferret model. Twelve healthy female ferrets were anesthetized and underwent combined PET/CT scanning. After the images were fused, volumes of interest (VOIs) were generated in the liver, heart, thymus, and bilateral lung fields. For each VOI, standardized uptake values (SUVs) were calculated. Additional comparisons were made between radiotracer uptake periods (60, 90, and >90 minutes), intravenous and intraperitoneal injections of 18F-FDG, and respiratory gated and ungated acquisitions. Pulmonary structures and the surrounding thoracic and upper abdominal anatomy were readily identified on the CT scans of all ferrets and were successfully fused with PET. VOIs were created in various tissues with the following SUV calculations: heart (maximum standardized uptake value [SUVMax] 8.60, mean standardized uptake value [SUVMean] 5.42), thymus (SUVMax 3.86, SUVMean 2.59), liver (SUVMax 1.37, SUVMean 0.99), right lung (SUVMax 0.92, SUVMean 0.56), and left lung (SUVMax 0.88, SUVMean 0.51). Sixty- to 90-minute uptake periods were sufficient to separate tissues based on background SUV activity. No gross differences in image quality were seen between intraperitoneal and intravenous injections of 18F-FDG. Respiratory gating also did not have a significant impact on image quality of lung parenchyma. The authors concluded that 18F-FDG PET and CT imaging can be performed successfully in normal healthy ferrets with the parameters identified in this study. They obtained similar imaging

  5. Central Pontine Myelinolysis and Localized Fluorodeoxyglucose Uptake Seen on 18F-FDG PET/CT

    PubMed Central

    Rønne, Frederik; Tfelt-Hansen, Peer Carsten; Rørdam, Lene

    2017-01-01

    Case report describing the finding of central pontine myelinolysis (CPM) using combined fluorine-18 ( 18F)-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). The patient was a known alcoholic who, during admission was under treatment for hyponatremia, showed a significant decline in both motor and cognitive function. Combined 18F-FDG PET/CT showed localized FDG uptake in the pons, consistent with the finding of CPM observed on magnetic resonance imaging (MRI). CPM is a demyelinating lesion of the pons, resulting in several neurological symptoms. The exact cause of CPM is not clear, but a strong relations between loss of myelin and osmotic stress exists, especially during rapid correction of hyponatremia. The osmotic stress is thought to induce disruption of the blood-brain barrier, allowing access for inflammatory mediators in extravascular brain tissue, which most likely attracts glial cells of the brain, attracts macrophages and activates astocytes. We suggest that metabolism in these activated cells could be responsible for the localized FDG uptake during active CPM. PMID:28217021

  6. Role of 18F-FDG PET/CT in the management of a case of autoimmune pancreatitis with extrapancreatic manifestations.

    PubMed

    Santhosh, Sampath; Bhattacharya, Anish; Harisankar, Chidambaram Natarajan Balasubramanian; Kochhar, Rakesh; Mittal, Bhagwant Rai

    2013-11-01

    Autoimmune pancreatitis and pancreatic cancer share many clinical features like advanced age, painless jaundice, weight loss, and elevated serum levels of CA 19-9. The authors report a 58-year-old male patient provisionally diagnosed with periampullary carcinoma on the basis of ultrasonography and serological markers and planned for Whipple resection. (18)F-FDG PET/CT findings were suggestive of autoimmune pancreatitis, subsequently confirmed on cytological diagnosis. The follow-up PET/CT scan after 1 week of steroid therapy showed regression of FDG uptake in most of the lesions with appearance of salivary gland uptake.

  7. Lymph Node Metastasis from Tall-Cell Thyroid Cancer Negative on 18F-FDG PET/CT and Detected by 18F-Choline PET/CT.

    PubMed

    Piccardo, Arnoldo; Massollo, Michela; Bandelloni, Roberto; Arlandini, Anselmo; Foppiani, Luca

    2015-08-01

    A 77-year-old woman underwent thyroidectomy and (131)I remnant ablation for tall-cell differentiated cancer (DTC) of the left lobe. Detectable Tg levels (4.1 μg/L) under TSH suppression, with undetectable serum Tg-antibody levels, prompted neck ultrasonography, which revealed a lymph node in the left laterocervical region and in the right retroclavicular region. (18)F-FDG PET/CT showed uptake by the left lymph node. (18)F-choline PET/CT showed increased uptake by both lymph nodes. Histopathology revealed DTC solid metastasis in the left lymph node and solid and cystic metastasis in the right one. (18)F-choline PET/CT can locate virulent DTC recurrence, thereby increasing (18)F-FDG PET/CT information.

  8. Radiation exposure to nuclear medicine staffs during 18F-FDG PET/CT procedures at Ramathibodi Hospital

    NASA Astrophysics Data System (ADS)

    Donmoon, T.; Chamroonrat, W.; Tuntawiroon, M.

    2016-03-01

    The aim of this study is to estimate the whole body and finger radiation doses per study received by nuclear medicine staff involved in dispensing, administration of 18F-FDG and interacting with radioactive patients during PET/CT imaging procedures in a PET/CT facility. The whole-body doses received by radiopharmacists, technologists and nurses were measured by electronic dosimeter and the finger doses by ring dosimeter during a period of 4 months. In 70 PET/CT studies, the mean whole-body dose per study to radiopharmacist, technologist, and nurse were 1.07±0.09, 1.77±0.46, μSv, and not detectable respectively. The mean finger doses per study received by radiopharmacist, technologist, and nurse were 265.65±107.55, 4.84±1.08 and 19.22±2.59 μSv, respectively. The average time in contact with 18F-FDG was 5.88±0.03, 39.06±1.89 and 1.21±0.02 minutes per study for radiopharmacist, technologist and nurse respectively. Technologists received highest mean effective whole- body dose per study and radiopharmacist received the highest finger dose per study. When compared with the ICRP dose limit, each individual worker can work with many more 18F- FDG PET/CT studies for a whole year without exceeding the occupational dose limits. This study confirmed that low levels of radiation does are received by our medical personnel involved in 18F-FDG PET/CT procedures.

  9. 18F-FDG PET/CT/MRI Fusion Images Showing Cranial and Peripheral Nerve Involvement in Neurolymphomatosis

    PubMed Central

    Trevisan, Ana Carolina; Ribeiro, Fernanda Borges; Itikawa, Emerson Nobuyuki; Alexandre, Leonardo Santos; Pitella, Felipe Arriva; Santos, Antonio Carlos; Simões, Belinda Pinto; Wichert-Ana, Lauro

    2017-01-01

    We report a 56-year-old female patient with non-Hodgkin's diffuse large B cell lymphoma (NHL) who, on magnetic resonance imaging (MRI) with a T1 weighted and gadolinium-enhanced imaging, was found to have thickening and infiltration in 75% of peripheral nerves of the patient and enlargements of cranial nerves, possibly related to lymphomatous infiltration. Subsequent positron emission tomography/computed tomography (PET/CT) using 18F-labeled 2-deoxy-2-fluoro-d-glucose (18F-FDG) showed widespread active involvement of the cervical plexus, bilateral peripheral nerves, right femoral nerve, the parasellar region of the skull, and marked hypermetabolism in the left trigeminal ganglia. This case re-emphasizes that while CT and MRI provide anatomical details, 18F-FDG PET/CT images better delineate the metabolic activity of neurolymphomatosis (NL) in the peripheral and central nervous system. PMID:28242998

  10. Whole-body staging of female patients with recurrent pelvic malignancies: Ultra-fast 18F-FDG PET/MRI compared to 18F-FDG PET/CT and CT

    PubMed Central

    Sawicki, Lino Morris; Suntharalingam, Saravanabavaan; Grueneisen, Johannes; Ruhlmann, Verena; Aktas, Bahriye; Deuschl, Cornelius; Herrmann, Ken; Antoch, Gerald; Forsting, Michael

    2017-01-01

    Objectives To evaluate the diagnostic feasibility of an ultra-fast 18F-FDG PET/MRI protocol, including T2-w and contrast-enhanced T1-w imaging as well as metabolic assessment (PET) in comparison to 18F-FDG PET/CT and CT for whole-body staging of female patients with suspected recurrence of pelvic malignancies. Methods 43 female patients with suspected tumor recurrence were included in this study. Suspicion was based on clinical follow-up and abnormal findings on imaging follow-up. All patients underwent a PET/CT and a subsequent PET/MRI examination. Two readers were asked to evaluate ultra-fast PET/MRI, PET/CT as well as CT datasets of PET/CT separately for suspect lesions regarding lesion count, lesion localization and lesion characterization. Statistical analyses were performed both, on a per-patient and a per-lesion basis. Results Tumor relapse was present in 38 of the 43 patients. Based on CT readings 25/38 tumor relapses were correctly identified. PET/CT enabled correct identification of 37/38 patients, PET/MRI correctly identified 36 of the 38 patients with recurrent cancer. On a lesion-based analysis PET/MRI enabled the correct detection of more lesions, comprising a lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 50%, 58%, 76%, 31%, and 53% for CT, 97%, 83%, 93%, 94%, and 92% for PET/CT and 98%, 83%, 94%, 94%, and 94% for PET/MRI, respectively. Mean scan duration of ultra-fast PET/MRI, PET/CT and whole-body CT amounted to 18.5 ± 1 minutes, 18.2 ± 1 minutes and 3.5 minutes, respectively. Conclusion Ultra-fast PET/MRI provides equivalent diagnostic performance and examination time when compared to PET/CT and superior diagnostic performance to CT in restaging female patients suspected to have recurrent pelvic cancer. PMID:28225831

  11. 18F-FDG PET/CT can predict survival of advanced hepatocellular carcinoma patients: A multicenter retrospective cohort study.

    PubMed

    Na, Sae Jung; Oh, Jin Kyoung; Hyun, Seung Hyup; Lee, Jeong Won; Hong, Il Ki; Song, Bong-Il; Kim, Tae-Sung; Eo, Jae Seon; Lee, Sung Won; Yoo, Ie Ryung; Chung, Yong An; Yun, Mijin

    2016-10-27

    Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) consists of a heterogeneous group of patients with a wide range of survival times, requiring further prognostic stratification to facilitate treament allocation. We evaluated the prognostic value of (18)F-flurodeoxyglucose ((18)F-FDG) uptake on positron emission tomography/computed tomography (PET/CT) at the time of presentation in patients with BCLC stage C HCC.

  12. [Findings of the (18)F-FDG PET-CT in a cardiac angiosarcoma complicated by a cardiac rupture].

    PubMed

    Santiago-Chinchilla, Alicia; Ruiz-Carazo, Eduardo; Moral-Ruiz, Antonio; Testart Dardel, Nathalie; Martínez-Martínez, Alberto; López-Fernández, Silvia

    2014-01-01

    Primary malignant tumors of the heart are a rare condition. The most common type is the cardiac angiosarcoma. The symptoms of this disease are very nonspecific and can be very difficult to diagnose by conventional imaging techniques. We report the case of a male patient with cardiac angiosarcoma who also had a rare complication, this being cardiac rupture, which required the use of (18)F-FDG PET-CT to demonstrate the mass malignancy and to reach a definitive diagnosis.

  13. 18F-FDG PET/CT in suspected recurrences of epithelial malignant pleural mesothelioma in asbestos-fibers-exposed patients (comparison to standard diagnostic follow-up).

    PubMed

    Niccoli-Asabella, Artor; Notaristefano, Antonio; Rubini, Domenico; Altini, Corinna; Ferrari, Cristina; Merenda, Nunzio; Fanelli, Margherita; Rubini, Giuseppe

    2013-01-01

    This retrospective study evaluated the role of 18-fluorine-labeled 2-deoxy-2-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with previous occupational or environmental exposure to asbestos, with histopathological diagnosis of epithelial malignant pleural mesothelioma and suspected recurrences, comparing the data from 18F-FDG PET/CT and computed tomography with contrast enhancement (CECT). 18F-FDG PET/CT has greater sensitivity than CECT in identifying local extent, lymph nodes, and metastasis. 18F-FDG PET/CT whole-body explorations are useful to monitor the follow-up and evaluate the metabolic response to chemo- and radiotherapy, modifying the scheduled treatment plan.

  14. Asymmetric (99m)Tc-MDP uptake in mineralized tendons might mimic bone lesions: heterotopic tendon mineralization on a (99m)Tc-MDP bone scan and a (18)F-FDG PET/CT scan.

    PubMed

    Chen, Yu-Ren; Hsieh, Te-Chun; Yen, Kuo-Yang; Shen, Yeh-You; Kao, Chia-Hung

    2014-05-01

    A 55-year-old man was a hepatocellular carcinoma patient, diagnosed by sonography and a biopsy. Because of his musculoskeletal tenderness, a bone scan was performed to exclude skeletal metastasis. A subsequent F-FDG PET/CT scan revealed that the unilateral abnormal uptake seen on the bone scan was actually a mineralized tendon. A mineralized tendon is easily detectable using Tc-MDP; therefore, it is imperative to differentiate between bone lesions and mineralized tendons. In addition, few studies have reported F-FDG uptake in a calcified tendon.

  15. IgG4-Related Tubulointerstitial Nephritis Pattern in 18F-FDG PET/CT.

    PubMed

    Bélissant, Ophélie; Guernou, Mohamed; Rouvier, Philippe; Compain, Caroline; Bonardel, Gérald

    2015-10-01

    A 17-year-old adolescent girl was admitted with chronic arthralgia, Raynaud phenomenon, pericarditis, and evidences of chronic diffuse inflammation. F-FDG PET/CT scan was performed to search systemic vasculitis and showed diffuse moderate uptake in the kidneys. We suggested the existence of a nephritis, but the ultrasonography result was normal, and no treatment was introduced. Another F-FDG PET/CT scan was performed 7 months later to explore abdominal pain. It showed again diffuse intense uptake in both kidneys. A proteinuria was highlighted, and renal biopsy allowed to diagnose IgG4-related disease.

  16. Evaluation of Spleen Glucose Metabolism Using (18)F-FDG PET/CT in Patients with Febrile Autoimmune Disease.

    PubMed

    Ahn, Sung Soo; Hwang, Sang Hyun; Jung, Seung Min; Lee, Sang-Won; Park, Yong-Beom; Yun, Mijin; Song, Jason Jungsik

    2017-03-01

    The purpose of this study was to evaluate the clinical significance of (18)F-FDG uptake by the spleen in patients with autoimmune disease. Methods: We retrospectively reviewed Severance Hospital's electronic medical records of patients hospitalized for the evaluation of fever who underwent (18)F-FDG PET/CT. We found 91 patients with autoimmune diseases and 101 patients with localized infection. (18)F-FDG uptake was assessed by measuring SUV in the spleen and liver. The spleen-to-liver ratio of the SUVmean (SLRmean) was calculated. Clinical and laboratory parameters were collected and evaluated for association with SLRmean In-hospital mortality was defined as all-cause mortality during hospital admission for fever. Results: SLRmean was significantly higher in autoimmune disease than in localized infectious disease (1.28 ± 0.43 vs. 0.91 ± 0.21, P < 0.001). In autoimmune disease, SLRmean was correlated with monocytes, aspartate aminotransferase, alanine aminotransferase, albumin, and ferritin. Analysis of receiver-operating-characteristic curves revealed that in comparison with laboratory parameters, SLRmean had the highest performance in differentiating autoimmune from localized infectious disease. Multivariate logistic regression analysis demonstrated that high SLRmean and low platelets were significantly associated with in-hospital mortality in febrile autoimmune disease. Conclusion: These findings suggest that spleen glucose metabolism is increased in febrile autoimmune disease. Spleen (18)F-FDG uptake may provide information useful in differentiating febrile autoimmune disease from localized infectious disease and predicting clinical outcomes in febrile autoimmune disease.

  17. [68Ga]Pentixafor-PET/CT for imaging of chemokine receptor CXCR4 expression in multiple myeloma - Comparison to [18F]FDG and laboratory values

    PubMed Central

    Lapa, Constantin; Schreder, Martin; Schirbel, Andreas; Samnick, Samuel; Kortüm, Klaus Martin; Herrmann, Ken; Kropf, Saskia; Einsele, Herrmann; Buck, Andreas K.; Wester, Hans-Jürgen; Knop, Stefan; Lückerath, Katharina

    2017-01-01

    Chemokine (C-X-C motif) receptor 4 (CXCR4) is a key factor for tumor growth and metastasis in several types of human cancer including multiple myeloma (MM). Proof-of-concept of CXCR4-directed radionuclide therapy in MM has recently been reported. This study assessed the diagnostic performance of the CXCR4-directed radiotracer [68Ga]Pentixafor in MM and a potential role for stratifying patients to CXCR4-directed therapies. Thirty-five patients with MM underwent [68Ga]Pentixafor-PET/CT for evaluation of eligibility for endoradiotherapy. In 19/35 cases, [18F]FDG-PET/CT for correlation was available. Scans were compared on a patient and on a lesion basis. Tracer uptake was correlated with standard clinical parameters of disease activity. [68Ga]Pentixafor-PET detected CXCR4-positive disease in 23/35 subjects (66%). CXCR4-positivity at PET was independent from myeloma subtypes, cytogenetics or any serological parameters and turned out as a negative prognostic factor. In the 19 patients in whom a comparison to [18F]FDG was available, [68Ga]Pentixafor-PET detected more lesions in 4/19 (21%) subjects, [18F]FDG proved superior in 7/19 (37%). In the remaining 8/19 (42%) patients, both tracers detected an equal number of lesions. [18F]FDG-PET positivity correlated with [68Ga]Pentixafor-PET positivity (p=0.018). [68Ga]Pentixafor-PET provides further evidence that CXCR4 expression frequently occurs in advanced multiple myeloma, representing a negative prognostic factor and a potential target for myeloma specific treatment. However, selecting patients for CXCR4 directed therapies and prognostic stratification seem to be more relevant clinical applications for this novel imaging modality, rather than diagnostic imaging of myeloma. PMID:28042328

  18. Febrile syndrome of unknown origin: Indications for (18)F-FDG PET/CT in inflammatory and infectious processes.

    PubMed

    García, J R

    2016-09-23

    Fever of unknown origin is defined as a body temperature greater than 38.3°C lasting more than three weeks for which the cause could not be found within one week of hospital admission. More than 200 causes have been reported, and these can be classified into four categories: infections, inflammatory diseases, oncologic processes, and miscellaneous conditions. Noninvasive diagnostic techniques are used in 69.2% of cases and invasive techniques in 30.8%. Structural imaging techniques show the morphological changes from infectious, inflammatory, and tumor-related processes, but they do not allow the detection of the early changes brought about by these processes. The metabolic information provided by (18)F-FDG PET/CT has a promising role in these patients. (18)F-FDG uptake is based on the cells' use of glucose as a source of energy, so it can be observed in infectious, inflammatory, and tumor-related processes. The established non-oncologic indications for (18)F-FDG PET/CT are sarcoidosis, osteomyelitis, spondylodiscitis, fever of unknown origin, and vasculitis, which together account for more than 85% of studies.

  19. (18)F-FDG PET/CT and functional MRI in a case of crossed logopenic primary progressive aphasia.

    PubMed

    Cabrera-Martín, M N; Matías-Guiu, J A; Yus-Fuertes, M; Valles-Salgado, M; Moreno-Ramos, T; Matías-Guiu, J; Carreras Delgado, J L

    Primary progressive aphasia is a clinical syndrome caused by a neurodegeneration of areas and neural networks involved in language, usually in the left hemisphere. The term "crossed aphasia" denotes an acquired language dysfunction caused by a lesion in the hemisphere ipsilateral to the dominant hand. A case is presented on a 75-year-old right-handed woman with a logopenic variant of primary progressive aphasia with word-finding difficulties of 2 years onset. The (18)F-FDG PET/CT showed right temporoparietal hypometabolism. A functional MRI scan was performed during a verb naming task in order to characterise language lateralisation patterns. A similar activation pattern was observed in both hemispheres, with less activation than expected in bilateral inferior frontal gyrus. These findings support that logopenic variant of primary progressive aphasia should not be considered as a neurodegeneration starting in the left brain hemisphere, but as a syndrome characterised by asymmetric neurodegeneration of brain regions and neural networks involved in language.

  20. Estimation of patient radiation dose from whole body 18F- FDG PET/CT examination in cancer imaging: a preliminary study

    NASA Astrophysics Data System (ADS)

    Mahmud, M. H.; Nordin, A. J.; Saad, F. F. Ahmad; Fattah Azman, A. Z.

    2014-11-01

    This study aims to estimate the radiation effective dose resulting from whole body fluorine-18 flourodeoxyglucose Positron Emission Tomography (18F-FDG PET) scanning as compared to conservative Computed Tomography (CT) techniques in evaluating oncology patients. We reviewed 19 oncology patients who underwent 18F-FDG PET/CT at our centre for cancer staging. Internal and external doses were estimated using radioactivity of injected FDG and volume CT Dose Index (CTDIvol), respectively with employment of the published and modified dose coefficients. The median differences of dose among the conservative CT and PET protocols were determined using Kruskal Wallis test with p < 0.05 considered as significant. The median (interquartile range, IQR) effective doses of non-contrasted CT, contrasted CT and PET scanning protocols were 7.50 (9.35) mSv, 9.76 (3.67) mSv and 6.30 (1.20) mSv, respectively, resulting in the total dose of 21.46 (8.58) mSv. Statistically significant difference was observed in the median effective dose between the three protocols (p < 0.01). The effective doses of whole body 18F-FDG PET technique may be effective the lowest amongst the conventional CT imaging techniques.

  1. The diagnostic value of [18F]-FDG-PET/CT in hematopoietic radiation toxicity: a Tibet minipig model

    PubMed Central

    Chen, Chi; Yan, Li-Meng; Guo, Kun-Yuan; Wang, Yu-Jue; Zou, Fei; Gu, Wei-Wang; Tang, Hua; Li, Yan-Ling; Wu, Shao-Jie

    2012-01-01

    This study was undertaken to assess the diagnostic value of 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography with computed tomography ([18F]-FDG-PET/CT) in the detection of radiation toxicity in normal bone marrow using Tibet minipigs as a model. Eighteen Tibet minipigs were caged in aseptic rooms and randomly divided into six groups. Five groups (n = 3/group) were irradiated with single doses of 2, 5, 8, 11 and 14 Gy of total body irradiation (TBI) using an 8-MV X-ray linear accelerator. These pigs were evaluated with [18F]-FDG-PET/CT, and their marrow nucleated cells were counted. The data were initially collected at 6, 24 and 72 h after treatment and were then collected on Days 5–60 post-TBI at 5-day intervals. At 24 and 72 h post-TBI, marrow standardized uptake value (SUV) data showed a dose-dependent decrease in the radiation dose range from 2–8 Gy. Upon long-term observation, SUV and marrow nucleated cell number in the 11-Gy and 14-Gy groups showed a continuous and marked reduction throughout the entire time course, while Kaplan–Meier curves of survival showed low survival. In contrast, the SUVs in the 2-, 5- and 8-Gy groups showed early transient increases followed by a decline from approximately 72 h through Days 5–15 and then normalized or maintained low levels through the endpoint; marrow nucleated cell number and survival curves showed approximately the same trend and higher survival, respectively. Our findings suggest that [18F]-FDG-PET/CT may be helpful in quickly assessing the absorbed doses and predicting the prognosis in patients. PMID:22843618

  2. 68Ga-DOTATOC PET/CT in Patients with Iodine- and 18F-FDG-Negative Differentiated Thyroid Carcinoma and Elevated Serum Thyroglobulin.

    PubMed

    Binse, Ina; Poeppel, Thorsten D; Ruhlmann, Marcus; Ezziddin, Samer; Görges, Rainer; Sabet, Amir; Beiderwellen, Karsten; Bockisch, Andreas; Rosenbaum-Krumme, Sandra J

    2016-10-01

    This study evaluated the impact of (68)Ga-DOTATOC PET/CT in detecting recurrence or metastases in differentiated thyroid carcinoma (DTC) patients with elevated serum thyroglobulin and both negative radioiodine imaging and negative (18)F-FDG PET/CT.

  3. Adrenal cryptococcosis in an immunosuppressed patient showing intensely increased metabolic activity on (18)F-FDG PET/CT.

    PubMed

    Papadakis, Georgios Z; Holland, Steven M; Quezado, Martha; Patronas, Nicholas J

    2016-12-01

    Disseminated cryptococcosis most commonly occurs in immunosuppressed patients and can rarely affect the adrenal glands. We report on a patient with biopsy proven bilateral adrenal cryptococcosis resulting in primary adrenal insufficiency, which was evaluated with whole-body positron emission tomography/computed tomography scan using (18)F-FDG. Both enlarged adrenal glands presented intensely increased (18)F-FDG activity in the periphery, while central necrotic regions were photopenic. Although diagnosis was established by adrenal gland biopsy, (18)F-FDG positron emission tomography/computed tomography scan can significantly contribute to the assessment of disease activity and monitoring of treatment response. Furthermore, fungal infections should always be considered when encountering hypermetabolic adrenal masses, especially in the setting of immunodeficient patients.

  4. A case of gouty arthritis to tophi on 18F-FDG PET/CT imaging.

    PubMed

    Ito, Kimiteru; Minamimoto, Ryogo; Morooka, Miyako; Kubota, Kazuo

    2012-06-01

    We report a case of gouty arthritis with tophi that was evaluated using 18F-fluorodeoxyglucose (FDG) positron emission tomography. A 77-year-old man with a history of gouty attacks was admitted with severe polyarticular pain and fever. 18F-FDG positron emission tomography/CT demonstrated focal uptake at multiple joints, including the juxta-articular soft-tissue-density masses of the elbows, and the bases of bilateral large toes. Gouty arthritis should be considered with focal 18F-FDG uptake in juxta-articular soft-tissue-density masses (tophi) with or without associated erosions.

  5. (18)F-FDG PET/CT in bilateral primary adrenal T-cell lymphoma.

    PubMed

    Santhosh, Sampath; Mittal, Bhagwant Rai; Shankar, Praveen; Kashyap, Raghava; Bhattacharya, Anish; Singh, Baljinder; Das, Ashim; Bhansali, Anil

    2011-01-01

    Primary adrenal lymphoma is extremely rare. We report a young patient who presented with non- specific symptoms of fever and abdominal pain. Conventional imaging modalities demonstrated bilateral bulky adrenal masses, and whole-body fluorine-18-fluorodesoxyglucose ((18)F-FDG) positron emission tomography/computed tomography showed intense (18)F-FDG-avid bilateral adrenal masses with no evidence of extra-adrenal spread. A pathological diagnosis of non-Hodgkin lymphoma of peripheral T-cell type was made. The present case indicates that primary adrenal lymphoma should be included in the differential diagnosis of bilateral adrenal masses.

  6. Neurolymphomatosis as a late relapse of non-Hodgkin's lymphoma detected by 18F-FDG PET/CT: a case report.

    PubMed

    Kajáry, K; Molnár, Z; Mikó, I; Barsi, P; Lengyel, Z; Szakáll, S

    2014-01-01

    Neurolymphomatosis is a rare condition defined as an infiltration of nerves, nerve roots or nervous plexuses by haematological malignancy. Its diagnosis may sometimes be difficult with conventional imaging techniques. This paper aims to emphasize the importance of this entity and the role of (18)F-FDG PET/CT in this indication. We present the case of a 53-year-old male who complained of sharp pain in his right hip and right leg paresthesia after 2 years of complete remission from Non-Hodgkin's lymphoma. Physical examination and CT scan were negative and the lumbar MRI showed protrusion of L5-S1 disc. Physiotherapy, nonsteroid antiinflammatory drugs and steroids were inefficient. PET/CT was performed four months after the onset of the symptoms, revealing focal FDG uptake in the right S1 nerve root and linear FDG uptake along the right sacral plexus suggesting relapse. This was confirmed by histology.

  7. Summary of the UPICT Protocol for 18F-FDG PET/CT Imaging in Oncology Clinical Trials

    PubMed Central

    Graham, Michael M.; Wahl, Richard L.; Hoffman, John M.; Yap, Jeffrey T.; Sunderland, John J.; Boellaard, Ronald; Perlman, Eric S.; Kinahan, Paul E.; Christian, Paul E.; Hoekstra, Otto S.; Dorfman, Gary S.

    2015-01-01

    The Uniform Protocols for Imaging in Clinical Trials (UPICT) 18F-FDG PET/CT protocol is intended to guide the performance of whole-body FDG PET/CT studies within the context of single- and multiple-center clinical trials of oncologic therapies by providing acceptable (minimum), target, and ideal standards for all phases of imaging. The aim is to minimize variability in intra- and intersubject, intra- and inter-platform, interexamination, and interinstitutional primary or derived data. The goal of this condensed version of the much larger document is to make readers aware of the general content and subject area. The document has several main subjects: context of the imaging protocol within the clinical trial; site selection, qualification, and training; subject scheduling; subject preparation; imaging-related substance preparation and administration; imaging procedure; image postprocessing; image analysis; image interpretation; archiving and distribution of data; quality control; and imaging-associated risks and risk management. PMID:25883122

  8. Summary of the UPICT Protocol for 18F-FDG PET/CT Imaging in Oncology Clinical Trials.

    PubMed

    Graham, Michael M; Wahl, Richard L; Hoffman, John M; Yap, Jeffrey T; Sunderland, John J; Boellaard, Ronald; Perlman, Eric S; Kinahan, Paul E; Christian, Paul E; Hoekstra, Otto S; Dorfman, Gary S

    2015-06-01

    The Uniform Protocols for Imaging in Clinical Trials (UPICT) (18)F-FDG PET/CT protocol is intended to guide the performance of whole-body FDG PET/CT studies within the context of single- and multiple-center clinical trials of oncologic therapies by providing acceptable (minimum), target, and ideal standards for all phases of imaging. The aim is to minimize variability in intra- and intersubject, intra- and interplatform, interexamination, and interinstitutional primary or derived data. The goal of this condensed version of the much larger document is to make readers aware of the general content and subject area. The document has several main subjects: context of the imaging protocol within the clinical trial; site selection, qualification, and training; subject scheduling; subject preparation; imaging-related substance preparation and administration; imaging procedure; image postprocessing; image analysis; image interpretation; archiving and distribution of data; quality control; and imaging-associated risks and risk management.

  9. Prognostic value of 18F-FDG PET-CT-based functional parameters in patients with soft tissue sarcoma

    PubMed Central

    Chen, Linyan; Wu, Xin; Ma, Xuelei; Guo, Linghong; Zhu, Chenjing; Li, Qingfang

    2017-01-01

    Abstract Background: Considering the clinical importance of high 5-year mortality, we performed a meta-analysis of maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) from 18F-FDG PET-CT for overall survival (OS) and progression-free survival (PFS) in patients with soft tissue sarcoma. Methods: The search and selection of eligible articles was conducted on PubMed and EMBASE. We applied hazard ratio (HR) and odd ratio (OR) to measure the correlation between SUVmax, MTV, and TLG with PFS and OS. The SUVmax was analyzed through subgroup in terms of histological grade and HR of posttreatment SUVmax was also assessed. Results: Eleven studies with 582 patients were included. The pooled HRs of pretreatment SUVmax were 2.40 (95% CI: 1.38–4.17) for OS and 2.20 (95% CI: 1.47–3.30) for PFS. The HRs in terms of OS were 3.20 (95% CI: 1.71–5.98) based on MTV and 5.20 (95% CI: 2.34–11.56) based on TLG. Meanwhile, the predict results of pretreatment SUVmax on OR remained significant and the HRs of posttreatment SUVmax were 2.25 (95% CI: 1.33–3.80) for OS and 2.87 (95% CI: 1.81–4.55) for PFS. Conclusions: The pretreatment SUVmax, MTV, and TLG of 18F-FDG PET-CT showed significant prognostic value for OS and the PET-CT can be used in identifying high-risk patients about progression and survival. The analysis for posttreatment SUVmax suggested PET-CT as a promising equipment in monitoring therapy response. PMID:28178131

  10. 18F-FDG PET/CT for Monitoring Treatment Responses to the Epidermal Growth Factor Receptor Inhibitor Erlotinib

    PubMed Central

    Walter, Franziska; Garon, Edward B.; Reckamp, Karen L.; Figlin, Robert; Phelps, Michael E.; Weber, Wolfgang A.; Czernin, Johannes; Allen-Auerbach, Martin S.

    2016-01-01

    Response rates of unselected non–small cell lung cancer (NSCLC) patients to the epidermal growth factor receptor inhibitor erlotinib are low and range from 10% to 20%. Early response assessments are needed to avoid costs and side effects of inefficient treatments. Here we determined whether early changes in tumor uptake of 18F-FDG can predict progression-free and overall survival in NSCLC patients who are treated with erlotinib. Methods Twenty-two patients (6 men, 16 women; mean age ± SD, 64 ± 13 y) with stage III or stage IV NSCLC who received erlotinib treatment were enrolled prospectively. 18F-FDG PET/CT was performed before the initiation of treatment (n = 22), after 2 wk (n = 22), and after 78 ± 21 d (n = 11). Tumor maximum standardized uptake values were measured for a maximum of 5 lesions for each patient. Tumor responses were classified using modified PET Response Criteria in Solid Tumors (use of maximum standardized uptake values). Median overall survival by Kaplan–Meier analysis was compared between groups using a log-rank test. Results The overall median time to progression was 52 d (95% confidence interval, 47–57 d). The overall median survival time was 131 d (95% confidence interval, 0–351 d). Patients with progressive metabolic disease on early follow-up PET showed a significantly shorter time to progression (47 vs. 119 d; P < 0.001) and overall survival (87 vs. 828 d; P = 0.01) than patients classified as having stable metabolic disease or partial or complete metabolic response. Conclusion These data suggest that 18F-FDG PET/CT performed early after the start of erlotinib treatment can help to identify patients who benefit from this targeted therapy. PMID:22045706

  11. (18)F-FDG PET/CT quantification in head and neck squamous cell cancer: principles, technical issues and clinical applications.

    PubMed

    Manca, Gianpiero; Vanzi, Eleonora; Rubello, Domenico; Giammarile, Francesco; Grassetto, Gaia; Wong, Ka Kit; Perkins, Alan C; Colletti, Patrick M; Volterrani, Duccio

    2016-07-01

    (18)F-FDG PET/CT plays a crucial role in the diagnosis and management of patients with head and neck squamous cell cancer (HNSCC). The major clinical applications of this method include diagnosing an unknown primary tumour, identifying regional lymph node involvement and distant metastases, and providing prognostic information. (18)F-FDG PET/CT is also used for precise delineation of the tumour volume for radiation therapy planning and dose painting, and for treatment response monitoring, by detecting residual or recurrent disease. Most of these applications would benefit from a quantitative approach to the disease, but the quantitative capability of (18)F-FDG PET/CT is still underused in HNSCC. Innovations in PET/CT technology promise to overcome the issues that until now have hindered the employment of dynamic procedures in clinical practice and have limited "quantification" to the evaluation of standardized uptake values (SUV), de facto a semiquantitative parameter, the limits of which are well known to the nuclear medicine community. In this paper the principles of quantitative imaging and the related technical issues are reviewed so that professionals involved in HNSCC management can reflect on the advantages of "true" quantification. A discussion is then presented on how semiquantitative information is currently used in clinical (18)F-FDG PET/CT applications in HNSCC, by discussing the improvements that could be obtained with more advanced and "personalized" quantification techniques.

  12. Benign hormone-secreting adenoma within a larger adrenocortical mass showing intensely increased activity on (18)F-FDG PET/CT.

    PubMed

    Papadakis, Georgios Z; Millo, Corina; Stratakis, Constantine A

    2016-10-01

    Adrenal adenomas usually show (18)F-FDG activity less than that of the liver parenchyma. However, lipid-poor and hormone-secreting adenomas have been reported to show mild (18)F-FDG avidity. We report on a 51-year-old female with clinical symptoms of hypercortisolemia and a large right adrenal mass detected on CT. Post-contrast CT images showed an enhancing focus in the lower pole of the mass, with corresponding markedly increased activity on (18)F-FDG PET/CT. Right adrenalectomy was performed and histology revealed a benign adenoma, indicating that functioning benign adenomas can show intensely increased metabolic activity on (18)F-FDG mimicking malignancy.

  13. 18F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer

    PubMed Central

    Avril, Stefanie; Muzic, Raymond F.; Plecha, Donna; Traughber, Bryan J.; Vinayak, Shaveta; Avril, Norbert

    2016-01-01

    Changes in tumor metabolic activity have been shown to be an early indicator of treatment effectiveness for breast cancer, mainly in the neoadjuvant setting. The histopathologic response at the completion of chemotherapy has been used as the reference standard for assessment of the accuracy of 18F-FDG PET in predicting a response during systemic treatment. Although a pathologic complete response (pCR) remains an important positive prognostic factor for an individual patient, a recent metaanalysis could validate pCR as a surrogate marker for patient outcomes only in aggressive breast cancer subtypes. For establishment of the clinical application of metabolic treatment response studies, larger series of specific breast cancer subtypes—including hormone receptor–positive, human epidermal growth factor receptor 2–positive, and triple-negative breast cancers—are necessary. In addition, thresholds for relative changes in 18F-FDG uptake to distinguish between responding and nonresponding tumors need to be validated for different systemic treatment approaches, with progression-free survival and overall survival as references. A PET-based treatment stratification is applicable clinically only if valid alternative therapies are available. Of note, patients who do not achieve a pCR might still benefit from neoadjuvant therapy enabling breast-conserving surgery. In the metastatic setting, residual tumor metabolic activity after the initiation of systemic therapy is an indicator of active disease, whereas a complete resolution of metabolic activity is predictive of a successful treatment response. PMID:26834099

  14. Unusual Horner's Syndrome in Recurrent Breast Cancer: Evaluation Using (18)F-FDG PET/CT.

    PubMed

    Park, Sohyun; Kim, Tae Sung; Kim, Seok-Ki

    2017-03-01

    (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a widely used imaging modality in the initial diagnosis of cancer, treatment response evaluation and detection of recurrence. Herein, we present the case of a 39-year-old female who presented right ptosis on the follow-up of breast cancer after surgery. Clinicians suspected Horner's syndrome, and the patient underwent FDG PET/CT for the evaluation of recurrence that could cause Horner's syndrome. FDG PET/CT demonstrated a focal hypermetabolic lesion in the right cervicothoracic junction area, corresponding to the preganglionic cervical sympathetic trunk. A subsequent needle biopsy was done, and the lesion was confirmed as metastatic ductal carcinoma. In this case, we could detect the exact location of the recurring lesion that caused Horner's syndrome using FDG PET/CT.

  15. Is integrated 18F-FDG PET/MRI superior to 18F-FDG PET/CT in the differentiation of incidental tracer uptake in the head and neck area?

    PubMed Central

    Schaarschmidt, Benedikt Michael; Gomez, Benedikt; Buchbender, Christian; Grueneisen, Johannes; Nensa, Felix; Sawicki, Lino Morris; Ruhlmann, Verena; Wetter, Axel; Antoch, Gerald; Heusch, Philipp

    2017-01-01

    PURPOSE We aimed to investigate the accuracy of 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) compared with contrast-enhanced 18F-FDG PET/computed tomography (PET/CT) for the characterization of incidental tracer uptake in examinations of the head and neck. METHODS A retrospective analysis of 81 oncologic patients who underwent contrast-enhanced 18F-FDG PET/CT and subsequent PET/MRI was performed by two readers for incidental tracer uptake. In a consensus reading, discrepancies were resolved. Each finding was either characterized as most likely benign, most likely malignant, or indeterminate. Using all available clinical information including results from histopathologic sampling and follow-up examinations, an expert reader classified each finding as benign or malignant. McNemar’s test was used to compare the performance of both imaging modalities in characterizing incidental tracer uptake. RESULTS Forty-six lesions were detected by both modalities. On PET/CT, 27 lesions were classified as most likely benign, one as most likely malignant, and 18 as indeterminate; on PET/MRI, 31 lesions were classified as most likely benign, one lesion as most likely malignant, and 14 as indeterminate. Forty-three lesions were benign and one lesion was malignant according to the reference standard. In two lesions, a definite diagnosis was not possible. McNemar’s test detected no differences concerning the correct classification of incidental tracer uptake between PET/CT and PET/MRI (P = 0.125). CONCLUSION In examinations of the head and neck area, incidental tracer uptake cannot be classified more accurately by PET/MRI than by PET/CT. PMID:28089955

  16. Conjunctival Melanoma on 18F-FDG PET/CT as a Second Primary Cancer.

    PubMed

    Tsai, Szu-Ying; Shiau, Yu-Chien; Wang, Shan-Ying; Wu, Yen-Wen

    2016-03-01

    Herein we present the F-FDG PET/CT findings in conjunctival melanoma as a second primary cancer in a 56-year-old Taiwanese man with a history of small lymphocytic lymphoma/chronic lymphocytic leukemia and nasal cavity carcinoma under remission. The right eye lesion slowly progressed since noted by the patient himself 2 years ago, but he refused biopsy and further treatment including surgery. Either small lymphocytic lymphoma/chronic lymphocytic leukemia or conjunctival melanoma is extremely rare in Asians, left alone in combination with a third malignancy of nasal cavity carcinoma. FDG PET/CT could effectively evaluate malignancies with multiple primary origins.

  17. 18F-FDG PET/CT diagnosis of vagus nerve neurolymphomatosis.

    PubMed

    Tsang, Hailey Hoi Ching; Lee, Elaine Yuen Phin; Anthony, Marina-Portia; Khong, Pek-Lan

    2012-09-01

    A 62-year-old woman was in remission from previously treated stage IV diffuse large B-cell lymphoma with cranial involvement. She presented with new-onset hoarseness of voice and choking; MRI of the brain showed disease recurrence in the left cavernous sinus. She was subsequently referred for F-FDG PET/CT with contrast for further evaluation of lymphomatous recurrence. F-FDG PET/CT not only revealed hypermetabolic activity in the left cavernous sinus correlating to the MRI findings but also showed an interesting manifestation explaining the patient's hoarseness of voice, being neurolymphomatosis along the left vagus nerve.

  18. Pulmonary Artery Sarcoma Detected on 18F-FDG PET/CT With Unusual Findings.

    PubMed

    Guo, Yuehong; Wang, Tie; Yang, Minfu

    2015-11-01

    A 32-year-old woman, who presented with "sharp pain" in the right chest for more than 1 month and worsening dyspnea and fever for 10 days, was initially thought to have a pulmonary embolism. Cardiac ultrasound showed an ill-defined echogenic mass within the pulmonary trunk. F-FDG PET/CT was performed for further evaluation. PET/CT showed an intense hypermetabolism in the main, bilateral proximal, and the right main pulmonary arteries, suggesting the presence of a malignant lesion. Biopsy confirmed the lesion as a primary pulmonary artery sarcoma.

  19. An unusual orbital localization of wegener granulomatosis detected by 18F-FDG PET/CT.

    PubMed

    Bertagna, Francesco; Treglia, Giorgio; Rossini, Pierluigi; Giubbini, Raffaele

    2014-08-01

    We report a case of a 61-year-old male patient affected by Wegener granulomatosis and left exophthalmos who underwent F-FDG PET/CT during follow-up for rectal cancer. The study was negative for secondary lesions but revealed high uptake at the left orbital mass consistent with Wegener granulomatosis.

  20. Greater glucose uptake heterogeneity in knee muscles of old compared to young men during isometric contractions detected by [(18)F]-FDG PET/CT.

    PubMed

    Rudroff, Thorsten; Kindred, John H; Benson, John-Michael; Tracy, Brian L; Kalliokoski, Kari K

    2014-01-01

    We used positron emission tomography/computed tomography (PET/CT) and [(18)F]-FDG to test the hypothesis that glucose uptake (GU) heterogeneity in skeletal muscles as a measure of heterogeneity in muscle activity is greater in old than young men when they perform isometric contractions. Six young (26 ± 6 years) and six old (77 ± 6 years) men performed two types of submaximal isometric contractions that required either force or position control. [(18)F]-FDG was injected during the task and PET/CT scans were performed immediately after the task. Within-muscle heterogeneity of knee muscles was determined by calculating the coefficient of variation (CV) of GU in PET image voxels within the muscles of interest. The average GU heterogeneity (mean ± SD) for knee extensors and flexors was greater for the old (35.3 ± 3.3%) than the young (28.6 ± 2.4%) (P = 0.006). Muscle volume of the knee extensors were greater for the young compared to the old men (1016 ± 163 vs. 598 ± 70 cm(3), P = 0.004). In a multiple regression model, knee extensor muscle volume was a predictor (partial r = -0.87; P = 0.001) of GU heterogeneity for old men (R (2) = 0.78; P < 0.001), and MVC force predicted GU heterogeneity for young men (partial r = -0.95, P < 0.001). The findings demonstrate that GU is more spatially variable for old than young men and especially so for old men who exhibit greater muscle atrophy.

  1. Case report of primary renal pelvis squamous cell carcinoma coexisting with long-standing calculi in left kidney on 18F-FDG PET/CT

    PubMed Central

    Deng, Shengming; Zhang, Bin; Huang, Ying; Li, Jihui; Sang, Shibiao; Zhang, Wei

    2017-01-01

    Abstract Rationale: Primary renal pelvis squamous cell carcinoma (SCC) is an extremely rare neoplasm. In many patients, the SCC was associated with renal calculi. Patient concerns: A 61-year-old male presented with intermittent pain at the left lumbar region for 3 days. The PET/CT images demonstrated increased 18F-FDG uptake in the upper pole of the left kidney and left renal hilar lymph nodes. Diagnoses: Pathologic examination revealed well-moderately differentiated renal pelvis SCC with lymphatic metastasis. Interventions: The patient underwent a left nephrectomy a few days after the initial staging PET/CT study. Outcomes: No growing lesion or metastasis was observed during a 6-month follow-up. Lessons: Our case demonstrates that 18F-FDG PET/CT is a useful diagnostic tool to evaluate primary renal pelvic SCC and detect metastatic lymph nodes in patients with long-standing calculi. PMID:28296764

  2. Physiologic facial muscle uptake on 18F-FDG PET/CT by chewing-like habitual movement in patient with Sjögren syndrome.

    PubMed

    Lee, Dong Hyun; Yoon, Joon-Kee; Yoon, Seok-Ho; Lee, Su Jin; An, Young-Sil

    2015-03-01

    An 84-year-old female patient with known Sjögren syndrome underwent 18F-FDG PET/CT to detect recurrence of uterine cervix cancer. Sjögren syndrome is autoimmune disease that typically produces symptoms of dry mouth and eyes. We report a case of physiologic 18F-FDG uptake on facial muscles by chewing-like habitual movement, which was confused with salivary retention at first. The physiologic FDG uptake in oral cavity and facial muscles has to be reviewed carefully not to be confused with abnormal uptake.

  3. Preoperative Evaluation of Renal Cell Carcinoma by Using 18F-FDG PET/CT

    PubMed Central

    Takahashi, Miwako; Kume, Haruki; Koyama, Keitaro; Nakagawa, Tohru; Fujimura, Tetsuya; Morikawa, Teppei; Fukayama, Masashi; Homma, Yukio; Ohtomo, Kuni; Momose, Toshimitsu

    2015-01-01

    Purpose This study aimed to characterize the FDG uptake of renal cell carcinoma (RCC) by the pathological subtype and nuclear grade. Patients and Methods We retrospectively identified patients who underwent 18F-FDG PET and subsequent partial or radical nephrectomy for renal tumors. The relationships of the SUV of renal tumor with subtypes, nuclear grade, and clinicopathological variables were investigated. Results Ninety-two tumors were analyzed, including 52 low-grade (G1 and G2) and 18 high-grade (G3 and G4) clear cell RCC; 7 chromophobe, 5 papillary, and 1 unclassified RCC; and 9 benign tumors (7 angiomyolipoma and 2 oncocytoma). The SUVs of high-grade clear cell RCC (mean ± SD, 6.8 ± 5.1) and papillary RCC (6.6 ± 3.7) were significantly higher than that of the controls (2.2 ± 0.3). The SUV of high-grade clear cell RCC was higher than that of low-grade tumors (median, 4.0 vs. 2.2; P < 0.001). The optimal SUV cutoff value of 3.0 helped to differentiate high-grade from low-grade clear cell RCC, with 89% sensitivity and 87% specificity. On multiple regression analysis, a high grade was the most significant predictor of SUV for clear cell RCC. Conclusions FDG uptake higher than that observed in normal kidney tissues suggests a high-grade clear cell RCC or papillary RCC subtype. FDG-PET using SUV may have a role in prediction of pathological grade of renal tumor. PMID:26164183

  4. 18F-FDG PET/CT Imaging of Gallbladder Adenocarcinoma - A Pictorial Review

    PubMed Central

    Awan, Omer; Khan, Salman A

    2015-01-01

    Gallbladder adenocarcinoma is an uncommon and serious disease. The primary disease grows rapidly with local invasion into the liver and with distant spread to lymph nodes. It is often detected late, due to which management can be challenging. Despite routine use of computed tomography (CT) and ultrasonography (US) for detection, magnetic resonance imaging (MRI) is often considered for a detailed assessment of the anatomic behavior of these tumors. We share three cases where 18-FDG PET/CT played a role in management thereof. PMID:26430572

  5. Staging of Primary Abdominal Lymphomas: Comparison of Whole-Body MRI with Diffusion-Weighted Imaging and 18F-FDG-PET/CT

    PubMed Central

    Stecco, Alessandro; Buemi, Francesco; Quagliozzi, Martina; Lombardi, Mariangela; Santagostino, Alberto; Sacchetti, Gian Mauro; Carriero, Alessandro

    2015-01-01

    Background. The purpose of this study was to compare the accuracy of whole-body MRI with diffusion-weighted sequences (WB-DW-MRI) with that of 18F-FDG-PET/CT in the staging of patients with primary gastrointestinal lymphoma. Methods. This retrospective study involved 17 untreated patients with primary abdominal gastrointestinal lymphoma. All patients underwent 18F-FDG-PET/CT and WB-DW-MRI. Histopathology findings or at least 6 months of clinical and radiological follow-up was the gold standard. The Musshoff-modified Ann Arbor system was used for staging, and diagnostic accuracy was evaluated on a per-node basis. Results. WB-DW-MRI exhibited 100% sensitivity, 96.3% specificity, and 96.1% and 100% positive and negative predictive values (PPV and NPV), respectively. The sensitivity, specificity, and PPV and NPV of PET/CT were 95.9%, 100%, and 100% and 96.4%, respectively. There were no statistically significant differences between the two techniques (p = 0.05). The weighted kappa agreement statistics with a 95% confidence interval were 0.97 (0.95–0.99) between the two MRI readers and 0.87 (0.82–0.92) between the two methods. Conclusions. WB-DW-MRI appears to have a comparable diagnostic value to 18F-FDG-PET/CT in staging patients with gastrointestinal lymphoma. PMID:26798331

  6. 18F-FDG PET/CT and PET/MRI Perform Equally Well in Cancer: Evidence from Studies on More Than 2,300 Patients

    PubMed Central

    Spick, Claudio; Herrmann, Ken; Czernin, Johannes

    2016-01-01

    18F-FDG PET/CT has become the reference standard in oncologic imaging against which the performance of other imaging modalities is measured. The promise of PET/MRI includes multiparametric imaging to further improve diagnosis and phenotyping of cancer. Rather than focusing on these capabilities, many investigators have examined whether 18F-FDG PET combined with mostly anatomic MRI improves cancer staging and restaging. After a description of PET/MRI scanner designs and a discussion of technical and operational issues, we review the available literature to determine whether cancer assessments are improved with PET/MRI. The available data show that PET/MRI is feasible and performs as well as PET/CT in most types of cancer. Diagnostic advantages may be achievable in prostate cancer and in bone metastases, whereas disadvantages exist in lung nodule assessments. We conclude that 18F-FDG PET/MRI and PET/CT provide comparable diagnostic information when MRI is used simply to provide the anatomic framework. Thus, PET/MRI could be used in lieu of PET/CT if this approach becomes economically viable and if reasonable workflows can be established. Future studies should explore the multiparametric potential of MRI. PMID:26742709

  7. {sup 18}F-FDG PET-CT Simulation for Non-Small-Cell Lung Cancer: Effect in Patients Already Staged by PET-CT

    SciTech Connect

    Hanna, Gerard G.; McAleese, Jonathan; Carson, Kathryn J.; Stewart, David P.; Cosgrove, Vivian P.; Eakin, Ruth L.; Zatari, Ashraf; Lynch, Tom; Jarritt, Peter H.; Young, V.A. Linda D.C.R.; O'Sullivan, Joe M.

    2010-05-01

    Purpose: Positron emission tomography (PET), in addition to computed tomography (CT), has an effect in target volume definition for radical radiotherapy (RT) for non-small-cell lung cancer (NSCLC). In previously PET-CT staged patients with NSCLC, we assessed the effect of using an additional planning PET-CT scan for gross tumor volume (GTV) definition. Methods and Materials: A total of 28 patients with Stage IA-IIIB NSCLC were enrolled. All patients had undergone staging PET-CT to ensure suitability for radical RT. Of the 28 patients, 14 received induction chemotherapy. In place of a RT planning CT scan, patients underwent scanning on a PET-CT scanner. In a virtual planning study, four oncologists independently delineated the GTV on the CT scan alone and then on the PET-CT scan. Intraobserver and interobserver variability were assessed using the concordance index (CI), and the results were compared using the Wilcoxon signed ranks test. Results: PET-CT improved the CI between observers when defining the GTV using the PET-CT images compared with using CT alone for matched cases (median CI, 0.57 for CT and 0.64 for PET-CT, p = .032). The median of the mean percentage of volume change from GTV{sub CT} to GTV{sub FUSED} was -5.21% for the induction chemotherapy group and 18.88% for the RT-alone group. Using the Mann-Whitney U test, this was significantly different (p = .001). Conclusion: PET-CT RT planning scan, in addition to a staging PET-CT scan, reduces interobserver variability in GTV definition for NSCLC. The GTV size with PET-CT compared with CT in the RT-alone group increased and was reduced in the induction chemotherapy group.

  8. Primary central nervous system lymphoma with lymphomatosis cerebri in an immunocompetent child: MRI and 18F-FDG PET-CT findings.

    PubMed

    Jain, Tarun K; Sharma, Punit; Suman, Sudhir K C; Faizi, Nauroze A; Bal, Chandrasekhar; Kumar, Rakesh

    2013-01-01

    Primary central nervous system lymphoma (PCNSL) is extremely rare in immunocompetent children. We present the magnetic resonance imaging (MRI) and (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) findings of such a case in a 14-year old immunocompetent boy. In this patient, PCNSL was associated with lymphomatosis cerebri. Familiarity with the findings of this rare condition will improve the diagnostic confidence of the nuclear radiologist and avoid misdiagnosis.

  9. Giant Cell Tumor with Secondary Aneurysmal Bone Cyst Shows Heterogeneous Metabolic Pattern on (18)F-FDG PET/CT: A Case Report.

    PubMed

    Park, Hee Jeong; Kwon, Seong Young; Cho, Sang-Geon; Kim, Jahae; Song, Ho-Chun; Kim, Sung Sun; Yoon, Yeon Hong; Park, Jin Gyoon

    2016-12-01

    Giant cell tumor (GCT) is a generally benign bone tumor accounting for approximately 5 % of all primary bone neoplasms. Cystic components in GCTs that indicate secondary aneurysmal bone cysts (ABCs) are reported in 14 % of GCTs. Although both of them have been described separately in previous reports that may show considerable fluorodeoxyglucose (FDG) uptake despite their benign nature, the findings of GCT with secondary ABC on (18)F-FDG positron emission tomography/computed tomography (PET/CT) have not been well-known. We report a case of GCT with secondary ABC in a 26-year-old woman. (18)F-FDG PET/CT revealed a heterogeneous hypermetabolic lesion in the left proximal femur with the maximum standardized uptake value of 4.7. The solid components of the tumor showed higher FDG uptake than the cystic components. These observations suggest that the ABC components in GCTs show heterogeneous metabolic patterns on (18)F-FDG PET/CT.

  10. Quantitative assessment of brown adipose tissue metabolic activity and volume using 18F-FDG PET/CT and β3-adrenergic receptor activation

    PubMed Central

    2011-01-01

    Background Brown adipose tissue [BAT] metabolism in vivo is vital for the development of novel strategies in combating obesity and diabetes. Currently, BAT is activated at low temperatures and measured using 2-deoxy-2-18F-fluoro-D-glucose [18F-FDG] positron-emission tomography [PET]. We report the use of β3-adrenergic receptor-mediated activation of BAT at ambient temperatures using (R, R)-5-[2-[2,3-(3-chlorphenyl)-2-hydroxyethyl-amino]propyl]-1,3-benzodioxole-2,2-dicarboxylate, disodium salt [CL316,243] (a selective β3-adrenoceptor agonist) and measured by 18F-FDG PET/computed tomography [CT]. Methods Control and CL316,243-treated (2 mg/kg) male Sprague-Dawley rats were administered with 18F-FDG for PET/CT studies and were compared to animals at cold temperatures. Receptor-blocking experiments were carried out using propranolol (5 mg/kg). Dose effects of CL316,243 were studied by injecting 0.1 to 1 mg/kg 30 min prior to 18F-FDG administration. Imaging results were confirmed by autoradiography, and histology was done to confirm BAT activation. Results CL316,243-activated interscapular BAT [IBAT], cervical, periaortic, and intercostal BATs were clearly visualized by PET. 18F-FDG uptake of IBAT was increased 12-fold by CL316,243 vs. 1.1-fold by cold exposure when compared to controls. 18F-FDG uptake of the CL-activated IBAT was reduced by 96.0% using intraperitoneal administration of propranolol. Average 18F-FDG uptake of IBAT increased 3.6-, 3.5-, and 7.6-fold by doses of 0.1, 0.5, and 1 mg/kg CL, respectively. Ex vivo 18F-FDG autoradiography and histology of transverse sections of IBAT confirmed intense uptake in the CL-activated group and activated IBAT visualized by PET. Conclusion Our study indicated that BAT metabolic activity could be evaluated by 18F-FDG PET using CL316,243 at ambient temperature in the rodent model. This provides a feasible and reliable method to study BAT metabolism. PMID:22214183

  11. A clinical study of shrinking field radiation therapy based on (18)F-FDG PET/CT for stage III non-small cell lung cancer.

    PubMed

    Ding, Xiuping; Li, Hongsheng; Wang, Zhongtang; Huang, Wei; Li, Baosheng; Zang, Rukun; Sun, Hongfu; Yi, Yan

    2013-06-01

    The aim is to investigate the feasibility of shrinking field technique after 40 Gy for stage III non-small cell lung cancer (NSCLC) during radiation therapy. Eighty-seven consecutive patients treated with intensity-modulated radiation therapy or three-dimensional conformal radiation therapy were enrolled in this study. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) scanning was performed prior to treatment and repeated after 40 Gy, and the delineation of target volume was based on fused images of PET and CT. After 40 Gy of conventional fractionated radiotherapy to the initial planning target volume (PTV), a boost of 19.6-39.2 Gy was delivered to the shrunken PTV through late course accelerated hyperfractionated radiotherapy, and the median total dose was 66.0 Gy (range, 59.6-79.2 Gy). Gross tumor volume (GTV) and PTV regressions were recorded, and prescription doses with or without shrinking field were calculated. Local recurrence patterns were investigated through follow-up. The tumor volumes regressed in 84 (96.6%) patients and increased in 3 (3.4%) patients after 40 Gy. The mean GTV and PTV reduction was 38% (range, -13-95%) and 30% (range, -5-95%). Mean total prescription dose escalated from 62.0 Gy to 68.5 Gy through shrinking field technique. The median follow-up was 17 months, ranging from 5 to 46 months, and the 1- and 2-year overall survival rates in our study were 74.7% and 34.6%. The response rate was 79.5%, and radiation toxicity was acceptable. Tumor progression occurred in 67.8% (59/87) patients. Numbers of patients who had outfield, infield and both infield and outfield recurrences were 3 (3.4%), 26 (29.5%), and 3 (3.4%), respectively. In conclusion, significant tumor regression was observed after 40 Gy, and radiation dose escalated after shrinking field with acceptable toxicity and outfield relapse. Shrinking field radiotherapy based on (18)F-FDG PET/CT after 40 Gy was safe and

  12. Increased 18F-FDG Uptake Associated With Gastric Banding Surgical Mesh on PET/CT.

    PubMed

    Chism, Charles B; Somcio, Ray; Chasen, Beth A; Ravizzini, Gregory C

    2016-05-01

    Surgical mesh was used in the 1980s and early 1990s for vertical banded gastroplasty as treatment for morbid obesity. This procedure was replaced by the more popular laparoscopic gastric banding in the mid-1990s. Surgical mesh, commonly used in hernioplasty, has been associated with increased F-FDG uptake related to an inflammatory foreign body reaction and is a known cause of false-positive PET scans. We present a case of increased F-FDG uptake related to surgical mesh in a patient who had undergone vertical banded gastroplasty.

  13. 18F-FLT and 18F-FDG PET/CT in Predicting Response to Chemoradiotherapy in Nasopharyngeal Carcinoma: Preliminary Results

    PubMed Central

    Qi, Shi; Zhongyi, Yang; Yingjian, Zhang; Chaosu, Hu

    2017-01-01

    The purpose of this study was to explore the feasibility of 18F-Fluorothymidine (18F-FLT) and 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in predicting treatment response of nasopharyngeal carcinoma (NPC). Patients with NPC of Stage II-IVB were prospectively enrolled, receiving 2 cycles of neoadjuvant chemotherapy (NACT), followed by concurrent chemoradiotherapy. Each patient underwent pretreatment and post-NACT FLT PET/CT and FDG PET/CT. Standard uptake values (SUV) and tumor volume were measured. Tumor response to NACT was evaluated before radiotherapy by MRI (magnetic resonance imaging), and tumor regression at the end of radiotherapy was evaluated at 55 Gy, according to RECIST 1.1 Criteria. Finally, 20 patients were consecutively enrolled. At the end of radiotherapy, 7 patients reached complete regression while others were partial regression. After 2 cycles of NACT both FLT and FDG parameters declined remarkably. Parameters of FDG PET were more strongly correlated to tumor regression than those of FLT PET.70% SUVmax was the best threshold to define contouring margin around the target. Some residual lesions after NACT showed by MRI were negative in PET/CT. Preliminary results showed both 18F-FDG and 18F-FLT PET have the potential to monitor and predict tumor regression. PMID:28091565

  14. Multi-modality PET-CT imaging of breast cancer in an animal model using nanoparticle x-ray contrast agent and 18F-FDG

    NASA Astrophysics Data System (ADS)

    Badea, C. T.; Ghaghada, K.; Espinosa, G.; Strong, L.; Annapragada, A.

    2011-03-01

    Multi-modality PET-CT imaging is playing an important role in the field of oncology. While PET imaging facilitates functional interrogation of tumor status, the use of CT imaging is primarily limited to anatomical reference. In an attempt to extract comprehensive information about tumor cells and its microenvironment, we used a nanoparticle xray contrast agent to image tumor vasculature and vessel 'leakiness' and 18F-FDG to investigate the metabolic status of tumor cells. In vivo PET/CT studies were performed in mice implanted with 4T1 mammary breast cancer cells.Early-phase micro-CT imaging enabled visualization 3D vascular architecture of the tumors whereas delayedphase micro-CT demonstrated highly permeable vessels as evident by nanoparticle accumulation within the tumor. Both imaging modalities demonstrated the presence of a necrotic core as indicated by a hypo-enhanced region in the center of the tumor. At early time-points, the CT-derived fractional blood volume did not correlate with 18F-FDG uptake. At delayed time-points, the tumor enhancement in 18F-FDG micro-PET images correlated with the delayed signal enhanced due to nanoparticle extravasation seen in CT images. The proposed hybrid imaging approach could be used to better understand tumor angiogenesis and to be the basis for monitoring and evaluating anti-angiogenic and nano-chemotherapies.

  15. Anaplastic thyroid carcinoma and foscarnet use in a multitarget treatment documented by 18F-FDG PET/CT

    PubMed Central

    Giannetta, Elisa; Isidori, Andrea M.; Durante, Cosimo; Di Gioia, Cira; Longo, Flavia; Tombolini, Vincenzo; Bulzonetti, Nadia; Graziadio, Chiara; Pofi, Riccardo; Gianfrilli, Daniele; Verrienti, Antonella; Carletti, Raffaella; Filetti, Sebastiano; Lenzi, Andrea; Baroli, Alberto

    2017-01-01

    Abstract Rationale: The case reported the rapid remission of disease recurrence achieved adding foscarnet, a DNA polymerase inhibitor that interacts with fibroblast growth factor 2, to low molecular weight heparin and sunitinib for the first time in a patient with an anaplastic thyroid cancer (ATC). Patient concerns: A 65-year-old woman with a multinodular goiter referred for a rapid enlargement of a nodule. Histological examination revealed an ATC with a little area of papillary thyroid cancer (PTC). The patient was resistant to selective single-target treatment. DIagnoses: Immunophenotyping and gene analyses found a significant increase in FGF2 and FGFR1 expression in the primary ATC area (FGF2 = 38.2 ± 6.2% in ATC vs 34.6 ± 6.0% in the differentiated area of PTC, P < 0.05; FGFR1: 41.7 ± 6.0% in ATC vs 34.4 ± 4.2% in PTC, P < 0.001) and in metastatic neck lymph nodes (P < 0.001 vs normal control tissues). Unlike conventional imaging, 18F-FDG PET/CT with PERCIST 1.0 criteria promptly and quantitatively detected disease recurrence and remission before and after multitarget therapy, combining anatomic, metabolic, and functional data. Interventions: Foscarnet was administered given the positivity for FGF2, FGFR1 and FGFR4 in ATC. Low molecular wight heparin and Sunitinib were coadministere to limiti metastatic progression and on neck tumor masse, respectively. Outcomes: The rationale for the clinical response to this innovative multitarget association with foscarnet is based on the histological and genetic finding that fibroblast growth factors and their receptor super-family are up-regulated in the primary anaplastic thyroid tumor and in the metastatic lymph node of our patient. Lessons: We propose that fibroblast growth factors and their receptor super-family play a key role as potential therapeutic targets in anaplastic thyroid cancer and the positive relevance of this suggestion for patient care, especially for an

  16. Prognostic Value of Baseline 18F-FDG PET/CT Functional Parameters in Patients with Advanced Lung Adenocarcinoma Stratified by EGFR Mutation Status

    PubMed Central

    Wang, Dalong; Zhang, Minghui; Gao, Xuan; Yu, Lijuan

    2016-01-01

    The study objective was to retrospectively analyze the metabolic variables derived from 18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) as predictors of progression-free survival (PFS) and overall survival (OS) in advanced lung adenocarcinoma stratified by epidermal growth factor receptor (EGFR) mutation status. A total of 176 patients (91, EGFR mutation; 85, wild-type EGFR) who underwent 18F-FDG PET/CT before treatment were enrolled. The main 18F-FDG PET/CT-derived variables: primary tumor maximum standardized uptake value (SUVmaxT), primary tumor total lesion glycolysis (TLGT), the maximum SUVmax of all selected lesions in whole body determined using the Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 criteria (SUVmaxWBR), and whole-body total TLG determined using the RECIST 1.1 criteria (TLGWBR) were measured. Survival analysis regarding TLGWBR, and other factors in advanced lung adenocarcinoma patients stratified using EGFR mutation status, were evaluated. The results indicated that high TLGWBR (≥259.85), EGFR wild-type, and high serum LDH were independent predictors of worse PFS and OS in all patients with advanced lung adenocarcinoma. Among patients with wild-type EGFR, only TLGWBR retained significance as an independent predictor of both PFS and OS. Among patients with the EGFR mutation, high serum LDH level was an independent predictor of worse PFS and OS, and high TLGWBR (≥259.85) was an independent predictor of worse PFS but not worse OS. In conclusion, TLGWBR is a promising parameter for prognostic stratification of patients with advanced lung adenocarcinoma and EGFR status; however, it cannot be used to further stratify the risk of worse OS for patients with the EGFR mutation. Further prospective studies are needed to validate our findings. PMID:27336755

  17. 18F-NaF and 18F-FDG PET/CT in Gorham-Stout Disease.

    PubMed

    Papadakis, Georgios Z; Millo, Corina; Bagci, Ulas; Blau, Jenny; Collins, Michael T

    2016-11-01

    Gorham-Stout disease (GSD) is an extremely rare skeletal disorder of unknown etiology characterized by benign proliferation of vascular or lymphatic channels, leading to progressive bone resorption. We report on a patient diagnosed with GSD affecting the right scapula and the right ribs, who underwent PET/CT scans using F-FDG and F-NaF. The remnant upper portion of the affected scapula did not show F-FDG uptake but demonstrated markedly increased F-NaF activity. Furthermore, intense F-NaF activity was seen on the right posterior ribs, which were actively being resorbed, suggesting the potential application of F-NaF-PET/CT imaging in GSD diagnosis and follow-up.

  18. Do Gadolinium-Based Contrast Agents Affect (18)F-FDG PET/CT Uptake in the Dentate Nucleus and the Globus Pallidus? A Pilot Study.

    PubMed

    Bauer, Kyle; Lathrum, Alaina; Raslan, Osama; Kelly, Patrick V; Zhou, Yihua; Hewing, Debra; Botkin, Crystal; Turner, James A; Osman, Medhat

    2017-03-01

    Gadolinium is toxic and to avoid its deposition in tissues, it must be chemically bonded with nonmetal ions to facilitate its excretion by the kidneys. High signal intensity in the dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted MR images has been both morphologically and pathologically linked to gadolinium-based contrast agent (GBCA) retention in the brain. The purpose of this study was to determine whether repeated administrations of GBCA would affect the uptake of (18)F-FDG in the DN and GP on PET/CT. Methods: Three hundred seventy-six patients who underwent both contrast-enhanced MR (CE MR) of the brain and PET/CT from January 2004 to October 2015 were identified. Patients with a history of brain irradiation or hepatic or renal disease were excluded. The SUVmax was measured in the DN and GP on the PET/CT scan in patients who had 3-6 successive CE MR brain studies. The SUVmax of the corresponding areas in the control group of patients who had not undergone previous CE MR and who had a normal, unenhanced MR finding of the brain was also measured. A Wilcoxon 2-sample test was used for statistical analysis. Results: Fifteen of 376 (4%) patients (mean age ± SD, 54 ± 18 y; 10 men and 5 women) were included in the subject group, and 15 patients (mean age ± SD, 36 ± 9 y; 11 men and 4 women) were included in the control group. The median DN SUVmax was significantly lower in the subject group than in the control group (5.4 vs. 6.4, respectively; P = 0.021). Similarly, the median GP SUVmax was significantly lower in the subject group than in the control group (8.8 vs. 12.1, respectively; P = 0.003). Conclusion: The median SUVmax in the DN and GP was 16% and 27% lower, respectively, in patients who received GBCAs than in those who had not received GBCAs, possibly related to gadolinium deposition in these areas.

  19. Brain metastases detectability of routine whole body (18)F-FDG PET and low dose CT scanning in 2502 asymptomatic patients with solid extracranial tumors.

    PubMed

    Bochev, Pavel; Klisarova, Aneliya; Kaprelyan, Ara; Chaushev, Borislav; Dancheva, Zhivka

    2012-01-01

    As fluorine-18-fluorodesoxyglucose positron emission tomography/computed tomography ( (18)F-FDG PET/CT) is gaining wider availability, more and more patients with malignancies undergo whole body PET/CT, mostly to assess tumor spread in the rest of the body, but not in the brain. Brain is a common site of metastatic spread in patients with solid extracranial tumors. Gold standard in the diagnosis of brain metastases remains magnetic resonance imaging (MRI). However MRI is not routinely indicated and is not available for all cancer patients. Fluorine-18-FDG PET is considered as having poor sensitivity in detecting brain metastases, but this may not be true for PET/CT. The aim of our study was to assess the value of (18)F-FDG PET/CT in the detection of brain metastases found by whole body scan including the brain, in patients with solid extracranial neoplasms. A total of 2502 patients with solid extracranial neoplasms were studied. All patients underwent a routine whole body (18)F-FDG PET/CT scan with the whole brain included in the scanned field. Patients with known or suspected brain metastases were preliminary excluded from the study. Hypermetabolic and ring-like brain lesions on the PET scan were considered as metastases. Lesions with CT characteristics of brain metastases were regarded as such irrespective of their metabolic pattern. Lesions in doubt were verified by MRI during first testing or on follow-up or by operation. Our results showed that brain lesions, indicative of and verified to be metastases were detected in 25 out of the 2502 patients (1%), with lung cancer being the most common primary. Twenty three out of these 25 patients had no neurological symptoms by the time of the scan. The detection rate of brain metastases was relatively low, but information was obtained with a minimum increase of radiation burden. In conclusion, whole body (18)F-FDG PET/CT detected brain metastases in 1% of the patients if brain was included in the scanned field. Brain

  20. TU-F-12A-03: Using 18F-FDG-PET-CT and Deformable Registration During Head-And-Neck Cancer (HNC) Intensity Modulated Radiotherapy (IMRT) to Predict Treatment Response

    SciTech Connect

    Vergalasova, I; Mowery, Y; Yoo, D; Brizel, D; Das, S

    2014-06-15

    Purpose: To evaluate the effect of deformable vs. rigid registration of pre-treatment 18F-FDG-PET-CT to intra-treatment 18F-FDG-PET-CT on different standardized uptake value (SUV) parameters and investigate which parameters correlate best with post-treatment response in patients undergoing IMRT for HNC. Methods: Pre-treatment and intra-treatment PET-CT (after 20Gy) scans were acquired, in addition to a 12 week post-treatment PET-CT to assess treatment response. Primary and lymph node gross tumor volumes (GTV-PRI and GTV-LN) were contoured on the pre-treatment CT. These contours were then mapped to intra-treatment PET images via rigid and deformable registration. Absolute changes from pre- to intra-treatment scans for rigid and deformable registration were extracted for the following parameters: SUV-MAX, SUV-MEAN, SUV-20%, SUV-40%, and SUV-60% (SUV-X% is the minimum SUV to the highest-intensity X% volume). Results: Thirty-eight patients were evaluated, with 27 available for classification as complete or incomplete response (CR/ICR). The pre-treatment average tumor volumes for the patients were 24.05cm{sup 3} for GTV-PRI and 23.4cm{sup 3} for GTV-LN. For GTV-PRI, there was no statistically significant difference between rigid vs. deformable registration across all ΔSUV parameters. For GTV-LN contours, all parameters were significantly different except for ΔSUV-MAX. For deformably-registered GTV-PRI, changes in the following metrics were significantly different for CR vs. ICR: SUV-MEAN(p=0.003), SUV-20%(p=0.02), SUV-40%(p=0.02), and SUV-60%(p=0.008). The following cutoff values separated CR from ICR with high sensitivity and specificity: ΔSUV-MEAN=1.49, ΔSUV-20%=2.39, ΔSUV-40%=1.80 and ΔSUV-60%=1.31. Corresponding areas under the Receiver Operating Characteristics curve were 0.90, 0.81, 0.81, and 0.85, respectively. Conclusion: Rigidly and deformably registered contours yielded statistically similar SUV parameters for GTV-PRI, but not GTV-LN. This implies that

  1. 18F-FDG PET of the hands with a dedicated high-resolution PEM system (arthro-PET): correlation with PET/CT, radiography and clinical parameters

    PubMed Central

    Mhlanga, Joyce C.; Carrino, John A.; Lodge, Martin; Wang, Hao

    2015-01-01

    Purpose The aim of this study was to prospectively determine the feasibility and compare the novel use of a positron emission mammography (PEM) scanner with standard PET/CT for evaluating hand osteoarthritis (OA) with 18F-FDG. Methods Institutional review board approval and written informed consent were obtained for this HIPAA-compliant prospective study in which 14 adults referred for oncological 18F-FDG PET/CT underwent dedicated hand PET/CT followed by arthro-PET using the PEM device. Hand radiographs were obtained and scored for the presence and severity of OA. Summed qualitative and quantitative joint glycolytic scores for each modality were compared with the findings on plain radiography and clinical features. Results Eight patients with clinical and/or radiographic evidence of OA comprised the OA group (mean age 73±7.7 years). Six patients served as the control group (53.7±9.3 years). Arthro-PET quantitative and qualitative joint glycolytic scores were highly correlated with PET/CT findings in the OA patients (r=0.86. p =0.007; r=0.94, p=0.001). Qualitative arthro-PET and PET/CT joint scores were significantly higher in the OA patients than in controls (38.7±6.6 vs. 32.2±0.4, p=0.02; 37.5±5.4 vs. 32.2±0.4, p=0.03, respectively). Quantitative arthro-PET and PET/CT maximum SUV-lean joint scores were higher in the OA patients, although they did not reach statistical significance (20.8±4.2 vs. 18±1.8, p= 0.13; 22.8±5.38 vs. 20.1±1.54, p=0.21). By definition, OA patients had higher radiographic joint scores than controls (30.9±31.3 vs. 0, p=0.03). Conclusion Hand imaging using a small field of view PEM system (arthro-PET) with FDG is feasible, performing comparably to PET/CT in assessing metabolic joint activity. Arthro-PET and PET/CT showed higher joint FDG uptake in OA. Further exploration of arthro-PET in arthritis management is warranted. PMID:25134669

  2. 18F-FDG PET/CT in diagnosis and response evaluation in an unusual case of antisynthetase syndrome presenting as pyrexia of unknown origin.

    PubMed

    Jain, T K; Basher, R K; Bhattacharya, A; Mittal, B R; Shukla, J; Prakash, M

    2016-01-01

    Anti-histidyl (Jo-1) antibodies have been implicated in the pathogenesis of anti-synthetase syndrome (ASS). A case is presented of a 55-year-old male patient presenting with pyrexia of unknown origin and inconclusive routine investigations. (18)F-FDG PET/CT was performed to locate any abnormal focus, which showed increased FDG uptake in the proximal shoulder muscles, as well as lung lesions. Subsequent investigation showed the presence of anti Jo-1 antibody, and diagnosed as an anti-synthetase syndrome. The patient was successfully treated with glucocorticoids and cyclophosphamide, and the response was assessed with symptomatic relief and disappearance of FDG uptake in lung and muscle lesions on post-treatment FDG PET/CT.

  3. A comparative study of target volumes based on 18F-FDG PET-CT and ten phases of 4DCT for primary thoracic squamous esophageal cancer

    PubMed Central

    Guo, Yanluan; Li, Jianbin; Zhang, Peng; Zhang, Yingjie

    2017-01-01

    Purpose To investigate the correlations in target volumes based on 18F-FDG PET/CT and four-dimensional CT (4DCT) to detect the feasibility of implementing PET in determining gross target volumes (GTV) for tumor motion for primary thoracic esophageal cancer (EC). Methods Thirty-three patients with EC sequentially underwent contrast-enhanced 3DCT, 4DCT, and 18F-FDG PET-CT thoracic simulation. The internal gross target volume (IGTV)10 was obtained by combining the GTV from ten phases of 4DCT. The GTVs based on PET/CT images were defined by setting of different standardized uptake value thresholds and visual contouring. The difference in volume ratio, conformity index (CI), and degree of inclusion (DI) between IGTV10 and GTVPET was compared. Results The images from 20 patients were suitable for further analysis. The optimal volume ratio of 0.95±0.32, 1.06±0.50, 1.07±0.49 was at standardized uptake value (SUV)2.5, SUV20%, or manual contouring. The mean CIs were from 0.33 to 0.54. The best CIs were at SUV2.0 (0.51±0.11), SUV2.5 (0.53±0.13), SUV20% (0.53±0.12), and manual contouring (0.54±0.14). The mean DIs of GTVPET in IGTV10 were from 0.60 to 0.90, and the mean DIs of IGTV10 in GTVPET ranged from 0.35 to 0.78. A negative correlation was found between the mean CI and different SUV (P=0.000). Conclusion None of the PET-based contours had both close spatial and volumetric approximation to the 4DCT IGTV10. Further evaluation and optimization of PET as a tool for target identification are required. PMID:28123302

  4. Combined use of 18F-FDG and 18F-FMISO in unresectable non-small cell lung cancer patients planned for radiotherapy: a dynamic PET/CT study

    PubMed Central

    Sachpekidis, Christos; Thieke, Christian; Askoxylakis, Vasileios; Nicolay, Nils H; Huber, Peter E; Thomas, Michael; Dimitrakopoulou, Georgia; Debus, Juergen; Haberkorn, Uwe; Dimitrakopoulou-Strauss, Antonia

    2015-01-01

    Aim of this study was to evaluate and compare, by means of dynamic and static PET/CT, the distribution patterns and pharmacokinetics of fluorine-18 fluorodeoxyglucose (18F-FDG) and of fluorine-18-fluoromisonidazole (18F-FMISO) in non-small cell lung cancer (NSCLC) patients scheduled for intensity modulated radiation therapy (IMRT). Thirteen patients suffering from inoperable stage III NSCLC underwent PET/CTs with 18F-FDG and 18F-FMISO for tumor metabolism and hypoxia assessment accordingly. Evaluation of PET/CT studies was based on visual analysis, semi-quantitative (SUV) calculations and absolute quantitative estimations, after application of a two-tissue compartment model and a non-compartmental approach. 18F-FDG PET/CT revealed all thirteen primary lung tumors as sites of increased 18F-FDG uptake. Six patients demonstrated also in total 43 18F-FDG avid metastases; these patients were excluded from radiotherapy. 18F-MISO PET/CT demonstrated 12/13 primary lung tumors with faint tracer uptake. Only one tumor was clearly 18F-FMISO avid, (SUVaverage = 3.4, SUVmax = 5.0). Mean values for 18F-FDG, as derived from dPET/CT data, were SUVaverage = 8.9, SUVmax = 15.1, K1 = 0.23, k2 = 0.53, k3 = 0.17, k4 = 0.02, influx = 0.05 and fractal dimension (FD) = 1.25 for the primary tumors. The respective values for 18F-FMISO were SUVaverage = 1.4, SUVmax = 2.2, K1 = 0.26, k2 = 0.56, k3 = 0.06, k4 = 0.06, influx = 0.02 and FD = 1.14. No statistically significant correlation was observed between the two tracers. 18F-FDG PET/CT changed therapy management in six patients, by excluding them from planned IMRT. 18F-FMISO PET/CT revealed absence of significant tracer uptake in the majority of the 18F-FDG avid NSCLCs. Lack of correlation between the two tracers’ kinetics indicates that they reflect different molecular mechanisms and implies the discordance between increased glycolysis and hypoxia in the malignancy. PMID:25973334

  5. The role of 18F-FDG PET/CT in pediatric lymph-node acute lymphoblastic leukemia involvement.

    PubMed

    Cistaro, Angelina; Saglio, Francesco; Asaftei, Sebastian; Fania, Piercarlo; Berger, Massimo; Fagioli, Franca

    2011-01-01

    In pediatric oncology, positron emission tomography/computed tomography (PET/CT) is emerging as an essential diagnostic tool in characterizing suspicious neoplastic lesions and staging malignant diseases. Most studies regarding the possible role of FDG-PET/CT in the management of acute lymphoblastic leukemia (ALL) patients are limited to adults. Here we report a pediatric patient with recurrent ALL, in which FDG-PET/CT was used both to define more precisely the cause of lymphadenopathy and to assess the effect of the second-line therapy.

  6. Lymphoma and tuberculosis: temporal evolution of dual pathology on sequential 18F-FDG PET/CT.

    PubMed

    Mukherjee, Anirban; Sharma, Punit; Karunanithi, Sellam; Dhull, Varun Singh; Kumar, Rakesh

    2014-08-01

    Tuberculosis can often be seen in patients undergoing chemotherapy for lymphoma, especially in endemic countries. As both tuberculosis and lymphoma can lead to hypermetabolic lesions of F-FDG PET/CT, a diagnostic dilemma often ensues. We present the sequential F-FDG PET/CT images of a 22-year-old female patient with Hodgkin lymphoma who developed tuberculosis and later relapse of lymphoma. These images present the temporal evaluation of the dual pathology on F-FDG PET/CT.

  7. Primary squamous cell carcinoma of the thyroid. Initial assessment and follow-up using (18)F-FDG PET/CT.

    PubMed

    Caballero Gullón, L; Carmona González, E; Martínez Estévez, A; Gómez Camarero, M P; Corral, J J; Borrego Dorado, I

    2017-02-16

    Squamous cell carcinoma of thyroid is an uncommon, very aggressive neoplasm, having a poor prognosis and poor response to chemotherapy and radiotherapy. Surgery is the initial treatment of choice, although it often presents as a widespread disease at the time of diagnosis, usually with cervical swelling that causes most of the symptoms due to local infiltration or metastasis. Local infiltration from adjacent tumour and metastatic disease needs to be excluded from other primary epidermoid carcinomas, in order to make a correct diagnosis. This also requires the typical cytokeratin pattern seen in histological studies. The case is presented of a 53 year-old man with a medical history of hepatocarcinoma, with a cervical hypermetabolic lesion detected in an (18)F-FDG PET/CT performed to exclude widespread disease. The follow-up of this lesion with this technique and its usefulness is also described.

  8. Comparison of Whole-Body 18F FDG PET/MR Imaging and Whole-Body 18F FDG PET/CT in Terms of Lesion Detection and Radiation Dose in Patients with Breast Cancer

    PubMed Central

    Melsaether, Amy N.; Raad, Roy A.; Pujara, Akshat C.; Ponzo, Fabio D.; Pysarenko, Kristine M.; Jhaveri, Komal; Babb, James S.; Sigmund, Eric E.; Kim, Sungheon G.; Moy, Linda A.

    2016-01-01

    Purpose To compare fluorine 18 (18F) fluorodeoxyglucose (FDG) combined positron emission tomography (PET) and magnetic resonance (MR) imaging with 18F FDG combined PET and computed tomography (CT) in terms of organ-specific metastatic lesion detection and radiation dose in patients with breast cancer. Materials and Methods From July 2012 to October 2013, this institutional review board–approved HIPAA-compliant prospective study included 51 patients with breast cancer (50 women; mean age, 56 years; range, 32–76 years; one man; aged 70 years) who completed PET/MR imaging with diffusion-weighted and contrast material–enhanced sequences after unenhanced PET/CT. Written informed consent for study participation was obtained. Two independent readers for each modality recorded site and number of lesions. Imaging and clinical follow-up, with consensus in two cases, served as the reference standard. Results There were 242 distant metastatic lesions in 30 patients, 18 breast cancers in 17 patients, and 19 positive axillary nodes in eight patients. On a per-patient basis, PET/MR imaging with diffusion-weighted and contrast-enhanced sequences depicted distant (30 of 30 [100%] for readers 1 and 2) and axillary (eight of eight [100%] for reader 1, seven of eight [88%] for reader 2) metastatic disease at rates similar to those of unenhanced PET/CT (distant metastatic disease: 28 of 29 [96%] for readers 3 and 4, P = .50; axillary metastatic disease: seven of eight [88%] for readers 3 and 4, P > .99) and outperformed PET/CT in the detection of breast cancer (17 of 17 [100%] for readers 1 and 2 vs 11 of 17 [65%] for reader 3 and 10 of 17 [59%] for reader 4; P < .001). PET/MR imaging showed increased sensitivity for liver (40 of 40 [100%] for reader 1 and 32 of 40 [80%] for reader 2 vs 30 of 40 [75%] for reader 3 and 28 of 40 [70%] for reader 4; P < .001) and bone (105 of 107 [98%] for reader 1 and 102 of 107 [95%] for reader 2 vs 106 of 107 [99%] for reader 3 and 93 of 107 [87

  9. Role of 18F-FDG-PET/CT in the management of marginal zone B cell lymphoma.

    PubMed

    Carrillo-Cruz, Estrella; Marín-Oyaga, Victor A; de la Cruz Vicente, Fátima; Borrego-Dorado, Isabel; Ruiz Mercado, Marta; Acevedo Báñez, Irene; Solé Rodríguez, Maria; Fernández López, Rosa; Pérez Vega, Herminia; Calderón-Cabrera, Cristina; Espigado Tocino, Ildefonso; Pérez-Simón, Jose A; Vázquez-Albertino, Ricardo

    2015-12-01

    The use of PET in patients with marginal zone B cell lymphoma (MZL) is controversial because of variability of fluorodeoxyglucose (FDG) avidity. We analyzed 40 PET/CT in 25 consecutive patients to compare its performance with CT at staging and as a first-line response assessment. Sensitivity of PET/CT and CT was 96 and 76%. Mean standard uptake value was 6.1, 6.9 and 3.4 (p = 0.3) in nodal, extranodal and splenic subtypes, respectively. Of 17 patients (extranodal: n = 9; nodal: n = 6; splenic subtype: n = 2) with both imaging tests available at diagnosis, 8 (47%) had more involved areas with PET/CT than with CT, 75% of which were extranodal lesions. PET/CT resulted in upstaging of five patients although treatment of only two of them was changed. Responses of 15 patients with post-treatment PET/CT were the following: 9 negative and 6 positive of which 3 were isolated residual lesions. Progression was documented in two of these three patients. Response was also assessed by CT in 11 patients. Discrepancies were found in three: Two were in complete remission by CT while PET/CT detected localized residual disease; another patient was in partial remission by CT, whereas PET/CT showed only one positive lesion. Two of these three patients relapsed. Patients with negative post-treatment PET/CT did not relapse. With a median follow-up of 50 months (10-152 months), 3-year overall survival was 100 and 80% for patients with negative and positive post-treatment PET/CT (p = 0.2). Three-year disease-free survival was 86%; the negative predictive value (NPV) was 100%, and the positive predictive value (PPV) was 83.3%. Although a larger number of patients will be required to further confirm these data, we can conclude that PET/CT is a useful imaging tool for both staging and response assessment in patients with nodal and extranodal MZL as a result of its high sensitivity, NPV and PPV.

  10. The Predictive Value of Early Assessment After 1 Cycle of Induction Chemotherapy with 18F-FDG PET/CT and Diffusion-Weighted MRI for Response to Radical Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma.

    PubMed

    Wong, Kee H; Panek, Rafal; Welsh, Liam; Mcquaid, Dualta; Dunlop, Alex; Riddell, Angela; Murray, Iain; Du, Yong; Chua, Sue; Koh, Dow-Mu; Bhide, Shreerang; Nutting, Chris; Oyen, Wim J G; Harrington, Kevin; Newbold, Kate L

    2016-12-01

    The objective of this study was to assess the predictive value of early assessment (after 1 cycle of induction chemotherapy [IC]) with (18)F-FDG PET/CT and diffusion-weighted (DW) MRI for subsequent response to radical chemoradiotherapy in locally advanced head and neck squamous cell carcinoma (HNSCC).

  11. Comparison of 18F-FDG PET/CT and DWI for detection of mediastinal nodal metastasis in non-small cell lung cancer: A meta-analysis

    PubMed Central

    Zhang, Kan; Ren, Pengwei; Jia, Zhiyun

    2017-01-01

    Background Accurate clinical staging of mediastinal lymph nodes of patients with lung cancer is important in determining therapeutic options and prognoses. We aimed to compare the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting mediastinal nodal metastasis of lung cancer. Methods Relevant studies were systematically searched in the MEDLINE, EMBASE, PUBMED, and Cochrane Library databases. Based on extracted data, the pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR) with individual 95% confidence intervals were calculated. In addition, the publication bias was assessed by Deek’s funnel plot of the asymmetry test. The potential heterogeneity was explored by threshold effect analysis and subgroup analyses. Results Forty-three studies were finally included. For PET/CT, the pooled sensitivity and specificity were 0.65 (0.63–0.67) and 0.93 (0.93–0.94), respectively. The corresponding values of DWI were 0.72 (0.68–0.76) and 0.97 (0.96–0.98), respectively. The overall PLR and NLR of DWI were 13.15 (5.98–28.89) and 0.32 (0.27–0.39), respectively. For PET/CT, the corresponding values were 8.46 (6.54–10.96) and 0.38 (0.33–0.45), respectively. The Deek’s test revealed no significant publication bias. Study design and patient enrollment were potential causes for the heterogeneity of DWI studies and the threshold was a potential source for PET/CT studies. Conclusion Both modalities are beneficial in detecting lymph nodes metastases in lung cancer without significant differences between them. DWI might be an alternative modality for evaluating nodal status of NSCLC. PMID:28253364

  12. Response monitoring to bisphosphonate therapy in monostotic paget disease using (18)F-FDG PET/CT.

    PubMed

    Sharma, Punit; Chatterjee, Piyali

    2015-06-01

    Paget disease is a benign bone disorder characterized by abnormal bone absorption and mineralization, resulting in bone deformity and fragility. Currently, bisphosphonates form the cornerstone of treatment for Paget disease. We report the case of a 67-year-old man with monostotic Paget disease, where F-FDG PET/CT was used for assessment of response to bisphosphonate therapy.

  13. The Role of [18F]FDG-PET/CT in Predicting Malignant Transformation of Plexiform Neurofibromas in Neurofibromatosis-1

    PubMed Central

    Abdul Razak, Muzib; London, Kevin

    2016-01-01

    Background. Malignant peripheral nerve sheath tumours (MPNSTs) are difficult to diagnose and treat and contribute to significant morbidity and mortality for patients with Neurofibromatosis-1 (NF-1). FDG-PET/CT is being increasingly used as an imaging modality to discriminate between benign and malignant plexiform neurofibromas. Objectives. To assess the value of FDG-PET/CT in differentiating between benign and malignant peripheral nerve lesions for patients with Neurofibromatosis-1. Methods. A systematic review of the literature was performed prior to application of stringent selection criteria. Ultimately 13 articles with 796 tumours were deemed eligible for inclusion into the review. Results. There was a significant difference between mean SUVmax of benign and malignant lesions (1.93 versus 7.48, resp.). Sensitivity ranged from 89 to 100% and specificity from 72 to 94%. ROC analysis was performed to maximise sensitivity and specificity of SUVmax cut-off; however no clear value was identified (range 3.1–6.1). Significant overlap was found between the SUVmax of benign and malignant lesions making differentiation of lesions difficult. Many of the studies suffered from having a small cohort and from not providing histological data on all lesions which underwent FDG-PET/CT. Conclusion. This systematic review is able to demonstrate that FDG-PET/CT is a useful noninvasive test for discriminating between benign and malignant lesions but has limitations and requires further prospective trials. PMID:28058117

  14. 18F-FDG PET/CT demonstrating primary bone lymphoma of the extremities mimicking an inflammatory peripheral arthropathy.

    PubMed

    Tachibana, Ayano; Robinson, Richard J; Patel, Chirag N

    2015-02-01

    A 66-year-old woman presents with progressive bilateral swelling of her fingers, elbows, and toes. Initially thought to represent an inflammatory peripheral arthropathy, the patient underwent rheumatology review, but subsequent tissue biopsy confirmed diffuse large B-cell lymphoma. Results of bone marrow biopsy and staging CT were negative. F-FDG PET/CT demonstrates FDG-avid bony and adjacent soft tissue disease limited to the extremities with an excellent metabolic response to primary chemotherapy. This is a rare case of primary bone lymphoma limited to the extremities mimicking an inflammatory peripheral arthropathy.

  15. Discussion on the alteration of FDG uptake by the breast according to the menstrual cycle in 18F-FDG PET/CT

    NASA Astrophysics Data System (ADS)

    Park, H. H.; Park, M. S.; Lee, C. H.; Cho, J. H.; Dong, K. R.; Chung, W. K.

    2012-09-01

    18F-FDG (fluorodeoxyglucose) PET (positron emission tomography)/CT (computed tomography) is a useful modality for identifying high-glucose-consuming cells, such as cancer cells, by the glucose metabolism of FDG. FDG is taken up by cancer and inflammatory cells, but occasionally there is also some FDG uptake by normal tissues as a result of their individual physiological characteristics. In particular, in fertile females, unusual FDG uptake in the breast changes according to the stages in the menstrual cycle, which can adversely affect a diagnosis. Therefore, this study examined the change in breast FDG uptake in the menstrual cycle on 18F-FDG PET/CT. One hundred and sixty females (34±3.5 years old), who had not undergone a gynecologic anamnesis and had a regular menstrual cycle over the previous 6 months, were examined from March 2010 to February 2011. The subjects were divided into the following four groups (each with 40 patients): flow phase, proliferative phase, ovulatory phase and secretory phase using Pregnancy Calculator Ver. 0.14 and history taking. Discovery Ste was used as the PET/CT. The standardized uptake values (SUVs) on the accumulated region on the breast were analyzed, and three nuclear medicine specialists performed a blind test. The SUVs on the breast were the flow phase (1.64±0.25), proliferative phase (0.93±0.28), ovulatory phase (1.66±0.26) and secretory phase (1.77±0.28). A high uptake value was observed in the secretory, flow and ovulatory phases. The FDG accumulation of the breast was divided into the following three grades compared with the lung and liver by gross analysis: the breast uptake was equal to the lung (Grade I), between the lung and liver (Grade II) and equal to or greater than the liver (Grade III). These results showed a high uptake value in the secretory, flow and ovulatory phases. In fertile females, the FDG uptake of the breast showed changes according to the menstrual cycle, which can be used to improve the diagnosis

  16. (18)F-FLT and (18)F-FDG PET-CT imaging in the evaluation of early therapeutic effects of chemotherapy on Walker 256 tumor-bearing rats.

    PubMed

    Xu, Weina; Yu, Shupeng; Xin, Jun; Guo, Qiyong

    2016-12-01

    The present study aimed to evaluate the early therapeutic effects of chemotherapy on Walker 256 tumor-bearing Wistar rats via F-18-fluoro-3'-deoxy-3'-L-fluorothymidine ((18)F-FLT) and F-18-fluoro-deoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) imaging. Walker 256 tumor-bearing Wistar rats were subjected to (18)F-FLT and (18)F-FDG PET-CT imaging prior to and 24 and 48 h after epirubicin chemotherapy. (18)F-FLT and (18)F-FDG uptake [tumor/muscle (T/M)], the percentage of injected dose per gram (% ID/g), and the Ki-67 labeling index (LI-Ki-67) were quantitatively determined for each rat prior to and following epirubicin chemotherapy. The correlation between % ID/g and tumor LI-Ki-67 was analyzed. Both (18)F-FLT and (18)F-FDG tumor uptake decreased significantly at 24 and 48 h after chemotherapy (P<0.01 and P<0.05, respectively). LI-Ki-67 also significantly reduced 24 and 48 h after chemotherapy (P<0.001). Furthermore, (18)F-FLT and (18)F-FDG T/M tumor uptake correlated positively with LI-Ki-67 before and after chemotherapy (r=0.842 and 0.813, respectively). During the early post-chemotherapy stage, (18)F-FLT and (18)F-FDG uptake in Walker 256 tumors reduced significantly, which correlated positively with the tumor cell proliferative activity.

  17. 18F-FLT and 18F-FDG PET-CT imaging in the evaluation of early therapeutic effects of chemotherapy on Walker 256 tumor-bearing rats

    PubMed Central

    Xu, Weina; Yu, Shupeng; Xin, Jun; Guo, Qiyong

    2016-01-01

    The present study aimed to evaluate the early therapeutic effects of chemotherapy on Walker 256 tumor-bearing Wistar rats via F-18-fluoro-3′-deoxy-3′-L-fluorothymidine (18F-FLT) and F-18-fluoro-deoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) imaging. Walker 256 tumor-bearing Wistar rats were subjected to 18F-FLT and 18F-FDG PET-CT imaging prior to and 24 and 48 h after epirubicin chemotherapy. 18F-FLT and 18F-FDG uptake [tumor/muscle (T/M)], the percentage of injected dose per gram (% ID/g), and the Ki-67 labeling index (LI-Ki-67) were quantitatively determined for each rat prior to and following epirubicin chemotherapy. The correlation between % ID/g and tumor LI-Ki-67 was analyzed. Both 18F-FLT and 18F-FDG tumor uptake decreased significantly at 24 and 48 h after chemotherapy (P<0.01 and P<0.05, respectively). LI-Ki-67 also significantly reduced 24 and 48 h after chemotherapy (P<0.001). Furthermore, 18F-FLT and 18F-FDG T/M tumor uptake correlated positively with LI-Ki-67 before and after chemotherapy (r=0.842 and 0.813, respectively). During the early post-chemotherapy stage, 18F-FLT and 18F-FDG uptake in Walker 256 tumors reduced significantly, which correlated positively with the tumor cell proliferative activity. PMID:28101193

  18. Brain metabolic changes in Hodgkin disease patients following diagnosis and during the disease course: An 18F-FDG PET/CT study

    PubMed Central

    CHIARAVALLOTI, AGOSTINO; PAGANI, MARCO; CANTONETTI, MARIA; DI PIETRO, BARBARA; TAVOLOZZA, MARIO; TRAVASCIO, LAURA; DI BIAGIO, DANIELE; DANIELI, ROBERTA; SCHILLACI, ORAZIO

    2015-01-01

    The aim of the present study was to investigate brain glucose metabolism in patients with Hodgkin disease (HD) after diagnosis and during chemotherapy treatment. Following the administration of first-line doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy, 74 HD patients underwent 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET)/computed tomography brain scans, both baseline (PET0) and interim (PET2) at the Department of Biomedicine and Prevention, University of Rome Tor Vergata (Rome, Italy). Fifty-seven patients were further evaluated 15±6 days after four additional cycles (PET6). Furthermore, a control group (CG) of 40 chemotherapy-naïve subjects was enrolled. Differences in brain 18F-FDG uptake between the CG, PET0, PET2 and PET6 scans were analyzed using statistical parametric mapping. Compared with the PET0 and CG scans, the PET2 scan demonstrated a higher metabolic activity in Brodmann area (BA) 39, and a metabolic reduction in BA 11 bilaterally and in left BA 32. All of these changes disappeared at PET6. The results of the present study indicate that ABVD chemotherapy has a limited impact on brain metabolism. PMID:25621038

  19. A Solitary Metastasis for a Malignant Schwannoma in the Gallbladder Detected by 18F-FDG PET/CT.

    PubMed

    Evangelista, Laura; Burei, Marta; Basso, Umberto

    2016-08-01

    A 63-year-old woman with a history of malignant schwannoma in the left shoulder (pT1aNxMx) was treated with surgical resection in 2012. During follow-up, patient developed a metastasis in the right lung treated by further surgical intervention. For a suspicion on persistent disease in the lung, patient was sent to FDG PET/CT examination, which showed a focal uptake in the gallbladder. The patient underwent cholecystectomy, and a solitary metastasis from schwannoma was diagnosed by pathology. This case highlights that, in patients with a malignant schwannoma, a careful differential diagnosis should be made in case of a significant FDG uptake in the gallbladder.

  20. Paraneoplastic pemphigus as a first sign of metastatic retroperitoneal inflammatory myofibroblastic tumor: (18)F-FDG PET/CT findings.

    PubMed

    Dhull, V S; Passah, A; Rana, N; Arora, S; Mallick, S; Kumar, R

    2016-01-01

    A 30-year-old female presented with a 3-month history of erosive stomatitis and bullous lesions, along with recurrent episodes of abdominal pain. She was found to have a retroperitoneal lump in left lumbar region. Skin biopsy revealed bullous disorder. CT guided biopsy of the retroperitoneal mass was suggestive of inflammatory myofibroblastic tumor (IMT). She was started on oral steroids and supportive care, and surgery was being planned when she developed respiratory failure. CT chest revealed vertebral metastases. PET/CT for whole body work up revealed a left para-aortic mass along with multiple skeletal metastases. The patient was kept on conservative management. After 3 months, the patient has shown clinical improvement, and an exploratory laparotomy is now being planned for the excision of the tumor, followed by chemotherapy. This case of retroperitoneal IMT is rare in terms of skeletal metastases with paraneoplastic pemphigus.

  1. Preoperative Prediction of Cervical Lymph Node Metastasis Using Primary Tumor SUVmax on 18F-FDG PET/CT in Patients with Papillary Thyroid Carcinoma

    PubMed Central

    Jung, Ji-hoon; Kim, Choon-Young; Son, Seung Hyun; Kim, Do-Hoon; Jeong, Shin Young; Lee, Sang-Woo; Lee, Jaetae; Ahn, Byeong-Cheol

    2015-01-01

    Objectives The aim of the current study was to evaluate the value of preoperative 18F-FDG (FDG) PET/CT in predicting cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). Methods One hundred and ninety-three newly diagnosed PTC patients (M: F = 25:168, age = 46.8 ± 12.2) who had undergone pretreatment FDG PET/CT and had neck node dissection were included in this study. The FDG avidity of the primary tumor and the SUVmax of the primary tumor (pSUVmax) were analyzed for prediction of LN metastasis. Detectability by ultrasonography (US) and FDG PET/CT for cervical LN metastasis were also assessed and compared with the pSUVmax. Results The FDG avidity of the primary tumor was identified in 118 patients (FDG avid group: 61.0%, M: F = 16:102, age 47.0 ± 12.7 years) and pSUVmax ranged from 1.3 to 35.6 (median 4.6) in the FDG avid group. The tumor size in the FDG avid group was bigger and there was a higher incidence of LN metastasis compared to the FDG non-avid group (0.93 vs. 0.59 cm, p <0.001 and 49.2 vs. 33.3%, p <0.05). In the FDG avid group, patients with LN metastasis had higher pSUVmax than patients without LN metastasis (8.7 ± 8.3 vs. 5.7 ± 5.1, p <0.001). The incidence of central LN metastasis in patients with a pSUVmax >4.6 was 54%; however, the detectability of central LN metastasis by US and FDG PET/CT were 10.3% and 3.6%, respectively. Conclusion A high FDG avidity of the primary tumor was related to LN metastasis in PTC patients. Therefore, patients with a high pSUVmax should be cautiously assessed for LN metastasis and might need a more comprehensive surgical approach. PMID:26636824

  2. Predictive Role of the Number of 18F-FDG-Positive Lymph Nodes Detected by PET/CT for Pre-Treatment Evaluation of Locally Advanced Gastric Cancer

    PubMed Central

    Wang, Xin; Wei, Yuzhe; Xue, Yingwei; Lu, Peiou; Yu, Lijuan; Shen, Baozhong

    2016-01-01

    Objectives The aim of this study was to investigate the predictive value of the numbers of metabolically positive lymph nodes (MPLN) detected by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with locally advanced gastric cancer (LAGC). Methods We retrospectively analyzed the records of 50 patients with LAGC (stage T2-T4) who had undergone pre-operative PET/CT examination and laparotomy (total gastrectomy, n = 11; subtotal gastrectomy, n = 13; distal gastrectomy, n = 22; and bypass with gastrojejunstomy, n = 4). The numbers of MPLN were determined by combining visual observations with semi-quantitative measurements of the maximized standardized uptake value (SUVmax). Performance was investigated in terms of predicting post-surgical overall survival (OS). Results The median post-surgical OS was 32.57 months (range 3.0-94 months). The numbers of MPLN were moderately correlated with the numbers of histological positive LN (r = 0.694, p = 0.001). In univariate analyses, the numbers of MPLN (≤ 2 vs. ≥3), PET/CT LN (positivity vs. negativity), SUVmax of LN (< 2.8 vs. ≥ 2.8), TNM stage (I, II vs. III, IV), and surgery type (R0 vs. non-R0) were significantly associated with OS. In multivariate analysis, surgery type (R0 vs. non-R0) and numbers of MPLN (≤ 2 vs. ≥ 3) were both independent factors for poor OS. Conclusions This explored study indicates that the number of MPLN could provide additional information for LAGC prognosis. Patients with MPLNs ≥ 3 may be at the risk of the more bad outcomes, and the further clinical trials are needed. PMID:27936109

  3. Assessment of the usefulness of the standardized uptake values and the radioactivity levels for the preoperative diagnosis of thyroid cancer measured by using 18F-FDG PET/CT dual-time-point imaging

    NASA Astrophysics Data System (ADS)

    Lee, Hyeon-Guck; Hong, Seong-Jong; Cho, Jae-Hwan; Han, Man-Seok; Kim, Tae-Hyung; Lee, Ik-Han

    2013-02-01

    The purpose of this study was to assess and compare the changes in the SUV (standardized uptake value), the 18F-FDG (18F-fluorodeoxyglucose) uptake pattern, and the radioactivity level for the diagnosis of thyroid cancer via dual-time-point 18F-FDG PET/CT (positron emission tomographycomputed tomography) imaging. Moreover, the study aimed to verify the usefulness and significance of SUV values and radioactivity levels to discriminate tumor malignancy. A retrospective analysis was performed on 40 patients who received 18F-FDG PET/CT for thyroid cancer as a primary tumor. To set the background, we compared changes in values by calculating the dispersion of scattered rays in the neck area and the lung apex, and by comparing the mean and SD (standard deviation) values of the maxSUV and the radioactivity levels. According to the statistical analysis of the changes in 18F-FDG uptake for the diagnosis of thyroid cancer, a high similarity was observed with the coefficient of determination being R2 = 0.939, in the SUVs and the radioactivity levels. Moreover, similar results were observed in the assessment of tumor malignancy using dual-time-point. The quantitative analysis method for assessing tumor malignancy using radioactivity levels was neither specific nor discriminative compared to the semi-quantitative analysis method.

  4. Value of 18F-FDG PET/CT and MRI in diagnosing primary endometrial small cell carcinoma

    PubMed Central

    Wan, Qi; Jiao, Qian; Zhou, Jiaxuan; Zou, Qiao; Deng, Yingshi

    2014-01-01

    Primary small cell carcinoma (SCC) is a group of aggressive neoplasms that mainly arise from the lung and digestive tract. Endometrial small cell carcinoma (ESCC) is extremely rare. To our knowledge, less than 90 cases have been reported, and most of these reports were dedicated to describing the clinicopathologic or immunochemical features of ESCC. Herein, we present a new case of ESCC involving a 51-year-old woman and mainly focus on the magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) findings. MRI showed that the uterus was significantly enlarged (11.6 cm × 11.1 cm × 14.4 cm), and a giant irregular mass (7.5 cm × 8.4 cm × 8.5 cm) was observed in the uterine cavity. The lesion demonstrated an extremely low apparent diffusion coefficient (ADC) value [(0.553±0.088)×10–3 mm2/s] and a high FDG uptake value (22.7). Multiple metastatic lymph nodes (LNs) were identified at different positions, with diameters ranging from 0.3 to 2.8 cm and a maximum standardized uptake value (SUVmax) ranging from 6.9 to 19.3. PMID:25400430

  5. Pediatric Hodgkin Lymphoma: Predictive value of interim 18F-FDG PET/CT in therapy response assessment.

    PubMed

    Ferrari, Cristina; Niccoli Asabella, Artor; Merenda, Nunzio; Altini, Corinna; Fanelli, Margherita; Muggeo, Paola; De Leonardis, Francesco; Perillo, Teresa; Santoro, Nicola; Rubini, Giuseppe

    2017-02-01

    We investigated the prognostic value of interim F-FDG PET/CT (PET-2) in pediatric Hodgkin lymphoma (pHL), evaluating both visual and semiquantitative analysis.Thirty pHL patients (age ≤16) underwent serial F-FDG PET/CT: at baseline (PET-0), after 2 cycles of chemotherapy (PET-2) and at the end of first-line chemotherapy (PET-T). PET response assessment was carried out visually according to the Deauville Score (DS), as well as semiquantitatively by using the semiquantitative parameters reduction from PET-0 to PET-2 (ΔΣSUVmax0-2, ΔΣSUVmean0-2). Final clinical response assessment (outcome) at the end of first-line chemotherapy was the criterion standard, considering patients as responders (R) or nonresponders (NR). Disease status was followed identifying patients with absence or relapsed/progression disease (mean follow-up: 24 months, range 3-78).Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of visual and semiquantitative assessment were calculated; furthermore, Fisher exact test was performed to evaluate the association between both visual and semiquantitative assessment and outcome at the end of the first-line chemotherapy. The prognostic capability of PET-2 semiquantitative parameters was calculated by ROC analysis and expressed as area under curve (AUC). Finally, progression-free survival (PFS) was analyzed according to PET-2 results based on the 5-point scale and semiquantitative criteria, using the Kaplan-Meier method.Based on the outcome at the end of first-line chemotherapy, 5 of 30 patients were NR, the remnant 25 of 30 were R. Sensitivity, specificity, PPV, NPV, and accuracy of visual analysis were 60%,72%,30%,90%,70%; conversely, sensitivity, specificity, PPV, NPV, and accuracy of semiquantitative assessment were 80%, 92%, 66.7%, 95.8%, 90%. The highest AUC resulted for ΔΣSUVmax0-2 (0.836; cut-off <12.5; sensitivity 80%; specificity 91%). The association between ΔΣSUVmax0-2 and outcome at

  6. Metabolic Tumour Burden Measured by 18F-FDG PET/CT Predicts Malignant Transformation in Patients with Neurofibromatosis Type-1

    PubMed Central

    Van Der Gucht, Axel; Zehou, Ouidad; Djelbani-Ahmed, Soraya; Valeyrie-Allanore, Laurence; Ortonne, Nicolas; Brugières, Pierre; Wolkenstein, Pierre; Luciani, Alain; Rahmouni, Alain; Sbidian, Emilie; Itti, Emmanuel

    2016-01-01

    Background To investigate the diagnostic and prognostic performances of 18F-FDG PET/CT measures of metabolic tumour burden in patients with neurofibromatosis type-1 (NF1), suspect of malignant transformation. Methods This retrospective study included 49 patients (15–60 years old, 30 women) with a diagnosis of NF1, followed in our Reference Centre for Rare Neuromuscular Diseases, who presented clinical signs of tumour progression (pain, neurological deficit, tumour growth). Quantitative metabolic parameters were measured on 149 tumoral targets, using semi-automatic software and the best cut off values to predict transformation was assessed by Receiver Operating Characteristics (ROC) analysis. Prognostic value of PET/CT metabolic parameters was assessed by Kaplan-Meier estimates of overall survival. Results Lesions were histologically documented in 40 patients: a sarcomatous transformation was found in 16, a dysplastic neurofibroma (NF) in 7, and a benign NF in 17; in the remaining 9 patients, a minimal follow-up of 12 mo (median 59 mo) confirmed the absence of transformation. The optimal cut off values for detection of malignant transformation were, in decreasing order of area under the ROC curves, a tumour-to-liver (T/L) ratio >2.5, SUVmax > 4.5, total lesion glycolysis (TLG) > 377, total metabolic tumour volume (TMTV) > 88 cm3, and heterogeneity index (HIsuv) > 1.69. The best prognostic marker was the TLG: the 4-y estimates of survival were 97% [95% CI, 90% - 100%] in patients with TLG ≤ 377 vs. 27% [95% CI, 5% - 49%] in patients with TLG > 377 (P < 0.0001; χ2 27.85; hazard ratio 13.27 [95% CI, 3.72–47.35]). T/L ratio, SUVmax and TMTV demonstrated slightly lower performance to predict survival, with χ2 ranging 14.41–19.12. The HIsuv index was not predictive of survival. Conclusion Our study demonstrates that TLG and TMTV, as PET/CT measures of metabolic tumour burden, may be used clinically to identify sarcomatous transformation in patients with NF1 and

  7. The added clinical value of 18F-FDG PET/CT in evaluating intratracheal recurrence of differentiated thyroid carcinoma: implications for planning surgery, assessing its completeness, and planning radioiodine therapy.

    PubMed

    Basu, Sandip; Abhyankar, Amit

    2013-12-01

    In selected patients with differentiated thyroid carcinoma, (18)F-FDG PET/CT has been shown to have added value. We present 2 clinical examples in the settings of both iodine-concentrating and non-iodine-concentrating lesions with tracheal involvement with special reference to its importance in planning of surgery or radioiodine therapy and assessing completeness of surgery. We believe that the use of PET/CT should be considered on a case-by-case basis and specifically when SPECT/CT is unavailable or has inconclusive findings.

  8. Management of epithelial ovarian cancer from diagnosis to restaging: an overview of the role of imaging techniques with particular regard to the contribution of 18F-FDG PET/CT.

    PubMed

    Musto, Alessandra; Grassetto, Gaia; Marzola, Maria Cristina; Rampin, Lucia; Chondrogiannis, Sotirios; Maffione, Anna Margherita; Colletti, Patrick M; Perkins, Alan C; Fagioli, Giorgio; Rubello, Domenico

    2014-06-01

    Epithelial ovarian carcinoma is a major form of cancer affecting women in the western world. The silent nature of this disease results in late presentation at an advanced stage in many patients. It is therefore important to assess the role of imaging techniques in the management of these patients. This article presents a review of the literature on the role of (18)F-FDG-PET/CT in the different stages of management of epithelial ovarian cancer. Moreover, a comparison with other imaging techniques has been made and the relationship between (18)F-PET/CT and the assay of serum CA-125 levels has been discussed.

  9. Semiautomated segmentation of head and neck cancers in 18F-FDG PET scans: A just-enough-interaction approach

    PubMed Central

    Beichel, Reinhard R.; Van Tol, Markus; Ulrich, Ethan J.; Bauer, Christian; Chang, Tangel; Plichta, Kristin A.; Smith, Brian J.; Sunderland, John J.; Graham, Michael M.; Sonka, Milan; Buatti, John M.

    2016-01-01

    Purpose: The purpose of this work was to develop, validate, and compare a highly computer-aided method for the segmentation of hot lesions in head and neck 18F-FDG PET scans. Methods: A semiautomated segmentation method was developed, which transforms the segmentation problem into a graph-based optimization problem. For this purpose, a graph structure around a user-provided approximate lesion centerpoint is constructed and a suitable cost function is derived based on local image statistics. To handle frequently occurring situations that are ambiguous (e.g., lesions adjacent to each other versus lesion with inhomogeneous uptake), several segmentation modes are introduced that adapt the behavior of the base algorithm accordingly. In addition, the authors present approaches for the efficient interactive local and global refinement of initial segmentations that are based on the “just-enough-interaction” principle. For method validation, 60 PET/CT scans from 59 different subjects with 230 head and neck lesions were utilized. All patients had squamous cell carcinoma of the head and neck. A detailed comparison with the current clinically relevant standard manual segmentation approach was performed based on 2760 segmentations produced by three experts. Results: Segmentation accuracy measured by the Dice coefficient of the proposed semiautomated and standard manual segmentation approach was 0.766 and 0.764, respectively. This difference was not statistically significant (p = 0.2145). However, the intra- and interoperator standard deviations were significantly lower for the semiautomated method. In addition, the proposed method was found to be significantly faster and resulted in significantly higher intra- and interoperator segmentation agreement when compared to the manual segmentation approach. Conclusions: Lack of consistency in tumor definition is a critical barrier for radiation treatment targeting as well as for response assessment in clinical trials and in

  10. Multimodality functional imaging using DW-MRI and 18F-FDG-PET/CT during radiation therapy for human papillomavirus negative head and neck squamous cell carcinoma: Meixoeiro Hospital of Vigo Experience

    PubMed Central

    Aramburu Núñez, David; Lopez Medina, Antonio; Mera Iglesias, Moisés; Salvador Gomez, Francisco; Dave, Abhay; Hatzoglou, Vaios; Paudyal, Ramesh; Calzado, Alfonso; Deasy, Joseph O; Shukla-Dave, Amita; Muñoz, Victor M

    2017-01-01

    AIM To noninvasively investigate tumor cellularity measured using diffusion-weighted magnetic resonance imaging (DW-MRI) and glucose metabolism measured by 18F-labeled fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) during radiation therapy (RT) for human papillomavirus negative (HPV-) head and neck squamous cell carcinoma (HNSCC). METHODS In this prospective study, 6 HPV- HNSCC patients underwent a total of 34 multimodality imaging examinations DW-MRI at 1.5 T Philips MRI scanner [(n = 24) pre-, during- (2-3 wk), and post-treatment (Tx), and 18F-FDG PET/CT pre- and post-Tx (n = 10)]. All patients received RT. Monoexponential modeling of the DW-MRI data yielded the imaging metric apparent diffusion coefficient (ADC) and the mean of standardized uptake value (SUV) was measured from 18F-FDG PET uptake. All patients had a clinical follow-up as the standard of care and survival status was documented at 1 year. RESULTS There was a strong negative correlation between the mean of pretreatment ADC (ρ = -0.67, P = 0.01) and the pretreatment 18F-FDG PET SUV. The percentage (%) change in delta (∆) ADC for primary tumors and neck nodal metastases between pre- and Wk2-3 Tx were as follows: 75.4% and 61.6%, respectively, for the patient with no evidence of disease, 27.5% and 32.7%, respectively, for those patients who were alive with disease, and 26.9% and 7.31%, respectively, for those who were dead with disease. CONCLUSION These results are preliminary in nature and are indicative, and not definitive, trends rendered by the imaging metrics due to the small sample size of HPV- HNSCC patients in a Meixoeiro Hospital of Vigo Experience. PMID:28144403

  11. Whole body 18F-FDG PET/CT is superior to CT as first line diagnostic imaging in patients referred with serious non-specific symptoms or signs of cancer: a randomized prospective study of 200 patients.

    PubMed

    Lebech, Anne-Mette; Gaardsting, Anne; Loft, Annika; Graff, Jesper; Markova, Elena; Berthelsen, Anne Kiil; Madsen, Jan Lysgaard; Helms, Morten; Mathiesen, Lars R; David, Kim P; Kronborg, Gitte; Kjaer, Andreas

    2017-01-12

    A fast-track pathway has been established in Denmark to investigate patients with serious non-specific symptoms and signs of cancer (NSSC), which are not eligible to enter an organ-specific cancer program. The prevalence of cancer in this cohort is approximately 20%. The optimal screening strategy in patients with NSSC remains unknown. The aim was to investigate if (18)F-FDG-positron emission tomography/computed tomography (PET/CT) was superior to CT as initial imaging modality in patients with NSSC. In a randomized prospective trial the imaging modalities were compared with regard to diagnostic performance.

  12. MIB-1 Index-Stratified Assessment of Dual-Tracer PET/CT with (68)Ga-DOTATATE and (18)F-FDG and Multimodality Anatomic Imaging in Metastatic Neuroendocrine Tumors of Unknown Primary in a PRRT Workup Setting.

    PubMed

    Sampathirao, Nikita; Basu, Sandip

    2017-03-01

    Our aim was to comparatively assess dual-tracer PET/CT ((68)Ga-DOTATATE and (18)F-FDG) and multimodality anatomic imaging in studying metastatic neuroendocrine tumors (NETs) of unknown primary (CUP-NETs) scheduled for peptide receptor radionuclide therapy for divergence of tracer uptake on dual-tracer PET/CT, detection of primary, and overall lesion detection vis-a-vis tumor proliferation index (MIB-1/Ki-67). Methods: Fifty-one patients with CUP-NETs (25 men, 26 women; age, 22-74 y), histopathologically proven and thoroughly investigated with conventional imaging modalities (ultrasonography, CT/contrast-enhanced CT, MRI, and endoscopic ultrasound, wherever applicable), were retrospectively analyzed. Patients were primarily referred for deciding on feasibility of peptide receptor radionuclide therapy (except 2 patients), and all had undergone (68)Ga-DOTATATE and (18)F-FDG PET/CT as part of pretreatment workup. The sites of metastases included liver, lung/mediastinum, skeleton, abdominal nodes, and other soft-tissue sites. Patients were divided into 5 groups on the basis of MIB-1/Ki-67 index on a 5-point scale: group I (1%-5%) (n = 35), group II (6%-10%) (n = 8), group III (11%-15%) (n = 4), group IV (16%-20%) (n = 2), and group V (>20%) (n = 2). Semiquantitative analysis of tracer uptake was undertaken by SUVmax of metastatic lesions and the primary (when detected). The SUVmax values were studied over increasing MIB-1/Ki-67 index. The detection sensitivity of (68)Ga-DOTATATE for primary and metastatic lesions was assessed and compared with other imaging modalities including (18)F-FDG PET/CT. Results: Unknown primary was detected on (68)Ga-DOTATATE in 31 of 51 patients, resulting in sensitivity of 60.78% whereas overall lesion detection sensitivity was 96.87%. The overall lesion detection sensitivities (individual groupwise from group I to group V) were 97.75%, 87.5%, 100%, 100%, and 66.67%, respectively. As MIB-1/Ki-67 index increased, (68)Ga-DOTATATE uptake

  13. Pineal gland involvement in Erdheim-Chester disease detected on (18)F-FDG PET-CT imaging: a case report and review of literature.

    PubMed

    Mukherjee, Anirban; Dhull, Varun Singh; Karunanithi, Sellam; Sharma, Punit; Durgapal, Prashant; Kumar, Rakesh

    2014-01-01

    Erdheim-Chester disease (ECD) is a rare non-Langerhan's cell histiocytosis affecting multiple organ systems. The most common systemic manifestations are bone lesions, infiltration of the pituitary stalk sometimes leading to diabetes insipidus, pulmonary fibrosis, cardiac failure and exophthalmus. Neurological symptoms as the first clinical manifestations of ECD have been reported in less than one third of cases. We report a rare presentation of a patient of ECD on 18F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography which revealed abnormal (18)F-FDG accumulation in the region of pineal gland, pericardium and bilateral distal tibiae.

  14. Occipital Hypometabolism on FDG PET/CT Scan in a Child with Hodgkin's Lymphoma

    PubMed Central

    Tatci, Ebru; Ozmen, Ozlem; Gokcek, Atila; Demir, Haci Ahmet; Gulleroglu, Nadide Basak

    2016-01-01

    It is known that Fluorodeoxyglucose (FDG) Positron Emission/Computed Tomography (PET/CT) images may be helpful for evaluation of brain function in newborns. Here we described the fluorine-18 [18-F] FDG PET/CT imaging findings of encephalomalacia due to perinatal asphyxia in a child with refractory Hodgkin's Lymphoma (HL) who underwent PET/CT scan to stage the primary disease. Prominent hypometabolism was incidentally detected in the occipital regions bilaterally apart from the FDG uptakes in the malign lymphatic infiltrations. This case highlights the potential coexistence of a malignancy and a functional brain disorder. PMID:27965911

  15. Effect of different segmentation algorithms on metabolic tumor volume measured on 18F-FDG PET/CT of cervical primary squamous cell carcinoma

    PubMed Central

    Xu, Weina; Yu, Shupeng; Ma, Ying; Liu, Changping

    2017-01-01

    Background and purpose It is known that fluorine-18 fluorodeoxyglucose PET/computed tomography (CT) segmentation algorithms have an impact on the metabolic tumor volume (MTV). This leads to some uncertainties in PET/CT guidance of tumor radiotherapy. The aim of this study was to investigate the effect of segmentation algorithms on the PET/CT-based MTV and their correlations with the gross tumor volumes (GTVs) of cervical primary squamous cell carcinoma. Materials and methods Fifty-five patients with International Federation of Gynecology and Obstetrics stage Ia∼IIb and histologically proven cervical squamous cell carcinoma were enrolled. A fluorine-18 fluorodeoxyglucose PET/CT scan was performed before definitive surgery. GTV was measured on surgical specimens. MTVs were estimated on PET/CT scans using different segmentation algorithms, including a fixed percentage of the maximum standardized uptake value (20∼60% SUVmax) threshold and iterative adaptive algorithm. We divided all patients into four different groups according to the SUVmax within target volume. The comparisons of absolute values and percentage differences between MTVs by segmentation and GTV were performed in different SUVmax subgroups. The optimal threshold percentage was determined from MTV20%∼MTV60%, and was correlated with SUVmax. The correlation of MTViterative adaptive with GTV was also investigated. Results MTV50% and MTV60% were similar to GTV in the SUVmax up to 5 (P>0.05). MTV30%∼MTV60% were similar to GTV (P>0.05) in the 50.05) in the 100.05) in the SUVmax of at least 15 group. MTViterative adaptive was similar to GTV in both total and different SUVmax groups (P>0.05). Significant differences were observed among the fixed percentage method and the optimal threshold percentage was inversely correlated with SUVmax. The iterative adaptive segmentation algorithm led

  16. Association between osteogenesis and inflammation during the progression of calcified plaque as evaluated by combined (18)F-NaF and (18)F-FDG PET/CT.

    PubMed

    Li, Xiang; Heber, Daniel; Cal-Gonzales, Jacobo; Karanikas, Georgios; Mayerhoefer, Marius E; Rasul, Sazan; Beitzke, Dietrich; Zhang, Xiaoli; Agis, Hermine; Mitterhauser, Markus; Wadsak, Wolfgang; Beyer, Thomas; Loewe, Christian; Hacker, Marcus

    2017-02-23

    Background and Aim:(18)F-fluorodeoxyglucose ((18)F-FDG) is the most widely validated positron emission tomography (PET) tracer for the evaluation of atherosclerotic inflammation. (18)F-sodium fluoride ((18)F-NaF) has also been recently considered a potential novel biomarker of osteogenesis in atherosclerosis. We aimed to analyze the association between inflammation and osteogenesis at different stages of atherosclerosis, as well as the interrelationship between these two processes during disease progression. Methods: Thirty-four myeloma patients underwent (18)F-NaF and (18)F-FDG PET/computed tomography (CT) examinations. Three groups (non-calcified; mildly calcified; and severely calcified lesions) were divided based on the calcium density as measured in Hounsfield units (HU) by CT. Tissue-to-background ratios (TBR) were determined from PET for both tracers. The association between inflammation and the osteogenesis during atherosclerosis progression was evaluated in 19 patients who had at least two examinations with both tracers. Results: There were significant correlations between the TBRmax values of the two tracers (Spearman's r = 0.5, P < 0.01, Pearson r = 0.4, P < 0.01) in the 221 lesions at baseline. In non-calcified lesions, highest uptake of both tracers was observed, but without any correlation between both tracers (Pearson r = 0.06, P = 0.76). Compared to non-calcified plaques, concordant significantly lower accumulation was found in mildly calcified plaques, with good correlation between the tracers (Pearson r = 0.7, P < 0.01). In addition, there was enhanced osteogenesis-derived (18)F-NaF uptake, and regressive inflammation-derived (18)F-FDG uptake in severely calcified lesions (Pearson r = 0.4, P < 0.01). During follow-up, there was an increased calcium density and an increased mean (18)F-NaF uptake observed, while the mean (18)F-FDG uptake decreased. The majority of non-calcified (86%) and mildly calcified (81%) lesions and 47% of severely calcified

  17. 18F-FDG and 68Ga-DOTATATE PET/CT in von Hippel-Lindau Disease-Associated Retinal Hemangioblastoma.

    PubMed

    Papadakis, Georgios Z; Millo, Corina; Jassel, Inderbir S; Bagci, Ulas; Sadowski, Samira M; Karantanas, Apostolos H; Patronas, Nicholas J

    2017-03-01

    Retinal hemangioblastomas are highly vascular benign tumors that can be encountered either sporadically or within the von Hippel-Lindau (VHL) syndrome. We report a case of a VHL patient with retinal hemangioblastoma who underwent PET/CT scans using F-FDG and Ga-DOTATATE. The tumor showed low-level F-FDG and increased Ga-DOTATATE activity, suggesting cell-surface overexpression of somatostatin receptors. The presented case indicates the clinical applications of somatostatin receptor imaging with Ga-DOTA-conjugated peptides in detection and follow-up of VHL manifestations, screening of asymptomatic gene carriers, and in diagnosis of sporadic retinal hemangioblastomas, which may have similar features on MRI with other retinal tumors.

  18. Associations between the standardized uptake value of 18F-FDG PET/CT and demographic, clinical, pathological, radiological factors in lung cancer

    PubMed Central

    Sunnetcioglu, Aysel; Arısoy, Ahmet; Demir, Yusuf; Ekin, Selami; Dogan, Erkan

    2015-01-01

    Objectives: 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is extensively used to diagnose and stage of lung cancer. The aim of the current study was to investigate the correlation of demographic, clinical, pathological and radiological factors with primer tumor FDG Uptake in patients with lung cancer. Materials and methods: This cross-sectional, clinical study was performed on a total of 57 lung cancer patients newly diagnosed that underwent FDG PET/CT. In addition to descriptive variables, histopathological diagnosis, tumor site and size, hemoglobin level, red cell distribution width, neutrophil to lymphocyte ratio were noted for each patient. The correlation of these variables to SUVmax values in FDG PET/CT was investigated. Results: A total of 57 patients (4 women, 53 men) with an average age of 60.8±9.4 (range: 33-89) participated in the study. Histopathological diagnoses were consistent with squamous cell carcinoma (28, 49.1%), adenocarcinoma (15, 26.3%) and small cell cancer (14, 24.6%). The SUVmax of primary tumor was positively correlated with tumor size (P<0.001). The tumor SUVmax of squamous cell carcinoma (SqCC) (17.49±8.37) was higher than that of adenocarcinoma (AC) (12.80±4.77) and small cell carcinoma (SCC) (12.40±5.80) (P=0.038). Conclusion: SUVmax value was significantly higher for squamous cell carcinoma and it SUVmax values in PET scans was found to be positively correlated with tumor size. This study suggests that, tumor size and histologic subtype had influences upon FDG uptake in lung cancer. PMID:26629078

  19. Effect of {sup 18}F-FDG PET/CT Imaging in Patients With Clinical Stage II and III Breast Cancer

    SciTech Connect

    Groheux, David Moretti, Jean-Luc; Baillet, Georges; Espie, Marc; Giacchetti, Sylvie; Hindie, Elif; Hennequin, Christophe; Vilcoq, Jacques-Robert; Cuvier, Caroline; Toubert, Marie-Elisabeth; Filmont, Jean-Emmanuel; Sarandi, Farid; Misset, Jean-Louis

    2008-07-01

    Purpose: To investigate the potential effect of using {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in the initial assessment of patients with clinical Stage II or III breast cancer. Methods and Materials: During 14 consecutive months, 39 patients (40 tumors) who presented with Stage II or III breast cancer on the basis of a routine extension assessment were prospectively included in this study. PET/CT was performed in addition to the initial assessment. Results: In 3 cases, PET/CT showed extra-axillary lymph node involvement that had not been demonstrated with conventional techniques. Two of these patients had hypermetabolic lymph nodes in the subpectoral and infraclavicular regions, and the third had a hypermetabolic internal mammary node. PET/CT showed distant uptake in 4 women. Of these 4 women, 1 had pleural involvement and 3 had bone metastasis. Overall, of the 39 women, the PET/CT results modified the initial stage in 7 (18%). The modified staging altered the treatment plan for 5 patients (13%). It led to radiotherapy in 4 patients (bone metastasis, pleural lesion, subpectoral lymph nodes, and internal mammary nodes) and excision of, and radiotherapy to, the infraclavicular lymph nodes in 1 patient. Conclusions: PET/CT can provide information on extra-axillary lymph node involvement and can uncover occult distant metastases in a significant percentage of patients. Therefore, initial PET/CT could enable better treatment planning for patients with Stage II and III breast cancer.

  20. 18F-FDG PET/CT for Monitoring the Response of Breast Cancer to miR-143-Based Therapeutics by Targeting Tumor Glycolysis

    PubMed Central

    Miao, Ying; Zhang, Ling-fei; Guo, Rui; Liang, Sheng; Zhang, Min; Shi, Shuo; Shang-Guan, Cheng-fang; Liu, Mo-fang; Li, Biao

    2016-01-01

    Increased glucose utilization is a hallmark of cancer, and tumor metabolism is emerging as anticancer target for therapeutic intervention. Triple-negative breast cancers TNBC are highly glycolytic and show poor clinical outcomes. We previously identified hexokinase 2, the major glycolytic enzyme, as a target gene of miR-143 in TNBC. Here, we developed a therapeutic formulation using cholesterol-modified miR-143 agomir encapsulated in a neutral lipid-based delivery agent that blocked tumor growth and glucose metabolism in TNBC tumor-bearing mice when administered systemically. The antioncogenic effects were accompanied by a reduction in the direct target hexokinase 2 and [18F]-fluorodeoxyglucose (18F-FDG) uptake based on positron emission tomography/computed tomography. Treatment with miR-143 formulation has minimal toxic effects and mice tolerated it well. Thus, we demonstrated that miR-143 is a robust inhibitor of the Warburg effect and an effective therapeutic target for TNBC. In addition, 18F-FDG positron emission tomography/computed tomography can be used to specifically monitor the response of TNBC to miR-143-based therapeutics by targeting tumor glycolysis. PMID:27574783

  1. (18)F-FDG PET/CT for Monitoring the Response of Breast Cancer to miR-143-Based Therapeutics by Targeting Tumor Glycolysis.

    PubMed

    Miao, Ying; Zhang, Ling-Fei; Guo, Rui; Liang, Sheng; Zhang, Min; Shi, Shuo; Shang-Guan, Cheng-Fang; Liu, Mo-Fang; Li, Biao

    2016-01-01

    Increased glucose utilization is a hallmark of cancer, and tumor metabolism is emerging as anticancer target for therapeutic intervention. Triple-negative breast cancers TNBC are highly glycolytic and show poor clinical outcomes. We previously identified hexokinase 2, the major glycolytic enzyme, as a target gene of miR-143 in TNBC. Here, we developed a therapeutic formulation using cholesterol-modified miR-143 agomir encapsulated in a neutral lipid-based delivery agent that blocked tumor growth and glucose metabolism in TNBC tumor-bearing mice when administered systemically. The antioncogenic effects were accompanied by a reduction in the direct target hexokinase 2 and [(18)F]-fluorodeoxyglucose ((18)F-FDG) uptake based on positron emission tomography/computed tomography. Treatment with miR-143 formulation has minimal toxic effects and mice tolerated it well. Thus, we demonstrated that miR-143 is a robust inhibitor of the Warburg effect and an effective therapeutic target for TNBC. In addition, (18)F-FDG positron emission tomography/computed tomography can be used to specifically monitor the response of TNBC to miR-143-based therapeutics by targeting tumor glycolysis.

  2. (18)F-FDG PET/CT for Monitoring the Response of Breast Cancer to miR-143-Based Therapeutics by Targeting Tumor Glycolysis.

    PubMed

    Miao, Ying; Zhang, Ling-Fei; Guo, Rui; Liang, Sheng; Zhang, Min; Shi, Shuo; Shang-Guan, Cheng-Fang; Liu, Mo-Fang; Li, Biao

    2016-08-30

    Increased glucose utilization is a hallmark of cancer, and tumor metabolism is emerging as anticancer target for therapeutic intervention. Triple-negative breast cancers TNBC are highly glycolytic and show poor clinical outcomes. We previously identified hexokinase 2, the major glycolytic enzyme, as a target gene of miR-143 in TNBC. Here, we developed a therapeutic formulation using cholesterol-modified miR-143 agomir encapsulated in a neutral lipid-based delivery agent that blocked tumor growth and glucose metabolism in TNBC tumor-bearing mice when administered systemically. The antioncogenic effects were accompanied by a reduction in the direct target hexokinase 2 and [(18)F]-fluorodeoxyglucose ((18)F-FDG) uptake based on positron emission tomography/computed tomography. Treatment with miR-143 formulation has minimal toxic effects and mice tolerated it well. Thus, we demonstrated that miR-143 is a robust inhibitor of the Warburg effect and an effective therapeutic target for TNBC. In addition, (18)F-FDG positron emission tomography/computed tomography can be used to specifically monitor the response of TNBC to miR-143-based therapeutics by targeting tumor glycolysis.

  3. Clinical utility of multimodality imaging with dynamic contrast-enhanced MRI, diffusion-weighted MRI, and 18F-FDG PET/CT for the prediction of neck control in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation.

    PubMed

    Ng, Shu-Hang; Lin, Chien-Yu; Chan, Sheng-Chieh; Lin, Yu-Chun; Yen, Tzu-Chen; Liao, Chun-Ta; Chang, Joseph Tung-Chieh; Ko, Sheung-Fat; Wang, Hung-Ming; Chang, Chee-Jen; Wang, Jiun-Jie

    2014-01-01

    The clinical usefulness of pretreatment imaging techniques for predicting neck control in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) treated with chemoradiation remains unclear. In this prospective study, we investigated the role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI), diffusion-weighted MR imaging (DWI), and [18F]fluorodeoxyglucose-positron emission tomography (18F-FDG PET)/CT derived imaging markers for the prediction of neck control in OHSCC patients treated with chemoradiation. Patients with untreated OHSCC scheduled for chemoradiation between August, 2010 and July, 2012 were eligible for the study. Clinical variables and the following imaging parameters of metastatic neck lymph nodes were examined in relation to neck control: transfer constant, volume of blood plasma, and volume of extracellular extravascular space (Ve) on DCE-PWI; apparent diffusion coefficient (ADC) on DWI; maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis on 18F-FDG PET/CT. There were 69 patients (37 with oropharynx SCC and 32 with hypopharynx SCC) with successful pretreatment DCE-PWI and DWI available for analysis. After a median follow-up of 31 months, 25 (36.2%) participants had neck failure. Multivariate analysis identified hemoglobin level <14.3 g/dL (P = 0.019), Ve <0.23 (P = 0.040), and ADC >1.14×10-3 mm2/s (P = 0.003) as independent prognostic factors for 3-year neck control. A prognostic scoring system was formulated by summing up the three significant predictors of neck control. Patients with scores of 2-3 had significantly poorer neck control and overall survival rates than patients with scores of 0-1. We conclude that hemoglobin levels, Ve, and ADC are independent pretreatment prognostic factors for neck control in OHSCC treated with chemoradiation. Their combination may identify a subgroup of patients at high risk of developing neck failure.

  4. 18F-FDG PET/CT as a central tool in the shift from chronic Q fever to Coxiella burnetii persistent focalized infection: A consecutive case series.

    PubMed

    Eldin, Carole; Melenotte, Cléa; Million, Matthieu; Cammilleri, Serge; Sotto, Albert; Elsendoorn, Antoine; Thuny, Franck; Lepidi, Hubert; Roblot, France; Weitten, Thierry; Assaad, Souad; Bouaziz, Anissa; Chapuzet, Claire; Gras, Guillaume; Labussiere, Anne-Sophie; Landais, Cécile; Longuet, Pascale; Masseau, Agathe; Mundler, Olivier; Raoult, Didier

    2016-08-01

    Because Q fever is mostly diagnosed serologically, localizing a persistent focus of Coxiella burnetii infection can be challenging. F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) could be an interesting tool in this context.We performed a retrospective study on patients diagnosed with C burnetii infection, who had undergone F-FDG PET/CT between 2009 and 2015. When positive F-FDG PET/CT results were obtained, we tried to determine if it changed the previous diagnosis by discovering or confirming a suspected focus of C burnetii infection.One hundred sixty-seven patients benefited from F-FDG PET/CT. The most frequent clinical subgroup before F-FDG PET/CT was patients with no identified focus of infection, despite high IgG1 serological titers (34%). For 59% (n = 99) of patients, a hypermetabolic focus was identified. For 62 patients (62.6%), the positive F-FDG PET/CT allowed the diagnosis to be changed. For 24 of them, (38.7%), a previously unsuspected focus of infection was discovered. Forty-two (42%) positive patients had more than 1 hypermetabolic focus. We observed 21 valvular foci, 34 vascular foci, and a high proportion of osteoarticular localizations (n = 21). We also observed lymphadenitis (n = 27), bone marrow hypermetabolism (n = 11), and 9 pulmonary localizations.We confirmed thatF-FDG PET/CT is a central tool in the diagnosis of C burnetii focalized persistent infection. We proposed new diagnostic scores for 2 main clinical entities identified using F-FDG PET/CT: osteoarticular persistent infections and lymphadenitis.

  5. A rare case of non-small cell lung cancer metastasizing to the pituitary gland: detection with (18)F-FDG PET-CT.

    PubMed

    Agarwal, Krishan Kant; Sharma, Punit; Singla, Suhas; Suman Kc, Sudhir; Bal, Chandrasekhar; Kumar, Rakesh

    2014-05-01

    Metastases to the pituitary gland are rare. We here present a case of a 52-year-old man with non-small cell lung cancer where pituitary metastasis was detected on staging F-FDG PET-CT, characterized with MRI and confirmed at histopathology. By demonstrating such rare site of metastasis, F-FDG PET-CT can have significant impact on management of cancer patients.

  6. Evaluation of 18F-FDG PET/CT as a diagnostic imaging and staging tool for feline oral squamous cell carcinoma.

    PubMed

    Randall, E K; Kraft, S L; Yoshikawa, H; LaRue, S M

    2016-03-01

    18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (18FDG-PET/CT) has been shown to be effective for staging human oral squamous cell carcinoma (SCC) but its application for cats with oral SCC is unknown. Twelve cats with biopsy-proven oral SCC were imaged with whole body 18FDG-PET/CT to determine its value as a diagnostic imaging and staging tool and fine needle aspirates were obtained of accessible regional lymph nodes. All tumors were FDG avid and conspicuous on 18FDG-PET/CT images, with an average of the maximum standardized uptake value 9.88 ± 5.33 SD (range 2.9-24.9). Soft tissue infiltrative tumors that were subtle and ill defined on CT were highly visible and more extensive on FDG-PET/CT. Tumors invading the osseous structures were more similar in extent on 18FDG-PET/CT and CT although they were more conspicuous on PET images. Three cytologically confirmed metastases were hypermetabolic on PET, while two of those metastases were equivocal on CT.

  7. 18F-FDG PET in the Evaluation of Acuity of Deep Vein Thrombosis

    PubMed Central

    Rondina, Matthew T.; Lam, Uyen T.; Pendleton, Robert C.; Kraiss, Larry W.; Wanner, Nathan; Zimmerman, Guy A.; Hoffman, John M.; Hanrahan, Christopher; Boucher, Kenneth; Christian, Paul E.; Butterfield, Regan I.; Morton, Kathryn A.

    2013-01-01

    Purpose 18F-FDG PET has been used for vascular disease, but its role in deep vein thrombosis (DVT) remains prospectively unexplored. Patients and Methods Whole-body 18F-FDG PET/CT scans were performed in patients 1 to 10 weeks after onset of symptomatic DVT (n = 12) and in control subjects without DVT (n = 24). The metabolic activity (SUVmax) of thrombosed and contralateral nonthrombosed vein segments was determined. The sensitivity and specificity of 18F-FDG PET/CT for the diagnosis of DVT were determined by receiver operating characteristic curve analyses. In 2 patients with DVT, changes in the metabolic activity of thrombosed vein segments in serial 18F-FDG PET scans. Results The metabolic activity in thrombosed veins [SUVmax, 2.41 (0.75)] was visually appreciable and significantly higher than in nonthrombosed veins in either the contralateral extremity of patients with DVT [SUVmax, 1.09 (0.25), P = 0.007] or control subjects [1.21 (0.22), P < 001]. The area under the receiver operating characteristic curve for SUVmax was 0.9773 (P < 001), indicating excellent accuracy. An SUVmax threshold of greater than 1.645 was 87.5% sensitive and 100% specific for DVT. Metabolic activity in thrombosed veins correlated significantly with time from DVT symptom onset (decrease in SUVmax of 0.02/d, P < 0.05). Best-fit-line analyses suggested that approximately 84 to 91 days after acute DVT, the maximum metabolic activity of thrombosed veins would return to normal levels. Conclusions 18F-FDG PET/CT is accurate for detecting acute symptomatic, proximal DVT. Metabolic activity in thrombosed veins decreases with time, suggesting that 18F-FDG PET may be helpful in assessing the age of the clot. PMID:23154470

  8. Impact of (18)F-FDG PET/CT imaging in therapeutic decisions for malignant solitary fibrous tumor of the pelvis.

    PubMed

    Yan, Jinchun; Jones, Robin L; Lewis, David H; Eary, Janet F

    2013-06-01

    The decision to give neoadjuvant chemotherapy in patients with localized high-risk soft tissue sarcoma is often based on tumor grade evaluated from biopsies, but biopsies can have the inherent issue of sampling bias. Incorporation of SUVmax and heterogeneity assessed by F-FDG PET/CT could be other crucial components in the effort to tailor treatment to an individual patient, providing valuable parameters to guide the selection of the most appropriate management schedule for an individual. We present 1 representative case describing how FDG PET/CT can assist in clinical management decisions for treatment of malignant solitary fibrous tumor of the pelvis.

  9. Dyke-Davidoff-Masson Syndrome With Cerebral Hypometabolism and Unique Crossed Cerebellar Diaschisis in 18F-FDG PET/CT.

    PubMed

    Demir, Yusuf; Sürücü, Erdem; Çilingir, Vedat; Bulut, Mehmet Deniz; Tombul, Temel

    2015-09-01

    A 23-year-old man with Dyke-Davidoff-Masson syndrome (DDMS) was admitted to the hospital with increasing frequency of epileptic seizures. Physical examination revealed mental retardation, left facial asymmetry, and left-sided spastic hemiparesis. Dysdiadochokinesia on the left upper limb was detected, and there was no dysmetria. MRI confirmed the well-known radiological features of DDMS. PET/CT demonstrated cerebral and contralateral cerebellar hypometabolism. We present DDMS with crossed cerebellar diaschisis, which was demonstrated by PET/CT.

  10. 18F-FDG PET/CT Imaging of Extranodal Rosai-Dorfman Disease with Hepatopancreatic Involvement - A Pictorial and Literature Review

    PubMed Central

    Awan, Omer; Mohiuddin, Sohaib; Farooqui, Saleem; Khan, Salman A; McCartney, William

    2015-01-01

    We share our experience with serial PET/CT imaging on a patient with extranodal Rosai-Dorfman disease (RDD) with hepatopancreatic involvement. RDD is a benign proliferative disorder of histiocytes mainly involving the lymph nodes. It typically presents with fever and painless cervical lymphadenopathy in young adults and less than half of RDS cases demonstrate extranodal involvement. RDD involvement of the liver and pancreas is extremely rare, and this case highlights the role of PET/CT in its management. PMID:26798568

  11. Factors affecting bilateral temporal lobe hypometabolism on 18F-FDG PET brain scan in unilateral medial temporal lobe epilepsy.

    PubMed

    Tepmongkol, Supatporn; Srikijvilaikul, Teeradej; Vasavid, Pataramon

    2013-11-01

    Bilateral temporal lobe hypometabolism (BTH) on (18)F-FDG PET brain scan is frequently seen in unilateral medial temporal lobe epilepsy (mTLE). This study aimed to identify the factors that influence BTH in patients with mTLE in order to minimize the significant factor(s) prior to performing a FDG-PET brain scan. Forty patients with unilateral mTLE who underwent (18)F-FDG PET scan for presurgical epilepsy workup were included. Bilateral temporal lobe hypometabolism of the anterior and medial parts of the temporal lobe was identified by a semiquantitative visual scale. Lateralization of TLE was identified by either intracranial EEG (22/40 cases) and/or improvement of seizure 2 years after temporal lobectomy (37/40 cases). The factors analyzed included basic demographic characteristics (age, sex, occupation, years of education, and handedness), history related to seizure (age at epilepsy onset and epilepsy duration, history of febrile seizure and head injury, frequency of seizure with impaired cognition in the last 3 months, presence of secondarily generalized tonic-clonic seizure, automatism side, presence of postictal confusion, and side of MRI temporal abnormality), information during video-EEG monitoring (clinical lateralization, interictal scalp EEG lateralization (interictal epileptiform discharge), and ictal scalp EEG lateralization), and information during the FDG-PET study (duration from the last seizure (≤2 days or >2 days), last seizure type, and the presence of slow waves or sharp waves during the FDG uptake period). Significant factors related to BTH were analyzed using multivariate analysis. Only the ≤2-day duration from the last seizure to the PET scan shows a significant effect (p=0.021) on BTH finding with 15 times greater incidence compared to a duration >2 days. Bilateral temporal lobe hypometabolism, which causes conflict in lateralizing the epileptogenic zone in temporal lobe epilepsy, can be avoided by performing PET scan more than 2 days

  12. Imaging the Normal and Abnormal Anatomy of the Female Pelvis Using (18)F FDG-PET/CT, Including Pitfalls and Artifacts.

    PubMed

    Even-Sapir, Einat

    2010-10-01

    This article summarizes the normal biodistribution of (18)F fluorodeoxyglucose in the pelvis, physiologic changes in the female reproductive system and benign adnexal and uterine lesions which may be associated with increased tracer uptake that should be appreciated when PET/CT studies of female patients, mainly those with gynecologic malignancies are reviewed.

  13. Talc Pleurodesis With Intense 18F-FDG Activity But No 68Ga-DOTA-TATE Activity on PET/CT.

    PubMed

    Papadakis, Georgios Z; Millo, Corina; Bagci, Ulas; Patronas, Nicholas J; Stratakis, Constantine A

    2015-10-01

    Talc pleurodesis (TP) is a technique, widely employed in the management of patients with persistent pleural effusions or pneumothoraces not amenable to other treatment options. It is well documented that talc deposits produce areas of highly increased F-FDG uptake, because of talc-induced inflammation. We present a case of a patient with history of TP who was evaluated with both F-FDG and Ga-DOTA-TATE. The hypermetabolic area seen on F-FDG-PET-CT in the region of talc placement showed no uptake by Ga-DOTA-TATE, suggesting the potential role of Ga-DOTA-TATE-PET-CT in elucidating F-FDG-postitive lesions in patients with history of both neuroendocrine malignancy and TP.

  14. Primary Uterine Peripheral T-cell Lymphoma: A Case Report of MRI and 18F-FDG PET/CT Findings.

    PubMed

    Gong, Jing; Dong, Aisheng; Wang, Yang; Zhang, Xuefeng; Yang, Panpan; Wang, Li; Jing, Wei

    2016-04-01

    Primary uterine non-Hodgkin's lymphoma is extremely rare accounting for <1% of all extranodal non-Hodgkin's lymphomas. Imaging findings of primary uterine lymphoma have rarely been reported before. We present magnetic resonance imaging (MRI) and fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/CT findings in a patient with primary uterine peripheral T-cell lymphoma.A 27-year-old female presented with intermittent fever with neutropenia for 7 months. MRI showed an ill-defined mass involved both the uterine corpus and cervix, resulting in diffuse enlargement of the uterus. This mass showed inhomogeneous hypointensity on unenhanced T1-weighted images, hyperintensity on diffusion-weighted imaging, relative hypointensity compared to the surrounding myometrium on T2-weighted images and lower enhancement than the surrounding myometrium on enhanced T1-weighted images. FDG PET/CT showed intense FDG uptake in the thickened wall of the uterine corpus and cervix with SUVmax of 26.9. There were multiple hypermetabolic lymph nodes in the pelvis and retroperitoneum. Uterine curettage and CT-guided biopsy of the uterine mass revealed peripheral T-cell lymphoma. Bone marrow biopsy revealed no evidence of lymphomatous involvement. The imaging and pathologic findings were consistent with primary uterine lymphoma. After 3 circles of chemotherapy, follow-up enhanced MRI showed decreased thickness of the uterine wall.Despite its rarity, primary uterine non-Hodgkin's lymphoma should be taken into consideration when a uterine tumor shows large size, relative hypointesity on both T2-weighted images and enhanced T1-weighted images compared to the surrounding myometrium, and intense FDG uptake on PET/CT. MRI may be helpful for describing the relationship between the tumor and adjacent structures. FDG PET/CT may be useful for tumor detection and staging.

  15. 18F-FDG PET/CT in the Staging and Management of Breast Cancer: Value in Disease Outcome and Planning Therapy.

    PubMed

    Garcia, J R; Pérez, Cristina; Bassa, Pere; Capdevila, Laia; Ramos, Francisco; Valenti, Vicens

    2017-03-01

    In hormone receptor-positive locally advanced breast cancer, endocrine therapy becomes an integral part of the therapeutic strategy. There are now significant numbers of available hormonal directed compounds, including selective aromatase and mTOR inhibitors, which allow an important therapeutic advance in these patients. Sequential F-FDG PET/CT studies provided essential information regarding response to different treatments, including targeted therapies, and adverse therapeutic effects that helped to better define the right moment to implement each therapeutic approach.

  16. Silicone Granuloma in the Buttocks Incidentally Detected by 18F-FDG PET/CT 30 Years After Free Liquid Silicone Injections.

    PubMed

    Ohnona, Jessica; Durand, Pauline; Amegnizin, Jean-Louis; Kerrou, Khaldoun

    2016-06-01

    A 59-year-old transexual (male to female) patient presented with a squamous cell carcinoma of the larynx. She underwent an F-FDG PET/CT for initial staging. The examination showed high F-FDG uptake of the primary lesion and a homolateral lymphadenopathy. Incidental heterogeneous uptake of round hyperdense lesions in the gluteal muscles and subcutaneous fat was visualized. The medical history revealed secondly that the patient had had free liquid silicone injections 30 years before the examination. Although the injection of free silicone is not practised since the 1980s, this incidental finding should prompt to check the patient's medical history over several decades.

  17. 18F-FDG PET/CT Brain Imaging on a Patient With Paraneoplastic Opsoclonus-Myoclonus Syndrome Arising out of a Mature Cystic Teratoma.

    PubMed

    Na, Chang Ju; Jeong, Young Jin; Lim, Seok Tae; Sohn, Myung-Hee; Jeong, Hwan-Jeong

    2016-02-01

    Opsoclonus-myoclonus syndrome (OMS) is an involuntary multidirectional eye movement accompanied by myoclonic jerks and a subtype of paraneoplastic neurological syndromes. Clinical features of OMS include opsoclonus with myoclonic jerks and cerebellar ataxia. Although there have been a few studies on brain FDG PET in paraneoplastic neurological syndrome associated with some kinds of malignancies such as lung and gastric cancer, brain FDG PET of patients with OMS caused by a mature cystic teratoma has not been reported. Here, we described a case of brain FDG PET/CT studies performed in a woman with OMS provoked from a mature cystic teratoma.

  18. Prediction of Large Joint Destruction in Patients With Rheumatoid Arthritis Using 18F-FDG PET/CT and Disease Activity Score.

    PubMed

    Suto, Takahito; Okamura, Koichi; Yonemoto, Yukio; Okura, Chisa; Tsushima, Yoshito; Takagishi, Kenji

    2016-02-01

    The assessments of joint damage in patients with rheumatoid arthritis (RA) are mainly restricted to small joints in the hands and feet. However, the development of arthritis in RA patients often involves the large joints, such as the shoulder, elbow, hip, knee, and ankle. Few studies have been reported regarding the degree of large joint destruction in RA patients. F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) visualizes the disease activity in large joints affected by RA. In this study, the associations between destruction of the large joints and the findings of FDG-PET/CT as well as laboratory parameters were investigated, and factors associated with large joint destruction after the administration of biological therapy were identified in RA patients. A total of 264 large joints in 23 RA patients (6 men and 17 women; mean age of 66.9 ± 7.9 years) were assessed in this study. FDG-PET/CT was performed at baseline and 6 months after the initiation of biological therapy. The extent of FDG uptake in large joints (shoulder, elbow, wrist, hip, knee, and ankle) was analyzed using the maximum standardized uptake value (SUVmax). Radiographs of the 12 large joints per patient obtained at baseline and after 2 years were assessed according to Larsen's method. A logistic regression analysis was performed to determine the factors most significantly contributing to the progression of joint destruction within 2 years. Radiographic progression of joint destruction was detected in 33 joints. The SUVmax at baseline and 6 months, and the disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR) at 6, 12, and 24 months were significantly higher in the group with progressive joint destruction. The SUVmax at baseline and DAS28-ESR at 6 months were found to be factors associated with joint destruction at 2 years (P < 0.05). The FDG uptake in the joints with destruction was higher than that observed in the joints

  19. Motor Speech Apraxia in a 70-Year-Old Man with Left Dorsolateral Frontal Arachnoid Cyst: A [18F]FDG PET-CT Study

    PubMed Central

    Haugen, Jacob; Kluin, Karen; Kotagal, Vikas

    2016-01-01

    Motor speech apraxia is a speech disorder of impaired syllable sequencing which, when seen with advancing age, is suggestive of a neurodegenerative process affecting cortical structures in the left frontal lobe. Arachnoid cysts can be associated with neurologic symptoms due to compression of underlying brain structures though indications for surgical intervention are unclear. We present the case of a 70-year-old man who presented with a two-year history of speech changes along with decreased initiation and talkativeness, shorter utterances, and dysnomia. [18F]Fluorodeoxyglucose (FDG) Positron Emission and Computed Tomography (PET-CT) and magnetic resonance imaging (MRI) showed very focal left frontal cortical hypometabolism immediately adjacent to an arachnoid cyst but no specific evidence of a neurodegenerative process. PMID:28003922

  20. [Utility of positron emission tomography with 18F-FDG in a case of juvenile recurrent respiratory papillomatosis].

    PubMed

    Navales, I; Paredes, P; Cols, M; Perissinotti, A; Vancells, M; Pons, F

    2013-01-01

    Juvenile recurrent respiratory papillomatosis (JRRP) is an infectious disease caused by the growth of papillomas in the airway. Up to 4% of these cases degenerate into squamous cell carcinoma. We present the case of a 17-year-old female patient with JRRP in which the utility of (18)F-FDG-PET/CT in the characterization of suspicious papillomatous lesions of malignancy is evaluated. Morphometabolic techniques, CT scan and PET/CT scans were suggestive of malignancy. However, this was not confirmed in the histopathological analysis after its resection. The (18)F-FDG-PET/CT does not seem to be a useful tool for early detection of malignancy in JRRP. However, it does increase the diagnostic accuracy of the biopsy as it identifies the most active lesions and, therefore, those most likely to be malignant.

  1. Clinical NECR in 18F-FDG PET scans: optimization of injected activity and variable acquisition time. Relationship with SNR

    NASA Astrophysics Data System (ADS)

    Carlier, T.; Ferrer, L.; Necib, H.; Bodet-Milin, C.; Rousseau, C.; Kraeber-Bodéré, F.

    2014-10-01

    The injected activity and the acquisition time per bed position for 18F-FDG PET scans are usually optimized by using metrics obtained from phantom experiments. However, optimal activity and time duration can significantly vary from a phantom set-up and from patient to patient. An approach using a patient-specific noise equivalent count rate (NECR) modelling has been previously proposed for optimizing clinical scanning protocols. We propose using the clinical NECR on a large population as a function of the body mass index (BMI) for deriving the optimal injected activity and acquisition duration per bed position. The relationship between the NEC and the signal-to-noise ratio (SNR) was assessed both in a phantom and in a clinical setting. 491 consecutive patients were retrospectively evaluated and divided into 4 BMI subgroups. Two criteria were used to optimize the injected activity and the time per bed position was adjusted using the NECR value while keeping the total acquisition time constant. Finally, the relationship between NEC and SNR was investigated using an anthropomorphic phantom and a population of 507 other patients. While the first dose regimen suggested a unique injected activity (665 MBq) regardless of the BMI, the second dose regimen proposed a variable activity and a total acquisition time according to the BMI. The NEC improvement was around 35% as compared with the local current injection rule. Variable time per bed position was derived according to BMI and anatomical region. NEC and number of true events were found to be highly correlated with SNR for the phantom set-up and partially confirmed in the patient study for the BMI subgroup under 28 kg m-2 suggesting that for the scanner, the nonlinear reconstruction algorithm used in this study and BMI < 28 kg m-2, NEC, or the number of true events linearly correlated with SNR2.

  2. Prognostic value of whole-body SUVmax of nodal and extra-nodal lesions detected by 18F-FDG PET/CT in extra-nodal NK/T-cell lymphoma

    PubMed Central

    Gale, Robert Peter; Wang, Li; Xu, Ji; Qu, Xiao-Yan; Fan, Lei; Li, Tian-Lv; Li, Jian-Yong; Xu, Wei

    2017-01-01

    We analyzed data from 54 newly-diagnosed persons with extra-nodal natural killer/T-cell (NK/T) lymphoma, who had a pretreatment 18F-FDG PET/CT study, to determine whether the sum of SUVmax of all the nodal and extra-nodal lesions predicted progression-free survival (PFS) and/or overall survival (OS). Three models (WB1SUVmax, WB2SUVmax, WB3SUVmax) based on the basis of the sum of SUVmax of the whole-body SUVmax of 11 nodal and 10 extra-nodal lesions were tested. The discrimination value of these models was evaluated using time-dependent receiver-operator characteristic (ROC) curves and corresponding areas under the curve (AUC) in training and validation cohorts. Findings were validated in an independent cohort of 15 subjects. ROC curve analysis showed the optimal cut-off values for WB1SUVmax, WB2SUVmax and WB3SUVmax were 15.8 (sensitivity 92%, specificity 67%, AUC 0.811; P<0.001), 12.7 (sensitivity 96%; specificity 57%; AUC 0.785; P<0.001) and 15.8 (sensitivity 88%; specificity 70%; AUC 0.793; P<0.001). Multivariate analyses indicated WB3SUVmax was independently associated with PFS (hazard ratio [HR]=3.67, 95% confidence interval [95% CI]=1.19, 11.29; P=0.023) and OS (HR= 4.51 [1.02, 19.91]; P=0.047). WB3SUVmax calculated based of the sum of the SUVmax of 3 nodal and 10 extra-nodal lesions was significantly associated with PFS and OS. PMID:27974685

  3. Quantification of Local Tumor Response to Fractionated Radiation Therapy for Non-Hodgkin Lymphoma Using Weekly {sup 18}F-FDG PET/CT Imaging

    SciTech Connect

    Keller, Harald; Goda, Jayant Sastri; Vines, Douglass C.; Lockwood, Gina M.Math.; Tsang, Richard

    2010-03-01

    Purpose: To quantify, in a feasibility study, metabolic and volumetric response to fractionated radiation therapy (RT) using weekly {sup 18}F fluoro-deoxyglucose positron emission tomography (PET) imaging for 10 non-Hodgkin lymphoma (NHL) patients, and to correlate them to clinical outcome. Methods and Materials: Ten patients with chemotherapy-refractory NHL planned for radical RT were prospectively entered into a research study. PET/computed tomography (CT) scans were acquired before RT, and repeated weekly during the 3- to 4-week course of RT, and at 1 and 3 months after therapy. Gross tumor volumes were contoured on CT scans and the corresponding maximum standardized uptake values (SUV{sub max}) determined in the coregistered PET images. The clinical outcomes of interest were local tumor response at 3 months post-RT and local tumor status at last follow-up or time of death. Results: {sup 18}F fluoro-deoxyglucose uptake from inflammation was rarely observed. The responses showed a large variability between patients. SUV{sub max} decreased consistently with a median of -2.1% per Gy (range, -3.3 to -0.7) and the median of the volumetric response was -2.2% per Gy (range, -2.8 to +0.5). Initial SUV{sub max} was not correlated with local control, whereas smaller initial tumor volume was, with smaller tumors more likely to achieve local control. The responses after treatment were also correlated to local control, but not the responses during treatment. Conclusions: Radiation does not confound the FDG uptake in the NHL tumor and normal tissues. Only smaller initial tumor volume and metabolic and volumetric response after completion of radiation therapy significantly correlated with eventual local control.

  4. Interesting Layering of Excreted 18F-FDG in the Urinary Bladder in Patients with Urinary Tract Infection and Distended Bladder.

    PubMed

    Shen, Guohua; Zhang, Wenjie; Jia, Zhiyun; Deng, Houfu

    2015-09-01

    Settling of (18)F-FDG in the bladder is often noted on whole-body PET/CT images, but this phenomenon has never received any careful attention and the mechanism has been unclear. The 2 patients described in this report, one with a T1 pathologic fracture and another with widespread bone and lymph node metastases from an unknown primary tumor, underwent PET/CT. Both had urinary tract infection and a distended bladder during scanning. The interesting layering of (18)F-FDG in the urinary bladder was observed in both patients. The presence of this phenomenon demands careful evaluation of the urine by the clinician, and the mechanism is hypothesized to be slow (18)F-FDG excretion in patients with a distended urinary bladder, resulting in delayed mixing with urine. In addition, urinary tract infection may be a potential cause. Images showing this interesting layering should be interpreted with care.

  5. [{sup 18}F]FDG-Positron Emission Tomography Coregistration With Computed Tomography Scans for Radiation Treatment Planning of Lymphoma and Hematologic Malignancies

    SciTech Connect

    Terezakis, Stephanie A.; Hunt, Margie A.; Kowalski, Alexander; McCann, Patrick; Schmidtlein, C. Ross; Reiner, Anne; Goenen, Mithat; Kirov, Assen S.; Gonzales, Anne Marie; Schoeder, Heiko; Yahalom, Joachim

    2011-11-01

    Purpose: Positron emission-tomography (PET) using 2-[{sup 18}F]fluoro-2-deoxyglucose (FDG-PET) increases sensitivity and specificity of disease detection in lymphoma and thus is standard in lymphoma management. This study examines the effects of coregistering FDG-PET and computed tomography (CT) (PET/CT) scans on treatment planning for lymphoma patients. Methods and Materials: Twenty-nine patients (30 positive PET scans) underwent PET/CT treatment planning from July 2004 to February 2007 and were retrospectively studied. For each patient, gross tumor volume was blindly contoured on the CT-only and PET/CT studies by a radiation oncologist. Treatment plans were generated for both the CT-only and PET/CT planning target volumes (PTVs) for all patients. Normal tissue doses and PTV coverage were evaluated using dose--volume histograms for all sites. Results: Thirty-two treatment sites were evaluated. Twenty-one patients had non-Hodgkin lymphoma, 5 patients had Hodgkin lymphoma, and 3 patients had plasma cell neoplasms. Previously undetected FDG-avid sites were identified in 3 patients during PET/CT simulation, resulting in one additional treatment field. Due to unexpected PET/CT simulation findings, 2 patients did not proceed with radiation treatment. The addition of PET changed the volume of 23 sites (72%). The PTV was increased in 15 sites (47%) by a median of 11% (range, 6-40%) and reduced in 8 sites (25%) by a median of 20% (range, 6%-75%). In six (19%) replanned sites, the CT-based treatment plan would not have adequately covered the PTV defined by PET/CT. Conclusions: Incorporation of FDG-PET into CT-based treatment planning for lymphoma patients resulted in considerable changes in management, volume definition, and normal tissue dosimetry for a significant number of patients.

  6. 18F-FDG-PET/CT parameters as imaging biomarkers in oral cavity squamous cell carcinoma, is visual analysis of PET and contrast enhanced CT better than the numbers?

    PubMed Central

    Kendi, AT; Corey, A; Magliocca, KR; Nickleach, DC; Galt, J; Switchenko, Jeffrey M.; El-Deiry, MW; Wadsworth, JT; Hudgins, PA; Saba, NF; Schuster, DM

    2015-01-01

    Purpose This study was designed to seek associations between positron emission tomography/computed tomography (PET/CT) parameters, contrast enhanced neck computed tomography (CECT) and pathological findings, and to determine the potential prognostic value of PET/CT and CECT parameters in oral cavity squamous cell carcinoma (OCSCC). Materials and method 36 OCSCC patients underwent staging PET/CT and 30/36 of patients had CECT. PET/CT parameters were measured for the primary tumor and the hottest involved node, including maximum, mean, and peak standardized uptake values (SUV max, SUV mean, and SUV peak), metabolic tumor volume (MTV), total lesion glycolysis (TLG), standardized added metabolic activity (SAM), and normalized standardized added metabolic activity (N SAM). Qualitative assessment of PET/CT and CECT were also performed. Pathological outcomes included: perineural invasion, lymphovascular invasion, nodal extracapsular spread, grade, pathologic T and N stages. Multivariable logistic regression models were fit for each parameter and outcome adjusting for potentially confounding variables. Multivariable Cox proportional hazards models were used for progression free survival (PFS), locoregional recurrence free survival (LRFS), overall survival (OS) and distant metastasis free survival (DMFS). Results In multivariable analysis, patients with high (>=median) tumor SUV max (OR 6.3), SUV mean (OR 6.3), MTV (OR 19.0), TLG (OR 19.0), SAM (OR 11.7) and N SAM (OR 19.0) had high pathological T-stage (T3/T4) (p<0.05). Ring/heterogeneous pattern on CECT qualitative assessment was associated with worse DMFS and OS. Conclusion High PET/CT parameters were associated with pathologically advanced T stage (T3/T4). Qualitative assessment of CECT has prognostic value. PET/CT parameters did not predict clinical outcome. PMID:25816993

  7. Comparison of Methods to Reduce Myocardial 18F-FDG Uptake in Mice: Calcium Channel Blockers versus High-Fat Diets

    PubMed Central

    Cussó, Lorena; Vaquero, Juan José; Bacharach, Stephen; Desco, Manuel

    2014-01-01

    Purpose Besides its application in oncology, 18F-FDG PET-CT imaging is also useful in the diagnosis of certain lung infections, inflammatory diseases, and atherosclerotic plaques. Myocardial uptake of 18F-FDG may hamper visualization of the lesions caused by these diseases. Two approaches have been proposed for reducing myocardial uptake in preclinical studies, namely, calcium channel blockers (verapamil) and high-fat diets such as commercial ketogenic diets and sunflower seed diets. The objective of this study was to compare the efficacy of these approaches in reducing myocardial uptake of 18F-FDG in mice. Methods We performed two experiments. In experiment A, each animal underwent four 18F-FDG PET/CT scans in the following order: baseline, after administration of verapamil, after two days on ketogenic diet and after two days on sunflower seeds. PET scans were performed 60 minutes after injection of 18.5 MBq of 18F-FDG. In experiment B, the best protocol of the three (ketogenic diet) was evaluated in a lung inflammation model to assess the efficacy of reducing myocardial uptake of 18F-FDG. Results Compared with baseline (SUV 2.03±1.21); the greatest reduction in uptake of 18F-FDG was with ketogenic diet (SUV 0.79±0.16; p = 0.008), followed by sunflower seeds (SUV 0.91±0.13; p = 0.015); the reduction in myocardial uptake produced by verapamil was not statistically significant (SUV 1.78±0.79; p = NS). In experiment B, complete suppression of myocardial uptake noticeably improved the visualization of inflamed areas near the heart, while in the case of null or partial myocardial suppression, it was much harder to distinguish lung inflammation from myocardial spillover. Conclusion A high-fat diet appeared to be the most effective method for decreasing myocardial uptake of 18F-FDG in healthy mice, outperforming verapamil. Our findings also demonstrate that ketogenic diet actually improves visualization of inflammatory lesions near the heart. PMID

  8. Recommendations of the Spanish Societies of Radiation Oncology (SEOR), Nuclear Medicine & Molecular Imaging (SEMNiM), and Medical Physics (SEFM) on 18F-FDG PET-CT for radiotherapy treatment planning

    PubMed Central

    Caballero Perea, Begoña; Villegas, Antonio Cabrera; Rodríguez, José Miguel Delgado; Velloso, María José García; Vicente, Ana María García; Cabrerizo, Carlos Huerga; López, Rosa Morera; Romasanta, Luis Alberto Pérez; Beltrán, Moisés Sáez

    2012-01-01

    Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) is a valuable tool for diagnosing and staging malignant lesions. The fusion of PET and computed tomography (CT) yields images that contain both metabolic and morphological information, which, taken together, have improved the diagnostic precision of PET in oncology. The main imaging modality for planning radiotherapy treatment is CT. However, PET-CT is an emerging modality for use in planning treatments because it allows for more accurate treatment volume definition. The use of PET-CT for treatment planning is highly complex, and protocols and standards for its use are still being developed. It seems probable that PET-CT will eventually replace current CT-based planning methods, but this will require a full understanding of the relevant technical aspects of PET-CT planning. The aim of the present document is to review these technical aspects and to provide recommendations for clinical use of this imaging modality in the radiotherapy planning process. PMID:24377032

  9. Utility of baseline, interim and end-of-treatment 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma patients treated with L-asparaginase/pegaspargase

    PubMed Central

    Chang, Yu; Fu, Xiaorui; Sun, Zhenchang; Xie, Xinli; Wang, Ruihua; Li, Zhaoming; Zhang, Xudong; Sheng, Guangyao; Zhang, Mingzhi

    2017-01-01

    Positron emission tomography-computed tomography (PET/CT) is widely used for initial staging and monitoring treatment responses in Hodgkin and diffuse large B-cell lymphoma. However, its prognostic value in extranodal natural killer (NK)/T-cell lymphoma (ENKL) remains unclear. Here, we conducted a retrospective study to determine the impact of PET/CT in ENKL. Fifty-two patients newly diagnosed with ENKL were enrolled. Baseline maximum standardized uptake values (SUVmax), whole-body metabolic tumor volume (WBMTV) and whole-body total lesion glycolysis (WBTLG) were recorded. Additionally, interim PET/CT (I-PET) and end-of-treatment PET/CT (E-PET) results were scored using a 5-point scale. Patients were divided into groups using baseline parameter cut-off values; significant differences were found in overall survival (OS) and progression-free survival (PFS) between the high and low WBMTV and WBTLG groups and in OS between the two SUVmax groups. Positive I-PET and E-PET results predicted inferior PFS and OS. A multivariate analysis showed that baseline WBTLG, I-PET and E-PET results were associated with PFS and OS, and baseline SUVmax was an independent predictor of OS. Thus, baseline WBTLG, I-PET and E-PET results are good predictors of PFS and OS in ENKL patients who received L-asparaginase/pegaspargase in their first-line treatment, and baseline SUVmax is a valuable tool for assessing OS. PMID:28117395

  10. Recommendations of the Spanish Societies of Radiation Oncology (SEOR), Nuclear Medicine & Molecular Imaging (SEMNiM), and Medical Physics (SEFM) on (18)F-FDG PET-CT for radiotherapy treatment planning.

    PubMed

    Caballero Perea, Begoña; Villegas, Antonio Cabrera; Rodríguez, José Miguel Delgado; Velloso, María José García; Vicente, Ana María García; Cabrerizo, Carlos Huerga; López, Rosa Morera; Romasanta, Luis Alberto Pérez; Beltrán, Moisés Sáez

    2012-01-01

    Positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) is a valuable tool for diagnosing and staging malignant lesions. The fusion of PET and computed tomography (CT) yields images that contain both metabolic and morphological information, which, taken together, have improved the diagnostic precision of PET in oncology. The main imaging modality for planning radiotherapy treatment is CT. However, PET-CT is an emerging modality for use in planning treatments because it allows for more accurate treatment volume definition. The use of PET-CT for treatment planning is highly complex, and protocols and standards for its use are still being developed. It seems probable that PET-CT will eventually replace current CT-based planning methods, but this will require a full understanding of the relevant technical aspects of PET-CT planning. The aim of the present document is to review these technical aspects and to provide recommendations for clinical use of this imaging modality in the radiotherapy planning process.

  11. Equivalent dose rate at 1m of patients with known or suspected neuroendocrine tumor exiting a nuclear medicine department after (68)Ga-DOTATOC, (18)F-FDOPA or (18)F-FDG PET/CT, or (111)In-pentetreotide or (123)I-mIBG SPECT/CT.

    PubMed

    Zhang-Yin, Jules; Dirand, Anne-Sophie; Sasanelli, Myriam; Corrégé, Gwenaelle; Peudon, Aude; Kiffel, Thierry; Nataf, Valérie; Clerc, Jérôme; Montravers, Françoise; Talbot, Jean-Noël

    2017-02-16

    (123)I-mIBG and (111)In-pentetrotide SPECT have been used for functional imaging of neuroendocrine tumors (NET) for the last two decades. More recently, PET/CT imaging with (18)F-FDG, (18)F-FDOPA and (68)Ga somatostatin-receptor ligands in NETs has been expanding. No direct measurements of the dose rate from NET patients exiting the nuclear medicine department could be found in the literature after PET/CT with (18)F-FDOPA or (68)Ga-DOTATOC, a somatostatin analogue. Methods: We measured the dose rates from NET patients undergoing PET/CT or SPECT/CT in our centers. A total of 103 paired measurements of equivalent dose rate at 1m of the patient (EDR-1m) were performed in 98 patients on leaving the department. The detector was facing the sternum or the urinary bladder, at a distance of 1 meter from and right in front of the patient. The practice for exiting the department differed according to whether the patient was referred to PET/CT or to SPECT/CT. PET/CT patients were discharged after imaging. Results: The median administered activity was 122 MBq in 53 (68)Ga-DOTATOC PET/CTs, 198 MBq in 15 (18)F-FDOPA PET/CTs and 176 MBq in 13 (18)F-FDG PET/CTs. The corresponding median EDR-1m (in µSv/h) were 4.8, 9.5 and 8.8 respectively facing the sternum, and 5.1, 10.1 and 9.5 respectively facing the bladder. SPECT/CT patients left the department earlier, just after radiopharmaceutical injection. The median administered activity was 170 MBq in 12 (111)In-pentetreotide SPECT/CTs and 186 MBq in 10 (123)I-mIBG SPECT/CTs. The corresponding median EDR-1m (in µSv/h) were 9.4, and 4.9 respectively at the level of the sternum, and 9.3 and 4.7 respectively at the level of the bladder. The EDR-1m was <20 µSv/h in all patients. Thus when exiting the nuclear medicine department, the NET patients injected with (68)Ga-DOTATOC or (123)I mIBG emitted an average EDR-1m roughly half of that of patients injected with other radiopharmaceuticals. This is a complementary argument for replacing

  12. Sequential PET/CT with [18F]-FDG Predicts Pathological Tumor Response to Preoperative Short Course Radiotherapy with Delayed Surgery in Patients with Locally Advanced Rectal Cancer Using Logistic Regression Analysis

    PubMed Central

    Pecori, Biagio; Lastoria, Secondo; Caracò, Corradina; Celentani, Marco; Tatangelo, Fabiana; Avallone, Antonio; Rega, Daniela; De Palma, Giampaolo; Mormile, Maria; Budillon, Alfredo; Muto, Paolo; Bianco, Francesco; Aloj, Luigi; Petrillo, Antonella; Delrio, Paolo

    2017-01-01

    Previous studies indicate that FDG PET/CT may predict pathological response in patients undergoing neoadjuvant chemo-radiotherapy for locally advanced rectal cancer (LARC). Aim of the current study is evaluate if pathological response can be similarly predicted in LARC patients after short course radiation therapy alone. Methods: Thirty-three patients with cT2-3, N0-2, M0 rectal adenocarcinoma treated with hypo fractionated short course neoadjuvant RT (5x5 Gy) with delayed surgery (SCRTDS) were prospectively studied. All patients underwent 3 PET/CT studies at baseline, 10 days from RT end (early), and 53 days from RT end (delayed). Maximal standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and total lesion glycolysis (TLG) of the primary tumor were measured and recorded at each PET/CT study. We use logistic regression analysis to aggregate different measures of metabolic response to predict the pathological response in the course of SCRTDS. Results: We provide straightforward formulas to classify response and estimate the probability of being a major responder (TRG1-2) or a complete responder (TRG1) for each individual. The formulas are based on the level of TLG at the early PET and on the overall proportional reduction of TLG between baseline and delayed PET studies. Conclusions: This study demonstrates that in the course of SCRTDS it is possible to estimate the probabilities of pathological tumor responses on the basis of PET/CT with FDG. Our formulas make it possible to assess the risks associated to LARC borne by a patient in the course of SCRTDS. These risk assessments can be balanced against other health risks associated with further treatments and can therefore be used to make informed therapy adjustments during SCRTDS. PMID:28060889

  13. 123I-Mibg scintigraphy and 18F-Fdg-Pet imaging for diagnosing neuroblastoma

    PubMed Central

    Bleeker, Gitta; Tytgat, Godelieve Am; Adam, Judit A; Caron, Huib N; Kremer, Leontien Cm; Hooft, Lotty; van Dalen, Elvira C

    2015-01-01

    Background Neuroblastoma is an embryonic tumour of childhood that originates in the neural crest. It is the second most common extracranial malignant solid tumour of childhood. Neuroblastoma cells have the unique capacity to accumulate Iodine-123-metaiodobenzylguanidine (123I-MIBG), which can be used for imaging the tumour. Moreover, 123I-MIBG scintigraphy is not only important for the diagnosis of neuroblastoma, but also for staging and localization of skeletal lesions. If these are present, MIBG follow-up scans are used to assess the patient's response to therapy. However, the sensitivity and specificity of 123I-MIBG scintigraphy to detect neuroblastoma varies according to the literature. Prognosis, treatment and response to therapy of patients with neuroblastoma are currently based on extension scoring of 123I-MIBG scans. Due to its clinical use and importance, it is necessary to determine the exact diagnostic accuracy of 123I-MIBG scintigraphy. In case the tumour is not MIBG avid, fluorine-18-fluorodeoxy-glucose (18F-FDG) positron emission tomography (PET) is often used and the diagnostic accuracy of this test should also be assessed. Objectives Primary objectives: 1.1 To determine the diagnostic accuracy of 123I-MIBG (single photon emission computed tomography (SPECT), with or without computed tomography (CT)) scintigraphy for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old. 1.2 To determine the diagnostic accuracy of negative 123I-MIBG scintigraphy in combination with 18F-FDG-PET(-CT) imaging for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old, i.e. an add-on test. Secondary objectives: 2.1 To determine the diagnostic accuracy of 18F-FDG-PET(-CT) imaging for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old. 2.2 To compare the diagnostic accuracy of 123I

  14. Intracranial Leptomeningeal Carcinomatosis from Breast Cancer Detected on 18F-FDG PET.

    PubMed

    Carra, Bradley J; Clemenshaw, Michael N

    2015-09-01

    Leptomeningeal carcinomatosis is an uncommon manifestation of non-central nervous system (CNS) metastatic disease. Diagnosis, however, has important prognostic and treatment implications. We present a case in which intracranial leptomeningeal carcinomatosis from a primary breast cancer was detected with (18)F-FDG PET/CT, despite its low sensitivity for detection of CNS metastases from non-CNS primary tumors.

  15. Correlation of 18F-FDG Avid Volumes on Pre–Radiation Therapy and Post–Radiation Therapy FDG PET Scans in Recurrent Lung Cancer

    PubMed Central

    Shusharina, Nadya; Cho, Joseph; Sharp, Gregory C.; Choi, Noah C.

    2014-01-01

    Purpose To investigate the spatial correlation between high uptake regions of 2-deoxy-2-[18F]-fluoro-D-glucose positron emission tomography (18F-FDG PET) before and after therapy in recurrent lung cancer. Methods and Materials We enrolled 106 patients with inoperable lung cancer into a prospective study whose primary objectives were to determine first, the earliest time point when the maximum decrease in FDG uptake representing the maximum metabolic response (MMR) is attainable and second, the optimum cutoff value of MMR based on its predicted tumor control probability, sensitivity, and specificity. Of those patients, 61 completed the required 4 serial 18F-FDG PET examinations after therapy. Nineteen of 61 patients experienced local recurrence at the primary tumor and underwent analysis. The volumes of interest (VOI) on pretherapy FDG-PET were defined by use of an isocontour at ≥50% of maximum standard uptake value (SUVmax) (≥50% of SUVmax) with correction for heterogeneity. The VOI on posttherapy images were defined at ≥80% of SUVmax. The VOI of pretherapy and posttherapy 18F-FDG PET images were correlated for the extent of overlap. Results The size of VOI at pretherapy images was on average 25.7% (range, 8.8%-56.3%) of the pretherapy primary gross tumor volume (GTV), and their overlap fractions were 0.8 (95% confidence interval [CI]: 0.7-0.9), 0.63 (95% CI: 0.49-0.77), and 0.38 (95% CI: 0.19-0.57) of VOI of posttherapy FDG PET images at 10 days, 3 months, and 6 months, respectively. The residual uptake originated from the pretherapy VOI in 15 of 17 cases. Conclusions VOI defined by the SUVmax- ≥50% isocontour may be a biological target volume for escalated radiation dose. PMID:24725696

  16. Correlation of {sup 18}F-FDG Avid Volumes on Pre–Radiation Therapy and Post–Radiation Therapy FDG PET Scans in Recurrent Lung Cancer

    SciTech Connect

    Shusharina, Nadya Cho, Joseph; Sharp, Gregory C.; Choi, Noah C.

    2014-05-01

    Purpose: To investigate the spatial correlation between high uptake regions of 2-deoxy-2-[{sup 18}F]-fluoro-D-glucose positron emission tomography ({sup 18}F-FDG PET) before and after therapy in recurrent lung cancer. Methods and Materials: We enrolled 106 patients with inoperable lung cancer into a prospective study whose primary objectives were to determine first, the earliest time point when the maximum decrease in FDG uptake representing the maximum metabolic response (MMR) is attainable and second, the optimum cutoff value of MMR based on its predicted tumor control probability, sensitivity, and specificity. Of those patients, 61 completed the required 4 serial {sup 18}F-FDG PET examinations after therapy. Nineteen of 61 patients experienced local recurrence at the primary tumor and underwent analysis. The volumes of interest (VOI) on pretherapy FDG-PET were defined by use of an isocontour at ≥50% of maximum standard uptake value (SUV{sub max}) (≥50% of SUV{sub max}) with correction for heterogeneity. The VOI on posttherapy images were defined at ≥80% of SUV{sub max}. The VOI of pretherapy and posttherapy {sup 18}F-FDG PET images were correlated for the extent of overlap. Results: The size of VOI at pretherapy images was on average 25.7% (range, 8.8%-56.3%) of the pretherapy primary gross tumor volume (GTV), and their overlap fractions were 0.8 (95% confidence interval [CI]: 0.7-0.9), 0.63 (95% CI: 0.49-0.77), and 0.38 (95% CI: 0.19-0.57) of VOI of posttherapy FDG PET images at 10 days, 3 months, and 6 months, respectively. The residual uptake originated from the pretherapy VOI in 15 of 17 cases. Conclusions: VOI defined by the SUV{sub max}-≥50% isocontour may be a biological target volume for escalated radiation dose.

  17. Alterations in 18F-FDG accumulation into neck-related muscles after neck dissection for patients with oral cancers

    PubMed Central

    Kito, Shinji; Koga, Hirofumi; Kodama, Masaaki; Habu, Manabu; Kokuryo, Shinya; Oda, Masafumi; Matsuo, Kou; Nishino, Takanobu; Matsumoto-Takeda, Shinobu; Uehara, Masataka; Yoshiga, Daigo; Tanaka, Tatsurou; Nishimura, Shun; Miyamoto, Ikuya; Sasaguri, Masaaki; Tominaga, Kazuhiro; Yoshioka, Izumi; Morimoto, Yasuhiro

    2016-01-01

    Background 18F-fluoro-2-deoxy-D-glucose (18F-FDG) accumulations are commonly seen in the neck-related muscles of the surgical and non-surgical sides after surgery with neck dissection (ND) for oral cancers, which leads to radiologists having difficulty in diagnosing the lesions. To examine the alterations in 18F-FDG accumulation in neck-related muscles of patients after ND for oral cancer. Material and Methods 18F-FDG accumulations on positron emission tomography (PET)-computed tomography (CT) in neck-related muscles were retrospectively analyzed after surgical dissection of cervical lymph nodes in oral cancers. Results According to the extent of ND of cervical lymph nodes, the rate of patients with 18F-FDG-PET-positive areas increased in the trapezius, sternocleidomastoid, and posterior neck muscles of the surgical and/or non-surgical sides. In addition, SUVmax of 18F-FDG-PET-positive areas in the trapezius and sternocleidomastoid muscles were increased according to the extent of the ND. Conclusions In evaluating 18F-FDG accumulations after ND for oral cancers, we should pay attention to the 18F-FDG distributions in neck-related muscles including the non-surgical side as false-positive findings. Key words:18F-FDG, PET-CT, oral cancers, muscles. PMID:27031062

  18. 18F-FDG super bone marrow uptake

    PubMed Central

    Alam, Mohammed Shah; Fu, Lilan; Ren, Yun-Yan; Wu, Hu-Bing; Wang, Quan-Shi; Han, Yan-Jiang; Zhou, Wen-Lan; Li, Hong-Sheng; Wang, Zhen

    2016-01-01

    Abstract The present study was performed to investigate whether the markedly 2-deoxy-2-(fluorine-18) fluoro-D-glucose (18F-FDG) uptake in the bone marrow (BM) is a presentation of malignant infiltration (MI). Super bone marrow uptake (super BMU) was used to name the markedly 18F-FDG uptake on BM, which was similar to or higher than that of the brain. From April 2008 to December 2015, 31 patients with such presentation were retrospectively reviewed. The 18F-FDG uptake was semiquantified using SUVmax and BM to cerebellum (BM/C) ratio. The origin of super BMU was diagnosed by pathology. Some blood parameters, as well as fever, were also collected and analyzed. For comparison, 106 patients with mildly and moderately uptake in BM and 20 healthy subjects were selected as the control group. Bone marrow MI was diagnosed in 93.5% (29/31) patients with super BMU, which mostly originated from acute leukemia and highly aggressive lymphoma. The super BMU group had markedly higher 18F-FDG uptake in the BM than those of mildly and moderately uptake, and the control subjects (all P = 0.000) and the BM/C ratio reached a high of 1.24 ± 0.36. The incidence of bone marrow MI in the super BMU group was markedly higher than that of mildly and moderately uptake (93.5% vs 36.8%, P = 0.000). Based on the receiver operating characteristic analysis, when cut-off values of BM/C and SUVmax were set at 0.835 and 6.560, the diagnostic specificity for bone marrow MI reached the high levels of 91.4% and 95.7%, respectively. In 15 patients with bone marrow MI, the extra-BM malignant lesions were simultaneously detected by 18F-FDG PET/CT. The liver and the nasal cavity involvements were only found in the patients with lymphoma, but not in those with leukemia. A decrease of leukocyte, hemoglobin, and platelet counts was noted in 48.4%, 86.2%, and 51.5% of patients with bone marrow MI, respectively. The present study revealed that super BMU was a highly potent indicator for the bone

  19. Staging and evaluation of neoadjuvant chemotherapy response with ¹⁸F-FDG PET/CT in NUT-midline carcinoma in a child: a case report and review of the literature.

    PubMed

    Ciftci, E; Demirsoy, U; Anik, Y; Gorur, G; Corapcioglu, F; Demir, H

    2015-01-01

    NUT midline carcinoma (NMC) is a newly defined and lethal cancer with aggressive course. It mostly affects children and young adults. Diagnosis is confirmed with the evidence of BRD4-NUT mutation on the chromosome 15q14 by fluorescence in situ hybridization. Use of (18)F-FDG PET/CT in NMC patients is very limited in the literature. In this report, we describe a 7-year-old boy with the diagnosis of NMC who was scanned with (18)F-FDG PET/CT for staging and treatment response evaluation after the chemotherapy. It was disseminated and had moderate FDG avidity in the initial scan and showed progression after 4 cycles of chemotherapy. We also reviewed the literature related to (18)F-FDG PET/CT in staging and assessment of chemotherapy response of NMC.

  20. Usefulness of PET/CT in the diagnosis of recurrent or metastasized differentiated thyroid carcinoma

    PubMed Central

    LU, CUN-ZHI; CAO, SU-SHENG; WANG, WEI; LIU, JUN; FU, NING; LU, FENG

    2016-01-01

    The aim of the present study was to determine the usefulness of the positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) in the detection of recurrence or metastasization of differentiated thyroid carcinoma (DTC) in patients with abnormal thyroglobulin levels and negative findings on the 131I-diagnostic whole-body scanning (dWBS). Fifteen patients with DTC, abnormal thyroglobulin levels, and negative 131I-dWBS findings were scanned using the 18F-FDG PET/CT. Positive diagnosis was based on postoperative histologic findings, and clinical and imaging follow-up results obtained in the subsequent 6 months. In addition, preoperative and postoperative thyroglobulin levels were compared. Using the findings of 18F-FDG PET/CT and data on confirmed positive diagnosis, sensitivity and positive predictive value (PPV) were calculated. Sensitivity and PPV of PET/CT in detecting recurrence or metastasisization of DTC were 93.30 and 91.40%, respectively. Furthermore, postoperative thyroglobulin levels were markedly lower compared to the preoperative levels (respectively, 4.67±1.71 vs. 58.53±18.34 ng/ml; p<0.05). PET/CT scan with 18F-FDG is an informative technique for the detection of recurrent or metastasized DTC in patients with abnormal thyroglobulin levels and negative 131I-dWBS findings. PMID:27073490

  1. Human radiation dosimetry of 6-[{sup 18}F]FDG predicted from preclinical studies

    SciTech Connect

    Muzic, Raymond F.; Chandramouli, Visvanathan; Hatami, Ahmad; Huang, Hsuan-Ming; Wu, Chunying; Ismail-Beigi, Faramarz

    2014-03-15

    Purpose: The authors are developing 6-[{sup 18}F]fluoro-6-deoxy-D-glucose (6-[{sup 18}F]FDG) as an in vivo tracer of glucose transport. While 6-[{sup 18}F]FDG has the same radionuclide half-life as 2-[{sup 18}F]fluoro-2-deoxy-D-glucose (2-[{sup 18}F]FDG) which is ubiquitously used for PET imaging, 6-[{sup 18}F]FDG has special biologic properties and different biodistributions that make it preferable to 2-[{sup 18}F]FDG for assessing glucose transport. In preparation for 6-[{sup 18}F]FDG use in human PET scanning, the authors would like to determine the amount of 6-[{sup 18}F]FDG to inject while maintaining radiation doses in a safe range. Methods: Rats were injected with 6-[{sup 18}F]FDG, euthanized at specified times, and tissues were collected and assayed for activity content. For each tissue sample, the percent of injected dose per gram was calculated and extrapolated to that for humans in order to construct predicted time-courses. Residence times were calculated as areas under the curves and were used as inputs to OLINDA/EXM in order to calculate the radiation doses. Results: Unlike with 2-[{sup 18}F]FDG for which the urinary bladder wall receives the highest absorbed dose due to urinary excretion, with 6-[{sup 18}F]FDG there is little urinary excretion and osteogenic cells and the liver are predicted to receive the highest absorbed doses: 0.027 mGy/MBq (0.100 rad/mCi) and 0.018 mGy/MBq (0.066 rad/mCi), respectively. Also, the effective dose from 6-[{sup 18}F]FDG, i.e., 0.013 mSv/MBq (0.046 rem/mCi), is predicted to be approximately 30% lower than that from 2-[{sup 18}F]FDG. Conclusions: 6-[{sup 18}F]FDG will be safe for use in the PET scanning of humans.

  2. (18)F-FDG positron emission tomography/computed tomography and (99m)Tc-MDP skeletal scintigraphy in a case of Erdheim-Chester disease.

    PubMed

    Asabella, Artor Niccoli; Cimmino, Antonietta; Altini, Corinna; Notaristefano, Antonio; Rubini, Giuseppe

    2011-01-01

    of (18)F-FDG, leading to the suspision of ECD. A technetium-99m-methyl-diphosphonate skeletal scintigraphy ((99m)Tc-MDP) scan showed diffuse uptake of the radiopharmaceutical, in the diaphysis of long bones and in the left portion of the body and the spinous process of L2. Considering the difficulties of an osteomedullary or brain biopsy, biopsy was performed on a right anterior thoracic cutaneous xanthelasma. Histology showed lipid-laden histiocytes (CD1a-, CD68+, S-100 protein -) with small nuclei, Touton giant, lymphocytic infiltrates, eosinophils and fibrosis, ECD gold standard patterns as reported in literature. The patient was discharged with the diagnosis of ECD with central nervous system (CNS) manifestations, and treatment started. The diagnosis can be lead by the most charateristic bone findings of symmetrical osteosclerosis of the long bones, especially the lower limbs (tibia and fibula), involving metaphyses and diaphyses but sparing epiphyses. The typical pattern of osteoscerosis of the long bones reflects increased osteoblastic activity. About half of all ECD patients may experience extraskeletal manifestations, including CNS. Visceral involvement in ECD is not specific, and this enforces the diagnostic value of skeletal imaging findings. Furthermore xanthomas can be found at any location on the skin, especially the eyelids as in our patient. For visceral involvement, CT is most useful, while MRI is more sensitive for CNS lesions. Involvement of CNS may be frequently revealed clinically by diabetes insipidus. Few case reports have shown that (18)F-FDG PET/CT scanning could be useful in assessing the extension of ECD lesions. Both radiography and (99m)Tc-MDP skeletal scintigraphy may reveal osteosclerosis of the long bones, which is a typical finding in ECD. The typical bone pattern of (18)F-FDG PET/CT scan is specific for ECD and (99m)Tc-MDP skeletal scintigraphy may be performed in patients in whom initial (18)F-FDG PET/CT scans present the possibility

  3. High (18)F-FDG uptake by the remaining adrenal gland four months after surgery and initiation of mitotane treatment in two patients with adrenocortical carcinoma.

    PubMed

    Mpanaka, Ioanna; Lyra, Vassiliki D; Kaltsas, Gregory; Chatziioannou, Sofia N

    2011-01-01

    Two men, one 42 and the other 35 years old were both subjected to adrenalectomy for adrenocortical carcinoma (ACC). Adjuvant treatment with mitotane [o,p΄-dichloro-diphenyl-dichloroethane, (o,p΄-DDD)], was initiated following surgery. Mitotane is the only agent available at present for treatment in ACC because of a late-onset specific adrenocortical cell toxicity. Both patients underwent a (18)F-FDG-PET/CT scan, which revealed 4 months after starting treatment with mitotane significantly high (18)F-FDG uptake in the contralateral adrenal gland. Both patients underwent magnetic resonance imaging, while one had a laparotomy, because of an abcess at the site of previous adrenalectomy. No metastasis or size increase of the remaining adrenal glands were found suggesting that their hypermetabolic state could be attributed to mitotane treatment. Beside its cytotoxic delayed-effect, mitotane has an early -onset effect on steroid metabolism. In conclusion, an abnormal high (18)F-FDG uptake was observed in the contralateral adrenal gland in both our adrenalectomized ACC patients, 4 months after starting mitotane treatment, probably related to mitotane's effect on steroid metabolism, not yet fully understood.

  4. Spatial-Temporal [{sup 18}F]FDG-PET Features for Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemoradiation Therapy

    SciTech Connect

    Tan, Shan; Kligerman, Seth; Chen, Wengen; Lu, Minh; Kim, Grace; Feigenberg, Steven; D'Souza, Warren D.; Suntharalingam, Mohan; Lu, Wei

    2013-04-01

    Purpose: To extract and study comprehensive spatial-temporal {sup 18}F-labeled fluorodeoxyglucose ([{sup 18}F]FDG) positron emission tomography (PET) features for the prediction of pathologic tumor response to neoadjuvant chemoradiation therapy (CRT) in esophageal cancer. Methods and Materials: Twenty patients with esophageal cancer were treated with trimodal therapy (CRT plus surgery) and underwent [{sup 18}F]FDG-PET/CT scans both before (pre-CRT) and after (post-CRT) CRT. The 2 scans were rigidly registered. A tumor volume was semiautomatically delineated using a threshold standardized uptake value (SUV) of ≥2.5, followed by manual editing. Comprehensive features were extracted to characterize SUV intensity distribution, spatial patterns (texture), tumor geometry, and associated changes resulting from CRT. The usefulness of each feature in predicting pathologic tumor response to CRT was evaluated using the area under the receiver operating characteristic curve (AUC) value. Results: The best traditional response measure was decline in maximum SUV (SUV{sub max}; AUC, 0.76). Two new intensity features, decline in mean SUV (SUV{sub mean}) and skewness, and 3 texture features (inertia, correlation, and cluster prominence) were found to be significant predictors with AUC values ≥0.76. According to these features, a tumor was more likely to be a responder when the SUV{sub mean} decline was larger, when there were relatively fewer voxels with higher SUV values pre-CRT, or when [{sup 18}F]FDG uptake post-CRT was relatively homogeneous. All of the most accurate predictive features were extracted from the entire tumor rather than from the most active part of the tumor. For SUV intensity features and tumor size features, changes were more predictive than pre- or post-CRT assessment alone. Conclusion: Spatial-temporal [{sup 18}F]FDG-PET features were found to be useful predictors of pathologic tumor response to neoadjuvant CRT in esophageal cancer.

  5. 68Ga-DOTATATE PET/CT imaging of indeterminate pulmonary nodules and lung cancer

    PubMed Central

    Walker, Ronald; Deppen, Stephen; Smith, Gary; Shi, Chanjuan; Lehman, Jonathan; Clanton, Jeff; Moore, Brandon; Burns, Rena; Grogan, Eric L.; Massion, Pierre P.

    2017-01-01

    Purpose 18F-FDG PET/CT is widely used to evaluate indeterminate pulmonary nodules (IPNs). False positive results occur, especially from active granulomatous nodules. A PET-based imaging agent with superior specificity to 18F-FDG for IPNs, is badly needed, especially in areas of endemic granulomatous nodules. Somatostatin receptors (SSTR) are expressed in many malignant cells including small cell and non-small cell lung cancers (NSCLCs). 68Ga-DOTATATE, a positron emitter labeled somatostatin analog, combined with PET/CT imaging, may improve the diagnosis of IPNs over 18F-FDG by reducing false positives. Our study purpose was to test this hypothesis in our region with high endemic granulomatous IPNs. Methods We prospectively performed 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT scans in the same 30 patients with newly diagnosed, treatment-naïve lung cancer (N = 14) or IPNs (N = 15) and one metastatic nodule. 68Ga-DOTATATE SUVmax levels at or above 1.5 were considered likely malignant. We analyzed the scan results, correlating with ultimate diagnosis via biopsy or 2-year chest CT follow-up. We also correlated 68Ga-DOTATATE uptake with immunohistochemical (IHC) staining for SSTR subtype 2A (SSTR2A) in pathological specimens. Results We analyzed 31 lesions in 30 individuals, with 14 (45%) being non-neuroendocrine lung cancers and 1 (3%) being metastatic disease. McNemar’s result comparing the two radiopharmaceuticals (p = 0.65) indicates that their accuracy of diagnosis in this indication are equivalent. 68Ga-DOTATATE was more specific (94% compared to 81%) and less sensitive 73% compared to 93%) than 18F-FDG. 68Ga-DOTATATE uptake correlated with SSTR2A expression in tumor stroma determined by immunohistochemical (IHC) staining in 5 of 9 (55%) NSCLCs. Conclusion 68Ga-DOTATATE and 18F-FDG PET/CT had equivalent accuracy in the diagnosis of non-neuroendocrine lung cancer and 68Ga-DOTATATE was more specific than 18F-FDG for the diagnosis of IPNs. IHC staining for SSTR2A

  6. “Talc Pleurodesis with intense 18F-FDG activity but no 68Ga-DOTA-TATE activity on PET/CT”

    PubMed Central

    Papadakis, Georgios Z.; Millo, Corina; Bagci, Ulas; Patronas, Nicholas J.; Stratakis, Constatntine A.

    2015-01-01

    Talc pleurodesis (TP) is a technique, widely employed in the management of patients with persistent pleural effusions or pneumothoraces not amenable to other treatment options. It is well documented, that talc deposits produce areas of highly increased 18F-FDG uptake, due to talc-induced inflammation. We present a case of a patient with history of TP who was evaluated with both 18F-FDG and 68Ga-DOTA-TATE. The hypermetabolic area seen on 18F-FDG-PET-CT in the region of talc placement, showed no uptake by 68Ga-DOTA-TATE, suggesting the potential role of 68Ga-DOTA-TATE-PET-CT in elucidating 18F-FDG-postitive lesions in patients with history of both neuroendocrine malignancy and TP. PMID:26018715

  7. 68Ga-PRGD2 PET/CT in the Evaluation of Glioma: A Prospective Study

    PubMed Central

    2015-01-01

    Integrin αvβ3 is overexpressed in both neovasculature and glioma cells. We aimed to evaluate 68gallium-BNOTA-PRGD2 (68Ga-PRGD2) as a new reagent for noninvasive integrin αvβ3 imaging in glioma patients. With informed consent, 12 patients with suspicious brain glioma, as diagnosed by enhanced magnetic resonance imaging (MRI) scanning, were enrolled to undergo 68Ga-PRGD2 PET/CT and 18F-FDG PET/CT scans before surgery. The preoperative images were compared and correlated with the pathologically determined WHO grade. Next, the expression of integrin αvβ3, CD34, and Ki-67 were determined by immunohistochemical staining of the resected brain tumor tissue. Our findings demonstrated that 68Ga-PRGD2 specifically accumulated in the brain tumors that were rich of integrin αvβ3 and other neovasculature markers, but not in the brain parenchyma other than the choroid plexus. Therefore, 68Ga-PRGD2 PET/CT was able to evaluate the glioma demarcation more specifically than 18F-FDG PET/CT. The maximum standardized uptake values (SUVmax) of 68Ga-PRGD2, rather than those of 18F-FDG, were significantly correlated with the glioma grading. The maximum tumor-to-brain ratios (TBRmax) of both tracers were significantly correlated with glioma grading, whereas 68Ga-PRGD2 seemed to be more superior to 18F-FDG in differentiating high-grade glioma (HGG) from low-grade glioma (LGG). Moreover, 68Ga-PRGD2 PET/CT showed different accumulation patterns for HGG of WHO grades III and IV. This is the first noninvasive integrin imaging study, to the best of our knowledge, conducted in preoperative patients with different grades of glioma, and it preliminarily indicated the effectiveness of this novel method for evaluating glioma grading and demarcation. PMID:25093246

  8. Purulent lupus panniculitis unmasked by FDG-PET/CT scan

    PubMed Central

    van der Geest, Kornelis S.M.; Moerman, Rada V.; Koopmans, Klaas P.; Holman, Nicole D.; Janssen, Wilbert M.T.

    2016-01-01

    Abstract Rationale: Lupus panniculitis (LP) is a unique variant of cutaneous lupus erythematosus. Clinical manifestations are typically mild and include erythema, nodules, and small ulcers. In certain cases, diagnosing LP may be challenging. Skin overlying the typical subcutaneous inflammation may appear normal, and bacterial superinfections of the skin sometimes mask the underlying LP. It has been suggested that a computed tomography (CT) scan may help to identify obscure LP lesions. Here, we report a case of a 54-year-old woman with an unusually severe form of LP, in which the full disease extent was only revealed by a fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan. Patient concerns/Diagnoses/Interventions/Outcomes: Our patient initially presented with a bacterial infection of the skin. After initial improvement with antibiotic treatment, new erythematous lesions and sterile subcutaneous pus collections developed. An FDG-PET/CT scan revealed extensive subcutaneous inflammation at sites that had appeared normal during physical examination and on CT scan. As the subcutaneous lesions showed a remarkably linear pattern on FDG-PET/CT scan, the patient was suspected of having LP. After confirmation of this diagnosis by a deep-skin biopsy, our patient was treated with systemic glucocorticoids. Eventually, our patient succumbed to complications of LP and its treatment. Lessons: Our case demonstrates that clinical manifestations of LP are not always mild and that timely diagnosis is needed. Furthermore, we show that obscure LP lesions are more readily identified on an FDG-PET/CT scan than CT scan. PMID:27902603

  9. Evaluation of [18F]-FDG-Based Hybrid Imaging Combinations for Assessment of Bone Marrow Involvement in Lymphoma at Initial Staging

    PubMed Central

    2016-01-01

    The purpose of our study was to determine the value of different hybrid imaging combinations for the detection of focal and diffuse bone marrow infiltration in lymphoma. Patients with histologically proven lymphoma, who underwent both [18F]-FDG-PET/CT and whole-body MRI (including T1- and diffusion-weighted [DWI] sequences) within seven days, and a subsequent bone marrow biopsy, were retrospectively included. Three hybrid imaging combinations were evaluated: (1) [18F]-FDG-PET/CT; (2) [18F]-FDG-PET/T1; and (3) [18F]-FDG-PET/DWI. The presence of focal or diffuse bone marrow infiltration was assessed by two rater teams. Sensitivity, specificity, and accuracy for the detection of overall, focal, and diffuse bone marrow involvement were compared between the three hybrid imaging combinations. Overall, lymphomatous bone marrow involvement was found in 16/60 patients (focal, 8; diffuse, 8). Overall sensitivity, specificity, and accuracy were 81.3%, 95.5%, and 91.7% for [18F]-FDG-PET/CT; 81.3%, 97.7%, and 93.3% for [18F]-FDG-PET/T1; and 81.3%, 95.5%, and 91.7% for [18F]-FDG-PET/DWI. No statistically significant differences between the three imaging combinations were observed, based on overall bone marrow involvement, focal involvement, or diffuse involvement. The sensitivity of all three imaging combinations for detecting diffuse bone marrow involvement was only moderate (62.5% for all three combinations). Although the combination of [18F]-FDG-PET and T1-weighted MRI generally showed the best diagnostic performance for the detection of bone marrow involvement in lymphoma, it was not significantly superior to the two other hybrid imaging combinations. Since the sensitivity of all imaging combinations for the detection of diffuse bone marrow involvement was only moderate, bone marrow biopsy cannot be replaced by imaging as yet. PMID:27723817

  10. Validation of true low-dose (18)F-FDG PET of the brain.

    PubMed

    Fällmar, David; Lilja, Johan; Kilander, Lena; Danfors, Torsten; Lubberink, Mark; Larsson, Elna-Marie; Sörensen, Jens

    2016-01-01

    The dosage of (18)F-FDG must be sufficient to ensure adequate PET image quality. For younger patients and research controls, the lowest possible radiation dose should be used. The purpose of this study was to find a protocol for FDG-PET of the brain with reduced radiation dose and preserved quantitative characteristics. Eight patients with neurodegenerative disorders and nine controls (n=17) underwent FDG-PET/CT twice on separate occasions, first with normal-dose (3 MBq/kg), and second with low-dose (0.75 MBq/kg, 25% of the original). Five additional controls (total n=22) underwent FDG-PET twice, using normal-dose and ultra-low-dose (0.3 MBq/kg, 10% of original). All subjects underwent MRI. Ten-minute summation images were spatially normalized and intensity normalized. Regional standard uptake value ratios (SUV-r) were calculated using an automated atlas. SUV-r values from the normal- and low-dose images were compared pairwise. No clinically significant bias was found in any of the three groups. The mean absolute difference in regional SUV-r values was 0.015 (1.32%) in controls and 0.019 (1.67%) in patients. The ultra-low-dose protocol produced a slightly higher mean difference of 0.023 (2.10%). The main conclusion is that 0.75 MBq/kg (56 MBq for a 75-kg subject) is a sufficient FDG dose for evaluating regional SUV-ratios in brain PET scans in adults with or without neurodegenerative disease, resulting in a reduction of total PET/CT effective dose from 4.54 to 1.15 mSv. The ultra-low-dose (0.5 mSv) could be useful in research studies requiring serial PET in healthy controls or children.

  11. Validation of true low-dose 18F-FDG PET of the brain

    PubMed Central

    Fällmar, David; Lilja, Johan; Kilander, Lena; Danfors, Torsten; Lubberink, Mark; Larsson, Elna-Marie; Sörensen, Jens

    2016-01-01

    The dosage of 18F-FDG must be sufficient to ensure adequate PET image quality. For younger patients and research controls, the lowest possible radiation dose should be used. The purpose of this study was to find a protocol for FDG-PET of the brain with reduced radiation dose and preserved quantitative characteristics. Eight patients with neurodegenerative disorders and nine controls (n=17) underwent FDG-PET/CT twice on separate occasions, first with normal-dose (3 MBq/kg), and second with low-dose (0.75 MBq/kg, 25% of the original). Five additional controls (total n=22) underwent FDG-PET twice, using normal-dose and ultra-low-dose (0.3 MBq/kg, 10% of original). All subjects underwent MRI. Ten-minute summation images were spatially normalized and intensity normalized. Regional standard uptake value ratios (SUV-r) were calculated using an automated atlas. SUV-r values from the normal- and low-dose images were compared pairwise. No clinically significant bias was found in any of the three groups. The mean absolute difference in regional SUV-r values was 0.015 (1.32%) in controls and 0.019 (1.67%) in patients. The ultra-low-dose protocol produced a slightly higher mean difference of 0.023 (2.10%). The main conclusion is that 0.75 MBq/kg (56 MBq for a 75-kg subject) is a sufficient FDG dose for evaluating regional SUV-ratios in brain PET scans in adults with or without neurodegenerative disease, resulting in a reduction of total PET/CT effective dose from 4.54 to 1.15 mSv. The ultra-low-dose (0.5 mSv) could be useful in research studies requiring serial PET in healthy controls or children. PMID:27766185

  12. [18F]FDG Accumulation in Early Coronary Atherosclerotic Lesions in Pigs

    PubMed Central

    Tarkia, Miikka; Saraste, Antti; Stark, Christoffer; Vähäsilta, Tommi; Savunen, Timo; Strandberg, Marjatta; Saunavaara, Virva; Tolvanen, Tuula; Teuho, Jarmo; Teräs, Mika; Metsälä, Olli; Rinne, Petteri; Heinonen, Ilkka; Savisto, Nina; Pietilä, Mikko; Saukko, Pekka; Roivainen, Anne; Knuuti, Juhani

    2015-01-01

    Objective Inflammation is an important contributor to atherosclerosis progression. A glucose analogue 18F-fluorodeoxyglucose ([18F]FDG) has been used to detect atherosclerotic inflammation. However, it is not known to what extent [18F]FDG is taken up in different stages of atherosclerosis. We aimed to study the uptake of [18F]FDG to various stages of coronary plaques in a pig model. Methods First, diabetes was caused by streptozotocin injections (50 mg/kg for 3 days) in farm pigs (n = 10). After 6 months on high-fat diet, pigs underwent dual-gated cardiac PET/CT to measure [18F]FDG uptake in coronary arteries. Coronary segments (n = 33) were harvested for ex vivo measurement of radioactivity and autoradiography (ARG). Results Intimal thickening was observed in 16 segments and atheroma type plaques in 10 segments. Compared with the normal vessel wall, ARG showed 1.7±0.7 times higher [18F]FDG accumulation in the intimal thickening and 4.1±2.3 times higher in the atheromas (P = 0.004 and P = 0.003, respectively). Ex vivo mean vessel-to-blood ratio was higher in segments with atheroma than those without atherosclerosis (2.6±1.2 vs. 1.3±0.7, P = 0.04). In vivo PET imaging showed the highest target-to-background ratio (TBR) of 2.7. However, maximum TBR was not significantly different in segments without atherosclerosis (1.1±0.5) and either intimal thickening (1.2±0.4, P = 1.0) or atheroma (1.6±0.6, P = 0.4). Conclusions We found increased uptake of [18F]FDG in coronary atherosclerotic lesions in a pig model. However, uptake in these early stage lesions was not detectable with in vivo PET imaging. Further studies are needed to clarify whether visible [18F]FDG uptake in coronary arteries represents more advanced, highly inflamed plaques. PMID:26120829

  13. Response-adapted therapy for aggressive non-Hodgkin's lymphomas based on early [18F] FDG-PET scanning: ECOG-ACRIN Cancer Research Group study (E3404).

    PubMed

    Swinnen, Lode J; Li, Hailun; Quon, Andrew; Gascoyne, Randy; Hong, Fangxin; Ranheim, Erik A; Habermann, Thomas M; Kahl, Brad S; Horning, Sandra J; Advani, Ranjana H

    2015-07-01

    A persistently positive positron emission tomography (PET) scan during therapy for diffuse large B-cell lymphoma (DLBCL) is predictive of treatment failure. A response-adapted strategy consisting of an early treatment change to four cycles of R-ICE (rituximab, ifosfamide, carboplatin, etoposide) was studied in the Eastern Cooperative Oncology Group E3404 trial. Previously untreated patients with DLBCL stage III, IV, or bulky II, were eligible. PET scan was performed after three cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and scored as positive or negative by central review during the fourth cycle. PET-positive patients received four cycles of R-ICE, PET-negative patients received two more cycles of R-CHOP. A ≥ 45% 2-year progression-free survival (PFS) for mid-treatment PET-positive patients was viewed as promising. Of 74 patients, 16% were PET positive, 79% negative. The PET positivity rate was much lower than the 33% expected. Two-year PFS was 70%; 42% [90% confidence interval (CI), 19-63%] for PET-positives and 76% (90% CI 65-84%) for PET-negatives. Three-year overall survival (OS) was 69% (90% CI 43-85%) and 93% (90% CI 86-97%) for PET-positive and -negative cases, respectively. The 2-year PFS for mid-treatment PET-positive patients intensified to R-ICE was 42%, with a wide confidence interval due to the low proportion of positive mid-treatment PET scans. Treatment modification based on early PET scanning should remain confined to clinical trials.

  14. Radiation-induced DNA damage and the relative biological effectiveness of 18F-FDG in wild-type mice

    DOE PAGES

    Taylor, Kristina; Lemon, Jennifer A.; Boreham, Douglas R.

    2014-05-28

    Clinically, the most commonly used positron emission tomography (PET) radiotracer is the glucose analog 2-[18F] fluoro-2-deoxy-d-glucose (18F-FDG), however little research has been conducted on the biological effects of 18F-FDG injections. The induction and repair of DNA damage and the relative biological effectiveness (RBE) of radiation from 18F-FDG relative to 662 keV γ-rays were investigated. The study also assessed whether low-dose radiation exposure from 18F-FDG was capable of inducing an adaptive response. DNA damage to the bone marrow erythroblast population was measured using micronucleus formation and lymphocyte γH2A.X levels. To test the RBE of 18F-FDG, mice were injected with a rangemore » of activities of 18F-FDG (0–14.80 MBq) or irradiated with Cs-137 γ-rays (0–100 mGy). The adaptive response was investigated 24 h after the 18F-FDG injection by 1 Gy in vivo challenge doses for micronucleated reticulocyte (MN-RET) formation or 1, 2 and 4 Gy in vitro challenges doses for γH2A.X formation. A significant increase in MN-RET formation above controls occurred following injection activities of 3.70, 7.40 or 14.80 MBq (P < 0.001) which correspond to bone marrow doses of ~35, 75 and 150 mGy, respectively. Per unit dose, the Cs-137 radiation exposure induced significantly more damage than the 18F-FDG injections (RBE = 0.79 ± 0.04). A 20% reduction in γH2A.X fluorescence was observed in mice injected with a prior adapting low dose of 14.80 MBq 18F-FDG relative to controls (P < 0.019). A 0.74 MBq 18F-FDG injection, which gives mice a dose approximately equal to a typical human PET scan, did not cause a significant increase in DNA damage nor did it generate an adaptive response. Typical 18F-FDG injection activities used in small animal imaging (14.80 MBq) resulted in a decrease in DNA damage, as measured by γH2A.X formation, below spontaneous levels observed in control mice. Lastly, the 18F-FDG RBE was <1.0, indicating that the mixed radiation quality

  15. [Accidental discovery of 18F-fluorodeoxyglucose PET/CT-positive papilloma in sinus sphenoidalis in a patient with recurrence of breast cancer].

    PubMed

    Hansen, Lasse Berg

    2015-02-02

    A patient suspected for metastatic breast cancer went through an 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT). Along with metastatic lymph nodes in the neck it showed high 18F-FDG uptake in a polypoidal structure in the sinus sphenoidalis. When asked she had no related symptoms due to the sphenoid polyp and the CT-scan showed no bone destruction. To rule out malignancy a biopsy was made showing benign sinonasal papilloma of oncocytic origin. High 18F-FDG PET uptake can be seen in benign structures and should therefore not be the only predictor for malignancy.

  16. Comparison of prone versus supine 18F-FDG-PET of locally advanced breast cancer: Phantom and preliminary clinical studies

    SciTech Connect

    Williams, Jason M.; Rani, Sudheer D.; Li, Xia; Whisenant, Jennifer G.; Abramson, Richard G.; Arlinghaus, Lori R.; Lee, Tzu-Cheng; MacDonald, Lawrence R.; Partridge, Savannah C.; Kang, Hakmook; Linden, Hannah M.; Kinahan, Paul E.; Yankeelov, Thomas E.

    2015-07-15

    significantly lower than supine in both original and uptake time-adjusted data across a range of index times (P < < 0.0001, Wilcoxon signed rank test). Before correcting for uptake time differences, Bland–Altman analyses revealed proportional bias between prone and supine measurements (SUV{sub peak} and SUV{sub max}) that increased with higher levels of FDG uptake. After uptake time correction, this bias was significantly reduced (P < 0.01). Significant prone-supine differences, with regard to the spatial distribution of lesions relative to isocenter, were observed between the two scan positions, but this was poorly correlated with the residual (uptake time-corrected) prone-supine SUV{sub peak} difference (P = 0.78). Conclusions: Quantitative 18F-FDG-PET/CT of the breast in the prone position is not deleteriously affected by the support device but yields SUV that is consistently lower than those obtained in the standard supine position. SUV differences between scans arising from FDG uptake time differences can be substantially reduced, but not removed entirely, with the current correction method. SUV from the two scan orientations is quantitatively different and should not be assumed equivalent or interchangeable within the same subject. These findings have clinical relevance in that they underscore the importance of patient positioning while scanning as a clinical variable that must be accounted for with longitudinal PET measurement, for example, in the assessment of treatment response.

  17. Correlation between 18F-FDG Positron-Emission Tomography 18F-FDG Uptake Levels at Diagnosis and Histopathologic and Immunohistochemical Factors in Patients with Breast Cancer

    PubMed Central

    Uğurluer, Gamze; Yavuz, Sinan; Çalıkuşu, Züleyha; Seyrek, Ertuğrul; Kibar, Mustafa; Serin, Meltem; Ersöz, Canan; Demircan, Orhan

    2016-01-01

    Objective In this study, we aimed to determine the correlation between pretreatment-staging 18F-FDG total body positron-emission tomography/computed tomography (PET/CT) maximum standardized uptake value (SUVmax) levels and histopathologic and immunohistochemical predictive and prognostic factors in patients with breast cancer. Materials and Methods One hundred thirty-nine women with breast cancer who were treated between 2009 and 2015 at our hospital and who had pretreatment-staging PET/CT were included in the study. SUVmax levels and histopathologic and immunohistochemical results were compared. Results The median age was 48 years (range, 29–79 years). The mean tumor diameter was 33.4 mm (range, 7–120 mm). The histology was invasive ductal carcinoma in 80.6% of the patients. In the univariate analysis, SUVmax levels were significantly higher in patients with invasive ductal carcinoma; in patients with a maximum tumor diameter more than 2 cm; patients who were estrogen, progesterone, and combined hormone receptor-negative, triple-negative patients, and in tumors with higher grades (p<0.05). In HER2-positive patients, SUVmax levels were higher even if it was not statistically significant. There was no correlation between lymph node metastases and pathologic stage. In multivariate analysis, tumor diameter was an independent factor. Conclusion SUVmax levels are correlated with known histopathologic and immunohistochemical prognostic factors. PET/CT could be useful in preoperative evaluation of patients with breast cancer to predict biologic characteristics of tumors and prognosis.

  18. Identifying prognostic intratumor heterogeneity using pre- and post-radiotherapy 18F-FDG PET images for pancreatic cancer patients

    PubMed Central

    Osipov, Arsen; Fraass, Benedick; Sandler, Howard; Zhang, Xiao; Nissen, Nicholas; Hendifar, Andrew; Tuli, Richard

    2017-01-01

    Background To stratify risks of pancreatic adenocarcinoma (PA) patients using pre- and post-radiotherapy (RT) PET/CT images, and to assess the prognostic value of texture variations in predicting therapy response of patients. Methods Twenty-six PA patients treated with RT from 2011–2013 with pre- and post-treatment 18F-FDG-PET/CT scans were identified. Tumor locoregional texture was calculated using 3D kernel-based approach, and texture variations were identified by fitting discrepancies of texture maps of pre- and post-treatment images. A total of 48 texture and clinical variables were identified and evaluated for association with overall survival (OS). The prognostic heterogeneity features were selected using lasso/elastic net regression, and further were evaluated by multivariate Cox analysis. Results Median age was 69 y (range, 46–86 y). The texture map and temporal variations between pre- and post-treatment were well characterized by histograms and statistical fitting. The lasso analysis identified seven predictors (age, node stage, post-RT SUVmax, variations of homogeneity, variance, sum mean, and cluster tendency). The multivariate Cox analysis identified five significant variables: age, node stage, variations of homogeneity, variance, and cluster tendency (with P=0.020, 0.040, 0.065, 0.078, and 0.081, respectively). The patients were stratified into two groups based on the risk score of multivariate analysis with log-rank P=0.001: a low risk group (n=11) with a longer mean OS (29.3 months) and higher texture variation (>30%), and a high risk group (n=15) with a shorter mean OS (17.7 months) and lower texture variation (<15%). Conclusions Locoregional metabolic texture response provides a feasible approach for evaluating and predicting clinical outcomes following treatment of PA with RT. The proposed method can be used to stratify patient risk and help select appropriate treatment strategies for individual patients toward implementing response

  19. Rheumatic fever: a forgotten but still existing cause of fever of unknown origin detected on FDG PET/CT.

    PubMed

    Sathekge, Mike; Stoltz, Anton; Gheysens, Olivier

    2015-03-01

    We present a case of heterogeneous and strongly increased myocardial and valvular 18F-FDG uptake on 18F-FDG PET/CT in an HIV-positive patient with productive cough, fever, weight loss, and progressive dyspnea for 6 months. Contrast-enhanced CT did not reveal the cause of fever, but hyperechogenic valvular lesions on echocardiography in combination with PET/CT findings are suggestive of endocarditis/myocarditis. Postmortem histology 3 weeks after PET/CT showed Aschoff bodies with Anitschkow cells, pathognomonic for rheumatic carditis. This case illustrates that rheumatic heart disease can be detected on 18F-FDG PET/CT and demonstrates the value of 18F-FDG PET/CT in patients with fever of unknown origin.

  20. Multicenter Standardized 18F-FDG PET Diagnosis of Mild Cognitive Impairment, Alzheimer’s Disease, and Other Dementias

    PubMed Central

    Mosconi, Lisa; Tsui, Wai H.; Herholz, Karl; Pupi, Alberto; Drzezga, Alexander; Lucignani, Giovanni; Reiman, Eric M.; Holthoff, Vjera; Kalbe, Elke; Sorbi, Sandro; Diehl-Schmid, Janine; Perneczky, Robert; Clerici, Francesca; Caselli, Richard; Beuthien-Baumann, Bettina; Kurz, Alexander; Minoshima, Satoshi; de Leon, Mony J.

    2013-01-01

    This multicenter study examined 18F-FDG PET measures in the differential diagnosis of Alzheimer’s disease (AD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB) from normal aging and from each other and the relation of disease-specific patterns to mild cognitive impairment (MCI). Methods We examined the 18F-FDG PET scans of 548 subjects, including 110 healthy elderly individuals (“normals” or NLs), 114 MCI, 199 AD,98FTD, and 27 DLB patients, collected at 7 participating centers. Individual PET scans were Z scored using automated voxel-based comparison with generation of disease-specific patterns of cortical and hippocampal 18F-FDG uptake that were then applied to characterize MCI. Results Standardized disease-specific PET patterns were developed that correctly classified 95%AD, 92% DLB,94%FTD,and 94%NL. MCI patients showed primarily posterior cingulate cortex and hippocampal hypometabolism (81%), whereas neocortical abnormalities varied according to neuropsychological profiles. An AD PET pattern was observed in 79% MCI with deficits in multiple cognitive domains and 31% amnesic MCI. 18F-FDG PET heterogeneity in MCI with nonmemory deficits ranged from absent hypometabolism to FTD and DLB PET patterns. Conclusion Standardized automated analysis of 18F-FDG PET scans may provide an objective and sensitive support to the clinical diagnosis in early dementia. PMID:18287270

  1. [Extension study and evaluation of the therapeutic response in a patient with metastatic lung adenocarcinoma using sequential study with ¹⁸F-FDG PET-CT and ¹⁸F-fluoride PET-CT].

    PubMed

    Moragas, M; Soler, M; Riera, E; García, J R

    2015-01-01

    We report a case of a patient with lung adenocarcinoma and bone and extraosseus metastases studied with (18)F-FDG PET-CT, (99m)Tc-HMDP and (18)F-fluoride PET-CT. It assesses the usefulness of (18)F-FDG PET-CT for initial staging of the disease and monitoring response to therapy. For the study of the sclerotic bone metastases it shows the superiority of 99mTc-HMDP bone scintigraphy and (18)F-fluoride PET-CT over (18)F-FDG PET-CT, and (18)F-fluoride PET-CT over bone scintigraphy. It also shows the usefulness of (18)F-fluoride PET-CT for monitoring the bone metastases.

  2. 68Gallium-DOTATATE PET/CT Scanning Results in Patients with MEN1

    PubMed Central

    Sadowski, Samira M; Millo, Corina; Cottle-Delisle, Candice; Merkel, Roxanne; Yang, Lily A; Herscovitch, Peter; Pacak, Karel; Simonds, William F; Marx, Stephen J; Kebebew, Electron

    2015-01-01

    Background Screening for neuroendocrine tumors (NETs) in patients with multiple endocrine neoplasia type 1 (MEN1) is recommended to detect primary and metastatic tumors, which can result in significant morbidity and mortality. The utility of somatostatin receptor imaging 68Gallium-DOTATATE PET/CT in patients with MEN1 is not known. The aim of this study was to prospectively determine the accuracy of 68Gallium-DOTATATE PET/CT versus 111In-pentetreotide SPECT/CT and anatomic imaging in patients with MEN1. Study design Prospective study comparing 68Gallium-DOTATATE PET/CT, 111In-pentetreotide SPECT/CT, and triphasic CT scan to clinical, biochemical and pathological data in 26 patients with MEN1. Results 68Gallium-DOTATATE PET/CT detected 107 lesions; 111In- pentetreotide SPECT/CT detected 33 lesions; and CT scan detected 48 lesions. Lesions detected on 68Gallium-DOTATATE PET/CT had high SUVmax (median SUVmax = 72.8 [range 19–191]). In 7 of the 26 patients (27%), 68Gallium-DOTATATE PET/CT was positive with a negative 111In-pentetreotide SPECT/CT, and in 10 patients (38.5%), additional metastases were detected (range 0.3 cm to 1.5 cm). In 8 of the 26 patients (31%), there was a change in management recommendations as a result of the findings on 68Gallium-DOTATATE PET/CT that were not seen on 111In- pentetreotide SPECT/CT and CT scan. Conclusions 68Gallium-DOTATATE PET/CT is more sensitive for detecting NETs than 111In-pentetreotide SPECT/CT and CT scan in patients with MEN1. This imaging technique should be integrated into radiologic screening and surveillance of patients with MEN1, as it can significantly alter management recommendations. PMID:26206648

  3. Clinical utility of (18)F-FDG positron emission tomography/computed tomography scan vs. (99m)Tc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis.

    PubMed

    Lauridsen, Trine K; Iversen, Kasper K; Ihlemann, Nikolaj; Hasbak, Philip; Loft, Annika; Berthelsen, Anne K; Dahl, Anders; Dejanovic, Danijela; Albrecht-Beste, Elisabeth; Mortensen, Jann; Kjær, Andreas; Bundgaard, Henning; Bruun, Niels Eske

    2017-01-03

    The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether (18)FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49-0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61-0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.

  4. Imaging Radiation-Induced Gastrointestinal, Bone Marrow Injury and Recovery Kinetics Using 18F-FDG PET

    PubMed Central

    Tang, Tien T.; Rendon, David A.; Zawaski, Janice A.; Afshar, Solmaz F.; Kaffes, Caterina K.; Sabek, Omaima M.

    2017-01-01

    Positron emission tomography using 18F-Fluro-deoxy-glucose (18F-FDG) is a useful tool to detect regions of inflammation in patients. We utilized this imaging technique to investigate the kinetics of gastrointestinal recovery after radiation exposure and the role of bone marrow in the recovery process. Male Sprague-Dawley rats were either sham irradiated, irradiated with their upper half body shielded (UHBS) at a dose of 7.5 Gy, or whole body irradiated (WBI) with 4 or 7.5 Gy. Animals were imaged using 18F-FDG PET/CT at 5, 10 and 35 days post-radiation exposure. The gastrointestinal tract and bone marrow were analyzed for 18F-FDG uptake. Tissue was collected at all-time points for histological analysis. Following 7.5 Gy irradiation, there was a significant increase in inflammation in the gastrointestinal tract as indicated by the significantly higher 18F-FDG uptake compared to sham. UHBS animals had a significantly higher activity compared to 7.5 Gy WBI at 5 days post-exposure. Animals that received 4 Gy WBI did not show any significant increase in uptake compared to sham. Analysis of the bone marrow showed a significant decrease of uptake in the 7.5 Gy animals 5 days post-irradiation, albeit not observed in the 4 Gy group. Interestingly, as the metabolic activity of the gastrointestinal tract returned to sham levels in UHBS animals it was accompanied by an increase in metabolic activity in the bone marrow. At 35 days post-exposure both gastrointestinal tract and bone marrow 18F-FDG uptake returned to sham levels. 18F-FDG imaging is a tool that can be used to study the inflammatory response of the gastrointestinal tract and changes in bone marrow metabolism caused by radiation exposure. The recovery of the gastrointestinal tract coincides with an increase in bone marrow metabolism in partially shielded animals. These findings further demonstrate the relationship between the gastrointestinal syndrome and bone marrow recovery, and that this interaction can be studied

  5. Application of 18F-FDG PET and diffusion weighted imaging (DWI) in multiple myeloma: comparison of functional imaging modalities

    PubMed Central

    Sachpekidis, Christos; Mosebach, Jennifer; Freitag, Martin T; Wilhelm, Thomas; Mai, Elias K; Goldschmidt, Hartmut; Haberkorn, Uwe; Schlemmer, Heinz-Peter; Delorme, Stefan; Dimitrakopoulou-Strauss, Antonia

    2015-01-01

    Aim of this prospective study was to assess the sensitivity of positron emission tomography (PET) and diffusion-weighted imaging (DWI) in detecting multiple myeloma (MM) lesions, using the well-established morphologic modalities magnetic resonance imaging (MRI) and computed tomography (CT) as the standard of reference (RS). The study included 24 MM patients (15 newly diagnosed, 9 pre-treated). All underwent 18F-FDG PET/CT and wholebody DWI. The findings in PET and DWI were compared to matching imaging findings in combined non-enhanced T1w, fat-saturated T2w (TIRM)- MRI, and low-dose CT. Patient-based analysis revealed that 15/24 patients (10 primary MM, 5 pre-treated) had myeloma lesions according to our RS. PET was positive in 13/24 patients (11 primary MM, 2 pre-treated) and DWI in 18/24 patients (12 primary MM, 6 pre-treated). Lesion-based analysis demonstrated 128 MM lesions, of which PET depicted 60/128 lesions (sensitivity 47%), while DWI depicted 99/128 lesions (sensitivity 77%). Further analysis including only the 15 untreated MM patients revealed a sensitivity of 90% for both PET and DWI and an overall concordance of PET and DWI of 72%. In conclusion, DWI was more sensitive than 18F-FDG PET in detecting myeloma lesions in a mixed population of primary and pre-treated MM patients. However, 18F-FDG PET and DWI demonstrated equivalent sensitivities in the sub-population of primary, untreated MM patients. This higher sensitivity of DWI in pre-treated patients may be due to the fact that 18F-FDG PET becomes negative earlier in the course of treatment in contrary to MRI, in which already treated lesions can remain visible. PMID:26550539

  6. Clinical significance of incidental FDG uptake in the prostate gland detected by PET/CT

    PubMed Central

    Sahin, Ertan; Elboga, Umut; Kalender, Ebuzer; Basıbuyuk, Mustafa; Demir, Hasan Deniz; Celen, Yusuf Zeki

    2015-01-01

    The value of FDG-positron emission tomography/computed tomography (PET/CT) for detecting prostate cancer is unknown. We aimed to investigate the clinical value of incidental prostate FDG uptake on PET/CT scans. We reviewed 6128 male patients who underwent FDG-PET/CT scans and selected cases that reported hypermetabolic lesion in the prostate. The patients who have prior history of prostate carcinoma or prostate surgery were excluded from the study. We have analyzed the correlation between PET/CT findings and serum prostate-specific antigen (PSA) levels, imaging (USG), urological examinations and biopsy. Incidental 18F-FDG uptake of the prostate gland was observed in 79 patients (1.3%). While sixteen of them were excluded due to inadequate clinical data, the remaining 63 patients were included for further analysis. The patients were divided into two groups; 8 patients (12.7%) in the malignant group and 55 patients (87.3%) in the benign group. The SUVmax values were not significantly different between the two groups. In 6 (75%) patients with prostate cancer, FDG uptake was observed focally in the peripheral zone of the prostate glands. There was no significant correlation between the SUVmax and the PSA levels. Incidental 18F-FDG uptake in the prostate gland is a rare condition, but a substantial portion of it is associated with the cancer. Benign and malignant lesions of the prostate gland in FDG-PET/CT imaging could not be reliably distinguished. The peripheral focally FDG uptake of prostate glands should be further examined with the clinical and labaratory evaluations. PMID:26379847

  7. TU-AB-BRA-06: Texture Feature Reproducibility Between PET/CT and PET/MR Imaging Modalities

    SciTech Connect

    Galavis, P; Friedman, K; Chandarana, H; Jackson, K

    2015-06-15

    Purpose: Radiomics involves the extraction of texture features from different imaging modalities with the purpose of developing models to predict patient treatment outcomes. The purpose of this study is to investigate texture feature reproducibility across [18F]FDG PET/CT and [18F]FDG PET/MR imaging in patients with primary malignancies. Methods: Twenty five prospective patients with solid tumors underwent clinical [18F]FDG PET/CT scan followed by [18F]FDG PET/MR scans. In all patients the lesions were identified using nuclear medicine reports. The images were co-registered and segmented using an in-house auto-segmentation method. Fifty features, based on the intensity histogram, second and high order matrices, were extracted from the segmented regions from both image data sets. One-way random-effects ANOVA model of the intra-class correlation coefficient (ICC) was used to establish texture feature correlations between both data sets. Results: Fifty features were classified based on their ICC values, which were found in the range from 0.1 to 0.86, in three categories: high, intermediate, and low. Ten features extracted from second and high-order matrices showed large ICC ≥ 0.70. Seventeen features presented intermediate 0.5 ≤ ICC ≤ 0.65 and the remaining twenty three presented low ICC ≤ 0.45. Conclusion: Features with large ICC values could be reliable candidates for quantification as they lead to similar results from both imaging modalities. Features with small ICC indicates a lack of correlation. Therefore, the use of these features as a quantitative measure will lead to different assessments of the same lesion depending on the imaging modality from where they are extracted. This study shows the importance of the need for further investigation and standardization of features across multiple imaging modalities.

  8. (18)F-FDG-PET/MRI in lymphoma patients.

    PubMed

    Ferdová, Eva; Ferda, Jiří; Baxa, Jan

    2017-01-23

    The introduction of hybrid PET/MRI imaging using integrated systems into clinical practice has opened up the possibility of reducing the radiation dose from hybrid imaging by eliminating the contribution from computed tomography. Studies comparing the possibilities of PET/CT and PET/MRI imaging demonstrated it is possible to use the advantages of the high contrast resolution of magnetic resonance for soft tissue and bone marrow along with PET records in a quality comparable to PET/CT imaging. The significant feature for PET imaging in Hodgkińs lymphoma is that it is a tissue with high levels of radiopharmaceutical accumulation, which decreases proportionally after successful therapeutic effect, the effect of therapy is assessed using Deauville score system on interim examinations. While the efficacy of prognosis determined using the Deauville scale in HL is widely accepted, it turns out that in DLBCL, the prognostic value of PET imaging is bound to the evaluation of subtypes. PET/MRI scanning can be used to evaluate a relapse if follicular lymphoma has already been treated, or to confirm transformation into more aggressive forms. In children and adults with Burkitt's lymphoma, negative findings after induction therapy have a high negative predictive value for relapse prognosis.

  9. Whole Body FDG-PET and FDG-PET/CT in Patients with Suspected Paraneoplastic Syndrome: A Systematic review and Meta-analysis of Diagnostic Accuracy.

    PubMed

    Sheikhbahaei, Sara; Marcus, Charles; Fragomeni, Roberto S; Rowe, Steven P; Javadi, Mehrbod S; Solnes, Lilja B

    2016-12-15

    The purpose of this study was to assess the diagnostic performance of whole body (18)F-FDG-PET or (18)F-FDG-PET/CT for detection of underlying malignancy in patients with clinically suspected neurological and non-neurological paraneoplastic syndromes.

  10. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy

    PubMed Central

    Brodin, N P; Björk-Eriksson, T; Birk Christensen, C; Kiil-Berthelsen, A; Aznar, M C; Hollensen, C; Markova, E; Munck af Rosenschöld, P

    2015-01-01

    Objective: To investigate the impact of including fluorine-18 fludeoxyglucose (18F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). Methods: Target volumes were first delineated without and subsequently re-delineated with access to 18F-FDG PET scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP) and estimated risk of secondary cancer (SC). Results: Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. Conclusion: Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. Advances in knowledge: 18F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT. PMID:25494657

  11. Multimodality Functional Imaging in Radiation Therapy Planning: Relationships between Dynamic Contrast-Enhanced MRI, Diffusion-Weighted MRI, and 18F-FDG PET

    PubMed Central

    Mera Iglesias, Moisés; Aramburu Núñez, David; del Olmo Claudio, José Luis; Salvador Gómez, Francisco; Driscoll, Brandon; Coolens, Catherine; Alba Castro, José L.; Muñoz, Victor

    2015-01-01

    Objectives. Biologically guided radiotherapy needs an understanding of how different functional imaging techniques interact and link together. We analyse three functional imaging techniques that can be useful tools for achieving this objective. Materials and Methods. The three different imaging modalities from one selected patient are ADC maps, DCE-MRI, and 18F-FDG PET/CT, because they are widely used and give a great amount of complementary information. We show the relationship between these three datasets and evaluate them as markers for tumour response or hypoxia marker. Thus, vascularization measured using DCE-MRI parameters can determine tumour hypoxia, and ADC maps can be used for evaluating tumour response. Results. ADC and DCE-MRI include information from 18F-FDG, as glucose metabolism is associated with hypoxia and tumour cell density, although 18F-FDG includes more information about the malignancy of the tumour. The main disadvantage of ADC maps is the distortion, and we used only low distorted regions, and extracellular volume calculated from DCE-MRI can be considered equivalent to ADC in well-vascularized areas. Conclusion. A dataset for achieving the biologically guided radiotherapy must include a tumour density study and a hypoxia marker. This information can be achieved using only MRI data or only PET/CT studies or mixing both datasets. PMID:25788972

  12. Quantification with a dedicated breast PET/CT scanner

    PubMed Central

    Bowen, Spencer L.; Ferrero, Andrea; Badawi, Ramsey D.

    2012-01-01

    Purpose: Dedicated breast PET/CT is expected to have utility in local staging, surgical planning, monitoring of therapy response, and detection of residual disease for breast cancer. Quantitative metrics will be integral to several such applications. The authors present a validation of fully 3D data correction schemes for a custom built dedicated breast PET/CT (DbPET/CT) scanner via 18F-FDG phantom scans. Methods: A component-based normalization was implemented, live-time was estimated with a multicomponent model, and a variance reduced randoms estimate was computed from delayed coincidences. Attenuation factors were calculated by using a CT based segmentation scheme while scatter was computed using a Monte Carlo (MC) simulation method. As no performance standard currently exists for breast PET systems, custom performance tests were created based on prior patient imaging results. Count-rate linearity for live-time and randoms corrections was measured with a decay experiment for a solid polyethylene cylinder phantom with an offset line source. A MC simulation was used to validate attenuation correction, a multicompartment phantom with asymmetric activity distribution provided an assessment of scatter correction, and image uniformity after geometric and detector normalization was measured from a high count scan of a uniform cylinder phantom. Raw data were reconstructed with filtered back projection (FBP) after Fourier rebinning. To quantify performance absolute activity concentrations, contrast recovery coefficients and image uniformity were calculated through region of interest analysis. Results: The most significant source of error was attributed to mispositioning of events due to pile-up, presenting in count-related axial and transaxial nonuniformities that were not corrected for with the normalization method used here. Within the range of singles counts observed during clinical trials residual error after applying all corrections was comparable to that of a

  13. PET/CT imaging of age- and task-associated differences in muscle activity during fatiguing contractions

    PubMed Central

    Kalliokoski, Kari K.; Block, Derek E.; Gould, Jeffrey R.; Klingensmith, William C.; Enoka, Roger M.

    2013-01-01

    The study compared positron emission tomography/computed tomography (PET/CT) of [18F]-2-fluoro-2-deoxy-d-glucose ([18F]-FDG) uptake by skeletal muscles and the amount of muscle activity as indicated by surface electromyographic (EMG) recordings when young and old men performed fatiguing isometric contractions that required either force or position control. EMG signals were recorded from thigh muscles of six young men (26 ± 6 yr) and six old men (77 ± 6 yr) during fatiguing contractions with the knee extensors. PET/CT scans were performed immediately after task failure. Glucose uptake in 24 leg muscles, quantified as standardized uptake values, was greater for the old men after the force task and differed across tasks for the young men (force, 0.64 ± 0.3 g/ml; position, 0.73 ± 0.3 g/ml), but not the old men (force, 0.84 ± 0.3 g/ml; position, 0.79 ± 0.26 g/ml) (age × task interaction; P < 0.001). In contrast, the rate of increase in EMG amplitude for the agonist muscles was greater for the young men during the two contractions and there was no difference for either group of subjects in the rate of increase in EMG amplitude across the two tasks. The imaging estimates of glucose uptake indicated age- and task-dependent differences in the spatial distribution of [18F]-FDG uptake by skeletal muscles during fatiguing contractions. The findings demonstrate that PET/CT imaging of [18F]-FDG uptake, but not surface EMG recordings, detected the modulation of muscle activity across the fatiguing tasks by the young men but not the old men. PMID:23412899

  14. Striatofrontal Deafferentiation in MSA-P: Evaluation with [18F]FDG Brain PET

    PubMed Central

    Kim, Hae Won; Oh, Minyoung; Oh, Jungsu S.; Oh, Seung Jun; Lee, Sang Ju; Chung, Sun Ju; Kim, Jae Seung

    2017-01-01

    Background Although cognitive impairment is not a consistent feature of multiple system atrophy (MSA), increasing evidence suggests that cognitive impairment is common in MSA with predominant parkinsonism (MSA-P). It is assumed that the cognitive impairment in MSA-P is caused by the striatal dysfunction and disruption of striatofrontal connections. The aim of this study was to evaluate the relationship between regional glucose metabolism in the frontal cortex and striatum in patients with MSA-P using [18F]FDG brain PET. Methods Twenty-nine patients with MSA-P and 28 healthy controls underwent [18F]FDG brain PET scan. The [18F]FDG brain PET images were semiquantitatively analyzed on the basis of a template in standard space. The regional glucose metabolism of the cerebral cortex and striatum were compared between MSA-P and healthy control groups. The correlations between age, symptom duration, H&Y stage, UPDRS III score, MMSE score, and glucose metabolism in the cerebellum and striatum to glucose metabolism in the frontal cortex were evaluated by multivariate analysis. Results The glucose metabolism in the frontal cortex and striatum in MSA-P patients were significantly lower than those in healthy controls. Glucose metabolism in the striatum was the most powerful determinant of glucose metabolism in the frontal cortex in MSA-P. Only age and glucose metabolism in the cerebellum were independent variables affecting the glucose metabolism in the frontal cortex in healthy controls. Conclusion The decrease in frontal glucose metabolism in MSA-P is related to the decrease in striatal glucose metabolism. This result provided evidence of striatofrontal deafferentiation in patients with MSA-P. PMID:28085923

  15. 18F-FDG PET imaging in detection of radiation-induced vascular disease in lymphoma survivors

    PubMed Central

    Ripa, Rasmus S; Hag, Anne Mette; Knudsen, Andreas; Loft, Annika; Specht, Lena; Kjær, Andreas

    2015-01-01

    Radiation therapy (RT) induces vascular changes that increase the risk of cardiovascular diseases in some patients. The objective was to determine if in vivo positron emission tomography (PET) with fluorodeoxyglucose (18F-FDG) can identify increased vascular inflammation in patients without changes in vascular intima media thickness (IMT). Patients previously receiving unilateral RT due to lymphoma were prospectively recruited (N=10). The untreated contralateral artery functioned as control. All patients underwent a dedicated vascular PET/CT. Vascular tracer uptake was quantified by drawing regions of interests around the carotid artery or the iliac arteries. The IMT of the carotid arteries was measured using ultrasound. Eight patients (25% male, 42-83 years old) that had received RT involving unilateral carotid arteries and 2 patients (both male, 38 and 58 years old) that had received radiotherapy involving the unilateral iliac artery were included. The patients had completed their RT 2-7 years before. Eight patients showed increased uptake of 18F-FDG in the irradiated side compared to the non-irradiated side, 1 showed no difference, while 1 patient showed highest uptake in the non- irradiated side (P=0.04). Measurement of IMT showed that 4 patients had the highest thickness in the irradiated side, while the other 4 patients had the highest thickness in the non-irradiated side (P=0.8). In conclusion, we found that 18F-FDG PET imaging may be used to detect vascular changes induced by RT. Larger prospective follow-up studies are needed to determine the prognostic value of increased vascular FDG-uptake. PMID:26269778

  16. [18F FDG PET-Applications in Oncology].

    PubMed

    Răileanu, Irena; Rusu, V; Stefănescu, Cipriana; Cinotti, L; Hountis, D

    2002-01-01

    In the first part our intention was, essentially, to present the particularities of glucose tumoral cells metabolism, PET components, the synthesis of 18F FDG and the detection of unknown cancers. This second part makes reference about mainly types of tumors who benefit by FDG-PET indications. Clinical PET has a rapid growth because of its use in cancer diagnosis and management. According with published studies all over the world, the sensibility and specificity of FDG-PET, noninvasive method, is higher than that of the conventional methods like CT, IRM, ultrasonography. PET is en excellent detection method of most of common cancer types and depends not on the histological neoplasm type; the more aggressive is the tumor, more it will uptake the radiotracer. The cost is significant, so the indications must be very precise: evaluating the malignity of solitary pulmonary nodules, evaluating the recurrences of melanoma, colon cancer diagnosis, differentiation between recurrent brain tumor and radiation injury, differential diagnosis of the benign lymph and malign lymph nodes, staging of Hodgkin's and non-Hodgkin's lymphoma, evaluation the response to therapy. Because the PET images are difficult to interpret, appears the necessity of correlation with anatomic images: this was the fusion images beginnings (the PET and CT images combination); now the physiologic information has precise anatomic localization. The growing of this method is very probably, both using 18F FDG -thanks to its highly favorable physical characteristics- and other new radiopharmaceuticals. The clinical cases that illustrate the applications are investigated at CERMEP, Lyon, France.

  17. Impact of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography scan on initial evaluation of head and neck squamous cell carcinoma: our experience at a tertiary care center in India.

    PubMed

    Nair, Satish; Mohan, Sharad; Nilakantan, Ajith; Gupta, Atul; Malik, Akshat; Gupta, Abhishek

    2015-01-01

    The efficacy of the whole body (WB) (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) as a part of conventional initial staging in all cases of head and neck squamous cell carcinoma (HNSCC) is still controversial with various studies in literature giving contradictory reports. We conducted this study at a government tertiary care oncology center in India to identify the impact of WB (18)F-FDG PET-CT scan on HNSCC staging and treatment. A prospective clinical study of patients of HNSCC who were evaluated and treated at our center was performed. The patients included in the study were HNSCC of the oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, and carcinoma of unknown primary site (CUPS) with cervical metastasis. The study design was to evaluate the cases of HNSCC initially by staging with conventional investigations followed by staging with the information derived from WB (18)F-FDG PET-CT scan. At the end of the conventional investigations, a tumor, node, metastasis (TNM) staging as per AJCC 7(th) edition, and a detailed treatment plan as per NCCN 2012 guidelines was decided in consultation with the multidisciplinary oncology team of the hospital. WB (18)F-FDG PET-CT scan was carried out in all these patients. The findings of WB (18)F-FDG PET-CT were then interpreted with the staging with conventional investigations to identify the cases with change in staging and also those in whom the treatment protocol would be affected. Descriptive analysis of demographic data and analytical analysis of the sensitivity and specificity of WB (18)F-FDG PET-CT scan and also the change in staging and treatment plan after WB (18)F-FDG PET-CT scan was analyzed using SPSS version 18. A total of 131 patients met the inclusion criteria, which included 123 males and 8 females. The various sites involved among the study group are oral cavity 11 (8.3%), oropharyn × 39 (29.7%), hypopharyn × 31 (23.6%), laryn × 34 (25.9%), nasopharyn

  18. Effectiveness of FDG-PET/CT for evaluating early response to induction chemotherapy in head and neck squamous cell carcinoma

    PubMed Central

    dos Anjos, Renata Fockink; dos Anjos, Dalton Alexandre; Vieira, Danielle Leal; Leite, André Ferreira; Figueiredo, Paulo Tadeu de Souza; de Melo, Nilce Santos

    2016-01-01

    Abstract Background: 18F-Fluoro-Deoxy-Glucose Positron Emission Tomography with Computed Tomography (18F-FDG PET/CT) may be a powerful tool to predict treatment outcome. We aimed to review the effectiveness of 18F-FDG PET/CT in the assessment of early response to induction chemotherapy (IC) in patients with advanced Head and Neck Squamous Cell Cancer (HNSCC) without previous treatment. Methods: PubMed, Cochrane Library, Science Direct and Web of Science were searched to May 2016. Reference lists of the included articles and additional studies identified by one nuclear medicine expert were screened for potential relevant studies that investigated the effectiveness of 18F-FDG PET/CT performed before and after IC. Three authors independently screened all retrieved articles, selected studies that met inclusion criteria and extracted data. The methodology of the selected studies was evaluated by using the risk of bias checklist of the Agency for Healthcare Research and Quality (AHRQ). Results: Seven out of 170 eligible studies met our inclusion criteria. A total of 207 advanced HNSCC patients were evaluated with 18F-FDG PET/CT at baseline and after IC in the selected articles. Six from seven studies concluded that 18F-FDG PET/CT allowed early evaluation response to IC and predicted survival outcomes. Conclusion: The present systematic review confirms the potential value of 18F-FDG PET/CT as a diagnostic tool for early IV response assessment in HNSCC patients. However, the lack of standard definitions for response criteria and heterogeneous IC protocols indicate the need to further studies in order to better define the role of 18F-FDG PET/CT in these patients. PMID:27512861

  19. Pleuroperitoneal Mesothelioma: A Rare Entity on 18F-FDG PET/CT

    PubMed Central

    Sahoo, Manas Kumar; Mukherjee, Anirban; Girish; Parida, Kumar; Agarwal, Krishan Kant; Bal, Chandrasekhar; Tripathi, Madhavi; Das, Chandan Jyoti; Shamim, Shamim Ahmed

    2017-01-01

    Pleuroperitoneal mesothelioma is an extremely rare entity. Only few cases are reported worldwide. We hereby represent a case of pleural mesothelioma referred for F-18-Fluorodeoxyglucose positron emission tomography/computed tomography for response evaluation. Diffuse F-18-Fluorodeoxyglucose avid peritoneal and omental thickening noted which subsequently turned out to be mesothelial involvement on peritoneal biopsy. This case demonstrates the role of F-18-Fluorodeoxyglucose positron emission tomography/computed tomography in detecting other sites of involvement in case of malignant mesothelioma. PMID:28242997

  20. Inflammatory Fibroid Polyp of the Stomach Mimics Malignancy on 18F FDG PET/CT Imaging.

    PubMed

    Bilgin, Sabriye Sennur; Bilgin, Mehmet; Savas, Recep; Erdogan, Ezgi Basak

    2016-09-01

    Inflammatory fibroid polyps (IFPs) are rare non-neoplastic and proliferating submucosal lesions of the gastrointestinal tract. The classic IFP, which was first described by Vanek, consists of prominent blood vessels and is characterized by a heavy inflammatory infiltrate, which is rich in eosinophilic granulocytes. The clinical presentation depends on the size and location. Inflammatory fibroid polyps cannot be differentiated from malignancy without histological examination. We report a case of IFP in the stomach that mimicked a primary gastric malignancy showing an increased F-FDG uptake.

  1. Incidental abnormal FDG uptake in the prostate on 18-fluoro-2-deoxyglucose positron emission tomography-computed tomography scans.

    PubMed

    Kang, Pil Moon; Seo, Won Ik; Lee, Sun Seong; Bae, Sang Kyun; Kwak, Ho Sup; Min, Kweonsik; Kim, Wansuk; Kang, Dong Il

    2014-01-01

    18-fluoro-2-deoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) scans are commonly used for the staging and restaging of various malignancies, such as head and neck, breast, colorectal and gynecological cancers. However, the value of FDG PET/CT for detecting prostate cancer is unknown. The aim of this study was to evaluate the clinical value of incidental prostate 18F-FDG uptake on PET/CT scans. We reviewed 18F-FDG PET/CT scan reports from September 2009 to September 2013, and selected cases that reported focal/diffuse FDG uptake in the prostate. We analyzed the correlation between 18F-FDG PET/CT scan findings and data collected during evaluations such as serum prostate-specific antigen (PSA) levels, digital rectal examination (DRE), transrectal ultrasound (TRUS), and/or biopsy to confirm prostate cancer. Of a total of 18,393 cases, 106 (0.6%) exhibited abnormal hypermetabolism in the prostate. Additional evaluations were performed in 66 patients. Serum PSA levels were not significantly correlated with maximum standardized uptake values (SUVmax) in all patients (rho 0.483, p=0.132). Prostate biopsies were performed in 15 patients, and prostate cancer was confirmed in 11. The median serum PSA level was 4.8 (0.55-7.06) ng/mL and 127.4 (1.06-495) ng/mL in the benign and prostate cancer groups, respectively. The median SUVmax was higher in the prostate cancer group (mean 10.1, range 3.8-24.5) than in the benign group (mean 4.3, range 3.1-8.8), but the difference was not statistically significant (p=0.078). There was no significant correlation between SUVmax and serum PSA, prostatic volume, or Gleason score. 18F-FDG PET/CT scans did not reliably differentiate malignant or benign from abnormal uptake lesions in the prostate, and routine prostate biopsy was not usually recommended in patients with abnormal FDG uptake. Nevertheless, patients with incidental prostate uptake on 18F-FDG PET/ CT scans should not be ignored and should be undergo

  2. A Novel Method for Direct site-specific Radiolabeling of Peptides Using [18F]FDG

    PubMed Central

    Namavari, Mohammad; Cheng, Zhen; Zhang, Rong; De, Abhijit; Levi, Jelena; Hoerner, Joshua K.; Yaghoubi, Shahriar S.; Syud, Faisal A.; Gambhir, Sanjiv S.

    2009-01-01

    We have used the well-accepted and easily available 2-[18F]Fluoro-2-deoxyglucose ([18F]FDG) positron emission tomography (PET) tracer as a prosthetic group for synthesis of 18F-labeled peptides. We herein report the synthesis of [18F]FDG-RGD (18F labeled linear RGD) and [18F]FDG-cyclo(RGDDYK) (18F labeled cyclic RGD) as examples of the use of [18F]FDG. We have successfully prepared [18F]FDG-RGD and [18F]FDG-cyclo(RGDDYK) in 27.5% and 41% radiochemical yields (decay corrected) respectively. The receptor binding affinity study of FDG-cyclo(RGDDYK) for integrin αvβ3 , using αvβ3 positive U87MG cells confirmed a competitive displacement with 125I-echistatin as a radioligand. The IC50 value for FDG-cyclo(RGDDYK) was determined to be 0.67 ± 0.19µM. High contrast small animal PET images with relatively moderate tumor uptake were observed for [18F]FDG-RGD and [18F]FDG-cyclo(RGDDYK) as PET probes in xenografts models expressing αvβ3 integrin. In conclusion, we have successfully used [18F]FDG as a prosthetic group to prepare 18F]FDG-RGD and [18F]FDG-cyclic[RGDDYK] based on a simple one step radiosynthesis. The one step radiosynthesis methodology consists of chemoselective oxime formation between an aminooxy functionalized peptide and [18F]FDG. The results have implications for radiolabeling of other macromolecules and would lead to a very simple strategy for routine pre-clinical and clinical use. PMID:19226160

  3. Increased (18)F-fluorodeoxyglucose uptake in benign, nonphysiologic lesions found on whole-body positron emission tomography/computed tomography (PET/CT): accumulated data from four years of experience with PET/CT.

    PubMed

    Metser, Ur; Even-Sapir, Einat

    2007-05-01

    The use of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) in the field of oncology is rapidly evolving; however, (18)F-FDG is not tumor specific. Aside from physiological uptake (18)F-FDG also may accumulate in benign processes. Knowledge of these (18)F-FDG-avid nonmalignant lesions is essential for accurate PET interpretation in oncologic patients to avoid a false-positive interpretation. Through the systematic review of the reports of PET/computed tomography (CT) studies performed in oncologic patients during a 6-month period, we found benign nonphysiological uptake of (18)F-FDG in more than 25% of studies. In half of these, (18)F-FDG uptake was moderate or marked in intensity, similar to that of malignant sites. A total of 73% of benign lesions were inflammatory in nature, with post-traumatic bone and soft-tissue abnormalities (including iatrogenic injury) and benign tumors accounting for the remainder. The differentiation of benign from malignant uptake of (18)F-FDG on PET alone may be particularly challenging as a result of the low anatomical resolution of PET and paucity of anatomical landmarks. Fusion imaging, namely PET/CT, has been shown to improve not only the sensitivity of PET interpretation but also its specificity. Aside from better anatomical localization of lesions on PET/CT, morphological characterization of lesions on CT often may improve the diagnostic accuracy of nonspecific (18)F-FDG uptake. Correlation with CT on fused PET/CT data may obviate the need for further evaluation or biopsy in more than one-third of scintigraphic equivocal lesions. Familiarity with (18)F-FDG-avid nonmalignant lesions also may extend the use of (18)F-FDG-PET imaging beyond the field of oncology. We have tabulated our experience with benign entities associated with increased (18)F-FDG uptake on whole-body PET/CT from 12,000 whole-body (18)F-FDG-PET/CT studies performed during a 4-year period.

  4. Bilateral primary renal lymphoma in a pediatric patient: staging and response evaluation with ¹⁸F-FDG PET/CT.

    PubMed

    Dhull, V S; Mukherjee, A; Karunanithi, S; Durgapal, P; Bal, C; Kumar, R

    2015-01-01

    Primary renal lymphoma (PRL) is a rare disease. We here present the case of an 8-year-old child who presented with bilateral renal masses. On biopsy, it was confirmed to be B-cell non-Hodgkin's lymphoma. (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET/CT) for staging demonstrated (18)F-FDG avid bilateral renal masses, with no other abnormal focus. Follow up (18)F-FDG PET/CT showed complete resolution of the disease after six cycles of chemotherapy. Here we have highlighted the potential role of (18)F-FDG PET/CT in staging and response evaluation of a patient with PRL and presented a brief review.

  5. [(18)F]FDG PET monitoring of tumour response to chemotherapy: does [(18)F]FDG uptake correlate with the viable tumour cell fraction?

    PubMed

    Spaepen, Karoline; Stroobants, Sigrid; Dupont, Patrick; Bormans, Guy; Balzarini, Jan; Verhoef, Gregor; Mortelmans, Luc; Vandenberghe, Peter; De Wolf-Peeters, Christine

    2003-05-01

    Because metabolic changes induced by chemotherapy precede the morphological changes, fluorine-18 fluorodeoxyglucose positron emission tomography ([(18)F]FDG PET) is thought to predict response to therapy earlier and more accurately than other modalities. To be a reliable predictor of response, changes in tumour [(18)F]FDG uptake should reflect changes in viable cell fraction, but little is known about the contribution of apoptotic and necrotic cancer cells and inflammatory tissue to the [(18)F]FDG signal. In a tumour mouse model we investigated the relation between chemotherapy-induced changes in various tumoral components and tumour uptake and size. SCID mice were subcutaneously inoculated in the right thigh with 5 x 10(6) Daudi cells. When the tumour measured 15-20 mm, Endoxan was given intravenously. At different time points [1-15 days (d1-d15) after the injection of Endoxan], ex vivo autoradiography and histopathology were performed in two mice and [(18)F]FDG uptake in the tumour and tumour size were correlated with the different cell fractions measured with flow cytometry in five mice. At d1/d3, similar reductions in [(18)F]FDG uptake and viable tumoral cell fraction were observed and these reductions preceded changes in tumour size. By d8/d10, [(18)F]FDG uptake had stabilised despite a further reduction in viable tumoral cell fraction. At these time points a major inflammatory response was observed. At d15, an increase in viable tumour cells was again observed and this was accurately predicted by an increase in [(18)F]FDG uptake, while the tumour volume remained unchanged. In contrast with variations in tumour volume, [(18)F]FDG is a good marker for chemotherapy response monitoring. However, optimal timing seems crucial since a transient increase in stromal reaction may result in overestimation of the fraction of viable cells.

  6. Pitfalls and Pearls of Wisdom in 18F-FDG PET Imaging of Tumors.

    PubMed

    Britton, Tracey; Robinson, Nicholas

    2016-06-01

    (18)F-FDG PET imaging of tumors has pitfalls and pearls of wisdom that begin at the point of scheduling and continue through the patient interview, the resting phase, the scan itself, and the image review. Interviewing the patient at the time of scheduling, followed by placing a reminder phone call shortly before the appointment, can save a nuclear medicine department the financial loss of wasted doses and missed appointment slots in the schedule. The pitfalls and pearls of wisdom in tumor imaging are ever changing, and the technologist is in a constant state of inquiry about the patient's disease process and ability to comply. Consideration of each item on the worksheets in this article affects every scan. On completing this article, the reader will be able to identify questions that should be asked in the scheduling and preinjection patient interviews, interpret the answers to those questions, determine how the images may be affected, and adapt the scan.

  7. Is the Glut expression related to FDG uptake in PET/CT of non-small cell lung cancer patients?

    PubMed

    Choi, Woo Hee; Yoo, Ie Ryung; O, Joo Hyun; Kim, Tae Jung; Lee, Kyo Young; Kim, Young Kyoon

    2015-01-01

    Though 18F-FDG PET/CT scans are widely used in non-small cell lung cancer (NSCLC), the mechanism of FDG uptake by lung cancer cells has not yet been fully elucidated. This study evaluated the relationship between FDG uptake and the expression of glucose transporters in NSCLC. Sixty-four NSCLC patients who underwent both preoperative 18F-FDG PET/CT scanning and thoracotomy were included. The maximum standardized uptake value (SUVmax) of the primary lung cancer was compared to the immunohistochemistry results for Glut expression and tumor size. In all the NSCLC cases, degree of FDG uptake significantly correlated with both Glut-1 and Glut-3 expression. When stratified by the histology, squamous cell carcinomas showed higher mean SUVmax, Glut-1 expression intensity, and percentage of area positive for Glut-1 expression than adenocarcinomas. Glut-1 and Glut-3 expressions correlated with SUVmax in adenocarcinomas, but there was no significant correlation in squamous cell carcinomas. No significant correlation was observed between tumor size and FDG uptake or Glut expression. These results show that Glut expression was significantly correlated with SUVmax in NSCLC, especially in adenocarcinomas, and that neither FDG uptake nor the expression of Glut was associated with tumor size.

  8. Posttreatment PET/CT Rather Than Interim PET/CT Using Deauville Criteria Predicts Outcome in Pediatric Hodgkin Lymphoma: A Prospective Study Comparing PET/CT with Conventional Imaging.

    PubMed

    Bakhshi, Sameer; Bhethanabhotla, Sainath; Kumar, Rakesh; Agarwal, Krishankant; Sharma, Punit; Thulkar, Sanjay; Malhotra, Arun; Dhawan, Deepa; Vishnubhatla, Sreenivas

    2017-04-01

    Data about the significance of (18)F-FDG PET at interim assessment and end of treatment in pediatric Hodgkin lymphoma (HL) are limited. Methods: Patients (≤18 y) with HL were prospectively evaluated with contrast-enhanced CT (CECT) and PET combined with low-dose CT (PET/CT) at baseline, after 2 cycles of chemotherapy, and after completion of treatment. Revised International Working Group (RIW) criteria and Deauville 5 point-scale for response assessment by PET/CT were used. All patients received doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine chemotherapy along with involved-field radiotherapy (25 Gy) for early stage (IA, IB, and IIA) and advanced stage (IIB-IV) with bulky disease. Results: Of the 57 enrolled patients, median follow-up was 81.6 mo (range, 11-97.5 mo). Treatment decisions were based on CECT. At baseline, PET/CT versus CECT identified 67 more disease sites; 23 patients (40.3%) were upstaged and of them in 9 patients (39%) upstaging would have affected treatment decision; notably none of these patients relapsed. The specificity of interim PET/CT based on RIW criteria (61.5%) and Deauville criteria (91.4%) for predicting relapse was higher than CECT (40.3%) (P = 0.03 and P < 0.0001, respectively). Event-free survival based on interim PET/CT (RIW) response was 93.3 ± 4.1 versus 89.6 ± 3.8 (positive vs. negative scan, respectively; P = 0.44). The specificity of posttreatment PET/CT (Deauville) was 95.7% versus 76.4% by CECT (P = 0.006). Posttreatment PET/CT (Deauville) showed significantly inferior overall survival in patients with positive scan versus negative scan results (66.4 ± 22.5 vs. 94.5 ± 2.0, P = 0.029). Conclusion: Interim PET/CT has better specificity, and use of Deauville criteria further improves it. Escalation of therapy based on interim PET in pediatric HL needs further conclusive evidence to justify its use. Posttreatment PET/CT (Deauville) predicts overall survival and has better specificity in comparison to

  9. Determination of the unmetabolised (18)F-FDG fraction by using an extension of simplified kinetic analysis method: clinical evaluation in paragangliomas.

    PubMed

    Barbolosi, Dominique; Hapdey, Sebastien; Battini, Stephanie; Faivre, Christian; Mancini, Julien; Pacak, Karel; Farman-Ara, Bardia; Taïeb, David

    2016-01-01

    Tumours with high (18)F-FDG uptake values on static late PET images do not always exhibit high proliferation indices. These discrepancies might be related to high proportion of unmetabolised (18)F-FDG components in the tissues. We propose a method that enables to calculate different (18)F-FDG kinetic parameters based on a new mathematical approach that integrates a measurement error model. Six patients with diagnosed non-metastatic paragangliomas (PGLs) and six control patients with different types of lesions were investigated in this pilot study using (18)F-FDG PET/CT. In all cases, a whole-body acquisition was followed by four static acquisitions centred over the target lesions, associated with venous blood samplings. We used an extension of the Hunter's method to calculate the net influx rate constant (K H). The exact net influx rate constant and vascular volume fraction (K i and V, respectively) were subsequently obtained by the method of least squares. Next, we calculated the mean percentages of metabolised (PM) and unmetabolised (PUM) (18)F-FDG components, and the times required to reach 80 % of the amount of metabolised (18)F-FDG (T80%). A test-retest evaluation indicated that the repeatability of our approach was accurate; the coefficients of variation were below 2 % regardless of the kinetic parameters considered. We observed that the PGLs were characterised by high dispersions of the maximum standardised uptake value SUVmax (9.7 ± 11, coefficient of variation CV = 114 %), K i (0.0137 ± 0.0119, CV = 87 %), and V (0.292 ± 0.306, CV = 105 %) values. The PGLs were associated with higher PUM (p = 0.02) and T80% (p = 0.02) values and lower k 3 (p = 0.02) values compared to the malignant lesions despite the similar SUVmax values (p = 0.55). The estimations of these new kinetic parameters are more accurate than SUVmax or K i for in vivo metabolic assessment of PGLs at the molecular level.

  10. Diagnostic performance of an automated analysis software for the diagnosis of Alzheimer’s dementia with 18F FDG PET

    PubMed Central

    Partovi, Sasan; Yuh, Roger; Pirozzi, Sara; Lu, Ziang; Couturier, Spencer; Grosse, Ulrich; Schluchter, Mark D; Nelson, Aaron; Jones, Robert; O’Donnell, James K; Faulhaber, Peter

    2017-01-01

    The objective of this study was to assess the ability of a quantitative software-aided approach to improve the diagnostic accuracy of 18F FDG PET for Alzheimer’s dementia over visual analysis alone. Twenty normal subjects (M:F-12:8; mean age 80.6 years) and twenty mild AD subjects (M:F-12:8; mean age 70.6 years) with 18F FDG PET scans were obtained from the ADNI database. Three blinded readers interpreted these PET images first using a visual qualitative approach and then using a quantitative software-aided approach. Images were classified on two five-point scales based on normal/abnormal (1-definitely normal; 5-definitely abnormal) and presence of AD (1-definitely not AD; 5-definitely AD). Diagnostic sensitivity, specificity, and accuracy for both approaches were compared based on the aforementioned scales. The sensitivity, specificity, and accuracy for the normal vs. abnormal readings of all readers combined were higher when comparing the software-aided vs. visual approach (sensitivity 0.93 vs. 0.83 P = 0.0466; specificity 0.85 vs. 0.60 P = 0.0005; accuracy 0.89 vs. 0.72 P<0.0001). The specificity and accuracy for absence vs. presence of AD of all readers combined were higher when comparing the software-aided vs. visual approach (specificity 0.90 vs. 0.70 P = 0.0008; accuracy 0.81 vs. 0.72 P = 0.0356). Sensitivities of the software-aided and visual approaches did not differ significantly (0.72 vs. 0.73 P = 0.74). The quantitative software-aided approach appears to improve the performance of 18F FDG PET for the diagnosis of mild AD. It may be helpful for experienced 18F FDG PET readers analyzing challenging cases. PMID:28123864

  11. Comparative Analysis between [(18)F]Fludarabine-PET and [(18)F]FDG-PET in a Murine Model of Inflammation.

    PubMed

    Hovhannisyan, Narinée; Dhilly, Martine; Guillouet, Stéphane; Leporrier, Michel; Barré, Louisa

    2016-06-06

    Lymphoma research has advanced thanks to introduction of [(18)F]fludarabine, a positron-emitting tool. This novel radiotracer has been shown to display a great specificity for lymphoid tissues. However, in a benign process such as inflammation, the uptake of this tracer has not been questioned. Indeed, in inflammatory zones, elevated glucose metabolism rate may result in false-positives with [(18)F]FDG-PET Imaging. In the present investigation, it has been argued that cells, involved in inflammation, might be less avid of [(18)F]fludarabine. To generate inflammation, Swiss mice were intramuscularly injected with 0.1 mL of turpentine oil into the right front paw. Imaging sessions with (18)F-labeled tracers named above were conducted on days 5 and 25 after inoculation. For each animal, volumes of interest (VOI), delineating the muscle of the inflamed (IP) and normal paws (NP), were determined on PET scans. For characterization of inflammation, muscle samples from IP and NP were stained with hematoxylin and eosin (H&E). In early (day 5) inflammation, [(18)F]FDG accumulation was 4.00 ± 1.65 times greater in the IP than in the contralateral NP; for [(18)F]fludarabine, this IP/NP ratio was 1.31 ± 0.28, resulting in a significant difference between radiotracer groups (p < 0.01). In late (day 25) inflammation, the IP/NP ratios were 2.07 ± 0.49 and 1.03 ± 0.07, for [(18)F]FDG and [(18)F]fludarabine, respectively (p < 0.001). [(18)F]Fludarabine showed significantly weaker uptake in inflammation when compared with [(18)F]FDG. This encouraging finding suggests that [(18)F]fludarabine-PET might well be a robust approach for distinguishing tumor from inflammatory tissue, avoiding false-positive PET results and thus enabling an accurate imaging of lymphoma.

  12. Longitudinal Characterization of [18F]-FDG and [18F]-AV45 Uptake in the Double Transgenic TASTPM Mouse Model

    PubMed Central

    Waldron, Ann-Marie; wyffels, Leonie; Verhaeghe, Jeroen; Richardson, Jill C.; Schmidt, Mark; Stroobants, Sigrid; Langlois, Xavier; Staelens, Steven

    2016-01-01

    We aimed to monitor the timing of amyloid-β deposition in relation to changes in brain function using in vivo imaging with [18F]-AV45 and [18F]-FDG in a mouse model of Alzheimer’s disease. TASTPM transgenic mice and wild-type controls were scanned longitudinally with [18F]-AV45 and [18F]-FDG before (3 months of age) and at multiple time points after the onset of amyloid deposition (6, 9, 12, and 15 months of age). As expected with increasing amyloidosis, TASTPM mice demonstrated progressive age-dependent increases in [18F]-AV45 uptake that were significantly higher than for WT from 9 months onwards and correlated to ex vivo measures of amyloid burden. The metabolism of [18F]-AV45 produces several brain penetrant radiometabolites and normalization to a reference region helps to negate this non-specific binding and improve the sensitivity of [18F]-AV45. The observed trajectory of [18F]-FDG alterations deviated from our proposed hypothesis of gradual decreases with worsening amyloidosis. While [18F]-FDG uptake in TASTPM mice was significantly lower than that of WT at 9 months, reduced [18F]-FDG was not associated with aging in TASTPM mice. Moreover, [18F]-FDG uptake did not correlate to measures of ex vivo amyloid burden. Our findings suggest that while amyloid-β is sufficient to induce hypometabolism, these pathologies are not linked in a dose-dependent manner in TASTPM mice. PMID:27911309

  13. Predicting Future Morphological Changes of Lesions from Radiotracer Uptake in 18F-FDG-PET Images

    PubMed Central

    Bagci, Ulas; Yao, Jianhua; Miller-Jaster, Kirsten; Chen, Xinjian; Mollura, Daniel J.

    2013-01-01

    We introduce a novel computational framework to enable automated identification of texture and shape features of lesions on 18F-FDG-PET images through a graph-based image segmentation method. The proposed framework predicts future morphological changes of lesions with high accuracy. The presented methodology has several benefits over conventional qualitative and semi-quantitative methods, due to its fully quantitative nature and high accuracy in each step of (i) detection, (ii) segmentation, and (iii) feature extraction. To evaluate our proposed computational framework, thirty patients received 2 18F-FDG-PET scans (60 scans total), at two different time points. Metastatic papillary renal cell carcinoma, cerebellar hemongioblastoma, non-small cell lung cancer, neurofibroma, lymphomatoid granulomatosis, lung neoplasm, neuroendocrine tumor, soft tissue thoracic mass, nonnecrotizing granulomatous inflammation, renal cell carcinoma with papillary and cystic features, diffuse large B-cell lymphoma, metastatic alveolar soft part sarcoma, and small cell lung cancer were included in this analysis. The radiotracer accumulation in patients' scans was automatically detected and segmented by the proposed segmentation algorithm. Delineated regions were used to extract shape and textural features, with the proposed adaptive feature extraction framework, as well as standardized uptake values (SUV) of uptake regions, to conduct a broad quantitative analysis. Evaluation of segmentation results indicates that our proposed segmentation algorithm has a mean dice similarity coefficient of 85.75±1.75%. We found that 28 of 68 extracted imaging features were correlated well with SUVmax (p<0.05), and some of the textural features (such as entropy and maximum probability) were superior in predicting morphological changes of radiotracer uptake regions longitudinally, compared to single intensity feature such as SUVmax. We also found that integrating textural features with SUV measurements

  14. Automatic Segmentation and Quantification of White and Brown Adipose Tissues from PET/CT Scans.

    PubMed

    Hussein, Sarfaraz; Green, Aileen; Watane, Arjun; Reiter, David; Chen, Xinjian; Papadakis, Georgios Z; Wood, Bradford; Cypess, Aaron; Osman, Medhat; Bagci, Ulas

    2016-12-06

    In this paper, we investigate the automatic detection of white and brown adipose tissues using Positron Emission Tomography/ Computed Tomography (PET/CT) scans, and develop methods for the quantification of these tissues at the whole-body and body-region levels. We propose a patient-specific automatic adiposity analysis system with two modules. In the first module, we detect white adipose tissue (WAT) and its two sub-types from CT scans: Visceral Adipose Tissue (VAT) and Subcutaneous Adipose Tissue (SAT). This process relies conventionally on manual or semi-automated segmentation, leading to inefficient solutions. Our novel framework addresses this challenge by proposing an unsupervised learning method to separate VAT from SAT in the abdominal region for the clinical quantification of central obesity. This step is followed by a context driven label fusion algorithm through sparse 3D Conditional Random Fields (CRF) for volumetric adiposity analysis. In the second module, we automatically detect, segment, and quantify brown adipose tissue (BAT) using PET scans because unlike WAT, BAT is metabolically active. After identifying BAT regions using PET, we perform a co-segmentation procedure utilizing asymmetric complementary information from PET and CT. Finally, we present a new probabilistic distance metric for differentiating BAT from non-BAT regions. Both modules are integrated via an automatic body-region detection unit based on one-shot learning. Experimental evaluations conducted on 151 PET/CT scans achieve state-of-the-art performances in both central obesity as well as brown adiposity quantification.

  15. 18F-FDG-avid brunner gland hyperplasia.

    PubMed

    Park, Seol Hoon; Park, Kwang-Min; Kim, Jae Seung

    2014-08-01

    Brunner gland hyperplasia, a rare duodenal tumor, usually presents with benign features. A 68-year-old man with a history of anemia presented with a polypoid duodenal mass that was detected by CT and esophagogastroduodenoscopy. This mass showed high F-FDG avidity on PET/CT and was histopathologically confirmed as Brunner gland hyperplasia. We suggest that Brunner gland hyperplasia should be considered in the differential diagnosis of F-FDG-avid duodenal tumors.

  16. [Understanding positon emission tomography (PET) with [18F]-FDG in clinical oncology. Informations dedicated to patients and relatives].

    PubMed

    Bourguet, Patrick; Brusco, Sylvie; Corone, Corinne; Devillers, Anne; Foehrenbach, Hervé; Lumbroso, Jean-Daniel; Maszelin, Philippe; Montravers, Françoise; Moretti, Jean-Luc; Rain, Jean-Didier; Talbot, Jean-Noël; Carretier, Julien; Leichtnam-Dugarin, Line; Delavigne, Valérie; Philip, Thierry; Fervers, Béatrice

    2005-07-01

    ), binds to cancer cells and temporarily emits radiations that can be recorded by a special camera in the PET scanner. PET scanning can be used to obtain complementary information at different stages of the disease, whether for assessing diagnosis, treatment evolution or follow-up. By 2007, in the framework of the government plan against cancer, about seventy-five PET scanners are expected to be installed in France. Twenty-four are currently in use; a similar number is under installation. At the end of this process, all French regions should have at least one PET imaging equipment. The SOR SAVOIR PATIENT guide: Understanding positron emission tomography (PET) with [18F]-FDG in clinical oncology and the integral report of CPG SOR 2003: Standards, Options and Recommendations for positron emission tomography (PET) with [18F]-FDG in clinical oncology can be downloaded from the FNCLCC website: http:\\\\www.fnclcc.fr.

  17. Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma

    PubMed Central

    Johnson, Peter; Federico, Massimo; Kirkwood, Amy; Fosså, Alexander; Berkahn, Leanne; Carella, Angelo; d’Amore, Francesco; Enblad, Gunilla; Franceschetto, Antonella; Fulham, Michael; Luminari, Stefano; O’Doherty, Michael; Patrick, Pip; Roberts, Thomas; Sidra, Gamal; Stevens, Lindsey; Smith, Paul; Trotman, Judith; Viney, Zaid; Radford, John; Barrington, Sally

    2016-01-01

    Background We tested interim positron-emission tomography–computed tomography (PET-CT) as a measure of early response to chemotherapy in order to guide treatment for patients with advanced Hodgkin’s lymphoma. Methods Patients with newly diagnosed advanced classic Hodgkin’s lymphoma underwent a baseline PET-CT scan, received two cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy, and then underwent an interim PET-CT scan. Images were centrally reviewed with the use of a 5-point scale for PET findings. Patients with negative PET findings after two cycles were randomly assigned to continue ABVD (ABVD group) or omit bleomycin (AVD group) in cycles 3 through 6. Those with positive PET findings after two cycles received BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). Radiotherapy was not recommended for patients with negative findings on interim scans. The primary outcome was the difference in the 3-year progression-free survival rate between randomized groups, a noninferiority comparison to exclude a difference of 5 or more percentage points. Results A total of 1214 patients were registered; 937 of the 1119 patients (83.7%) who underwent an interim PET-CT scan according to protocol had negative findings. With a median follow-up of 41 months, the 3-year progression-free survival rate and overall survival rate in the ABVD group were 85.7% (95% confidence interval [CI], 82.1 to 88.6) and 97.2% (95% CI, 95.1 to 98.4), respectively; the corresponding rates in the AVD group were 84.4% (95% CI, 80.7 to 87.5) and 97.6% (95% CI, 95.6 to 98.7). The absolute difference in the 3-year progression-free survival rate (ABVD minus AVD) was 1.6 percentage points (95% CI, −3.2 to 5.3). Respiratory adverse events were more severe in the ABVD group than in the AVD group. BEACOPP was given to the 172 patients with positive findings on the interim scan, and 74.4% had negative findings on a third

  18. Characterization of brown adipose tissue ¹⁸F-FDG uptake in PET/CT imaging and its influencing factors in the Chinese population.

    PubMed

    Shao, Xiaonan; Shao, Xiaoliang; Wang, Xiaosong; Wang, Yuetao

    2016-01-01

    (18)F-FDG PET/CT has been widely applied for tumor imaging. However, it is reported that many normal tissues, e.g., brown adipose tissue, can also uptake (18)F-FDG. The purpose of this study was to determine the imaging characteristics of (18)F-FDG uptake in brown adipose tissue (BAT) in PET/CT. A total of 2,944 patients who underwent PET/CT from September 2011 to March 2013 were analyzed retrospectively. Imaging features of (18)F-FDG uptake in BAT were analyzed. Univariate analysis and logistic regression analysis were performed to evaluate the effect of age, gender, cancer status, body mass index (BMI), average daily maximum temperature of imaging month and fasting plasma glucose (Glu) on the positive rate of (18)F-FDG uptake in BAT. The results showed that 1.9% (57/2944) patients had (18)F-FDG uptake in BAT. (18)F-FDG, manifested as flaky, nodular and beaded shape, was symmetrically distributed in the adipose tissues of cervical and supraclavicular, mediastinal, paravertebral, and perirenal areas. Uptake of (18)F-FDG within cervical/supraclavicular area was most common (89.5%, 51/57) with an SUVmax ranging from 2.8 to 31.4. Univariate analysis showed that gender and cancer status were not significantly correlated with the BAT (18)F-FDG uptake rate. In contrast, age, BMI, Glu and average daily maximum temperature in the imaging month were significantly correlated with the BAT (18)F-FDG uptake rate (P<0.05). Further logistic regression analysis showed that only age, BMI and average daily maximum temperature were significant (OR<1, P<0.05). Based on the value of OR, the most significant factor that affects BAT (18)F-FDG uptake rate was age, followed by the average daily maximum temperature and BMI. We concluded that Chinese adult has low positive rate of (18)F-FDG uptake in BAT. Cervical/Supraclavicular is the most common area with BAT (18)F-FDG uptake. Age, average daily maximum temperature and BMI are independent factors affecting (18)F-FDG uptake.

  19. Focal Colonic FDG Activity with PET/CT: Guidelines for Recommendation of Colonoscopy

    PubMed Central

    Liu, Tianye; Behr, Spencer; Khan, Sana; Osterhoff, Robert; Aparici, Carina Mari

    2015-01-01

    Focal 18F-fluorodeoxyglucose (FDG) colonic activity can be incidentally seen in positron emission tomography/computed tomography (PET/CT) scans. Its clinical significance is still unclear. The purpose of this study was to assess the significance of focal FDG activity in PET/CT scans by correlating the imaging findings to colonoscopy results, and come up with some guidelines for recommendation of follow-up colonoscopy. A total of 133 patients who underwent both 18F-FDG PET/CT for different oncological indications and colonoscopy within 3 months were retrospectively studied. Imaging, colonoscopy and pathology results were analyzed. Of the 133 FDG-PET/CT scans, 109/133 (82%) did not show focal colonic FDG activity, and 24/133 (18%) did. Of the 109/133 PET/CTs without focal colonic FDG activity, 109/109 (100%) did not have evidence of colon cancer after colonoscopy and histology. Of the 24/133 PET/CTs with focal colonic FDG activity, 10/24 (42%) had pathologic confirmation of colon cancer and 14/24 (58%) did not have evidence of colon cancer after colonoscopy and histological analysis. Sensitivity was 10/10 (100%), specificity 109/123 (89%), positive predictive value (PPV) 10/24 (42%) and negative predictive value (NPV) 109/109 (100%). Incidental focal 18FDG activity in PET/CT imaging shows a high sensitivity, specificity and NPV for malignancy, with a not so high PPV of 42%. Although some people would argue that a 42% chance of malignancy justifies colonoscopy, this maybe is not possible in all cases. However, the high sensitivity of the test does not allow these studies to be overlooked. We provide our recommendations as per when to send patients with focal FDG colonic activity to have further characterization with colonoscopy. PMID:25709541

  20. 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan in an Unusual Case of Lymphoma with Secondary Involvement of Uterine Cervix Presenting as a Pathological Fracture

    PubMed Central

    Sasikumar, Arun; Joy, Ajith; Pillai, M. R. A.; Thomas, Boben

    2017-01-01

    A 48-year-old female presented with a pathological fracture of the right femur. 99mTc methylene diphosphonate bone scan revealed multiple areas of increased osteoblastic activity consistent with metastatic disease. Serum electrophoresis revealed monoclonal gammopathy. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan revealed metabolically active lesions in bulky uterine cervix and osteolytic skeletal lesions. Unusual pattern of FDG uptake in uterine cervix and osteolytic skeletal lesions warranted a biopsy of the uterine cervix which revealed diffuse large B-cell lymphoma. 18F-FDG PET/CT scan helped in guiding the site of biopsy to reach a final diagnosis in this unusual case of lymphoma with a secondary involvement of uterine cervix presenting as a pathological fracture. PMID:28242988

  1. [(18)F]FDG PET signal is driven by astroglial glutamate transport.

    PubMed

    Zimmer, Eduardo R; Parent, Maxime J; Souza, Débora G; Leuzy, Antoine; Lecrux, Clotilde; Kim, Hyoung-Ihl; Gauthier, Serge; Pellerin, Luc; Hamel, Edith; Rosa-Neto, Pedro

    2017-03-01

    Contributions of glial cells to neuroenergetics have been the focus of extensive debate. Here we provide positron emission tomography evidence that activation of astrocytic glutamate transport via the excitatory amino acid transporter GLT-1 triggers widespread but graded glucose uptake in the rodent brain. Our results highlight the need for a reevaluation of the interpretation of [(18)F]FDG positron emission tomography data, whereby astrocytes would be recognized as contributing to the [(18)F]FDG signal.

  2. Two years of experience with the [ 18F]FDG production module

    NASA Astrophysics Data System (ADS)

    Kim, Sang Wook; Hur, Min Goo; Chai, Jong-Seo; Park, Jeong Hoon; Yu, Kook Hyun; Jeong, Cheol Ki; Lee, Goung Jin; Min, Young Don; Yang, Seung Dae

    2007-08-01

    Chemistry module for a conventional [18F]FDG production by using tetrabutylammonium bicarbonate (TBA) and an acidic hydrolysis has been manufactured and evaluated. In this experiment, 75 mM (pH 7.5-7.8) of TBA solution and a ca. 2-curies order of [18F]-fluoride have been used for the evaluation. The commercial acidic purification cartridge was purchased from GE or UKE. The operation system (OS) was programmed with Lab-View which was selected because of its easy customization of the OS. Small sized solenoid valves (Burkert; type 6124) were selected to reduce the module dimensions (W 350 × D 270 × H 250). The total time for the synthesis of [18F]FDG was 30 ± 3 min. The production yield of [18F]FDG was 60 ± 2% on an average at EOS, with the decay uncorrected. This experimental data show that the traditional chemistry module can provide a good [18F]FDG production yield by optimizing the operational conditions. The radiochemical purity, radionuclidic purity, acidity, residual solvent, osmolality and endotoxin were determined to assess the quality of [18F]FDG. The examined contents for the quality control of [18F]FDG were found to be suitable for a clinical application.

  3. Clinical Utility of 4D FDG-PET/CT Scans in Radiation Treatment Planning

    SciTech Connect

    Aristophanous, Michalis; Sher, David J.; Allen, Aaron M.; Larson, Elysia; Chen, Aileen B.

    2012-01-01

    Purpose: The potential role of four-dimensional (4D) positron emission tomography (PET)/computed tomography (CT) in radiation treatment planning, relative to standard three-dimensional (3D) PET/CT, was examined. Methods and Materials: Ten patients with non-small-cell lung cancer had sequential 3D and 4D [{sup 18}F]fluorodeoxyglucose PET/CT scans in the treatment position prior to radiation therapy. The gross tumor volume and involved lymph nodes were contoured on the PET scan by use of three different techniques: manual contouring by an experienced radiation oncologist using a predetermined protocol; a technique with a constant threshold of standardized uptake value (SUV) greater than 2.5; and an automatic segmentation technique. For each technique, the tumor volume was defined on the 3D scan (VOL3D) and on the 4D scan (VOL4D) by combining the volume defined on each of the five breathing phases individually. The range of tumor motion and the location of each lesion were also recorded, and their influence on the differences observed between VOL3D and VOL4D was investigated. Results: We identified and analyzed 22 distinct lesions, including 9 primary tumors and 13 mediastinal lymph nodes. Mean VOL4D was larger than mean VOL3D with all three techniques, and the difference was statistically significant (p < 0.01). The range of tumor motion and the location of the tumor affected the magnitude of the difference. For one case, all three tumor definition techniques identified volume of moderate uptake of approximately 1 mL in the hilar region on the 4D scan (SUV maximum, 3.3) but not on the 3D scan (SUV maximum, 2.3). Conclusions: In comparison to 3D PET, 4D PET may better define the full physiologic extent of moving tumors and improve radiation treatment planning for lung tumors. In addition, reduction of blurring from free-breathing images may reveal additional information regarding regional disease.

  4. Attenuation correction of PET cardiac data with low-dose average CT in PET/CT

    SciTech Connect

    Pan Tinsu; Mawlawi, Osama; Luo, Dershan; Liu, Hui H.; Chi Paichun, M.; Mar, Martha V.; Gladish, Gregory; Truong, Mylene; Erasmus, Jeremy Jr.; Liao Zhongxing; Macapinlac, H. A.

    2006-10-15

    We proposed a low-dose average computer tomography (ACT) for attenuation correction (AC) of the PET cardiac data in PET/CT. The ACT was obtained from a cine CT scan of over one breath cycle per couch position while the patient was free breathing. We applied this technique on four patients who underwent tumor imaging with {sup 18}F-FDG in PET/CT, whose PET data showed high uptake of {sup 18}F-FDG in the heart and whose CT and PET data had misregistration. All four patients did not have known myocardiac infarction or ischemia. The patients were injected with 555-740 MBq of {sup 18}F-FDG and scanned 1 h after injection. The helical CT (HCT) data were acquired in 16 s for the coverage of 100 cm. The PET acquisition was 3 min per bed of 15 cm. The duration of cine CT acquisition per 2 cm was 5.9 s. We used a fast gantry rotation cycle time of 0.5 s to minimize motion induced reconstruction artifacts in the cine CT images, which were averaged to become the ACT images for AC of the PET data. The radiation dose was about 5 mGy for 5.9 s cine duration. The selection of 5.9 s was based on our analysis of the respiratory signals of 600 patients; 87% of the patients had average breath cycles of less than 6 s and 90% had standard deviations of less than 1 s in the period of breath cycle. In all four patient studies, registrations between the CT and the PET data were improved. An increase of average uptake in the anterior and the lateral walls up to 48% and a decrease of average uptake in the septal and the inferior walls up to 16% with ACT were observed. We also compared ACT and conventional slow scan CT (SSCT) of 4 s duration in one patient study and found ACT was better than SSCT in depicting average respiratory motion and the SSCT images showed motion-induced reconstruction artifacts. In conclusion, low-dose ACT improved registration of the CT and the PET data in the heart region in our study of four patients. ACT was superior than SSCT for depicting average respiration

  5. Fluorine-18 fluorodeoxyglucose PET/CT patterns of extranodal involvement in patients with Non-Hodgkin lymphoma and Hodgkin's disease.

    PubMed

    Even-Sapir, Einat; Lievshitz, Genady; Perry, Chava; Herishanu, Yair; Lerman, Hedva; Metser, Ur

    2007-07-01

    Lymphoma may originate in extranodal sites. Extranodal lymphoma may also be secondary to and accompany nodal disease. Fluorine-18 fluorodeoxyglucose (18F-FDG) imaging has an essential role in the staging of lymphoma, in monitoring the response to therapy, and in detection of recurrence. The introduction of 18F-FDG PET/CT hybrid imaging allows for accurate localization of disease and may be specifically beneficial for the detection of unexpected extranodal sites of disease or exclusion of disease in the presence of nonspecific extranodal CT findings. Accurate staging and localization often dictate the appropriate treatment strategy in patients with lymphoma. Therefore, at any stage in the course of the disease, the potential presence of extranodal disease should be considered when interpreting 18F-FDG PET/CT studies in patients with non-Hodgkin lymphoma and Hodgkin's disease.

  6. Dual Tracer PET Imaging (68Ga-DOTATATE and 18F-FDG) Features in Pulmonary Carcinoid: Correlation with Tumor Proliferation Index

    PubMed Central

    Bhatkar, Dhiraj; Utpat, Ketaki; Basu, Sandip; Joshi, Jyotsna M.

    2017-01-01

    Pulmonary carcinoid tumors are rare group of lung neoplasms representing 1% of all the lung tumors. The typical bronchial carcinoids showed higher and more selective uptake of 68Ga-DOTATATE than of 18F-FDG on PET-CT. The Ki-67(MIB-1), a tumor proliferation index is a prognostic marker in neuroendocrine tumors for estimating tumor progression. Atypical carcinoids have higher Ki-67 index and have an increased propensity to metastasize as compared to typical ones. 68Ga-DOTATATE PET imaging along with Ki-67 can be correlated for better management of patients with neuroendocrine tumors. We describe the dual tracer imaging features in a patient of pulmonary carcinoid with avid 68Ga-DOTATATE and minimal 18FDG (18Flurodeoxyglucose) uptake diagnosed on the basis of imaging and bronchoscopic biopsy and its correlation with tumor proliferation index. PMID:28242984

  7. 123I-MIBG, 18F-DOPA and 18F-FDG in a patient with MEN2 syndrome and recurrent pheochromocytoma.

    PubMed

    Cuenca-Cuenca, J I; Marín-Oyaga, V A; Borrego-Dorado, I; Navarro-González, E; Martos-Martínez, J M; Vázquez-Albertino, R

    2013-01-01

    Pheochromocytoma is a rare tumor located in the medulla of the adrenal gland that is characterized by high catecholamine synthesis. Surgery is the treatment of choice and is usually curative if appropriately diagnosed and excised. Imaging methods, both morphological and functional, are of great importance in presurgical evaluation. We report the case of a female patient with multiple endocrine neoplasia syndrome type 2, with bilateral adrenalectomy due to two pheochromocytomas and progressive elevation of urinary metanephrine. Magnetic resonance imaging showed a nodular image in the right adrenal fossa. The patient was referred to our unit in order to confirm suspicion of recurrence. Due to the absence of pathological findings in the (123)I-MIBG scintigraphy and high suspicion of recurrence, PET/CT imaging with (18)F-DOPA and (18)F-FDG were performed, and the diagnosis was confirmed.

  8. Simplified [18F]FDG Image-Derived Input Function Using the Left Ventricle, Liver, and One Venous Blood Sample

    PubMed Central

    Tantawy, Mohammed Noor; Peterson, Todd E.

    2014-01-01

    A relatively simple, almost entirely noninvasive imaging-based method is presented for deriving arterial blood input functions for quantitative [18F]2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomographic (PET) studies in rodents. It requires only one venous blood sample at the end of the scan. MicroPET images and arterial blood time-activity curves (TACs) were downloaded from the Mouse Quantitation Program database at the University of California, Los Angeles. Three-dimensional regions of interest were drawn around the blood-pool region of the left ventricle and within the liver to derive their respective TACs. To construct the “hybrid” image-derived input function (IDIF), the initial part of the left ventricle TAC, containing the peak concentration of [18F]FDG in the arterial blood, was corrected for spillout (ie, partial-volume effect yielding a recovery coefficient < 1) and then joined to the liver TAC (normalized to the 60-minute arterial blood sample) immediately after it peaks. To validate our method, the [18F]FDG influx constant (Ki) was estimated using a two-tissue compartment model and compared to estimates of Ki obtained using measured arterial blood TACs. No significant difference in the Ki estimates was obtained with the arterial blood input function and our hybrid IDIF. We conclude that the normalized hybrid IDIF can be used in practice to obtain reliable Ki estimates. PMID:20236605

  9. Metabolic changes after MRgFUS treatment of a bone metastasis using PET/CT: A case report

    NASA Astrophysics Data System (ADS)

    Candiano, Giuliana; Russo, Giorgio; Stefano, Alessandro; Marino, Lorenza; Ganguzza, Francesca; Vaccari, Arturo; Tripoli, Vincenzo; Galluzzo, Anna; Pulizzi, Sabina; Messana, Domenico; Borasi, Giovanni; Messa, Cristina; Gilardi, Maria Carla

    2012-11-01

    Aim of the present study is to evaluate the efficacy of the Magnetic Resonance guided Focused Ultrasound (Insightec ExAblate 2000 system) in a clinical case of a pelvic bone metastasis, accessible to the ultrasonic beam. Multiple 18F-FDG PET/CT examinations allowed to follow the metabolic and morphological modification of the cancerous lesion.

  10. HPLC and TLC methods for analysis of [(18)F]FDG and its metabolites from biological samples.

    PubMed

    Rokka, Johanna; Grönroos, Tove J; Viljanen, Tapio; Solin, Olof; Haaparanta-Solin, Merja

    2017-03-24

    The most used positron emission tomography (PET) tracer, 2-[(18)F]fluoro-2-deoxy-d-glucose ([(18)F]FDG), is a glucose analogue that is used to measure tissue glucose consumption. Traditionally, the Sokoloff model is the basis for [(18)F]FDG modeling. According to this model, [(18)F]FDG is expected to be trapped in a cell in the form of [(18)F]FDG-6-phosphate ([(18)F]FDG-6-P). However, several studies have shown that in tissues, [(18)F]FDG metabolism goes beyond [(18)F]FDG-6-P. Our aim was to develop radioHPLC and radioTLC methods for analysis of [(18)F]FDG metabolites from tissue samples. The radioHPLC method uses a sensitive on-line scintillation detector to detect radioactivity, and the radioTLC method employs digital autoradiography to detect the radioactivity distribution on a TLC plate. The HPLC and TLC methods were developed using enzymatically in vitro-produced metabolites of [(18)F]FDG as reference standards. For this purpose, three [(18)F]FDG metabolites were synthesized: [(18)F]FDG-6-P, [(18)F]FD-PGL, and [(18)F]FDG-1,6-P2. The two methods were evaluated by analyzing the [(18)F]FDG metabolic profile from rodent ex vivo tissue homogenates. The HPLC method with an on-line scintillation detector had a wide linearity in a range of 5Bq-5kBq (LOD 46Bq, LOQ 139Bq) and a good resolution (Rs ≥1.9), and separated [(18)F]FDG and its metabolites clearly. The TLC method combined with digital autoradiography had a high sensitivity in a wide range of radioactivity (0.1Bq-2kBq, LOD 0.24Bq, LOQ 0.31Bq), and multiple samples could be analyzed simultaneously. As our test and the method validation with ex vivo samples showed, both methods are useful, and at best they complement each other in analysis of [(18)F]FDG and its radioactive metabolites from biological samples.

  11. Extrapulmonary Small Cell Carcinoma of the Seminal Vesicles and Prostate Demonstrated on 18F-FDG Positron Emission Tomography/Computed Tomography.

    PubMed

    Tabrizipour, Amir Iravani; Shen, Lily; Mansberg, Robert; Chuong, Bui

    2016-02-05

    Extrapulmonary primary small cell carcinomas arising from the urogenital tract is infrequent. It can rarely arise from the prostate and even more rarely from the seminal vesicles. We present a 79-year-old male who was admitted due to acute renal failure with a history of radical radiotherapy for prostate adenocarcinoma 13 years ago. The prostate specific antigen level was not elevated. An abdominopelvic computed tomography (CT) scan showed markedly enlarged seminal vesicles causing bilateral ureteral obstruction and a mildly enlarged prostate. Further evaluation with fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT demonstrated extensive 18F-FDG uptake in the pelvis with diffuse involvement of both seminal vesicles and the prostate without pathologic uptake in the lungs or elsewhere in the body. Core biopsies of the prostate and both seminal vesicles revealed diffuse involvement by small cell carcinoma. Therapy could not be instituted due to a rapid deterioration in the patient's clinical condition.

  12. A New Method of Detecting Pulmonary Nodules with PET/CT Based on an Improved Watershed Algorithm

    PubMed Central

    Zhao, Juanjuan; Ji, Guohua; Qiang, Yan; Han, Xiaohong; Pei, Bo; Shi, Zhenghao

    2015-01-01

    Background Integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is widely performed for staging solitary pulmonary nodules (SPNs). However, the diagnostic efficacy of SPNs based on PET/CT is not optimal. Here, we propose a method of detection based on PET/CT that can differentiate malignant and benign SPNs with few false-positives. Method Our proposed method combines the features of positron-emission tomography (PET) and computed tomography (CT). A dynamic threshold segmentation method was used to identify lung parenchyma in CT images and suspicious areas in PET images. Then, an improved watershed method was used to mark suspicious areas on the CT image. Next, the support vector machine (SVM) method was used to classify SPNs based on textural features of CT images and metabolic features of PET images to validate the proposed method. Results Our proposed method was more efficient than traditional methods and methods based on the CT or PET features alone (sensitivity 95.6%; average of 2.9 false positives per scan). PMID:25853496

  13. Caged [(18)F]FDG Glycosylamines for Imaging Acidic Tumor Microenvironments Using Positron Emission Tomography.

    PubMed

    Flavell, Robert R; Truillet, Charles; Regan, Melanie K; Ganguly, Tanushree; Blecha, Joseph E; Kurhanewicz, John; VanBrocklin, Henry F; Keshari, Kayvan R; Chang, Christopher J; Evans, Michael J; Wilson, David M

    2016-01-20

    Solid tumors are hypoxic with altered metabolism, resulting in secretion of acids into the extracellular matrix and lower relative pH, a feature associated with local invasion and metastasis. Therapeutic and diagnostic agents responsive to this microenvironment may improve tumor-specific delivery. Therefore, we pursued a general strategy whereby caged small-molecule drugs or imaging agents liberate their parent compounds in regions of low interstitial pH. In this manuscript, we present a new acid-labile prodrug method based on the glycosylamine linkage, and its application to a class of positron emission tomography (PET) imaging tracers, termed [(18)F]FDG amines. [(18)F]FDG amines operate via a proposed two-step mechanism, in which an acid-labile precursor decomposes to form the common radiotracer 2-deoxy-2-[(18)F]fluoro-d-glucose, which is subsequently accumulated by glucose avid cells. The rate of decomposition of [(18)F]FDG amines is tunable in a systematic fashion, tracking the pKa of the parent amine. In vivo, a 4-phenylbenzylamine [(18)F]FDG amine congener showed greater relative accumulation in tumors over benign tissue, which could be attenuated upon tumor alkalinization using previously validated models, including sodium bicarbonate treatment, or overexpression of carbonic anhydrase. This new class of PET tracer represents a viable approach for imaging acidic interstitial pH with potential for clinical translation.

  14. Response Assessment and Prediction in Esophageal Cancer Patients via F-18 FDG PET/CT Scans

    NASA Astrophysics Data System (ADS)

    Higgins, Kyle J.

    Purpose: The purpose of this study is to utilize F-18 FDG PET/CT scans to determine an indicator for the response of esophageal cancer patients during radiation therapy. There is a need for such an indicator since local failures are quite common in esophageal cancer patients despite modern treatment techniques. If an indicator is found, a patient's treatment strategy may be altered to possibly improve the outcome. This is investigated with various standard uptake volume (SUV) metrics along with image texture features. The metrics and features showing the most promise and indicating response are used in logistic regression analysis to find an equation for the prediction of response. Materials and Methods: 28 patients underwent F-18 FDG PET/CT scans prior to the start of radiation therapy (RT). A second PET/CT scan was administered following the delivery of ~32 Gray (Gy) of dose. A physician contoured gross tumor volume (GTV) was used to delineate a PET based GTV (GTV-pre-PET) based on a threshold of >40% and >20% of the maximum SUV value in the GTV. Deformable registration was used in VelocityAI software to register the pre-treatment and intra-treatment CT scans so that the GTV-pre-PET contours could be transferred from the pre to intra scans (GTV-intra-PET). The fractional decrease in the maximum, mean, volume to the highest intensity 10%-90%, and combination SUV metrics of the significant previous SUV metrics were compared to post-treatment pathologic response for an indication of response. Next for the >40% threshold, texture features based on a neighborhood gray-tone dimension matrix (NGTDM) were analyzed. The fractional decrease in coarseness, contrast, busyness, complexity, and texture strength were compared to the pathologic response of the patients. From these previous two types of analysis, SUV and texture features, the two most significant results were used in logistic regression analysis to find an equation to predict the probability of a non

  15. 18F-FDG positron autoradiography with a particle counting silicon pixel detector.

    PubMed

    Russo, P; Lauria, A; Mettivier, G; Montesi, M C; Marotta, M; Aloj, L; Lastoria, S

    2008-11-07

    We report on tests of a room-temperature particle counting silicon pixel detector of the Medipix2 series as the detector unit of a positron autoradiography (AR) system, for samples labelled with (18)F-FDG radiopharmaceutical used in PET studies. The silicon detector (1.98 cm(2) sensitive area, 300 microm thick) has high intrinsic resolution (55 microm pitch) and works by counting all hits in a pixel above a certain energy threshold. The present work extends the detector characterization with (18)F-FDG of a previous paper. We analysed the system's linearity, dynamic range, sensitivity, background count rate, noise, and its imaging performance on biological samples. Tests have been performed in the laboratory with (18)F-FDG drops (37-37 000 Bq initial activity) and ex vivo in a rat injected with 88.8 MBq of (18)F-FDG. Particles interacting in the detector volume produced a hit in a cluster of pixels whose mean size was 4.3 pixels/event at 11 keV threshold and 2.2 pixels/event at 37 keV threshold. Results show a sensitivity for beta(+) of 0.377 cps Bq(-1), a dynamic range of at least five orders of magnitude and a lower detection limit of 0.0015 Bq mm(-2). Real-time (18)F-FDG positron AR images have been obtained in 500-1000 s exposure time of thin (10-20 microm) slices of a rat brain and compared with 20 h film autoradiography of adjacent slices. The analysis of the image contrast and signal-to-noise ratio in a rat brain slice indicated that Poisson noise-limited imaging can be approached in short (e.g. 100 s) exposures, with approximately 100 Bq slice activity, and that the silicon pixel detector produced a higher image quality than film-based AR.

  16. Estimation of radiation dose to patients from 18FDG whole body PET/CT investigations using dynamic PET scan protocol

    PubMed Central

    Kaushik, Aruna; Jaimini, Abhinav; Tripathi, Madhavi; D’Souza, Maria; Sharma, Rajnish; Mondal, Anupam; Mishra, Anil K.; Dwarakanath, Bilikere S.

    2015-01-01

    Background & objectives: There is a growing concern over the radiation exposure of patients from undergoing 18FDG PET/CT (18F-fluorodeoxyglucose positron emission tomography/computed tomography) whole body investigations. The aim of the present study was to study the kinetics of 18FDG distributions and estimate the radiation dose received by patients undergoing 18FDG whole body PET/CT investigations. Methods: Dynamic PET scans in different regions of the body were performed in 49 patients so as to measure percentage uptake of 18FDG in brain, liver, spleen, adrenals, kidneys and stomach. The residence time in these organs was calculated and radiation dose was estimated using OLINDA software. The radiation dose from the CT component was computed using the software CT-Expo and measured using computed tomography dose index (CTDI) phantom and ionization chamber. As per the clinical protocol, the patients were refrained from eating and drinking for a minimum period of 4 h prior to the study. Results: The estimated residence time in males was 0.196 h (brain), 0.09 h (liver), 0.007 h (spleen), 0.0006 h (adrenals), 0.013 h (kidneys) and 0.005 h (stomach) whereas it was 0.189 h (brain), 0.11 h (liver), 0.01 h (spleen), 0.0007 h (adrenals), 0.02 h (kidneys) and 0.004 h (stomach) in females. The effective dose was found to be 0.020 mSv/MBq in males and 0.025 mSv/MBq in females from internally administered 18FDG and 6.8 mSv in males and 7.9 mSv in females from the CT component. For an administered activity of 370 MBq of 18FDG, the effective dose from PET/CT investigations was estimated to be 14.2 mSv in males and 17.2 mSv in females. Interpretation & conclusions: The present results did not demonstrate significant difference in the kinetics of 18FDG distribution in male and female patients. The estimated PET/CT doses were found to be higher than many other conventional diagnostic radiology examinations suggesting that all efforts should be made to clinically justify and

  17. Solitary pulmonary nodule and (18)F-FDG PET/CT. Part 1: epidemiology, morphological evaluation and cancer probability.

    PubMed

    Mosmann, Marcos Pretto; Borba, Marcelle Alves; de Macedo, Francisco Pires Negromonte; Liguori, Adriano de Araujo Lima; Villarim Neto, Arthur; de Lima, Kenio Costa

    2016-01-01

    Solitary pulmonary nodule corresponds to a common radiographic finding, which is frequently detected incidentally. The investigation of this entity remains complex, since characteristics of benign and malignant processes overlap in the differential diagnosis. Currently, many strategies are available to evaluate solitary pulmonary nodules with the main objective of characterizing benign lesions as best as possible, while avoiding to expose patients to the risks inherent to invasive methods, besides correctly detecting cases of lung cancer so as the potential curative treatment is not delayed. This first part of the study focuses on the epidemiology, the morfological evaluation and the methods to determine the likelihood of cancer in cases of indeterminate solitary pulmonary nodule.

  18. Solitary pulmonary nodule and (18)F-FDG PET/CT. Part 2: accuracy, cost-effectiveness, and current recommendations.

    PubMed

    Mosmann, Marcos Pretto; Borba, Marcelle Alves; de Macedo, Francisco Pires Negromonte; Liguori, Adriano de Araujo Lima; Villarim Neto, Arthur; de Lima, Kenio Costa

    2016-01-01

    A solitary pulmonary nodule is a common, often incidental, radiographic finding. The investigation and differential diagnosis of solitary pulmonary nodules remain complex, because there are overlaps between the characteristics of benign and malignant processes. There are currently many strategies for evaluating solitary pulmonary nodules. The main objective is to identify benign lesions, in order to avoid exposing patients to the risks of invasive methods, and to detect cases of lung cancer accurately, in order to avoid delaying potentially curative treatment. The focus of this study was to review the evaluation of solitary pulmonary nodules, to discuss the current role of (18)F-fluorodeoxyglucose positron-emission tomography, addressing its accuracy and cost-effectiveness, and to detail the current recommendations for the examination in this scenario.

  19. Solitary pulmonary nodule and 18F-FDG PET/CT. Part 1: epidemiology, morphological evaluation and cancer probability*

    PubMed Central

    Mosmann, Marcos Pretto; Borba, Marcelle Alves; de Macedo, Francisco Pires Negromonte; Liguori, Adriano de Araujo Lima; Villarim Neto, Arthur; de Lima, Kenio Costa

    2016-01-01

    Solitary pulmonary nodule corresponds to a common radiographic finding, which is frequently detected incidentally. The investigation of this entity remains complex, since characteristics of benign and malignant processes overlap in the differential diagnosis. Currently, many strategies are available to evaluate solitary pulmonary nodules with the main objective of characterizing benign lesions as best as possible, while avoiding to expose patients to the risks inherent to invasive methods, besides correctly detecting cases of lung cancer so as the potential curative treatment is not delayed. This first part of the study focuses on the epidemiology, the morfological evaluation and the methods to determine the likelihood of cancer in cases of indeterminate solitary pulmonary nodule. PMID:26929459

  20. Solitary pulmonary nodule and 18F-FDG PET/CT. Part 2: accuracy, cost-effectiveness, and current recommendations*

    PubMed Central

    Mosmann, Marcos Pretto; Borba, Marcelle Alves; de Macedo, Francisco Pires Negromonte; Liguori, Adriano de Araujo Lima; Villarim Neto, Arthur; de Lima, Kenio Costa

    2016-01-01

    A solitary pulmonary nodule is a common, often incidental, radiographic finding. The investigation and differential diagnosis of solitary pulmonary nodules remain complex, because there are overlaps between the characteristics of benign and malignant processes. There are currently many strategies for evaluating solitary pulmonary nodules. The main objective is to identify benign lesions, in order to avoid exposing patients to the risks of invasive methods, and to detect cases of lung cancer accurately, in order to avoid delaying potentially curative treatment. The focus of this study was to review the evaluation of solitary pulmonary nodules, to discuss the current role of 18F-fluorodeoxyglucose positron-emission tomography, addressing its accuracy and cost-effectiveness, and to detail the current recommendations for the examination in this scenario. PMID:27141133

  1. [(18)F]FDG Uptake in the Aortic Wall Smooth Muscle of Atherosclerotic Plaques in the Simian Atherosclerosis Model.

    PubMed

    Iwaki, Takayuki; Mizuma, Hiroshi; Hokamura, Kazuya; Onoe, Hirotaka; Umemura, Kazuo

    2016-01-01

    Atherosclerosis is a self-sustaining inflammatory fibroproliferative disease that progresses in discrete stages and involves a number of cell types and effector molecules. Recently, [(18)F]fluoro-2-deoxy-D-glucose- ([(18)F]FDG-) positron emission tomography (PET) has been suggested as a tool to evaluate atherosclerotic plaques by detecting accumulated macrophages associated with inflammation progress. However, at the cellular level, it remains unknown whether only macrophages exhibit high uptake of [(18)F]FDG. To identify the cellular origin of [(18)F]FDG uptake in atherosclerotic plaques, we developed a simian atherosclerosis model and performed PET and ex vivo macro- and micro-autoradiography (ARG). Increased [(18)F]FDG uptake in the aortic wall was observed in high-cholesterol diet-treated monkeys and WHHL rabbits. Macro-ARG of [(18)F]FDG in aortic sections showed that [(18)F]FDG was accumulated in the media and intima in the simian model as similar to that in WHHL rabbits. Combined analysis of micro-ARG with immunohistochemistry in the simian atherosclerosis model revealed that most cellular [(18)F]FDG uptake observed in the media was derived not only from the infiltrated macrophages in atherosclerotic plaques but also from the smooth muscle cells (SMCs) of the aortic wall in atherosclerotic lesions.

  2. [18F]FDG Uptake in the Aortic Wall Smooth Muscle of Atherosclerotic Plaques in the Simian Atherosclerosis Model

    PubMed Central

    Mizuma, Hiroshi; Hokamura, Kazuya; Onoe, Hirotaka; Umemura, Kazuo

    2016-01-01

    Atherosclerosis is a self-sustaining inflammatory fibroproliferative disease that progresses in discrete stages and involves a number of cell types and effector molecules. Recently, [18F]fluoro-2-deoxy-D-glucose- ([18F]FDG-) positron emission tomography (PET) has been suggested as a tool to evaluate atherosclerotic plaques by detecting accumulated macrophages associated with inflammation progress. However, at the cellular level, it remains unknown whether only macrophages exhibit high uptake of [18F]FDG. To identify the cellular origin of [18F]FDG uptake in atherosclerotic plaques, we developed a simian atherosclerosis model and performed PET and ex vivo macro- and micro-autoradiography (ARG). Increased [18F]FDG uptake in the aortic wall was observed in high-cholesterol diet-treated monkeys and WHHL rabbits. Macro-ARG of [18F]FDG in aortic sections showed that [18F]FDG was accumulated in the media and intima in the simian model as similar to that in WHHL rabbits. Combined analysis of micro-ARG with immunohistochemistry in the simian atherosclerosis model revealed that most cellular [18F]FDG uptake observed in the media was derived not only from the infiltrated macrophages in atherosclerotic plaques but also from the smooth muscle cells (SMCs) of the aortic wall in atherosclerotic lesions. PMID:28101514

  3. [PET/CT in breast cancer: an update].

    PubMed

    Groheux, D; Moretti, J-L; Giacchetti, S; Hindié, E; Teyton, P; Cuvier, C; Bousquet, G; Misset, J-L; Boin, C; Espié, M

    2009-11-01

    The authors discuss the various roles of 18F-FDG PET/CT in the management of breast cancer. Roles of new tracers such as F-18 fluoro-L-thymidine (a marker of cell proliferation), 18-fluoro-17-B-estradiol (marker of estrogen receptor) and sodium fluoride (marker of bone matrix) are also mentioned. There is little justification for the use of FDG-PET/CT in patient with clinically T1 (< or = 2 cm) N0 tumours. Notably, it cannot be used as a substitute to SLNB "sentinel lymph node biopsy" for axillary staging due to limited sensitivity for the detection of small metastases. The case is different in higher risk patients, and especially so in patients with locally advanced disease. FDG-PET/CT in these patients might depict lymph node involvement in the level III of Berg or in supraclavicular or internal mammary basins. It might also uncover occult distant metastases, notably, early osteomedullary infiltration. Thus, for these tumors, initial PET/CT can enable better intramodality treatment planning or a change in treatment. PET/CT as a whole-body examination is also very efficient in case of suspicion of recurrence. On the other hand, many studies show that this functional imaging could be used to assess early response to neoadjuvant chemotherapy or to chemotherapy of metastatic disease. 18FDG-PET/CT could thus become an unavoidable modality to answer various clinical situations.

  4. Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist.

    PubMed

    Cacicedo, Jon; Navarro, Arturo; Del Hoyo, Olga; Gomez-Iturriaga, Alfonso; Alongi, Filippo; Medina, Jose A; Elicin, Olgun; Skanjeti, Andrea; Giammarile, Francesco; Bilbao, Pedro; Casquero, Francisco; de Bari, Berardino; Dal Pra, Alan

    2016-11-01

    Squamous cell carcinoma is the most common malignant tumour of the head and neck. The initial TNM staging, the evaluation of the tumour response during treatment, and the long-term surveillance are crucial moments in the approach to head and neck squamous cell carcinoma (HNSCC). Thus, at each of these moments, the choice of the best diagnostic tool providing the more precise and larger information is crucial. Positron emission tomography with fluorine-18 fludeoxyglucose integrated with CT ((18)F-FDG-PET/CT) rapidly gained clinical acceptance, and it has become an important imaging tool in routine clinical oncology. However, controversial data are currently available, for example, on the role of (18)F-FDG-PET/CT imaging during radiotherapy planning, the prognostic value or its real clinical impact on treatment decisions. In this article, the role of (18)F-FDG-PET/CT imaging in HNSCC during pre-treatment staging, radiotherapy planning, treatment response assessment, prognosis and follow-up is reviewed focusing on current evidence and controversial issues. A proposal on how to integrate (18)F-FDG-PET/CT in daily clinical practice is also described.

  5. SU-D-201-07: Exploring the Utility of 4D FDG-PET/CT Scans in Design of Radiation Therapy Planning Compared with 3D PET/CT: A Prospective Study

    SciTech Connect

    Ma, C; Yin, Y

    2015-06-15

    Purpose: A method using four-dimensional(4D) PET/CT in design of radiation treatment planning was proposed and the target volume and radiation dose distribution changes relative to standard three-dimensional (3D) PET/CT were examined. Methods: A target deformable registration method was used by which the whole patient’s respiration process was considered and the effect of respiration motion was minimized when designing radiotherapy planning. The gross tumor volume of a non-small-cell lung cancer was contoured on the 4D FDG-PET/CT and 3D PET/CT scans by use of two different techniques: manual contouring by an experienced radiation oncologist using a predetermined protocol; another technique using a constant threshold of standardized uptake value (SUV) greater than 2.5. The target volume and radiotherapy dose distribution between VOL3D and VOL4D were analyzed. Results: For all phases, the average automatic and manually GTV volume was 18.61 cm3 (range, 16.39–22.03 cm3) and 31.29 cm3 (range, 30.11–35.55 cm3), respectively. The automatic and manually volume of merged IGTV were 27.82 cm3 and 49.37 cm3, respectively. For the manual contour, compared to 3D plan the mean dose for the left, right, and total lung of 4D plan have an average decrease 21.55%, 15.17% and 15.86%, respectively. The maximum dose of spinal cord has an average decrease 2.35%. For the automatic contour, the mean dose for the left, right, and total lung have an average decrease 23.48%, 16.84% and 17.44%, respectively. The maximum dose of spinal cord has an average decrease 1.68%. Conclusion: In comparison to 3D PET/CT, 4D PET/CT may better define the extent of moving tumors and reduce the contouring tumor volume thereby optimize radiation treatment planning for lung tumors.

  6. PET/CT for differentiating between tuberculous peritonitis and peritoneal carcinomatosis

    PubMed Central

    Wang, Shao-Bo; Ji, Yun-Hai; Wu, Hu-Bing; Wang, Quan-Shi; Zhou, Wen-Lan; Lv, Liang; Shou, Tao; Hu, Jing

    2017-01-01

    Abstract Objectives: Tuberculous peritonitis (TBP) mimics peritoneal carcinomatosis (PC). We aimed to investigate the discriminative use of PET/CT findings in the parietal peritoneum. Materials and Methods: Parietal peritoneal PET/CT findings from 76 patients with TBP (n = 25) and PC (n = 51) were retrospectively reviewed. The lesion locations were noted as right subdiaphragmatic, left subdiaphragmatic, right paracolic gutters, left paracolic gutters, and pelvic regions. The distribution characteristic consisted of a dominant distribution in the pelvic and/or right subdiaphragmatic region (susceptible area for peritoneal implantation, SAPI) (SAPI distribution), a dominant distribution in the remaining regions (less-susceptible area for peritoneal implantation, LSAPI) (LSAPI distribution), or a uniform distribution. PET morphological patterns were classified as F18-fluorodeoxyglucose (18F-FDG) uptake in a long beaded line (string-of-beads 18F-FDG uptake) or in a cluster (clustered 18F-FDG uptake) or focal 18F-FDG uptake. CT patterns included smooth uniform thickening, irregular thickening, or nodules. Results: More common findings in the parietal peritoneum corresponding to TBP as opposed to PC were (a) ≥4 involved regions (80.0% vs 19.6%), (b) uniform distribution (72.0% vs 5.9%), (c) string-of-beads 18F-FDG uptake (76.0% vs 7.8%), and (d) smooth uniform thickening (60.0% vs 7.8%) (all P < 0.001), whereas more frequent findings in PC compared with TBP were (a) SAPI distribution (78.4% vs 28.0%), (b) clustered 18F-FDG uptake (56.9% vs 20.0%), (c) focal 18F-FDG uptake (21.6% vs 4.0%), (d) irregular thickening (51.0% vs 12.0%), and (e) nodules (21.6% vs 4.0%) (P < 0.001, P < 0.05, P > 0.05, P < 0.05, P > 0.05, respectively). Conclusion: Our data show that PET/CT findings in the parietal peritoneum are useful for differentiating between TBP and PC. PMID:28079823

  7. A new assessment model for tumor heterogeneity analysis with [18]F-FDG PET images.

    PubMed

    Wang, Ping; Xu, Wengui; Sun, Jian; Yang, Chengwen; Wang, Gang; Sa, Yu; Hu, Xin-Hua; Feng, Yuanming

    2016-01-01

    It has been shown that the intratumor heterogeneity can be characterized with quantitative analysis of the [18]F-FDG PET image data. The existing models employ multiple parameters for feature extraction which makes it difficult to implement in clinical settings for the quantitative characterization. This article reports an easy-to-use and differential SUV based model for quantitative assessment of the intratumor heterogeneity from 3D [18]F-FDG PET image data. An H index is defined to assess tumor heterogeneity by summing voxel-wise distribution of differential SUV from the [18]F-FDG PET image data. The summation is weighted by the distance of SUV difference among neighboring voxels from the center of the tumor and can thus yield increased values for tumors with peripheral sub-regions of high SUV that often serves as an indicator of augmented malignancy. Furthermore, the sign of H index is used to differentiate the rate of change for volume averaged SUV from its center to periphery. The new model with the H index has been compared with a widely-used model of gray level co-occurrence matrix (GLCM) for image texture characterization with phantoms of different configurations and the [18]F-FDG PET image data of 6 lung cancer patients to evaluate its effectiveness and feasibility for clinical uses. The comparison of the H index and GLCM parameters with the phantoms demonstrate that the H index can characterize the SUV heterogeneity in all of 6 2D phantoms while only 1 GLCM parameter can do for 1 and fail to differentiate for other 2D phantoms. For the 8 3D phantoms, the H index can clearly differentiate all of them while the 4 GLCM parameters provide complicated patterns in the characterization. Feasibility study with the PET image data from 6 lung cancer patients show that the H index provides an effective single-parameter metric to characterize tumor heterogeneity in terms of the local SUV variation, and it has higher correlation with tumor volume change after

  8. A new assessment model for tumor heterogeneity analysis with [18]F-FDG PET images

    PubMed Central

    Wang, Ping; Xu, Wengui; Sun, Jian; Yang, Chengwen; Wang, Gang; Sa, Yu; Hu, Xin-Hua; Feng, Yuanming

    2016-01-01

    It has been shown that the intratumor heterogeneity can be characterized with quantitative analysis of the [18]F-FDG PET image data. The existing models employ multiple parameters for feature extraction which makes it difficult to implement in clinical settings for the quantitative characterization. This article reports an easy-to-use and differential SUV based model for quantitative assessment of the intratumor heterogeneity from 3D [18]F-FDG PET image data. An H index is defined to assess tumor heterogeneity by summing voxel-wise distribution of differential SUV from the [18]F-FDG PET image data. The summation is weighted by the distance of SUV difference among neighboring voxels from the center of the tumor and can thus yield increased values for tumors with peripheral sub-regions of high SUV that often serves as an indicator of augmented malignancy. Furthermore, the sign of H index is used to differentiate the rate of change for volume averaged SUV from its center to periphery. The new model with the H index has been compared with a widely-used model of gray level co-occurrence matrix (GLCM) for image texture characterization with phantoms of different configurations and the [18]F-FDG PET image data of 6 lung cancer patients to evaluate its effectiveness and feasibility for clinical uses. The comparison of the H index and GLCM parameters with the phantoms demonstrate that the H index can characterize the SUV heterogeneity in all of 6 2D phantoms while only 1 GLCM parameter can do for 1 and fail to differentiate for other 2D phantoms. For the 8 3D phantoms, the H index can clearly differentiate all of them while the 4 GLCM parameters provide complicated patterns in the characterization. Feasibility study with the PET image data from 6 lung cancer patients show that the H index provides an effective single-parameter metric to characterize tumor heterogeneity in terms of the local SUV variation, and it has higher correlation with tumor volume change after

  9. Systematic analysis of biological and physical limitations of proton beam range verification with offline PET/CT scans

    NASA Astrophysics Data System (ADS)

    Knopf, A.; Parodi, K.; Bortfeld, T.; Shih, H. A.; Paganetti, H.

    2009-07-01

    The clinical use of offline positron emission tomography/computed tomography (PET/CT) scans for proton range verification is currently under investigation at the Massachusetts General Hospital (MGH). Validation is achieved by comparing measured activity distributions, acquired in patients after receiving one fraction of proton irradiation, with corresponding Monte Carlo (MC) simulated distributions. Deviations between measured and simulated activity distributions can either reflect errors during the treatment chain from planning to delivery or they can be caused by various inherent challenges of the offline PET/CT verification method. We performed a systematic analysis to assess the impact of the following aspects on the feasibility and accuracy of the offline PET/CT method: (1) biological washout processes, (2) patient motion, (3) Hounsfield unit (HU) based tissue classification for the simulation of the activity distributions and (4) tumor site specific aspects. It was found that the spatial reproducibility of the measured activity distributions is within 1 mm. However, the feasibility of range verification is restricted to a limited amount of positions and tumor sites. Washout effects introduce discrepancies between the measured and simulated ranges of about 4 mm at positions where the proton beam stops in soft tissue. Motion causes spatial deviations of up to 3 cm between measured and simulated activity distributions in abdominopelvic tumor cases. In these later cases, the MC simulated activity distributions were found to be limited to about 35% accuracy in absolute values and about 2 mm in spatial accuracy depending on the correlativity of HU into the physical and biological parameters of the irradiated tissue. Besides, for further specific tumor locations, the beam arrangement, the limited accuracy of rigid co-registration and organ movements can prevent the success of PET/CT range verification. All the addressed factors explain why the proton beam range can

  10. High 18F-fluorodeoxyglucose (18F-FDG) uptake in microscopic peritoneal tumors requires physiological hypoxia

    PubMed Central

    Li, Xiao-Feng; Ma, Yuanyuan; Sun, Xiaorong; Humm, John L.; Ling, C. Clifton; O’Donoghue, Joseph A.

    2010-01-01

    The objective of this study was to examine 18F-fluorodeoxyglucose (18F-FDG) uptake in microscopic tumors grown intraperitoneally in nude mice and to relate this to physiological hypoxia and glucose transporter-1 (GLUT-1) expression. Methods Human colon cancer HT29 and HCT-8 cells were injected intraperitoneally into nude mice to generate disseminated tumors of varying sizes. Following overnight fasting, animals, either breathing air or carbogen (95% O2+ 5% CO2), were intravenously administered 18F-FDG together with the hypoxia marker pimonidazole (PIMO) and the cellular proliferation marker bromodeoxyuridine (BrdUrd) one hour before sacrifice. Hoechst 33342, a perfusion marker, was administered one minute before sacrifice. Following sacrifice, the intratumoral distribution of 18F-FDG was assessed by digital autoradiography of frozen tissue sections. This was compared with the distributions of PIMO, GLUT-1 expression, BrdUrd and Hoechst 33342 as visualized by immunofluorescent microscopy. Results Small tumors (< 1 mm diameter) had high 18F-FDG accumulation and were severely hypoxic with high GLUT-1 expression. Larger tumors (1–4 mm diameter) generally had low 18F-FDG accumulation and were not significantly hypoxic with low GLUT1 expression. Carbogen breathing significantly decreased 18F-FDG accumulation and tumor hypoxia in microscopic tumors but had little effect on GLUT1 expression. Conclusion There was high 18F-FDG uptake in microscopic tumors which was spatially associated with physiological hypoxia and high GLUT-1 expression. This enhanced uptake was abrogated by carbogen breathing, indicating that in the absence of physiological hypoxia, high GLUT1 expression, by itself, was insufficient to ensure high 18F-FDG uptake. PMID:20351353

  11. The Role of 18F-Sodium Fluoride PET/CT Bone Scans in the Diagnosis of Metastatic Bone Disease from Breast and Prostate Cancer.

    PubMed

    Kulshrestha, Randeep Kumar; Vinjamuri, Sobhan; England, Andrew; Nightingale, Julie; Hogg, Peter

    2016-12-01

    We describe the role of (18)F-sodium fluoride ((18)F-NaF) PET/CT bone scanning in the staging of breast and prostate cancer. (18)F-NaF PET was initially utilized as a bone scanning agent in the 1960s and early 1970s, however, its use was restricted by the then-available γ-cameras. The advent of hybrid PET/CT cameras in the late 1990s has shown a resurgence of interest in its use and role. After a brief introduction, this paper describes the radiopharmaceutical properties, dosimetry, pharmacokinetics, and mechanism of uptake of (18)F-NaF. The performance of (18)F-NaF PET/CT is then compared with that of conventional bone scintigraphy using current evidence from the literature. Strengths and weaknesses of (18)F-NaF PET/CT imaging are highlighted. Clinical examples of improved accuracy of diagnosis and impact on patient management are illustrated. Limitations of (18)F-NaF PET/CT imaging are outlined.

  12. ¹⁸F-FDG PET/CT in the early prediction of pathological response in aggressive subtypes of breast cancer: review of the literature and recommendations for use in clinical trials.

    PubMed

    Groheux, David; Mankoff, David; Espié, Marc; Hindié, Elif

    2016-05-01

    Early assessment of response to neoadjuvant chemotherapy (NAC) might be helpful in avoiding the toxicity of ineffective chemotherapy and allowing refinement of treatment. We conducted a review of the literature regarding the applicability of (18)F-FDG PET/CT to the prediction of an early pathological response in different subgroups of breast cancer. Clinical research in this field has intensified in the last few years. Early studies by various groups have shown the potential of (18)F-FDG PET/CT in the early assessment of response to NAC. However, interim PET/CT in breast cancer has not yet gained wide acceptance compared to its use in other settings such as lymphomas. This is in part due to a lack of consensus that early evaluation of response can be used to direct change in therapy in the neoadjuvant breast cancer setting, and only limited data showing that response-adaptive therapy leads to improved outcomes. However, one major element that has hampered the use of (18)F-FDG PET/CT in directing neoadjuvant therapy is its evaluation in populations with mixed subtypes of breast cancer. However, major improvements have occurred in recent years. Pilot studies have highlighted the need for considering breast cancer subtype and the type of treatment, and have offered criteria for the use of PET/CT for the early prediction of response in specific settings. (18)F-FDG PET/CT has considerable potential for the early prediction of pathological complete response to NAC in aggressive subtypes such as triple-negative or HER2-positive breast cancers. The results of a multicentre trial that used early metabolic response on (18)F-FDG PET/CT as a means to select poor responders to adapt neoadjuvant treatment have recently been published. Other trials are ongoing or being planned.

  13. [The clinical value of F-18 FDG PET/CT in patients with secondary hemophagocytic syndrome].

    PubMed

    Wang, Xing-Bing; Zhu, Yun-Xia; Liu, Xin; Pan, Bo; Zhang, Liang; Han, Yong-Sheng; Cai, Xiao-Yan; Zhu, Wei-Bo; Wu, Jing-Sheng; Sun, Zi-Min

    2014-12-01

    The aim of this study was to investigate the role of F-18 fluoro-2-deoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in diagnosis and prognostic evaluation of secondary hemophagocytic syndrome (HPS). A total of 11 secondary HPS patients examined with 18F-FDG-PET/CT were retrospectively analyzed. The diagnostic value of F-18 FDG PET/CT for malignancy detection was assessed. The values of maximum standardized uptake value (SUV(max)) in spleen (SUVS(p)) and in bone marrow (SUVBM) were measured to analyze their relationship with various laboratorial parameters and clinical outcome of secondary HPS patients. The results showed that 4 out of the 11 patients had malignancies, the sensitivity, specificity and diagnostic accuracy of F-18 FDG PET/CT for malignancy detection were 100%, 66.7% and 75% respectively, the SUV(max) of spleen and bone marrow showed no significant correlation with laboratorial parameters, a maximum SUVS(p) of 3.10 and a maximum SUVBM of 3.47 were the optimal cutoffs for predicting patients' outcome, the increased uptake of F-18 FDG in the BM and spleen were significantly associated with shorter survival time according to univariate analysis. It is concluded that 18F-FDG PET/CT may especially play an important role in diagnosis and predicting outcome of secondary HPS for the small sample size.

  14. Reduced grey matter metabolism due to white matter edema allows optimal assessment of brain tumors on 18F-FDG-PET.

    PubMed

    Pourdehnad, Michael; Basu, Sandip; Duarte, Paulo; Okpaku, Aubrey S; Saboury, Babak; Hustinx, Roland; Alavi, Abass

    2011-01-01

    The main aim of this research was to demonstrate that the cortical and subcortical grey matter hypometabolism as revealed by fluorine-18 fluorodesoxyglucose-positron emission tomography ((18)F-FDG-PET) imaging in brain tumors is related to associated edema as demonstrated by magnetic resonance imaging (MRI). This in turn enhances the ability to assess disease activity in the tumor and the degree of loss of cerebral function in the adjacent and distant structures. We evaluated brain T1 and T2 weighted MRI and (18)F-FDG-PET scans of 29 patients (19 adult, 10 pediatric) with history of brain tumor. Tumor histology types included 21 gliomas, 1 melanoma, 1 primitive neuroectodermal tumor, 3 medulloblastomas and 3 ependymomas. The majority of scans were performed within the same week (94% <1 month. The extent of hypo and hypermetabolism was assessed on the (18)F-FDG-PET scans. A template of 12 regions of interest (ROI) was applied and the laterality indices of the regional counts (signal intensity) were computed. Extent of edema, enhancement, and anatomical change were assessed on the MRI scans. Extent of edema in the same ROI was evaluated by a 6-point semiquantitative scale and laterality indices were generated. Metabolic activity of the grey matter was correlated with the extent of edema using these indices. In all cases where edema was present, significant hypometabolism was observed in the adjacent structures. Overall, there was a strong correlation between the extent of edema and severity of hypometabolism (r=0.92, P=0.01). This was true regardless of the location of edema, whether there was history of radiation treatment (r=0.91, P=0.03), or not (r=0.97, P=0.17). In conclusion, edema independent of underlying variables appeared to contribute significantly to cortical and sub-cortical grey matter hypometabolism observed in patients with brain tumors. This would indicate that brain tumors can be successfully assessed by (18)F-FDG-PET and therefore the efforts for

  15. 11C-Choline-Avid but 18F-FDG-Nonavid Prostate Cancer with Lymph Node Metastases on Positron Emission Tomography

    PubMed Central

    Kitajima, Kazuhiro; Fukushima, Kazuhito; Yamamoto, Shingo; Yamano, Toshiko; Takaki, Haruyuki; Yamakado, Koichiro; Nakanishi, Yukako; Kanematsu, Akihiro; Nojima, Michio; Hirota, Shozo

    2016-01-01

    Choline is a new positron emission tomography (PET) tracer useful for detection of prostate cancer and metastatic lesions. We report a 70-year-old man with prostate cancer and multiple abdominal, pelvic, and inguinal node metastases. PET scans demonstrated accumulation of 11C-choline in the primary tumor and lymph node metastases but no accumulation of 18F-FDG. Choline PET/computed tomography may be useful for diagnosis of advanced prostate cancer with suspected metastatic lesions and treatment planning. PMID:27920703

  16. Therapy response monitoring of the early effects of a new BRAF inhibitor on melanoma xenograft in mice: evaluation of (18) F-FDG-PET and (18) F-FLT-PET.

    PubMed

    Geven, Edwin J W; Evers, Stefan; Nayak, Tapan K; Bergström, Mats; Su, Fei; Gerrits, Danny; Franssen, Gerben M; Boerman, Otto C

    2015-01-01

    Inhibition of the V600E mutated BRAF kinase gene (BRAF(V600E) ) is an important and effective approach to treating melanomas. A new specific small molecule inhibitor of BRAF(V600E) , PLX3603, showed potent melanoma growth-inhibiting characteristics in preclinical studies and is currently under clinical investigation. In this study we investigated the feasibility of (18) F-FDG and (18) F-FLT-PET to monitor the early effects of the BRAF(V600E) inhibitor in mice with melanoma xenografts. SCID/beige mice with subcutaneous (s.c.) A375 melanoma xenografts, expressing BRAF(V600E) , received the BRAF(V600E) inhibitor twice daily orally (0, 25, 50 and 75 mg/kg). At 1, 3 and 7 days after start of therapy, the uptake of (18) F-FDG and (18) F-FLT in the tumor and normal tissues was determined in ex vivo tissue samples. Serial (18) F-FDG and (18) F-FLT-PET scans were acquired of animals at 1 day before and 1, 3 and 7 days after start of treatment with 75 mg/kg BRAF(V600E) inhibitor. A dose-dependent decrease in (18) F-FDG uptake in the A375 tumors was observed by ex vivo biodistribution analysis. Administration of 75 mg/kg BRAF inhibitor for 1, 3 and 7 days resulted in a significantly decreased (18) F-FDG uptake in A375 tumors (41, 35 and 51%, respectively). (18) F-FLT uptake in the A375 tumors was low at baseline and no significant changes in (18) F-FLT uptake were observed at any of the doses administered. These effects were corroborated by serial in vivo (18) F-FDG and (18) F-FLT-PET imaging. These data demonstrate that (18) F-FDG-PET can be used as an imaging biomarker to noninvasively evaluate the early effects of PLX3603.

  17. The contribution of PET/CT to improved patient management.

    PubMed

    Ell, P J

    2006-01-01

    With the introduction of both SPET/CT and PET/CT, multimodality imaging has truly entered routine clinical practice. Multiple slice spiral CT scanners have been incorporated with multiple detector gamma cameras or PET systems, such that the benefit of these modalities can be achieved in one patient sitting. The subject of this manuscript is PET/CT and its impact on patient management. Applications of PET/CT span the whole field of medical and surgical oncology since very few cancers do not take up the labelled glucose tracer, (18)F-FDG. Given the contrast achieved, high-quality data can be obtained with FDG PET/CT. This technology has now spread worldwide and has been the subject of intense interest, as witnessed by the vast body of published evidence. In this short overview, only a brief discussion of the main clinical applications is possible. Novel applications of PET/CT outside the field of oncology are expected in the near future.

  18. Brain (18)F-FDG PET Metabolic Abnormalities in Patients with Long-Lasting Macrophagic Myofascitis.

    PubMed

    Van Der Gucht, Axel; Aoun Sebaiti, Mehdi; Guedj, Eric; Aouizerate, Jessie; Yara, Sabrina; Gherardi, Romain K; Evangelista, Eva; Chalaye, Julia; Cottereau, Anne-Ségolène; Verger, Antoine; Bachoud-Levi, Anne-Catherine; Abulizi, Mukedaisi; Itti, Emmanuel; Authier, François-Jérôme

    2017-03-01

    The aim of this study was to characterize brain metabolic abnormalities in patients with macrophagic myofascitis (MMF) and the relationship with cognitive dysfunction through the use of PET with (18)F-FDG. Methods:(18)F-FDG PET brain imaging and a comprehensive battery of neuropsychological tests were performed in 100 consecutive MMF patients (age [mean ± SD], 45.9 ± 12 y; 74% women). Images were analyzed with statistical parametric mapping (SPM12). Through the use of analysis of covariance, all (18)F-FDG PET brain images of MMF patients were compared with those of a reference population of 44 healthy subjects similar in age (45.4 ± 16 y; P = 0.87) and sex (73% women; P = 0.88). The neuropsychological assessment identified 4 categories of patients: those with no significant cognitive impairment (n = 42), those with frontal subcortical (FSC) dysfunction (n = 29), those with Papez circuit dysfunction (n = 22), and those with callosal disconnection (n = 7). Results: In comparison with healthy subjects, the whole population of patients with MMF exhibited a spatial pattern of cerebral glucose hypometabolism (P < 0.001) involving the occipital lobes, temporal lobes, limbic system, cerebellum, and frontoparietal cortices, as shown by analysis of covariance. The subgroup of patients with FSC dysfunction exhibited a larger extent of involved areas (35,223 voxels vs. 13,680 voxels in the subgroup with Papez circuit dysfunction and 5,453 voxels in patients without cognitive impairment). Nonsignificant results were obtained for the last subgroup because of its small population size. Conclusion: Our study identified a peculiar spatial pattern of cerebral glucose hypometabolism that was most marked in MMF patients with FSC dysfunction. Further studies are needed to determine whether this pattern could represent a diagnostic biomarker of MMF in patients with chronic fatigue syndrome and cognitive dysfunction.

  19. WE-AB-204-03: A Novel 3D Printed Phantom for 4D PET/CT Imaging and SIB Radiotherapy Verification

    SciTech Connect

    Soultan, D; Murphy, J; Moiseenko, V; Cervino, L; Gill, B

    2015-06-15

    Purpose: To construct and test a 3D printed phantom designed to mimic variable PET tracer uptake seen in lung tumor volumes. To assess segmentation accuracy of sub-volumes of the phantom following 4D PET/CT scanning with ideal and patient-specific respiratory motion. To plan, deliver and verify delivery of PET-driven, gated, simultaneous integrated boost (SIB) radiotherapy plans. Methods: A set of phantoms and inserts were designed and manufactured for a realistic representation of lung cancer gated radiotherapy steps from 4D PET/CT scanning to dose delivery. A cylindrical phantom (40x 120 mm) holds inserts for PET/CT scanning. The novel 3D printed insert dedicated to 4D PET/CT mimics high PET tracer uptake in the core and lower uptake in the periphery. This insert is a variable density porous cylinder (22.12×70 mm), ABS-P430 thermoplastic, 3D printed by uPrint SE Plus with inner void volume (5.5×42 mm). The square pores (1.8×1.8 mm2 each) fill 50% of outer volume, resulting in a 2:1 SUV ratio of PET-tracer in the void volume with respect to porous volume. A matching in size cylindrical phantom is dedicated to validate gated radiotherapy. It contains eight peripheral holes matching the location of the porous part of the 3D printed insert, and one central hole. These holes accommodate adaptors for Farmer-type ion chamber and cells vials. Results: End-to-end test were performed from 4D PET/CT scanning to transferring data to the planning system and target volume delineation. 4D PET/CT scans were acquired of the phantom with different respiratory motion patterns and gating windows. A measured 2:1 18F-FDG SUV ratio between inner void and outer volume matched the 3D printed design. Conclusion: The novel 3D printed phantom mimics variable PET tracer uptake typical of tumors. Obtained 4D PET/CT scans are suitable for segmentation, treatment planning and delivery in SIB gated treatments of NSCLC.

  20. Bilateral symmetrical adrenal hypermetabolism on FDG PET/CT due to Cushing syndrome in well differentiated neuroendocrine carcinoma.

    PubMed

    Aktas, G E; Soyluoglu Demir, S; Sarikaya, A

    2016-01-01

    The (18)F-FDG PET/CT scan has been suggested for whole-body imaging to identify ectopic adrenocorticotrophic hormone secreting tumours, but there are some challenges involved. The case of a patient is presented, who was admitted with the pre-diagnosis of ectopic ACTH syndrome. On the CT, a nodular lesion was detected in the medial segment of the right lung. The FDG uptake of the lesion seemed to be increased visually, but was not pathological quantitatively (SUVmax: 1.8) on the PET/CT. There was also diffuse increased uptake (SUVmax: 14.2) in the enlarged adrenal glands. The lesion was reported as a possible malignant lesion with low FDG affinity, such as a low grade neuroendocrine tumour, while the diffuse enlarged adrenal glands with high uptake were interpreted as diffusely hyperplasic, due to Cushing's syndrome. The patient was treated with a surgical wedge resection. The histopathological diagnosis confirmed that the tumour was a grade 1 well-differentiated neuroendocrine carcinoma.

  1. TU-CD-BRB-10: 18F-FDG PET Image-Derived Tumor Features Highlight Altered Pathways Identified by Trancriptomic Analysis in Head and Neck Cancer

    SciTech Connect

    Tixier, F; Cheze-Le-Rest, C; Dufour, X; Hatt, M; Visvikis, D; Valette, G; Potard, G; Corcos, L

    2015-06-15

    Purpose: Several quantitative features can be extracted from 18F-FDG PET images, such as standardized uptake values (SUVs), metabolic tumor volume (MTV), shape characterization (SC) or intra-tumor radiotracer heterogeneity quantification (HQ). Some of these features calculated from baseline 18F-FDG PET images have shown a prognostic and predictive clinical value. It has been hypothesized that these features highlight underlying tumor patho-physiological processes at smaller scales. The objective of this study was to investigate the ability of recovering alterations of signaling pathways from FDG PET image-derived features. Methods: 52 patients were prospectively recruited from two medical centers (Brest and Poitiers). All patients underwent an FDG PET scan for staging and biopsies of both healthy and primary tumor tissues. Biopsies went through a transcriptomic analysis performed in four spates on 4×44k chips (Agilent™). Primary tumors were delineated in the PET images using the Fuzzy Locally Adaptive Bayesian algorithm and characterized using 10 features including SUVs, SC and HQ. A module network algorithm followed by functional annotation was exploited in order to link PET features with signaling pathways alterations. Results: Several PET-derived features were found to discriminate differentially expressed genes between tumor and healthy tissue (fold-change >2, p<0.01) into 30 co-regulated groups (p<0.05). Functional annotations applied to these groups of genes highlighted associations with well-known pathways involved in cancer processes, such as cell proliferation and apoptosis, as well as with more specific ones such as unsaturated fatty acids. Conclusion: Quantitative features extracted from baseline 18F-FDG PET images usually exploited only for diagnosis and staging, were identified in this work as being related to specific altered pathways and may show promise as tools for personalizing treatment decisions.

  2. Lymph nodes can accurately be measured on PET-CT for lymphoma staging/restaging without a concomitant contrast enhanced CT scan.

    PubMed

    Simpson, William L; Lee, Karen M; Sosa, Ninoska; Cooper, Nancy; Scigliano, Eileen; Brody, Joshua D; Doucette, John T; Kostakoglu, Lale

    2016-05-01

    Dual imaging with both contrast enhanced CT scan and PET-CT is recommended for evaluation of lymphoma. We compared the performance in identification and size measurements of involved lymph nodes in FDG-avid lymphomas on the low dose non-contrast enhanced CT of a PET-CT scan with those on a diagnostic contrast enhanced CT scan. The size of FDG-avid lymph nodes was measured in both the short and long axis on both the low dose non-contrast CT of the PET-CT and the contrast enhanced CT by two independent readers. A total of 307 FGD avid lymph nodes were identified in 52 patients. There was no statistically significant differences in the measured size of the nodes on the non-contrast and contrast enhanced scans (p=0.21). Baseline staging and restaging of FDG-avid lymphomas can be performed with one test, PET-CT, without an accompanying contrast enhanced CT scan, with no effect on the measured nodal size.

  3. WE-E-17A-05: Complementary Prognostic Value of CT and 18F-FDG PET Non-Small Cell Lung Cancer Tumor Heterogeneity Features Quantified Through Texture Analysis

    SciTech Connect

    Desseroit, M; Cheze Le Rest, C; Tixier, F; Majdoub, M; Visvikis, D; Hatt, M; Guillevin, R; Perdrisot, R

    2014-06-15

    Purpose: Previous studies have shown that CT or 18F-FDG PET intratumor heterogeneity features computed using texture analysis may have prognostic value in Non-Small Cell Lung Cancer (NSCLC), but have been mostly investigated separately. The purpose of this study was to evaluate the potential added value with respect to prognosis regarding the combination of non-enhanced CT and 18F-FDG PET heterogeneity textural features on primary NSCLC tumors. Methods: One hundred patients with non-metastatic NSCLC (stage I–III), treated with surgery and/or (chemo)radiotherapy, that underwent staging 18F-FDG PET/CT images, were retrospectively included. Morphological tumor volumes were semi-automatically delineated on non-enhanced CT using 3D SlicerTM. Metabolically active tumor volumes (MATV) were automatically delineated on PET using the Fuzzy Locally Adaptive Bayesian (FLAB) method. Intratumoral tissue density and FDG uptake heterogeneities were quantified using texture parameters calculated from co-occurrence, difference, and run-length matrices. In addition to these textural features, first order histogram-derived metrics were computed on the whole morphological CT tumor volume, as well as on sub-volumes corresponding to fine, medium or coarse textures determined through various levels of LoG-filtering. Association with survival regarding all extracted features was assessed using Cox regression for both univariate and multivariate analysis. Results: Several PET and CT heterogeneity features were prognostic factors of overall survival in the univariate analysis. CT histogram-derived kurtosis and uniformity, as well as Low Grey-level High Run Emphasis (LGHRE), and PET local entropy were independent prognostic factors. Combined with stage and MATV, they led to a powerful prognostic model (p<0.0001), with median survival of 49 vs. 12.6 months and a hazard ratio of 3.5. Conclusion: Intratumoral heterogeneity quantified through textural features extracted from both CT and FDG PET

  4. Construction and Evaluation of Quantitative Small-Animal PET Probabilistic Atlases for [18F]FDG and [18F]FECT Functional Mapping of the Mouse Brain

    PubMed Central

    Casteels, Cindy; Vunckx, Kathleen; Aelvoet, Sarah-Ann; Baekelandt, Veerle; Bormans, Guy; Van Laere, Koen; Koole, Michel

    2013-01-01

    Automated voxel-based or pre-defined volume-of-interest (VOI) analysis of small-animal PET data in mice is necessary for optimal information usage as the number of available resolution elements is limited. We have mapped metabolic ([18F]FDG) and dopamine transporter ([18F]FECT) small-animal PET data onto a 3D Magnetic Resonance Microscopy (MRM) mouse brain template and aligned them in space to the Paxinos co-ordinate system. In this way, ligand-specific templates for sensitive analysis and accurate anatomical localization were created. Next, using a pre-defined VOI approach, test-retest and intersubject variability of various quantification methods were evaluated. Also, the feasibility of mouse brain statistical parametric mapping (SPM) was explored for [18F]FDG and [18F]FECT imaging of 6-hydroxydopamine-lesioned (6-OHDA) mice. Methods Twenty-three adult C57BL6 mice were scanned with [18F]FDG and [18F]FECT. Registrations and affine spatial normalizations were performed using SPM8. [18F]FDG data were quantified using (1) an image-derived-input function obtained from the liver (cMRglc), using (2) standardized uptake values (SUVglc) corrected for blood glucose levels and by (3) normalizing counts to the whole-brain uptake. Parametric [18F]FECT binding images were constructed by reference to the cerebellum. Registration accuracy was determined using random simulated misalignments and vectorial mismatch determination. Results Registration accuracy was between 0.21–1.11 mm. Regional intersubject variabilities of cMRglc ranged from 15.4% to 19.2%, while test-retest values were between 5.0% and 13.0%. For [18F]FECT uptake in the caudate-putamen, these values were 13.0% and 10.3%, respectively. Regional values of cMRglc positively correlated to SUVglc measured within the 45–60 min time frame (spearman r = 0.71). Next, SPM analysis of 6-OHDA-lesioned mice showed hypometabolism in the bilateral caudate-putamen and cerebellum, and an unilateral striatal decrease in DAT

  5. Increased 18F-FDG Uptake in Multiple Muscles in a Patient With Violent Cough.

    PubMed

    Wang, Yu; Shao, Fuqiang; Zhang, Li; Luo, Xiufang; Chen, Yue

    2017-03-31

    Increased muscular FDG uptake could be due to various causes. Detailed analysis combined with history might be helpful for image interpretation. We present FDG PET/CT findings of a 69-year-old woman with lung cancer. The images demonstrated intense FDG uptake in multiple muscles, likely due to cough before the PET/CT study. To relieve the patient's cough, codeine was administrated. The second F-FDG PET/CT was performed 2 days later. The images showed that the abnormal muscular activity had become decreased, which was slightly lower than hepatic activity.

  6. Performance of 18F-FDG PET/contrast-enhanced CT in the staging of squamous cell carcinoma of the oral cavity and oropharynx.

    PubMed

    Krabbe, C A; Balink, H; Roodenburg, J L N; Dol, J; de Visscher, J G A M

    2011-11-01

    The aim of this study was to assess the diagnostic value of integrated whole body positron emission tomography/contrast-enhanced CT (PET/CECT) as a one step examination in the initial staging of oral and oropharyngeal squamous cell carcinoma (OOSCC). Seventy three consecutive OOSCC patients who underwent PET/CECT for initial staging and tumour resection and neck dissection as primary treatment, were included. For each PET/CECT result, the contribution of fluorine-18 fluorodeoxyglucose ((18)F-FDG)-uptake and radiologic criteria was assessed. PET/CECT results were correlated to histological specimens obtained with tumour resection and neck dissection. For detecting the primary tumour PET/CECT showed a sensitivity of 96% and for detecting cervical metastases a sensitivity and specificity of 89% and 81%, respectively. In the clinically N0 subgroup (n=37), PET/CECT showed a sensitivity and specificity of 64% and 81%, respectively. In five of six patients PET/CECT detected a second primary tumour. The results show that the use of diagnostic PET/CECT as a one step examination is a reliable alternative for PET/CT in combination with a separate diagnostic CT in patients with OOSC for initial staging. The need for treatment of the neck in the clinically negative neck should not be based on PET/CECT results only, due to the risk of missing a small metastasis.

  7. Sensitivity of 18F-FDG PET in evaluation of solitary pulmonary nodules

    PubMed Central

    Yilmaz, Farise; Tastekin, Gungor

    2015-01-01

    Introduction: The solitary pulmonary nodule (SPN) may be an early sign of lung cancer. Due to the difficulties of radiological imaging techniques in differentiation of benign/malignant nodules, functional imaging techniques like PET-CT are required in patients diagnosed with SPN. The aim of this study was the evaluation of the role of PET-CT in differentiation of malignant/benign SPN by some characteristic findings in PET-CT. Moreover, among the nodules with histopathologically diagnosed as benign, malignant or metastatic, the SUVmax and Hounsfield Units (HU) of PET-CT imaging were also aimed to be compared to assess the role of PET-CT in discrimination of malignant/benign SPN. Material and method: Among the patients evaluated with PET-CT with the pre-diagnosis of pulmonary nodule or non-pulmonary malignancies, between July 2010 and January 2012, in Konya University Meram Medical School Nuclear Medicine Department, 241 patients (167 male, 74 female) diagnosed with pulmonary nodule were enrolled in the study. In visual evaluation of PET-CT of all patients, there was only one nodule in lung parenchyma. The diameter in cm, location as central or peripheral, regularity of borders, presence of calcification and HU and Maximum standardized uptake values (SUVmax) values with quantitative analysis of all nodules was recorded. The histopathological evaluation of nodules was available in 91 of those 241 patients and they were also recorded. Results: In comparison of mean SUVmax values in regards to the characteristic findings of nodules in PET-CT, the mean SUVmax value of patients was statistically significantly higher in patients with the nodule diameter ≥1 cm, centrally located nodules, or nodules with irregular borders. Conclusion: In malignant/benign differentiation of solitary pulmonary nodules with the diameter of higher than 1 cm, PET-CT plays an essential role; however, for the nodules smaller than 1 cm in diameter, in small, single metastatic nodules and some

  8. Prognostic value of pre-treatment F-18-FDG PET-CT in patients with hepatocellular carcinoma undergoing radioembolization

    PubMed Central

    Abuodeh, Yazan; Naghavi, Arash O; Ahmed, Kamran A; Venkat, Puja S; Kim, Youngchul; Kis, Bela; Choi, Junsung; Biebel, Benjamin; Sweeney, Jennifer; Anaya, Daniel A; Kim, Richard; Malafa, Mokenge; Frakes, Jessica M; Hoffe, Sarah E; El-Haddad, Ghassan

    2016-01-01

    AIM To evaluate the value of pre-treatment 18F-FDG PET/CT in patients with HCC following liver radioembolization. METHODS We identified 34 patients with HCC who underwent an FDG PET/CT scan prior to hepatic radioembolization at our institution between 2009 and 2013. Patients were seen in clinic one month after radioembolization and then at 2-3 mo intervals. We assessed the influence of FDG tumor uptake on outcomes including local liver control (LLC), distant liver control (DLC), time to distant metastases (DM), progression free survival (PFS) and overall survival (OS). RESULTS The majority of patients were males (n = 25, 74%), and had Child Pugh Class A (n = 31, 91%), with a median age of 68 years (46-84 years). FDG-avid disease was found in 19 (56%) patients with SUVmax ranging from 3 to 20. Female patients were more likely to have an FDG-avid HCC (P = 0.02). Median follow up of patients following radioembolization was 12 months (1.2-62.8 mo). FDG-avid disease was associated with a decreased 1 year LLC, DLC, DM and PFS (P < 0.05). Using multivariate analysis, FDG avidity predicted for LLC, DLC, and PFS (all P < 0.05). CONCLUSION In this retrospective study, pre-treatment HCC FDG-avidity was found to be associated with worse LLC, DLC, and PFS following radioembolization. Larger studies are needed to validate our initial findings to assess the role of F-18-FDG PET/CT scans as biomarker for patients with HCC following radioembolization. PMID:28058021

  9. Variations in PET/CT Methodology for Oncologic Imaging at U.S. Academic Medical Centers: An Imaging Response Assessment Team Survey

    PubMed Central

    Graham, Michael M.; Badawi, Ramsey D.; Wahl, Richard L.

    2014-01-01

    In 2005, 8 Imaging Response Assessment Teams (IRATs) were funded by the National Cancer Institute (NCI) as supplemental grants to existing NCI Cancer Centers. After discussion among the IRATs regarding the need for increased standardization of clinical and research PET/CT methodology, it became apparent that data acquisition and processing approaches differ considerably among centers. To determine the variability in detail, a survey of IRAT sites and IRAT affiliates was performed. Methods A 34-question instrument evaluating patient preparation, scanner type, performance approach, display, and analysis was developed. Fifteen institutions, including the 8 original IRATs and 7 institutions that had developed affiliate IRATs, were surveyed. Results The major areas of variation were18F-FDG dose (259–740 MBq [7–20 mCi]) uptake time (45–90 min), sedation (never to frequently), handling of diabetic patients, imaging time (2–7 min/bed position), performance of diagnostic CT scans as a part of PET/CT, type of acquisition (2-dimensional vs. 3-dimensional), CT technique, duration of fasting (4 or 6 h), and (varying widely) acquisition, processing, display, and PACS software—with 4 sites stating that poor-quality images appear on PACS. Conclusion There is considerable variability in the way PET/CT scans are performed at academic institutions that are part of the IRAT network. This variability likely makes it difficult to quantitatively compare studies performed at different centers. These data suggest that additional standardization in methodology will be required so that PET/CT studies, especially those performed quantitatively, are more comparable across sites. PMID:21233185

  10. Interaction of thyroid hormone with brown adipose tissue. Lessons learned from PET-CT.

    PubMed

    Steinhoff, Karen G; Hankir, M; Krause, K; Tönjes, A; Fenske, W K; Sabri, O; Hesse, S

    2015-01-01

    Brown adipose tissue (BAT) plays an important role in regulating core-body temperature in various species including man. [18F]FDG-PET/CT imaging first revealed the presence of metabolically active BAT depots and that decreased BAT function is associated with various metabolic conditions. Thyroid hormone (TH) in concert with sympathetic nervous system signalling (SNS) stimulates BAT thermogenesis and thyroid disorders result in dysfunctional BAT. Currently, research is focussing not only on BAT regulation but also on browning of white adipose tissue (WAT) to BAT beige adipose tissue (BeAT) in order to develop novel treatments for human obesity and related conditions. While [18F]FDG-PET/CT imaging is continuing to provide valuable insights into BAT and BeAT function in health and disease, there is a pressing need to develop alternative radiotracers that reliably track their activity in vivo. As a result it is expected that preclinical micro PET/CT investigations of BAT and BeAT will gain in prominence. The aim of this short review is to i) describe fundamentals in BAT biology, ii) highlight some of the clinical and preclinical studies performed on humans and rodents with a focus on TH, BAT and PET/CT, and iii) bridge these data with our own studies within the DFG thyroid transact priority program.

  11. A new cubic phantom for PET/CT dosimetry: Experimental and Monte Carlo characterization

    SciTech Connect

    Belinato, Walmir; Silva, Rogerio M.V.; Souza, Divanizia N.; Santos, William S.; Caldas, Linda V.E.

    2015-07-01

    In recent years, positron emission tomography (PET) associated with multidetector computed tomography (MDCT) has become a diagnostic technique widely disseminated to evaluate various malignant tumors and other diseases. However, during PET/CT examinations, the doses of ionizing radiation experienced by the internal organs of patients may be substantial. To study the doses involved in PET/CT procedures, a new cubic phantom of overlapping acrylic plates was developed and characterized. This phantom has a deposit for the placement of the fluorine-18 fluoro-2-deoxy-D-glucose ({sup 18}F-FDG) solution. There are also small holes near the faces for the insertion of optically stimulated luminescence dosimeters (OSLD). The holes for OSLD are positioned at different distances from the {sup 18}F-FDG deposit. The experimental results were obtained in two PET/CT devices operating with different parameters. Differences in the absorbed doses were observed in OSLD measurements due to the non-orthogonal positioning of the detectors inside the phantom. This phantom was also evaluated using Monte Carlo simulations, with the MCNPX code. The phantom and the geometrical characteristics of the equipment were carefully modeled in the MCNPX code, in order to develop a new methodology form comparison of experimental and simulated results, as well as to allow the characterization of PET/CT equipments in Monte Carlo simulations. All results showed good agreement, proving that this new phantom may be applied for these experiments. (authors)

  12. Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy: A [18F]FDG PET Study

    PubMed Central

    Inami, Akie; Ogura, Takeshi; Watanuki, Shoichi; Masud, Md. Mehedi; Shibuya, Katsuhiko; Miyake, Masayasu; Matsuda, Rin; Hiraoka, Kotaro; Itoh, Masatoshi; Fuhr, Arlan W.; Yanai, Kazuhiko

    2017-01-01

    Objective. The aim of this study was to investigate changes in brain and muscle glucose metabolism that are not yet known, using positron emission tomography with [18F]fluorodeoxyglucose ([18F]FDG PET). Methods. Twenty-one male volunteers were recruited for the present study. [18F]FDG PET scanning was performed twice on each subject: once after the spinal manipulation therapy (SMT) intervention (treatment condition) and once after resting (control condition). We performed the SMT intervention using an adjustment device. Glucose metabolism of the brain and skeletal muscles was measured and compared between the two conditions. In addition, we measured salivary amylase level as an index of autonomic nervous system (ANS) activity, as well as muscle tension and subjective pain intensity in each subject. Results. Changes in brain activity after SMT included activation of the dorsal anterior cingulate cortex, cerebellar vermis, and somatosensory association cortex and deactivation of the prefrontal cortex and temporal sites. Glucose uptake in skeletal muscles showed a trend toward decreased metabolism after SMT, although the difference was not significant. Other measurements indicated relaxation of cervical muscle tension, decrease in salivary amylase level (suppression of sympathetic nerve activity), and pain relief after SMT. Conclusion. Brain processing after SMT may lead to physiological relaxation via a decrease in sympathetic nerve activity. PMID:28167971

  13. Comparison of autologous 111In-leukocytes, 18F-FDG, 11C-methionine, 11C-PK11195 and 68Ga-citrate for diagnostic nuclear imaging in a juvenile porcine haematogenous staphylococcus aureus osteomyelitis model

    PubMed Central

    Nielsen, Ole L; Afzelius, Pia; Bender, Dirk; Schønheyder, Henrik C; Leifsson, Páll S; Nielsen, Karin M; Larsen, Jytte O; Jensen, Svend B; Alstrup, Aage KO

    2015-01-01

    The aim of this study was to compare 111In-labeled leukocyte single-photon emission computed tomography (SPECT) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) to PET with tracers that potentially could improve detection of osteomyelitis. We chose 11C-methionine, 11C-PK11195 and 68Ga-citrate and validated their diagnostic utility in a porcine haematogenous osteomyelitis model. Four juvenile 14-15 weeks old female pigs were scanned seven days after intra-arterial inoculation in the right femoral artery with a porcine strain of Staphylococcus aureus using a sequential scan protocol with 18F-FDG, 68Ga-citrate, 11C-methionine, 11C-PK11195, 99mTc-Nanocoll and 111In-labelled autologous leukocytes. This was followed by necropsy of the pigs and gross pathology, histopathology and microbial examination. The pigs developed a total of five osteomyelitis lesions, five lesions characterized as abscesses/cellulitis, arthritis in three joints and five enlarged lymph nodes. None of the tracers accumulated in joints with arthritis. By comparing the 10 infectious lesions, 18F-FDG accumulated in nine, 111In-leukocytes in eight, 11C-methionine in six, 68Ga-citrate in four and 11C-PK11195 accumulated in only one lesion. Overall, 18F-FDG PET was superior to 111In-leukocyte SPECT in marking infectious and proliferative, i.e. hyperplastic, lesions. However, leukocyte SPECT was performed as early scans, approximately 6 h after injection of the leukocytes, to match the requirements of the 18 h long scan protocol. 11C-methionine and possibly 68Ga-citrate may be useful for diagnosis of soft issue lesions. PMID:25973338

  14. Standardized Input Function for 18F-FDG PET Studies in Mice: A Cautionary Study

    PubMed Central

    Fernandez, Philippe; Zanotti-Fregonara, Paolo

    2017-01-01

    Aim of the Study The aim of this study was to assess the accuracy of a standardized arterial input function (SAIF) for positron emission tomography 18F-FDG studies in mice. In particular, we tested whether the same SAIF could be applied to populations of mice whose fasting conditions differed. Methods The SAIF was first created from a population of fasting mice (n = 11) and validated within this group using a correlation analysis and a leave-one-out procedure. Then, the SAIF was prospectively applied to a population of non-fasting mice (n = 16). The SAIFs were scaled using a single individual blood sample taken 25 min after injection. The metabolic rates of glucose (CMRglc) calculated with the SAIFs were compared with the reference values obtained by full arterial sampling (AIF). Results In both populations of mice, CMRglc values showed a very small bias but an important variability. The SAIF/AIF CMRglc ratio in the fasting mice was 0.97 ± 0.22 (after excluding a major outlier). The SAIF/AIF CMRglc ratio in the non-fasting mice was 1.04 ± 0.22. This variability was due to the presence of cases in which the SAIF poorly estimated the shape of the input function based on full arterial sampling. Conclusion Although SAIF allows the estimation of the 18F-FDG mice input function with negligible bias and independently from the fasting state, errors in individual mice (as high as 30–50%) cause an important variability. Alternative techniques, such as image-derived input function, might be a better option for mice PET studies. PMID:28125579

  15. Correlation Between SUVmax and CT Radiomic Analysis Using Lymph Node Density in PET/CT-Based Lymph Node Staging.

    PubMed

    Giesel, Frederik L; Schneider, Florian; Kratochwil, Clemens; Rath, Daniel; Moltz, Jan; Holland-Letz, Tim; Kauczor, Hans-Ulrich; Schwartz, Lawrence H; Haberkorn, Uwe; Flechsig, Paul

    2017-02-01

    In patients with lung cancer (LC), malignant melanoma (MM), gastroenteropancreatic neuroendocrine tumors (GEP NETs), and prostate cancer (PCA), lymph node (LN) staging is often performed by (18)F-FDG PET/CT (LC and MM), (68)Ga-DOTATOC PET/CT (GEP NET), and (68)Ga-labeled prostate-specific membrane antigen PET/CT (PCA) but is sometimes not accurate because of indeterminate PET findings. To better evaluate malignant LN infiltration, additional surrogate parameters, especially in cases with indeterminate PET findings, would be helpful. The purpose of this study was to evaluate whether SUVmax in the PET examination might correlate with semiautomated density measurements of LNs in the CT component of the PET/CT examination.

  16. High Structural Stress and Presence of Intraluminal Thrombus Predict Abdominal Aortic Aneurysm 18F-FDG Uptake

    PubMed Central

    Huang, Yuan; Elkhawad, Maysoon; Tarkin, Jason M.; Joshi, Nikhil; Boyle, Jonathan R.; Buscombe, John R.; Fryer, Timothy D.; Zhang, Yongxue; Park, Ah Yeon; Wilkinson, Ian B.; Newby, David E.; Gillard, Jonathan H.

    2016-01-01

    Background— Abdominal aortic aneurysm (AAA) wall inflammation and mechanical structural stress may influence AAA expansion and lead to rupture. We hypothesized a positive correlation between structural stress and fluorine-18-labeled 2-deoxy-2-fluoro-d-glucose (18F-FDG) positron emission tomography–defined inflammation. We also explored the influence of computed tomography–derived aneurysm morphology and composition, including intraluminal thrombus, on both variables. Methods and Results— Twenty-one patients (19 males) with AAAs below surgical threshold (AAA size was 4.10±0.54 cm) underwent 18F-FDG positron emission tomography and contrast-enhanced computed tomography imaging. Structural stresses were calculated using finite element analysis. The relationship between maximum aneurysm 18F-FDG standardized uptake value within aortic wall and wall structural stress, patient clinical characteristics, aneurysm morphology, and compositions was explored using a hierarchical linear mixed-effects model. On univariate analysis, local aneurysm diameter, thrombus burden, extent of calcification, and structural stress were all associated with 18F-FDG uptake (P<0.05). AAA structural stress correlated with 18F-FDG maximum standardized uptake value (slope estimate, 0.552; P<0.0001). Multivariate linear mixed-effects analysis revealed an important interaction between structural stress and intraluminal thrombus in relation to maximum standardized uptake value (fixed effect coefficient, 1.68 [SE, 0.10]; P<0.0001). Compared with other factors, structural stress was the best predictor of inflammation (receiver-operating characteristic curve area under the curve =0.59), with higher accuracy seen in regions with high thrombus burden (area under the curve =0.80). Regions with both high thrombus burden and high structural stress had higher 18F-FDG maximum standardized uptake value compared with regions with high thrombus burdens but low stress (median [interquartile range], 1.93 [1

  17. Diffuse bone metastases on (68)Ga-PSMA PET-CT in a patient with prostate cancer and normal bone scan.

    PubMed

    Lavalaye, J; Kaldeway, P; van Melick, H H E

    2016-07-01

    A 75-year-old patient was diagnosed with a Gleason 9 prostate carcinoma. His PSA level was 50.4 ng/ml. Routine bone scintigraphy was negative for metastasis (a). Due to the high tumour grading and relatively high PSA level, (68)Ga-PSMA PET-CT was ordered to rule out distant metastases. This scan showed numerous skeletal lesions with high tracer accumulation as sign of diffuse osseous metastases (b). On low-dose CT there were no signs of sclerosis (c). (68)Ga-PSMA PET-CT also showed high uptake in the prostate and in para-iliac and para-aortal lymph nodes, without lymph node enlargement. No bone biopsy was obtained to confirm the metastases. Due to this result, the treatment plan was changed to systemic therapy, instead of local therapy.

  18. Initial Characterization of a Dedicated Breast PET/CT Scanner During Human Imaging

    PubMed Central

    Bowen, Spencer L.; Wu, Yibao; Chaudhari, Abhijit J.; Fu, Lin; Packard, Nathan J.; Burkett, George W.; Yang, Kai; Lindfors, Karen K.; Shelton, David K.; Hagge, Rosalie; Borowsky, Alexander D.; Martinez, Steve R.; Qi, Jinyi; Boone, John M.; Cherry, Simon R.; Badawi, Ramsey D.

    2010-01-01

    We have constructed a dedicated breast PET/CT scanner capable of high-resolution functional and anatomic imaging. Here, we present an initial characterization of scanner performance during patient imaging. Methods The system consisted of a lutetium oxyorthosilicate–based dual–planar head PET camera (crystal size, 3 × 3 × 20 mm) and 768-slice cone-beam CT. The position of the PET heads (separation and height) could be adjusted for varying breast dimensions. For scanning, the patient lay prone on a specialized bed and inserted a single pendent breast through an aperture in the table top. Compression of the breast as used in mammography is not required. PET and CT systems rotate in the coronal plane underneath the patient sequentially to collect fully tomographic datasets. PET images were reconstructed with the fully 3-dimensional maximum a posteriori method, and CT images were reconstructed with the Feldkamp algorithm, then spatially registered and fused for display. Phantom scans were obtained to assess the registration accuracy between PET and CT images and the influence of PET electronics and activity on CT image quality. We imaged 4 women with mammographic findings highly suggestive of breast cancer (breast imaging reporting and data system, category 5) in an ongoing clinical trial. Patients were injected with 18F-FDG and imaged for 12.5 min per breast. From patient data, noise-equivalent counting rates and the singles-to-trues ratio (a surrogate for the randoms fraction) were calculated. Results The average registration error between PET and CT images was 0.18 mm. PET electronics and activity did not significantly affect CT image quality. For the patient trial, biopsy-confirmed cancers were visualized on dedicated breast PET/CT on all patient scans, including the detection of ductal carcinoma in situ in 1 case. The singles-to-trues ratio was found to be inversely correlated with breast volume in the field of view, suggesting that larger breasts trend

  19. Endometriosis Under Estradiol Stimulation Imaged Using 18F-FDG and Its Control After Estradiol Cessation and Progesterone Hormonal Replacement.

    PubMed

    Arsenault, Frédéric; Turcotte, Éric

    2016-03-01

    Endometriosis is a frequent and benign cause of disabling abdominal pain, for which a diagnosis suspicion is clinically raised, but its confirmation necessitates a surgical exploration by laparoscopy. Foci of endometriosis proliferate under estrogen stimulation, like normal endometrium. We present a patient under estradiol stimulation for a history of endometrial cancer who underwent a PET/CT scan to assess an abdominal lesion showing a high F-FDG uptake, which normalized under progesterone hormonal replacement and cessation of estradiol. Two consecutive biopsies confirmed endometriosis. F-FDG evaluation of endometriosis under estrogen stimulation could be a promising approach to refractory endometriosis assessment.

  20. SU-E-J-270: Repeated 18F-FDG PET/CTs Based Feature Analysis for the Predication of Anal Cancer Recurrence

    SciTech Connect

    Wang, J; Chuong, M; Choi, W; Lu, W; Latifi, K; Saeed, N; Hoffe, S; Shridhar, R; Moros, E; Tan, S

    2015-06-15

    Purpose: To identify PET/CT based imaging predictors of anal cancer recurrence and evaluate baseline vs. mid-treatment vs. post-treatment PET/CT scans in the tumor recurrence prediction. Methods: FDG-PET/CT scans were obtained at baseline, during chemoradiotherapy (CRT, midtreatment), and after CRT (post-treatment) in 17 patients of anal cancer. Four patients had tumor recurrence. For each patient, the mid-treatment and post-treatment scans were respectively aligned to the baseline scan by a rigid registration followed by a deformable registration. PET/CT image features were computed within the manually delineated tumor volume of each scan to characterize the intensity histogram, spatial patterns (texture), and shape of the tumors, as well as the changes of these features resulting from CRT. A total of 335 image features were extracted. An Exact Logistic Regression model was employed to analyze these PET/CT image features in order to identify potential predictors for tumor recurrence. Results: Eleven potential predictors of cancer recurrence were identified with p < 0.10, including five shape features, five statistical texture features, and one CT intensity histogram feature. Six features were indentified from posttreatment scans, 3 from mid-treatment scans, and 2 from baseline scans. These features indicated that there were differences in shape, intensity, and spatial pattern between tumors with and without recurrence. Recurrent tumors tended to have more compact shape (higher roundness and lower elongation) and larger intensity difference between baseline and follow-up scans, compared to non-recurrent tumors. Conclusion: PET/CT based anal cancer recurrence predictors were identified. The post-CRT PET/CT is the most important scan for the prediction of cancer recurrence. The baseline and mid-CRT PET/CT also showed value in the prediction and would be more useful for the predication of tumor recurrence in early stage of CRT. This work was supported in part by the

  1. A Novel Method to Evaluate Local Control of Lung Cancer in Stereotactic Body Radiation Therapy (SBRT) Treatment Using 18F-FDG Positron Emission Tomography (PET)

    NASA Astrophysics Data System (ADS)

    Kathriarachchi, Vindu Wathsala

    An improved method is introduced for prediction of local tumor control following lung stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) patients using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET). A normalized background-corrected tumor maximum Standard Uptake Value (SUVcmax) is introduced using the mean uptake of adjacent aorta (SUVref), instead of the maximum uptake of lung tumor (SUVmax). This method minimizes the variations associated with SUVmax and objectively demonstrates a strong correlation between the low SUVcmax (< 2.5-3.0) and local control of post lung SBRT. The false positive rates of both SUVmax and SUVcmax increase with inclusion of early (<6 months) PET scans, therefore such inclusion is not recommended for assessing local tumor control of post lung SBRT.

  2. Comparative evaluation of target volumes defined by deformable and rigid registration of diagnostic PET/CT to planning CT in primary esophageal cancer

    PubMed Central

    Guo, Yanluan; Li, Jianbin; Zhang, Peng; Shao, Qian; Xu, Min; Li, Yankang

    2017-01-01

    Abstract Background: To evaluate the geometrical differences of target volumes propagated by deformable image registration (DIR) and rigid image registration (RIR) to assist target volume delineation between diagnostic Positron emission tomography/computed tomography (PET/CT) and planning CT for primary esophageal cancer (EC). Methods: Twenty-five patients with EC sequentially underwent a diagnostic 18F-fluorodeoxyglucose (18F-FDG) PET/CT scan and planning CT simulation. Only 19 patients with maximum standardized uptake value (SUVmax) ≥ 2.0 of the primary volume were available. Gross tumor volumes (GTVs) were delineated using CT and PET display settings. The PET/CT images were then registered with planning CT using MIM software. Subsequently, the PET and CT contours were propagated by RIR and DIR to planning CT. The properties of these volumes were compared. Results: When GTVCT delineated on CT of PET/CT after both RIR and DIR was compared with GTV contoured on planning CT, significant improvements using DIR were observed in the volume, displacements of the center of mass (COM) in the 3-dimensional (3D) direction, and Dice similarity coefficient (DSC) (P = 0.003; 0.006; 0.014). Although similar improvements were not observed for the same comparison using DIR for propagated PET contours from diagnostic PET/CT to planning CT (P > 0.05), for DSC and displacements of COM in the 3D direction of PET contours, the DIR resulted in the improved volume of a large percentage of patients (73.7%; 68.45%; 63.2%) compared with RIR. For diagnostic CT-based contours or PET contours at SUV2.5 propagated by DIR with planning CT, the DSC and displacements of COM in 3D directions in the distal segment were significantly improved compared to the upper and middle segments (P > 0.05). Conclusion: We observed a trend that deformable registration might improve the overlap for gross target volumes from diagnostic PET/CT to planning CT. The distal EC might benefit more from DIR

  3. TU-C-12A-09: Modeling Pathologic Response of Locally Advanced Esophageal Cancer to Chemo-Radiotherapy Using Quantitative PET/CT Features, Clinical Parameters and Demographics

    SciTech Connect

    Zhang, H; Chen, W; Kligerman, S; D’Souza, W; Suntharalingam, M; Lu, W; Tan, S; Kim, G

    2014-06-15

    Purpose: To develop predictive models using quantitative PET/CT features for the evaluation of tumor response to neoadjuvant chemo-radiotherapy (CRT) in patients with locally advanced esophageal cancer. Methods: This study included 20 patients who underwent tri-modality therapy (CRT + surgery) and had {sup 18}F-FDG PET/CT scans before initiation of CRT and 4-6 weeks after completion of CRT but prior to surgery. Four groups of tumor features were examined: (1) conventional PET/CT response measures (SUVmax, tumor diameter, etc.); (2) clinical parameters (TNM stage, histology, etc.) and demographics; (3) spatial-temporal PET features, which characterize tumor SUV intensity distribution, spatial patterns, geometry, and associated changes resulting from CRT; and (4) all features combined. An optimal feature set was identified with recursive feature selection and cross-validations. Support vector machine (SVM) and logistic regression (LR) models were constructed for prediction of pathologic tumor response to CRT, using cross-validations to avoid model over-fitting. Prediction accuracy was assessed via area under the receiver operating characteristic curve (AUC), and precision was evaluated via confidence intervals (CIs) of AUC. Results: When applied to the 4 groups of tumor features, the LR model achieved AUCs (95% CI) of 0.57 (0.10), 0.73 (0.07), 0.90 (0.06), and 0.90 (0.06). The SVM model achieved AUCs (95% CI) of 0.56 (0.07), 0.60 (0.06), 0.94 (0.02), and 1.00 (no misclassifications). Using spatial-temporal PET features combined with conventional PET/CT measures and clinical parameters, the SVM model achieved very high accuracy (AUC 1.00) and precision (no misclassifications), significantly better than using conventional PET/CT measures or clinical parameters and demographics alone. For groups with a large number of tumor features (groups 3 and 4), the SVM model achieved significantly higher accuracy than the LR model. Conclusion: The SVM model using all features

  4. 18F-FDG Uptake in Lung, Breast, and Colon Cancers: Molecular Biology Correlates and Disease Characterization*

    PubMed Central

    Jadvar, Hossein; Alavi, Abass; Gambhir, Sanjiv S.

    2009-01-01

    It is hoped that in the not too distant future, noninvasive imaging–based molecular interrogation and characterization of tumors can improve our fundamental understanding of the dynamic biologic behavior of cancer. For example, the new dimension of diagnostic information that is provided by 18F-FDG PET has led to improved clinical decision making and management changes in a substantial number of patients with cancer. In this context, the aim of this review is to bring together and summarize the current data on the correlation between the underlying molecular biology and the clinical observations of tumor 18F-FDG accumulation in 3 major human cancers: lung, breast, and colon. PMID:19837767

  5. Presurgical evaluation of pediatric epilepsy patients prior to hemispherotomy: the prognostic value of (18)F-FDG PET.

    PubMed

    Traub-Weidinger, Tatjana; Weidinger, Philip; Gröppel, Gundrun; Karanikas, Georgios; Wadsak, Wolfgang; Kasprian, Gregor; Dorfer, Christian; Dressler, Anastasia; Muehlebner, Angelika; Hacker, Marcus; Czech, Thomas; Feucht, Martha

    2016-12-01

    OBJECTIVE The objective of this study was to investigate whether fluorine-18 fluorodeoxyglucose PET ((18)F-FDG PET) can help to predict seizure outcome after hemispherotomy and therefore may be useful in decision making and patient selection. METHODS Children and adolescents less than 18 years of age who underwent (18)F-FDG PET studies during presurgical evaluation prior to hemispherotomy and had follow-up data of at least 12 months after surgery were included. Seizure outcome was classified according to the recommendations of the International League Against Epilepsy. PET data were reevaluated by two specialists in nuclear medicine blinded to clinical data and to MRI. MRI studies were also reinterpreted visually by an experienced neuroradiologist blinded to clinical data and PET findings. RESULTS Thirty-five patients (17 girls) with a median age of 5 years (range 0.4-17.8 years) were evaluable. Of the 35 patients, 91.4% were seizure free after surgery, including 100% of those with unilateral (18)F-FDG-PET hypometabolism compared with only 75% of those with bilateral hypometabolism. With respect to MRI, seizure freedom after surgery was observed in 96.4% of the patients with unilateral lesions compared with only 71.4% in those with bilateral MRI lesions. The best seizure outcomes were noted in patients with unilateral findings in both PET and MRI (100% seizure freedom) whereas only 50% of those with bilateral findings in both imaging techniques were seizure free. Furthermore, 100% of the patients with unilateral PET hypometabolism and bilateral MRI findings were also seizure free, but only 87.5% of those with bilateral PET hypometabolism and unilateral MRI findings. CONCLUSIONS According to these results, candidate selection for hemispherotomy can be optimized by the use of (18)F-FDG PET as part of a multimodal presurgical evaluation program, especially in patients with inconsistent (bilateral) MRI findings.

  6. The Effect of Xanthigen on the Expression of Brown Adipose Tissue Assessed by 18F-FDG PET

    PubMed Central

    Kim, Kwang-Min; Kim, Sang-Man; Cho, Doo-Yeon; Park, Soo-Jung

    2016-01-01

    Brown adipose tissue (BAT) is related with energy expenditure, in contrary to fat-storing white adipose tissue. Recent studies have shown that cold exposure could be related with the expression of BAT in adult subjects assessed by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). In addition, the application in previous clinical trials showed positive effect of xanthigen containing fucoxanthin and punicic acid on body weight and liver fat content. In this short-term intervention study, we evaluated the effect of xanthigen on the expression of BAT by 18F-FDG PET. Two healthy obese premenopausal women were enrolled and xanthigen 600 mg (2 capsules including fucoxanthin 3 mg, punicic acid 174 mg) was given for 3 months without dietary and exercise intervention. Body composition and dietary intake were assessed monthly. Laboratory test and 18F-FDG PET were performed before and after intervention. After intervention, there was neither weight reduction nor remarkable laboratory change. However, BAT, assessed by 18F-FDG PET, was detected in both cervical, supraclavicular and paravertebral space in one subject, even though her body weight showed mild increase. This result suggested that xanthigen can induce BAT in a healthy adult. However, a further large well-controlled study is needed. PMID:27189303

  7. Improved characterization of molecular phenotypes in breast lesions using 18F-FDG PET image homogeneity

    NASA Astrophysics Data System (ADS)

    Cao, Kunlin; Bhagalia, Roshni; Sood, Anup; Brogi, Edi; Mellinghoff, Ingo K.; Larson, Steven M.

    2015-03-01

    Positron emission tomography (PET) using uorodeoxyglucose (18F-FDG) is commonly used in the assessment of breast lesions by computing voxel-wise standardized uptake value (SUV) maps. Simple metrics derived from ensemble properties of SUVs within each identified breast lesion are routinely used for disease diagnosis. The maximum SUV within the lesion (SUVmax) is the most popular of these metrics. However these simple metrics are known to be error-prone and are susceptible to image noise. Finding reliable SUV map-based features that correlate to established molecular phenotypes of breast cancer (viz. estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) expression) will enable non-invasive disease management. This study investigated 36 SUV features based on first and second order statistics, local histograms and texture of segmented lesions to predict ER and PR expression in 51 breast cancer patients. True ER and PR expression was obtained via immunohistochemistry (IHC) of tissue samples from each lesion. A supervised learning, adaptive boosting-support vector machine (AdaBoost-SVM), framework was used to select a subset of features to classify breast lesions into distinct phenotypes. Performance of the trained multi-feature classifier was compared against the baseline single-feature SUVmax classifier using receiver operating characteristic (ROC) curves. Results show that texture features encoding local lesion homogeneity extracted from gray-level co-occurrence matrices are the strongest discriminator of lesion ER expression. In particular, classifiers including these features increased prediction accuracy from 0.75 (baseline) to 0.82 and the area under the ROC curve from 0.64 (baseline) to 0.75.

  8. Utility of 11C-methionine and 11C-donepezil for imaging of Staphylococcus aureus induced osteomyelitis in a juvenile porcine model: comparison to autologous 111In-labelled leukocytes, 99mTc-DPD, and 18F-FDG

    PubMed Central

    Afzelius, Pia; Alstrup, Aage KO; Schønheyder, Henrik C; Borghammer, Per; Jensen, Svend B; Bender, Dirk; Nielsen, Ole L

    2016-01-01

    The aim of this study was to compare 11C-methionine and 11C-donepezil positron emission tomography (PET) with 111In-labeled leukocyte and 99mTc-DPD (Tc-99m 3,3-diphosphono-1,2-propanedicarboxylic acid) single-photon emission computed tomography (SPECT), and 18F-fluorodeoxyglucose (18F-FDG) PET to improve detection of osteomyelitis. The tracers’ diagnostic utility where tested in a juvenile porcine hematogenously induced osteomyelitis model comparable to osteomyelitis in children. Five 8-9 weeks old female domestic pigs were scanned seven days after intra-arterial inoculation in the right femoral artery with a porcine strain of Staphylococcus aureus. The sequential scan protocol included Computed Tomography, 11C-methionine and 11C-donepezil PET, 99mTc-DPD and 111In-labelled leukocytes scintigraphy, and 18F-FDG PET. This was followed by necropsy of the pigs and gross pathology, histopathology, and microbial examination. The pigs developed a total of 24 osteomyelitic lesions, 4 lesions characterized as contiguous abscesses and pulmonary abscesses (in two pigs). By comparing the 24 osteomyelitic lesions, 18F-FDG accumulated in 100%, 111In-leukocytes in 79%, 11C-methionine in 79%, 11C-donepezil in 58%, and 99mTc-DPD in none. Overall, 18F-FDG PET was superior to 111In-leukocyte SPECT and 11C-methionine in marking infectious lesions. PMID:28078182

  9. Utility of (11)C-methionine and (11)C-donepezil for imaging of Staphylococcus aureus induced osteomyelitis in a juvenile porcine model: comparison to autologous (111)In-labelled leukocytes, (99m) Tc-DPD, and (18)F-FDG.

    PubMed

    Afzelius, Pia; Alstrup, Aage Ko; Schønheyder, Henrik C; Borghammer, Per; Jensen, Svend B; Bender, Dirk; Nielsen, Ole L

    2016-01-01

    The aim of this study was to compare (11)C-methionine and (11)C-donepezil positron emission tomography (PET) with (111)In-labeled leukocyte and (99m) Tc-DPD (Tc-99m 3,3-diphosphono-1,2-propanedicarboxylic acid) single-photon emission computed tomography (SPECT), and (18)F-fluorodeoxyglucose ((18)F-FDG) PET to improve detection of osteomyelitis. The tracers' diagnostic utility where tested in a juvenile porcine hematogenously induced osteomyelitis model comparable to osteomyelitis in children. Five 8-9 weeks old female domestic pigs were scanned seven days after intra-arterial inoculation in the right femoral artery with a porcine strain of Staphylococcus aureus. The sequential scan protocol included Computed Tomography, (11)C-methionine and (11)C-donepezil PET, (99m) Tc-DPD and (111)In-labelled leukocytes scintigraphy, and (18)F-FDG PET. This was followed by necropsy of the pigs and gross pathology, histopathology, and microbial examination. The pigs developed a total of 24 osteomyelitic lesions, 4 lesions characterized as contiguous abscesses and pulmonary abscesses (in two pigs). By comparing the 24 osteomyelitic lesions, (18)F-FDG accumulated in 100%, (111)In-leukocytes in 79%, (11)C-methionine in 79%, (11)C-donepezil in 58%, and (99m) Tc-DPD in none. Overall, (18)F-FDG PET was superior to (111)In-leukocyte SPECT and (11)C-methionine in marking infectious lesions.

  10. Quantifying murine bone marrow and blood radiation dose response following (18)F-FDG PET with DNA damage biomarkers.

    PubMed

    Manning, Grainne; Taylor, Kristina; Finnon, Paul; Lemon, Jennifer A; Boreham, Douglas R; Badie, Christophe

    2014-12-01

    The purpose of this study was to quantify the poorly understood radiation doses to murine bone marrow and blood from whole-body fluorine 18 ((18)F)-fluorodeoxyglucose (FDG) positron emission tomography (PET), by using specific biomarkers and comparing with whole body external low dose exposures. Groups of 3-5 mice were randomly assigned to 10 groups, each receiving either a different activity of (18)F-FDG: 0-37MBq or whole body irradiated with corresponding doses of 0-300mGy X-rays. Blood samples were collected at 24h and at 43h for reticulocyte micronucleus assays and QPCR analysis of gene expression in peripheral blood leukocytes. Blood and bone marrow dose estimates were calculated from injected activities of (18)F-FDG and were based on a recommended ICRP model. Doses to the bone marrow corresponding to 33.43mGy and above for internal (18)F-FDG exposure and to 25mGy and above for external X-ray exposure, showed significant increases in radiation-induced MN-RET formation relative to controls (P<0.05). Regression analysis showed that both types of exposure produced a linear response with linear regression analysis giving R(2) of 0.992 and 0.999 for respectively internal and external exposure. No significant difference between the two data sets was found with a P-value of 0.493. In vivo gene expression dose-responses at 24h for Bbc3 and Cdkn1 were similar for (18)F-FDG and X-ray exposures, with significant modifications occurring for doses over 300mGy for Bbc3 and at the lower dose of 150mGy for Cdkn1a. Both leucocyte gene expression and quantification of MN-RET are highly sensitive biomarkers for reliable estimation of the low doses delivered in vivo to, respectively, blood and bone marrow, following (18)F-FDG PET.

  11. Prediction of standard-dose brain PET image by using MRI and low-dose brain [{sup 18}F]FDG PET images

    SciTech Connect

    Kang, Jiayin; Gao, Yaozong; Shi, Feng; Lalush, David S.; Lin, Weili; Shen, Dinggang

    2015-09-15

    Purpose: Positron emission tomography (PET) is a nuclear medical imaging technology that produces 3D images reflecting tissue metabolic activity in human body. PET has been widely used in various clinical applications, such as in diagnosis of brain disorders. High-quality PET images play an essential role in diagnosing brain diseases/disorders. In practice, in order to obtain high-quality PET images, a standard-dose radionuclide (tracer) needs to be used and injected into a living body. As a result, it will inevitably increase the patient’s exposure to radiation. One solution to solve this problem is predicting standard-dose PET images using low-dose PET images. As yet, no previous studies with this approach have been reported. Accordingly, in this paper, the authors propose a regression forest based framework for predicting a standard-dose brain [{sup 18}F]FDG PET image by using a low-dose brain [{sup 18}F]FDG PET image and its corresponding magnetic resonance imaging (MRI) image. Methods: The authors employ a regression forest for predicting the standard-dose brain [{sup 18}F]FDG PET image by low-dose brain [{sup 18}F]FDG PET and MRI images. Specifically, the proposed method consists of two main steps. First, based on the segmented brain tissues (i.e., cerebrospinal fluid, gray matter, and white matter) in the MRI image, the authors extract features for each patch in the brain image from both low-dose PET and MRI images to build tissue-specific models that can be used to initially predict standard-dose brain [{sup 18}F]FDG PET images. Second, an iterative refinement strategy, via estimating the predicted image difference, is used to further improve the prediction accuracy. Results: The authors evaluated their algorithm on a brain dataset, consisting of 11 subjects with MRI, low-dose PET, and standard-dose PET images, using leave-one-out cross-validations. The proposed algorithm gives promising results with well-estimated standard-dose brain [{sup 18}F]FDG PET

  12. Comparison of brain MRI and 18F-FDG PET in the differential diagnosis of multiple system atrophy from Parkinson's disease.

    PubMed

    Kwon, Kyum-Yil; Choi, Choong G; Kim, Jae S; Lee, Myoung C; Chung, Sun J

    2007-12-01

    To investigate the diagnostic value of brain magnetic resonance image (MRI) and (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) in the differentiation of multiple system atrophy (MSA) from Parkinson's disease (PD). Thirty-five patients with MSA (23 MSA-P and 12 MSA-C) and 17 patients with PD were included in this study. Overall correct diagnosis rates between clinical and imaging diagnosis among MSA-P, MSA-C, and PD patients were 80% for visual MRI analysis, 88.5% for visual (18)F-FDG PET analysis, and 84.3% for SPM-supported analysis of (18)F-FDG PET. The sensitivity of brain MRI, and visual and SPM analysis of (18)F-FDG PET in differentiating MSA from PD was 72.7%, 90.9%, and 95.5%, respectively, the specificity was 100% for each imaging analysis, the positive predictive value was 100% for each imaging analysis, and the negative predictive value was 60%, 81.8%, and 90%, respectively. Our results suggest that brain MRI and (18)F-FDG PET are diagnostically useful in differentiating MSA (MSA-P and MSA-C) from PD, and indicate that (18)F-FDG PET has a tendency toward higher sensitivity compared to brain MRI, but a larger longitudinal study including pathological data will be required to confirm our findings.

  13. TU-C-12A-12: Differentiating Bone Lesions and Degenerative Joint Disease in NaF PET/CT Scans Using Machine Learning

    SciTech Connect

    Perk, T; Bradshaw, T; Muzahir, S; Jeraj, R; Meyer, E

    2014-06-15

    Purpose: [F-18]NaF PET can be used to image bone metastases; however, tracer uptake in degenerative joint disease (DJD) often appears similar to metastases. This study aims to develop and compare different machine learning algorithms to automatically identify regions of [F-18]NaF scans that correspond to DJD. Methods: 10 metastatic prostate cancer patients received whole body [F-18]NaF PET/CT scans prior to treatment. Image segmentation resulted in 852 ROIs, 69 of which were identified by a nuclear medicine physician as DJD. For all ROIs, various PET and CT textural features were computed. ROIs were divided into training and testing sets used to train eight different machine learning classifiers. Classifiers were evaluated based on receiver operating characteristics area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV). We also assessed the added value of including CT features in addition to PET features for training classifiers. Results: The training set consisted of 37 DJD ROIs with 475 non-DJD ROIs, and the testing set consisted of 32 DJD ROIs with 308 non-DJD ROIs. Of all classifiers, generalized linear models (GLM), decision forests (DF), and support vector machines (SVM) had the best performance. AUCs of GLM (0.929), DF (0.921), and SVM (0.889) were significantly higher than the other models (p<0.001). GLM and DF, overall, had the best sensitivity, specificity, and PPV, and gave a significantly better performance (p<0.01) than all other models. PET/CT GLM classifiers had higher AUC than just PET or just CT. GLMs built using PET/CT information had superior or comparable sensitivities, specificities and PPVs to just PET or just CT. Conclusion: Machine learning algorithms trained with PET/CT features were able to identify some cases of DJD. GLM outperformed the other classification algorithms. Using PET and CT information together was shown to be superior to using PET or CT features alone. Research supported by the Prostate

  14. 18F-AFETP, 18F-FET, and 18F-FDG Imaging of Mouse DBT Gliomas

    PubMed Central

    Sai, Kiran Kumar Solingapuram; Huang, Chaofeng; Yuan, Liya; Zhou, Dong; Piwnica-Worms, David; Garbow, Joel R.; Engelbach, John A.; Mach, Robert H.; Rich, Keith M.; McConathy, Jonathan

    2013-01-01

    The goal of this study was to evaluate the 18F-labeled nonnatural amino acid (S)-2-amino-3-[1-(2-18F-fluoroethyl)-1H-[1,2,3]triazol-4-yl]propanoic acid (18F-AFETP) as a PET imaging agent for brain tumors and to compare its effectiveness with the more-established tracers O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) and 18F-FDG in a murine model of glioblastoma. The tracer 18F-AFETP is a structural analog of histidine and is a lead compound for imaging cationic amino acid transport, a relatively unexplored target for oncologic imaging. Methods 18F-AFETP was prepared using the click reaction. BALB/c mice with intracranially implanted delayed brain tumor (DBT) gliomas (n = 4) underwent biodistribution and dynamic small-animal PET imaging for 60 min after intravenous injection of 18F-AFETP. Tumor and brain uptake of 18F-AFETP were compared with those of 18F-FDG and 18F-FET through small-animal PET analyses. Results 18F-AFETP demonstrated focally increased uptake in tumors with good visualization. Peak tumor uptake occurred within 10 min of injection, with stable or gradual decrease over time. All 3 tracers demonstrated relatively high uptake in the DBTs throughout the study. At late time points (47.5–57.5 min after injection), the average standardized uptake value with 18F-FDG (1.9 ± 0.1) was significantly greater than with 18F-FET (1.1 ± 0.1) and 18F-AFETP (0.7 ± 0.2). The uptake also differed substantially in normal brain, with significant differences in the standardized uptake values at late times among 18F-FDG (1.5 ± 0.2), 18F-FET (0.5 ± 0.05), and 18F-AFETP (0.1 ± 0.04). The resulting average tumor-to-brain ratio at the late time points was significantly higher for 18F-AFETP (7.5 ± 0.1) than for 18F-FDG (1.3 ± 0.1) and 18F-FET (2.0 ± 0.3). Conclusion 18F-AFETP is a promising brain tumor imaging agent, providing rapid and persistent tumor visualization, with good tumor–to–normal-brain ratios in the DBT glioma model. High tumor-to-brain, tumor

  15. Low-dose radiation from 18F-FDG PET does not increase cancer frequency or shorten latency but reduces kidney disease in cancer-prone Trp53+/- mice

    DOE PAGES

    Taylor, Kristina; Lemon, Jennifer A.; Phan, Nghi; ...

    2014-05-28

    There is considerable interest in the health effects associated with low-level radiation exposure from medical imaging procedures. Concerns in the medical community that increased radiation exposure from imaging procedures may increase cancer risk among patients are confounded by research showing that low-dose radiation exposure can extend lifespan by increasing the latency period of some types of cancer. The most commonly used radiopharmaceutical for positron emission tomography (PET) scans is 2-[18F] fluoro-2-deoxy-d-glucose (18F-FDG), which exposes tissue to a low-dose, mixed radiation quality: 634 keV β+ and 511 keV γ-rays. The goal of this research was to investigate how modification of cancermore » risk associated with exposure to low-dose ionising radiation in cancer-prone Trp53+/- mice is influenced by radiation quality from PET. At 7-8 weeks of age, Trp53+/- female mice were exposed to one of five treatments: 0 Gy, 10 mGy γ-rays, 10 mGy 18F-FDG, 4 Gy γ-rays, 10 mGy 18F-FDG + 4 Gy γ-rays (n > 185 per group). The large 4-Gy radiation dose significantly reduced the lifespan by shortening the latency period of cancer and significantly increasing the number of mice with malignancies, compared with unirradiated controls. The 10 mGy γ-rays and 10 mGy PET doses did not significantly modify the frequency or latency period of cancer relative to unirradiated mice. Similarly, the PET scan administered prior to a large 4-Gy dose did not significantly modify the latency or frequency of cancer relative to mice receiving a dose of only 4 Gy. The relative biological effectiveness of radiation quality from 18F-FDG, with respect to malignancy, is approximately 1. Furthermore, when non-cancer endpoints were studied, it was found that the 10-mGy PET group had a significant reduction in kidney lesions (P < 0.021), indicating that a higher absorbed dose (20 ± 0.13 mGy), relative to the whole-body average, which occurs in specific tissues, may not be detrimental.« less

  16. Low-dose radiation from 18F-FDG PET does not increase cancer frequency or shorten latency but reduces kidney disease in cancer-prone Trp53+/- mice.

    PubMed

    Taylor, Kristina; Lemon, Jennifer A; Phan, Nghi; Boreham, Douglas R

    2014-07-01

    There is considerable interest in the health effects associated with low-level radiation exposure from medical imaging procedures. Concerns in the medical community that increased radiation exposure from imaging procedures may increase cancer risk among patients are confounded by research showing that low-dose radiation exposure can extend lifespan by increasing the latency period of some types of cancer. The most commonly used radiopharmaceutical for positron emission tomography (PET) scans is 2-[(18)F] fluoro-2-deoxy-d-glucose ((18)F-FDG), which exposes tissue to a low-dose, mixed radiation quality: 634 keV β+ and 511 keV γ-rays. The goal of this research was to investigate how modification of cancer risk associated with exposure to low-dose ionising radiation in cancer-prone Trp53+/- mice is influenced by radiation quality from PET. At 7-8 weeks of age, Trp53+/- female mice were exposed to one of five treatments: 0 Gy, 10 mGy γ-rays, 10 mGy (18)F-FDG, 4 Gy γ-rays, 10 mGy (18)F-FDG + 4 Gy γ-rays (n > 185 per group). The large 4-Gy radiation dose significantly reduced the lifespan by shortening the latency period of cancer and significantly increasing the number of mice with malignancies, compared with unirradiated controls. The 10 mGy γ-rays and 10 mGy PET doses did not significantly modify the frequency or latency period of cancer relative to unirradiated mice. Similarly, the PET scan administered prior to a large 4-Gy dose did not significantly modify the latency or frequency of cancer relative to mice receiving a dose of only 4 Gy. The relative biological effectiveness of radiation quality from (18)F-FDG, with respect to malignancy, is approximately 1. However; when non-cancer endpoints were studied, it was found that the 10-mGy PET group had a significant reduction in kidney lesions (P < 0.021), indicating that a higher absorbed dose (20 ± 0.13 mGy), relative to the whole-body average, which occurs in specific tissues, may not be detrimental.

  17. The influence of tumor oxygenation on 18F-FDG (Fluorine-18 Deoxyglucose) uptake: A mouse study using positron emission tomography (PET)

    PubMed Central

    Chan, Linda W; Hapdey, Sebastien; English, Sean; Seidel, Jurgen; Carson, Joann; Sowers, Anastasia L; Krishna, Murali C; Green, Michael V; Mitchell, James B; Bacharach, Stephen L

    2006-01-01

    Background This study investigated whether changing a tumor's oxygenation would alter tumor metabolism, and thus uptake of 18F-FDG (fluorine-18 deoxyglucose), a marker for glucose metabolism using positron emission tomography (PET). Results Tumor-bearing mice (squamous cell carcinoma) maintained at 37°C were studied while breathing either normal air or carbogen (95% O2, 5% CO2), known to significantly oxygenate tumors. Tumor activity was measured within an automatically determined volume of interest (VOI). Activity was corrected for the arterial input function as estimated from image and blood-derived data. Tumor FDG uptake was initially evaluated for tumor-bearing animals breathing only air (2 animals) or only carbogen (2 animals). Subsequently, 5 animals were studied using two sequential 18F-FDG injections administered to the same tumor-bearing mouse, 60 min apart; the first injection on one gas (air or carbogen) and the second on the other gas. When examining the entire tumor VOI, there was no significant difference of 18F-FDG uptake between mice breathing either air or carbogen (i.e. air/carbogen ratio near unity). However, when only the highest 18F-FDG uptake regions of the tumor were considered (small VOIs), there was a modest (21%), but significant increase in the air/carbogen ratio suggesting that in these potentially most hypoxic regions of the tumor, 18F-FDG uptake and hence glucose metabolism, may be reduced by increasing tumor oxygenation. Conclusion Tumor 18F-FDG uptake may be reduced by increases in tumor oxygenation and thus may provide a means to further enhance 18F-FDG functional imaging. PMID:16722588

  18. Quantitative outcome of registration methods for correcting cardiac drift in cardiac PET/CT imaging.

    PubMed

    Nye, Jonathan A; Tudorascu, Dana; Esteves, Fabio; Votaw, John R

    2016-03-08

    Myocardial perfusion studies suffer from artifacts caused by misalignment of the transmission and emission data due to the influences of voluntary and involuntary patient motion. Regardless of 68Ge or respiratory-averaged CT based attenuation correction and good patient cooperation, approximately 21% of perfusion studies exhibit artifacts arising from misalignment that cannot be corrected by manipulating the attenuation acquisition protocol. This misalignment, termed cardiac drift, is caused by slow-moving abdominal cavity contents that reposition the heart in the thorax and appear as myocardial uptake overlying the left CT lung in fused PET/CT images. This study evaluates three postimaging registration techniques to correct PET/CT misalignment by altering the transmission map to match myo-cardial uptake. Simulated misalignment studies were performed with a cardiac torso phantom filled with [18F]FDG at 10:1 myocardium/background. An air-filled saline bag affixed to the medial left lung surface served as a distensible lung. An initial CT acquisition was followed by successive PET acquisitions consisting of small displacements of the cardiac insert into the left lung. Phantom transmission scans were aligned to the myocardial uptake in the emission scans by applying 1) full rigid-body translations and rotations, 2) rigid-body restricted to medial / lateral and superior / inferior translation, or 3) an emission-driven method that adds myocardial tissue to the transmission scan. These methods were also applied to 10 low-likelihood coronary artery disease (CAD) patients showing signs of cardiac drift. Full rigid-body registration showed significant over-correction (p < 0.004) of activity concentrations in the artifact areas of the phantom data due the relocation of highly attenuating structures (i.e., spine). Inaccurate regional activity distributions were also observed as streaks extending from the spine and these results were replicated in the patient population. There

  19. Occult breast primary malignancy presenting as isolated axillary lymph node metastasis - early detection of primary site by 18F-FDG PET/CT.

    PubMed

    Soundararajan, Ramya; Naswa, Niraj; Karunanithi, Sellam; Walia, Ritika; Kumar, Rakesh; Bal, Chandrasekhar

    2016-01-01

    Breast cancer patients rarely present with isolated axillary lymph node metastasis without any clinical or radiological evidence of primary tumor. Identification of the primary site of tumor helps in planning appropriate patient management which has definite impact on patient's survival. We present here a case of 30-year-old female who presented with isolated right axillary lymph node metastasis with no evidence of primary tumor clinically. Conventional imaging modalities were negative for primary site. She underwent whole body 18F-Flurodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and it contributed significantly in early detection of occult primary tumor in right breast.

  20. Combined PET/CT by 18F-FDOPA, 18F-FDA, 18F-FDG, and MRI correlation on a patient with Carney triad.

    PubMed

    Papadakis, Georgios Z; Patronas, Nicholas J; Chen, Clara C; Carney, J Aidan; Stratakis, Constantine A

    2015-01-01

    Carney triad is a rare syndrome involving gastrointestinal stromal tumor, pulmonary chondroma, and extra-adrenal paraganglioma. We present a 21-year-old woman with the complete triad who was evaluated with MRI, F-FDOPA, F-FDA, and F-FDG. F-FDOPA best demonstrated the paraganglioma, whereas hepatic metastases noted by MRI demonstrated increased uptake only by F-FDG.

  1. Pilot Preclinical and Clinical Evaluation of (4S)-4-(3-[18F]Fluoropropyl)-L-Glutamate (18F-FSPG) for PET/CT Imaging of Intracranial Malignancies

    PubMed Central

    Mittra, Erik S.; Koglin, Norman; Mosci, Camila; Kumar, Meena; Hoehne, Aileen; Keu, Khun Visith; Iagaru, Andrei H.; Mueller, Andre; Berndt, Mathias; Bullich, Santiago; Friebe, Matthias; Schmitt-Willich, Heribert; Gekeler, Volker; Fels, Lüder M.; Bacher-Stier, Claudia; Moon, Dae Hyuk; Chin, Frederick T.; Stephens, Andrew W.; Dinkelborg, Ludger M.; Gambhir, Sanjiv S.

    2016-01-01

    Purpose (S)-4-(3-[18F]Fluoropropyl)-L-glutamic acid (18F-FSPG) is a novel radiopharmaceutical for Positron Emission Tomography (PET) imaging. It is a glutamate analogue that can be used to measure xC- transporter activity. This study was performed to assess the feasibility of 18F-FSPG for imaging orthotopic brain tumors in small animals and the translation of this approach in human subjects with intracranial malignancies. Experimental Design For the small animal study, GS9L glioblastoma cells were implanted into brains of Fischer rats and studied with 18F-FSPG, the 18F-labeled glucose derivative 18F-FDG and with the 18F-labeled amino acid derivative 18F-FET. For the human study, five subjects with either primary or metastatic brain cancer were recruited (mean age 50.4 years). After injection of 300 MBq of 18F-FSPG, 3 whole-body PET/Computed Tomography (CT) scans were obtained and safety parameters were measured. The three subjects with brain metastases also had an 18F-FDG PET/CT scan. Quantitative and qualitative comparison of the scans was performed to assess kinetics, biodistribution, and relative efficacy of the tracers. Results In the small animals, the orthotopic brain tumors were visualized well with 18F-FSPG. The high tumor uptake of 18F-FSPG in the GS9L model and the absence of background signal led to good tumor visualization with high contrast (tumor/brain ratio: 32.7). 18F-FDG and 18F-FET showed T/B ratios of 1.7 and 2.8, respectively. In the human pilot study, 18F-FSPG was well tolerated and there was similar distribution in all patients. All malignant lesions were positive with 18F-FSPG except for one low-grade primary brain tumor. In the 18F-FSPG-PET-positive tumors a similar T/B ratio was observed as in the animal model. Conclusions 18F-FSPG is a novel PET radiopharmaceutical that demonstrates good uptake in both small animal and human studies of intracranial malignancies. Future studies on larger numbers of subjects and a wider array of brain tumors

  2. Impact of metal artefacts due to EEG electrodes in brain PET/CT imaging

    NASA Astrophysics Data System (ADS)

    Lemmens, Catherine; Montandon, Marie-Louise; Nuyts, Johan; Ratib, Osman; Dupont, Patrick; Zaidi, Habib

    2008-08-01

    The goal of this study is to investigate the impact of electroencephalogram (EEG) electrodes on the visual quality and quantification of 18F-FDG PET images in neurological PET/CT examinations. For this purpose, the scans of 20 epilepsy patients with EEG monitoring were used. The CT data were reconstructed with filtered backprojection (FBP) and with a metal artefact reduction (MAR) algorithm. Both data sets were used for CT-based attenuation correction (AC) of the PET data. Also, a calculated AC (CALC) technique was considered. A volume of interest (VOI)-based analysis and a voxel-based quantitative analysis were performed to compare the different AC methods. Images were also evaluated visually by two observers. It was shown with simulations and phantom measurements that from the considered AC methods, the MAR-AC can be used as the reference in this setting. The visual assessment of PET images showed local hot spots outside the brain corresponding to the locations of the electrodes when using FBP-AC. In the brain, no abnormalities were observed. The quantitative analysis showed a very good correlation between PET-FBP-AC and PET-MAR-AC, with a statistically significant positive bias in the PET-FBP-AC images of about 5-7% in most brain voxels. There was also good correlation between PET-CALC-AC and PET-MAR-AC, but in the PET-CALC-AC images, regions with both a significant positive and negative bias were observed. EEG electrodes give rise to local hot spots outside the brain and a positive quantification bias in the brain. However, when diagnosis is made by mere visual assessment, the presence of EEG electrodes does not seem to alter the diagnosis. When quantification is performed, the bias becomes an issue especially when comparing brain images with and without EEG monitoring.

  3. Assessment of intratumor hypoxia by integrated 18F-FDG PET / perfusion CT in a liver tumor model

    PubMed Central

    Wang, Yong; Stewart, Errol; Desjardins, Lise; Hadway, Jennifer; Morrison, Laura; Crukley, Cathie

    2017-01-01

    Objectives Hypoxia in solid tumors occurs when metabolic demands in tumor cells surpass the delivery of oxygenated blood. We hypothesize that the 18F-fluorodeoxyglucose (18F-FDG) metabolism and tumor blood flow mismatch would correlate with tumor hypoxia. Methods Liver perfusion computed tomography (CT) and 18F-FDG positron emission tomography (PET) imaging were performed in twelve rabbit livers implanted with VX2 carcinoma. Under CT guidance, a fiber optic probe was inserted into the tumor to measure the partial pressure of oxygen (pO2). Tumor blood flow (BF) and standardized uptake value (SUV) were measured to calculate flow-metabolism ratio (FMR). Tumor hypoxia was further identified using pimonidazole immunohistochemical staining. Pearson correlation analysis was performed to determine the correlation between the imaging parameters and pO2 and pimonidazole staining. Results Weak correlations were found between blood volume (BV) and pO2 level (r = 0.425, P = 0.004), SUV and pO2 (r = -0.394, P = 0.007), FMR and pimonidazole staining score (r = -0.388, P = 0.031). However, there was stronger correlation between tumor FMR and pO2 level (r = 0.557, P < 0.001). Conclusions FMR correlated with tumor oxygenation and pimonidazole staining suggesting it may be a potential hypoxic imaging marker in liver tumor. PMID:28264009

  4. The Role of PET/CT Molecular Imaging in the Diagnosis of Recurrence and Surveillance of Patients Treated for Non-Small Cell Lung Cancer

    PubMed Central

    Jiménez-Bonilla, Julio Francisco; Quirce, Remedios; Martínez-Rodríguez, I.; De Arcocha-Torres, María; Carril, José Manuel; Banzo, Ignacio

    2016-01-01

    Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide and its prognosis remains poor. Molecular imaging with 18F-FDG PET/CT can metabolically characterize the nature of lesions as benign or malignant, allowing a better staging at the diagnosis of this kind of patient. This advantage can also be applied in the re-staging due to the suspicion of recurrent disease. Many patients have a recurrence of the disease, including surgically treated patients. In the current context, with new personalized oncological treatments, the surveillance for recurrence and its accurate diagnosis are crucial to improve their survival. In this paper, we revise the current knowledge about the clinical and molecular factors related to the recurrent disease. In the context of new, promising, available personalized treatments, the role of molecular imaging with PET/CT and 18F-FDG and non-18F-FDG radiotracers in the follow-up of NSCLC-treated patients is especially attractive and interesting. PMID:27706025

  5. SU-D-201-03: Imaging Cellular Pharmacokinetics of 18F-FDG in Inflammatory/Stem Cells

    SciTech Connect

    Zaman, R; Tuerkcan, S; Mahmoudi, M; Toshinobu, T; Kosuge, H; Yang, P; Chin, F; McConnell, M; Xing, L

    2015-06-15

    Purpose: Atherosclerosis is a progressive inflammatory condition that underlies coronary artery disease (CAD)—the leading cause of death in the USA. Thus, understating the metabolism of inflammatory cells can be a valuable tool for investigating CAD. To the best of our knowledge, we are the first to successfully investigate the pharmacokinetics of [18F]fluoro-deoxyglucose (18F-FDG) uptake in a single macrophages and compared with induced pluripotent stem cells (iPSCs) and mesenchymal stem cells (MSCs) with a novel imaging technique, radioluminescence microscopy, initially developed for cancer imaging. Methods: Live cells were cultured sparsely on Matrigel in a glass-bottom dish and starved for 1 hour before incubation with 250 microCi of 18F-FDG for 45 minutes. Excess radiotracer was removed using DMEM medium without glucose. Before imaging, DMEM (1 mL) was added to the cell culture and a 100 microm-thin CdWO4 scintillator plate was placed on top of the cells. Light produced following beta decay was imaged with a highly sensitive inverted microscope (LV200, Olympus) fitted with a 40x/1.3 high-NA oil objective, and an EM-CCD camera. The images were collected over 18,000 frames with 4×4 binning (1200 MHz EM Gain, 300ms exposure). Custom-written software was developed in MATLAB for image processing (Figure 1). For statistical analysis 10 different region-of-interests (ROIs) were selected for each cell type. Results: Figures 2A–2B show bright-field/fusion images for all three different cell types. The relationship between cell-to-cell comparisons was found to be linear for macrophages unlike iPSCs and MSCs, which were best fitted with moving or rolling average (Figure 2C). The average observed decay of 18F-FDG in a single cell of MSCs per second (0.067) was 20% and 36% higher compared to iPSCs (0.054) and macrophages (0.043), respectively (Figure 2D). Conclusion: MSCs was found to be 2–3x more sensitive to glucose molecule despite constant parameters for each

  6. Micro Regional Heterogeneity of 64Cu-ATSM and 18F-FDG Uptake in Canine Soft Tissue Sarcomas: Relation to Cell Proliferation, Hypoxia and Glycolysis

    PubMed Central

    Zornhagen, Kamilla Westarp; Hansen, Anders E.; Oxboel, Jytte; Clemmensen, Andreas E.; El Ali, Henrik H.; Kristensen, Annemarie T.; Kjær, Andreas

    2015-01-01

    Objectives Tumour microenvironment heterogeneity is believed to play a key role in cancer progression and therapy resistance. However, little is known about micro regional distribution of hypoxia, glycolysis and proliferation in spontaneous solid tumours. The overall aim was simultaneous investigation of micro regional heterogeneity of 64Cu-ATSM (hypoxia) and 18F-FDG (glycolysis) uptake and correlation to endogenous markers of hypoxia, glycolysis, proliferation and angiogenesis to better therapeutically target aggressive tumour regions and prognosticate outcome. Methods Exploiting the different half-lives of 64Cu-ATSM (13h) and 18F-FDG (2h) enabled simultaneous investigation of micro regional distribution of hypoxia and glycolysis in 145 tumour pieces from four spontaneous canine soft tissue sarcomas. Pairwise measurements of radioactivity and gene expression of endogenous markers of hypoxia (HIF-1α, CAIX), glycolysis (HK2, GLUT1 and GLUT3), proliferation (Ki-67) and angiogenesis (VEGFA and TF) were performed. Dual tracer autoradiography was compared with Ki-67 immunohistochemistry. Results Micro regional heterogeneity in hypoxia and glycolysis within and between tumour sections of each tumour piece was observed. The spatial distribution of 64Cu-ATSM and 18F-FDG was rather similar within each tumour section as reflected in moderate positive significant correlations between the two tracers (ρ = 0.3920–0.7807; p = 0.0180 –<0.0001) based on pixel-to-pixel comparisons of autoradiographies and gamma counting of tumour pieces. 64Cu-ATSM and 18F-FDG correlated positively with gene expression of GLUT1 and GLUT3, but negatively with HIF-1α and CAIX. Significant positive correlations were seen between Ki-67 gene expression and 64Cu-ATSM (ρ = 0.5578, p = 0.0004) and 18F-FDG (ρ = 0.4629–0.7001, p = 0.0001–0.0151). Ki-67 gene expression more consistently correlated with 18F-FDG than with 64Cu-ATSM. Conclusions Micro regional heterogeneity of hypoxia and glycolysis

  7. Mucosa-associated lymphoid tissue lymphoma with unusual 18F-FDG hypermetabolism arising at the colorectal anastomosis

    PubMed Central

    Zhang, Na-Sha; Shi, Fang; Kong, Li; Zhu, Hui

    2017-01-01

    Mucosa-associated lymphoid tissue (MALT) lymphoma usually originates from the stomach and presents with low 18F-fluorodeoxyglucose (FDG) avidity with average maximum standard uptake value of 3.6. Colorectal MALT lymphoma is a rare entity that contributes to 1.6% of all MALT lymphomas and < 0.2% of large intestinal malignancies. The case reported herein firstly revealed stage IIE MALT lymphoma with unexpected higher 18F-FDG avidity of 18.9 arising at the colorectal anastomosis in a patient with a surgical history for sigmoid adenocarcinoma, which was strongly suspected as local recurrence before histopathological and immunohistochemical examinations. After accurate diagnosis, the patient received four cycles of standard R-CVP regimen (rituximab, cyclophosphamide, vincristine and prednisone), combined target therapy and chemotherapy, instead of radiotherapy recommended by National Comprehensive Cancer Network guidelines. He tolerated the treatment well and reached complete remission. PMID:28210093

  8. Minimizing artifacts resulting from respiratory and cardiac motion by optimization of the transmission scan in cardiac PET/CT

    SciTech Connect

    Nye, Jonathon A.; Esteves, Fabio; Votaw, John R.

    2007-06-15

    The introduction of positron emission/computed tomography (PET/CT) systems coupled with multidetector CT arrays has greatly increased the amount of clinical information in myocardial perfusion studies. The CT acquisition serves the dual role of providing high spatial anatomical detail and attenuation correction for PET. However, the differences between the interaction of respiratory and cardiac cycles in the CT and PET acquisitions presents a challenge when using the CT to determine PET attenuation correction. Three CT attenuation correction protocols were tested for their ability to produce accurate emission images: gated, a step mode acquisition covering the diastolic heart phase; normal, a high-pitch helical CT; and slow, a low-pitch, low-temporal-resolution helical CT. The amount of cardiac tissue in the emission image that overlaid lung tissue in the transmission image was used as the measure of mismatch between acquisitions. Phantom studies simulating misalignment of the heart between the transmission and emission sequences were used to correlate the amount of mismatch with the artificial defect changes in the emission image. Consecutive patients were studied prospectively with either paired gated (diastolic phase, 120 kVp, 280 mA, 2.6 s) and slow CT (0.562:1 pitch, 120 kVp, Auto-mA, 16 s) or paired normal (0.938:1 pitch, 120 kVp, Auto-mA, 4.8 s) and slow CT protocols, prior to a Rb-82 perfusion study. To determine the amount of mismatch, the transmission and emission images were converted to binary representations of attenuating tissue and cardiac tissue and overlaid using their native registration. The number of cardiac tissue pixels from the emission image present in the CT lung field yielded the magnitude of misalignment represented in terms of volume, of where a small volume indicates better registration. Acquiring a slow CT improved registration between the transmission and emission acquisitions compared to the gated and normal CT protocols. The volume

  9. Ectopic ACTH and CRH co-secreting tumor localized by 68Ga-DOTA-TATE PET/CT

    PubMed Central

    Papadakis, Georgios Z.; Bagci, Ulas; Sadowski, Samira M.; Patronas, Nicholas J.; Stratakis, Constantine A.

    2015-01-01

    Diagnosis of ectopic adrenocorticotropic hormone (ACTH) and corticotropin releasing hormone (CRH) co-secreting tumors causing Cushing syndrome (CS) is challenging, since these tumors are rare and their diagnosis is frequently confused with Cushing disease (CD), due to the effect of CRH on the pituitary. We report a case of a 21-year-old male who was referred to our institution with persistent hypercortisolemia and CS after undergoing unnecessary transsphenoidal surgery (TSS). 68Ga-DOTA-TATE PET/CT revealed increased tracer uptake in the thymus which was histologically proved to be neuroendocrine tumor (NET) staining positive for ACTH and CRH. Imaging with 18F-FDG PET/CT was not diagnostic. PMID:26018709

  10. Use of subsequent PET/CT in diffuse large B-cell lymphoma patients in complete remission following primary therapy.

    PubMed

    Zhang, Xu; Fan, Wei; Xia, Zhong-Jun; Hu, Ying-Ying; Lin, Xiao-Ping; Zhang, Ya-Rui; Li, Zhi-Ming; Liang, Pei-Yan; Li, Yuan-Hua

    2015-02-01

    Interim 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (I-PET/CT) is a powerful tool for monitoring the response to therapy in diffuse large B-cell lymphoma (DLBCL). This retrospective study aimed to determine when and how to use I-PET/CT in DLBCL. A total of 197 patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) were enrolled between October 2005 and July 2011; PET/CT was performed at the time of diagnosis (PET/CT0), after 2 and 4 cycles of chemotherapy (PET/CT2 and PET/CT4, respectively), and at the end of treatment (F-PET/CT). According to the International Harmonization Project for Response Criteria in Lymphoma, 110 patients had negative PET/CT2 scans, and 87 had positive PET/CT2 scans. The PET/CT2-negative patients had significantly higher 3-year progression-free survival rate (75.8% vs. 38.2%) and 3-year overall survival rate (93.5% vs. 55.6%) than PET/CT2-positive patients. All PET/CT2-negative patients remained negative at PET/CT4, but 3 were positive at F-PET/CT. Among the 87 PET/CT2-positive patients, 57 remained positive at F-PET/CT, and 32 progressed during chemotherapy (15 at PET/CT4 and 17 at F-PET/CT). Comparing PET/CT4 with PET/CT0, 7 patients exhibited progression, and 8 achieved partial remission. Comparing F-PET/CT with PET/CT0, 10 patients exhibited progression, and 7 achieved partial remission. In conclusion, our results indicate that I-PET/CT should be performed after 2 rather than 4 cycles of immunochemotherapy in DLBCL patients. There is a limited role for subsequent PET/CT in the detection of relapse in PET/CT2-negative patients, but repeat PET/CT is required if the PET/CT2 findings are positive.

  11. A comparison study of 11C-methionine and 18F-fluorodeoxyglucose positron emission tomography-computed tomography scans in evaluation of patients with recurrent brain tumors

    PubMed Central

    Sharma, Rajnish; D’Souza, Maria; Jaimini, Abhinav; Hazari, Puja Panwar; Saw, Sanjeev; Pandey, Santosh; Singh, Dinesh; Solanki, Yachna; Kumar, Nitin; Mishra, Anil K.; Mondal, Anupam

    2016-01-01

    Introduction: 11C-methonine ([11C]-MET) positron emission tomography-computed tomography (PET-CT) is a well-established technique for evaluation of tumor for diagnosis and treatment planning in neurooncology. [11C]-MET reflects amino acid transport and has been shown to be more sensitive than magnetic resonance imaging (MRI) in stereotactic biopsy planning. This study compared fluorodeoxyglucose (FDG) PET-CT and MET PET-CT in the detection of various brain tumors. Materials and Methods: Sixty-four subjects of brain tumor treated by surgery, chemotherapy, and/or radiotherapy were subjected to [18F]-FDG, [11C]-MET, and MRI scan. The lesion was analyzed semiquantitatively using tumor to normal contralateral ratio. The diagnosis was confirmed by surgery, stereotactic biopsy, clinical follow-up, MRI, or CT scans. Results: Tumor recurrence was found in 5 out of 22 patients on [F-18] FDG scan while [11C]-MET was able to detect recurrence in 18 out of 22 patients in low-grade gliomas. Two of these patients were false positive for the presence of recurrence of tumor and later found to be harboring necrosis. Among oligodendroglioma, medulloblastoma and high-grade glioma out of 42 patients 39 were found to be concordant MET and FDG scans. On semiquantitative analysis, mean T/NT ratio was found to be 2.96 ± 0.94 for lesions positive for recurrence of tumors and 1.18 ± 0.74 for lesions negative for recurrence of tumor on [11C]-MET scan. While the ratio for FDG scan on semiquantitative analysis was found to be 2.05 ± 1.04 for lesions positive for recurrence of tumors and 0.52 ± 0.15 for lesions negative for recurrence of tumors. Conclusion: The study highlight that [11C]-MET is superior to [18F]-FDG PET scans to detect recurrence in low-grade glioma. A cut-off value of target to nontarget value of 1.47 is a useful parameter to distinguish benign from malignant lesion on an [11C]-MET Scan. Both [18F]-FDG and [11C]-MET scans were found to be useful in high-grade astrocytoma

  12. Evaluation of radiation dose and image quality of CT scan for whole-body pediatric PET/CT: A phantom study

    SciTech Connect

    Yang, Ching-Ching; Liu, Shu-Hsin; Mok, Greta S. P.; Wu, Tung-Hsin

    2014-09-15

    Purpose: This study aimed to tailor the CT imaging protocols for pediatric patients undergoing whole-body PET/CT examinations with appropriate attention to radiation exposure while maintaining adequate image quality for anatomic delineation of PET findings and attenuation correction of PET emission data. Methods: The measurements were made by using three anthropomorphic phantoms representative of 1-, 5-, and 10-year-old children with tube voltages of 80, 100, and 120 kVp, tube currents of 10, 40, 80, and 120 mA, and exposure time of 0.5 s at 1.75:1 pitch. Radiation dose estimates were derived from the dose-length product and were used to calculate risk estimates for radiation-induced cancer. The influence of image noise on image contrast and attenuation map for CT scans were evaluated based on Pearson's correlation coefficient and covariance, respectively. Multiple linear regression methods were used to investigate the effects of patient age, tube voltage, and tube current on radiation-induced cancer risk and image noise for CT scans. Results: The effective dose obtained using three anthropomorphic phantoms and 12 combinations of kVp and mA ranged from 0.09 to 4.08 mSv. Based on our results, CT scans acquired with 80 kVp/60 mA, 80 kVp/80 mA, and 100 kVp/60 mA could be performed on 1-, 5-, and 10-year-old children, respectively, to minimize cancer risk due to CT scans while maintaining the accuracy of attenuation map and CT image contrast. The effective doses of the proposed protocols for 1-, 5- and 10-year-old children were 0.65, 0.86, and 1.065 mSv, respectively. Conclusions: Low-dose pediatric CT protocols were proposed to balance the tradeoff between radiation-induced cancer risk and image quality for patients ranging in age from 1 to 10 years old undergoing whole-body PET/CT examinations.

  13. Biodistribution of the radionuclides 18F-FDG, 11C-methionine, 11C-PK11195, and 68Ga-citrate in domestic juvenile female pigs and morphological and molecular imaging of the tracers in hematogenously disseminated Staphylococcus aureus lesions

    PubMed Central

    Afzelius, Pia; Nielsen, Ole L; Alstrup, Aage KO; Bender, Dirk; Leifsson, Páll S; Jensen, Svend B; Schønheyder, Henrik C

    2016-01-01

    Approximately 5-7% of acute-care patients suffer from bacteremia. Bacteremia may give rise to bacterial spread to different tissues. Conventional imaging procedures as X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and ultrasound are often first-line imaging methods for identification and localization of infection. These methods are, however, not always successful. Early identification and localization of infection is critical for the appropriate and timely selection of therapy. The aim of this study was thus; a head to head comparison of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) to PET with tracers that potentially could improve uncovering of infectious lesions in soft tissues. We chose 11C-methionine, 11C-PK11195, and 68Ga-citrate as tracers and besides presenting their bio-distribution we validated their diagnostic utility in pigs with experimental bacterial infection. Four juvenile 14-15 weeks old female domestic pigs were scanned seven days after intra-arterial inoculation in the right femoral artery with a porcine strain of S. aureus using a sequential scanning protocol with 18F-FDG, 11C-methionine, 11C-PK11195 and 68Ga-citrate. This was followed by necropsy of the pigs consisting of gross pathology, histopathology and microbial examination. The pigs primarily developed lesions in lungs and neck muscles. 18F-FDG had higher infection to background ratios and accumulated in most infectious foci caused by S. aureus, while 11C-methionine and particularly 11C-PK11195 and 68Ga-citrate accumulated to a lesser extent in infectious foci. 18F-FDG-uptake was seen in the areas of inflammatory cells and to a much lesser extent in reparative infiltration surrounding necrotic regions. PMID:27069765

  14. 18F-FDG PET imaging in a patient with late omental infarction after treatment of pancreatic adenocarcinoma.

    PubMed

    Chassagnon, Guillaume; Metrard, Gilles; Besse, Hélène; Gauvain, Sabine

    2014-06-01

    We report a case of late omental infarction visualized by F-FDG PET/CT during follow-up for pancreatic adenocarcinoma. The 65-year-old patient was referred for imaging 8 months after pancreaticoduodenectomy and 2 months after completion of a course of chemotherapy. PET/CT showed an FDG-avid omental lesion that suggested peritoneal carcinomatosis. The appearance and evolution at follow-up studies confirmed the diagnosis of omental infarction, a rare complication of pancreatic surgery. This case revealed the possibility of late FDG uptake in omental infarction.

  15. Evaluation of the combined effects of target size, respiratory motion and background activity on 3D and 4D PET/CT images

    NASA Astrophysics Data System (ADS)

    Park, Sang-June; Ionascu, Dan; Killoran, Joseph; Mamede, Marcelo; Gerbaudo, Victor H.; Chin, Lee; Berbeco, Ross

    2008-07-01

    Gated (4D) PET/CT has the potential to greatly improve the accuracy of radiotherapy at treatment sites where internal organ motion is significant. However, the best methodology for applying 4D-PET/CT to target definition is not currently well established. With the goal of better understanding how to best apply 4D information to radiotherapy, initial studies were performed to investigate the effect of target size, respiratory motion and target-to-background activity concentration ratio (TBR) on 3D (ungated) and 4D PET images. Using a PET/CT scanner with 4D or gating capability, a full 3D-PET scan corrected with a 3D attenuation map from 3D-CT scan and a respiratory gated (4D) PET scan corrected with corresponding attenuation maps from 4D-CT were performed by imaging spherical targets (0.5-26.5 mL) filled with 18F-FDG in a dynamic thorax phantom and NEMA IEC body phantom at different TBRs (infinite, 8 and 4). To simulate respiratory motion, the phantoms were driven sinusoidally in the superior-inferior direction with amplitudes of 0, 1 and 2 cm and a period of 4.5 s. Recovery coefficients were determined on PET images. In addition, gating methods using different numbers of gating bins (1-20 bins) were evaluated with image noise and temporal resolution. For evaluation, volume recovery coefficient, signal-to-noise ratio and contrast-to-noise ratio were calculated as a function of the number of gating bins. Moreover, the optimum thresholds which give accurate moving target volumes were obtained for 3D and 4D images. The partial volume effect and signal loss in the 3D-PET images due to the limited PET resolution and the respiratory motion, respectively were measured. The results show that signal loss depends on both the amplitude and pattern of respiratory motion. However, the 4D-PET successfully recovers most of the loss induced by the respiratory motion. The 5-bin gating method gives the best temporal resolution with acceptable image noise. The results based on the 4D

  16. Stereotactic Comparison Study of 18F-Alfatide and 18F-FDG PET Imaging in an LLC Tumor-Bearing C57BL/6 Mouse Model

    PubMed Central

    Wei, Yu-Chun; Gao, Yongsheng; Zhang, Jianbo; Fu, Zheng; Zheng, Jinsong; Liu, Ning; Hu, Xudong; Hou, Wenhong; Yu, Jinming; Yuan, Shuanghu

    2016-01-01

    This study aimed to stereotactically compare the PET imaging performance of 18F-Alfatide (18F-ALF-NOTA-PRGD2, denoted as 18F-Alfatide) and 18F-fluorodeoxyglucose (FDG) and immunohistochemistry (IHC) staining in Lewis lung carcinoma (LLC) tumor-bearing C57BL/6 mouse model. 18F-FDG standard uptake values (SUVs) were higher than 18F-Alfatide SUVs in tumors, most of the normal tissues and organs except for the bladder. Tumor-to-brain, tumor-to-lung, and tumor-to-heart ratios of 18F-Alfatide PET were significantly higher than those of 18F-FDG PET (P < 0.001). The spatial heterogeneity of the tumors was detected, and the tracer accumulation enhanced from the outer layer to the inner layer consistently using the two tracers. The parameters of the tumors were significantly correlated with each other between 18F-FDG SUV and GLUT-1 (R = 0.895, P < 0.001), 18F-Alfatide SUV and αvβ3 (R = 0.595, P = 0.019), 18F-FDG SUV and 18F-Alfatide SUV (R = 0.917, P < 0.001), and GLUT-1 and αvβ3 (R = 0.637, P = 0.011). Therefore, 18F-Alfatide PET may be an effective tracer for tumor detection, spatial heterogeneity imaging and an alternative supplement to 18F-FDG PET, particularly for patients with enhanced characteristics in the brain, chest tumors or diabetes, meriting further study. PMID:27350554

  17. Monitoring of anti-cancer treatment with (18)F-FDG and (18)F-FLT PET: a comprehensive review of pre-clinical studies.

    PubMed

    Jensen, Mette Munk; Kjaer, Andreas

    2015-01-01

    Functional imaging of solid tumors with positron emission tomography (PET) imaging is an evolving field with continuous development of new PET tracers and discovery of new applications for already implemented PET tracers. During treatment of cancer patients, a general challenge is to measure treatment effect early in a treatment course and by that to stratify patients into responders and non-responders. With 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) and 3'-deoxy-3'-[(18)F]fluorothymidine((18)F-FLT) two of the cancer hallmarks, altered energy metabolism and increased cell proliferation, can be visualized and quantified non-invasively by PET. With (18)F-FDG and (18)F-FLT PET changes in energy metabolism and cell proliferation can thereby be determined after initiation of cancer treatment in both clinical and pre-clinical studies in order to predict, at an early time-point, treatment response. It is hypothesized that decreases in glycolysis and cell proliferation may occur in tumors that are sensitive to the applied cancer therapeutics and that tumors that are resistant to treatment will show unchanged glucose metabolism and cell proliferation. Whether (18)F-FDG and/or (18)F-FLT PET can be used for prediction of treatment response has been analyzed in many studies both following treatment with conventional chemotherapeutic agents but also following treatment with different targeted therapies, e.g. monoclonal antibodies and small molecules inhibitors. The results from these studies have been most variable; in some studies early changes in (18)F-FDG and (18)F-FLT uptake predicted later tumor regression whereas in other studies no change in tracer uptake was observed despite the treatment being effective. The present review gives an overview of pre-clinical studies that have used (18)F-FDG and/or (18)F-FLT PET for response monitoring of cancer therapeutics.

  18. Using PET/CT Bone Scan Dynamic Data to Evaluate Tibia Remodeling When a Taylor Spatial Frame Is Used: Short and Longer Term Differences

    PubMed Central

    Lundblad, Henrik; Maguire, Gerald Q.; Karlsson-Thur, Charlotte; Jonsson, Cathrine; Noz, Marilyn E.; Zeleznik, Michael P.; Jacobsson, Hans; Weidenhielm, Lars

    2015-01-01

    Eighteen consecutive patients, treated with a Taylor Spatial Frame for complex tibia conditions, gave their informed consent to undergo Na18F− PET/CT bone scans. We present a Patlak-like analysis utilizing an approximated blood time-activity curve eliminating the need for blood aliquots. Additionally, standardized uptake values (SUV) derived from dynamic acquisitions were compared to this Patlak-like approach. Spherical volumes of interest (VOIs) were drawn to include broken bone, other (normal) bone, and muscle. The SUVm(t) (m = max, mean) and a series of slopes were computed as (SUVm(ti) − SUVm(tj))/(ti − tj), for pairs of time values ti and tj. A Patlak-like analysis was performed for the same time values by computing ((VOIp(ti)/VOIe(ti))−(VOIp(tj)/VOIe(tj)))/(ti − tj), where p = broken bone, other bone, and muscle and e = expected activity in a VOI. Paired comparisons between Patlak-like and SUVm slopes showed good agreement by both linear regression and correlation coefficient analysis (r = 84%, rs = 78%-SUVmax, r = 92%, and rs = 91%-SUVmean), suggesting static scans could substitute for dynamic studies. Patlak-like slope differences of 0.1 min−1 or greater between examinations and SUVmax differences of ~5 usually indicated good remodeling progress, while negative Patlak-like slope differences of −0.06 min−1 usually indicated poor remodeling progress in this cohort. PMID:26436093

  19. Thoracic cancer imaging with PET/CT in radiation oncology

    NASA Astrophysics Data System (ADS)

    Chi, Pai-Chun Melinda

    Significance. Respiratory motion has been shown to cause artifacts in PET/CT imaging. This breathing artifact can have a significant impact on PET quantification and it can lead to large uncertainties when using PET for radiation therapy planning. We have demonstrated a promising solution to resolve the breathing artifact by acquiring respiration-averaged CT (ACT) for PET/CT. The purpose of this work was to optimize the ACT acquisition for clinical implementation and to evaluate the impact of ACT on PET/CT quantification. The hypothesis was that ACT is an effective method in removing the breathing artifact when compared to our current clinical protocol. Methods. Phase and cine approaches for acquiring ACT were investigated and the results of these two approaches were compared to the ACT generated from clinical 4DCT data sets (abbreviated as ACT10phs ). In the phase approach, ACT was generated based on combinations of selected respiratory phases; in the cine approach, ACT was generated based on cine images acquired over a fixed cine duration. The phase combination and cine duration that best approximated the ACT10phs were determined to be the optimized scanning parameters. 216 thoracic PET/CT patients were scanned with both current clinical and the ACT protocols. The effects of ACT on PET/CT quantification were assessed by comparing clinical PET/CT and ACT PET/CT using 3 metrics: PET/CT image alignment, maximum standardized uptake value (SUVmax), and threshold segmented gross tumor volume (GTV). Results. ACT10phs can be best approximated to within 2% of SUV variation by phase averaging based on 4 representative phases, and to within 3% by cine image averaging based on >3s of cine duration. We implemented the cine approach on the PET/CT scanners and acquired 216 patient data sets. 68% of patients had breathing artifacts in their clinical PET/CT and the artifacts were removed/reduced in all corresponding ACT PET/CT. PET/CT quantification for lesions <50 cm3 and

  20. Effects of acupuncture at HT7 on glucose metabolism in a rat model of Alzheimer's disease: an 18F-FDG-PET study

    PubMed Central

    Lai, Xinsheng; Ren, Jie; Lu, Yangjia; Cui, Shaoyang; Chen, Junqi; Huang, Yong; Tang, Chunzhi; Shan, Baoci; Nie, Bingbing

    2016-01-01

    Objective To explore the effects of acupuncture at HT7 on different cerebral regions in a rat model of Alzheimer's disease (AD) with the application of 18F-2-fluoro-deoxy-D-glucose positron emission tomography (FDG-PET). Methods Sixty Wistar rats were included after undergoing a Y-maze electric sensitivity test. Ten rats were used as a healthy control group. The remaining 50 rats were injected stereotaxically with ibotenic acid into the right nucleus basalis magnocellularis and injected intraperitoneally with D-galactose. AD was successfully modelled in 36 rats, which were randomly divided into three groups (n=12 each): the AD group, which remained untreated; the AD+HT7 group, which received 20 sessions of acupuncture at HT7 over 1 month; and the AD+Sham group, which received acupuncture at a distant non-acupuncture point. Total reaction time (TRT) was measured by Y-maze and 18F-FDG-PET scans were conducted on day 1 and 30. PET images were processed with Statistical Parametric Mapping 8.0. Results Pre-treatment, TRT was greater in all AD groups versus controls (mean±SD 24.10±2.48 vs 41.34±5.00 s). Post-treatment, TRT was shortened in AD+HT7 versus AD+Sham and AD groups (p<0.0001, two-way analysis of variance). Glucose metabolic activity in the hippocampus, thalamus, hypothalamus, frontal lobe, and temporal lobe was decreased in AD rats compared with healthy controls and relatively elevated after HT7 acupuncture. Compared with sham acupuncture, HT7 needling had a greater positive influence on brain glucose metabolism. Conclusions Needling at HT7 can improve memory ability and cerebral glucose metabolic activity of the hippocampus, thalamus, hypothalamus, and frontal/temporal lobes in an AD rat model. PMID:26654890

  1. Fourier-wavelet restoration in PET/CT brain studies

    NASA Astrophysics Data System (ADS)

    Knešaurek, Karin

    2012-10-01

    Our goal is to improve brain PET imaging through the application of a novel, hybrid Fourier-wavelet (WFT) restoration technique. The major limitation of PET studies is a relatively poor resolution in comparison with MRI and CT imaging and there is a need for improved PET imaging. A GE DLS PET/CT 16 slice system was used to acquire the studies. In order to create restoration filters the point source study was performed. The 6-fillable spheres and 3D Hoffman brain phantom studies were acquired and used to test and optimize the restoration approach. The patient data used in the study were acquired in a 3D PET mode, using the standard clinical protocol. Here, we have implemented Fourier-wavelet regularized restoration. In the Fourier domain, the inverse of modulation transfer function was multiplied by a Butterworth low-pass filter, order n=6 and cut-off frequency f=0.35 cycles/pixel. In addition, wavelet (Daubechies, order 2) noise suppression was applied by “hard threshold”. Hot spheres and 3D Hoffman brain studies showed that the restoration process not only improves resolution and contrast but also improves quantification in 3D PET/CT imaging. The average contrast increase was 19% and the quantification improved in the range 8-20% depending on sphere size. In the restored images, there was no significant increase in noise when compared with the original images. The clinical studies followed brain phantom findings, i.e., the restored images had better contrast and resolution properties, when compared with the original images. The results of the study demonstrate that the quality and quantification of 3D brain 18F FDG PET images can be significantly improved by Fourier-wavelet (WFT) restoration filtering.

  2. Unusual ¹⁸F-FDG PET/CT finding of an oxyphil parathyroid adenoma in a patient with Hodgkin's Lymphoma.

    PubMed

    Niccoli-Asabella, Artor; Ferrari, Cristina; Antonica, Filippo; Scardapane, Arnaldo; Rubini, Domenico; Rubini, Giuseppe

    2014-01-01

    Malignancy-associated hypercalcemia is a complication of advanced tumours that is associated to a poor prognosis. Thorough evaluation to establish its cause is essential because some patients may actually have undiagnosed primary hyperparathyroidism. We report a case of a patient affected by Hodgkin's Lymphoma and persistent hypercalcemia with an incidental (18)F-FDG PET/CT finding in the anterior neck region, not ascribable to malignancy, confirmed with (99m)Tc-sestamibi scintigraphy. It was removed by minimally invasive surgery. It was shown to be an oxyphil parathyroid adenoma localized in an unusual site.

  3. Comparison of first pass bolus AIFs extracted from sequential 18F-FDG PET and DSC-MRI of mice

    NASA Astrophysics Data System (ADS)

    Evans, Eleanor; Sawiak, Stephen J.; Ward, Alexander O.; Buonincontri, Guido; Hawkes, Robert C.; Adrian Carpenter, T.

    2014-01-01

    Accurate kinetic modelling of in vivo physiological function using positron emission tomography (PET) requires determination of the tracer time-activity curve in plasma, known as the arterial input function (AIF). The AIF is usually determined by invasive blood sampling methods, which are prohibitive in murine studies due to low total blood volumes. Extracting AIFs from PET images is also challenging due to large partial volume effects (PVE). We hypothesise that in combined PET with magnetic resonance imaging (PET/MR), a co-injected bolus of MR contrast agent and PET ligand can be tracked using fast MR acquisitions. This protocol would allow extraction of a MR AIF from MR contrast agent concentration-time curves, at higher spatial and temporal resolution than an image-derived PET AIF. A conversion factor could then be applied to the MR AIF for use in PET kinetic analysis. This work has compared AIFs obtained from sequential DSC-MRI and PET with separate injections of gadolinium contrast agent and 18F-FDG respectively to ascertain the technique‧s validity. An automated voxel selection algorithm was employed to improve MR AIF reproducibility. We found that MR and PET AIFs displayed similar character in the first pass, confirmed by gamma variate fits (p<0.02). MR AIFs displayed reduced PVE compared to PET AIFs, indicating their potential use in PET/MR studies.

  4. Variability of [18F]FDG administered activities among patients undergoing PET examinations: an international multicenter survey.

    PubMed

    Del Sole, Angelo; Lecchi, Michela; Lucignani, Giovanni

    2016-03-01

    Given the large number of [(18)F]fluorodeoxyglucose (FDG) PET examinations performed annually throughout the world, reduction of the administered activity without compromise of the clinical information being sought is encouraged. Guidelines issued by the SNMMI and European Association of Nuclear Medicine (EANM) differ greatly on the choice of the activity that should be administered to patients: the EANM suggests a personalised activity based on the patient's body weight, whereas the SNMMI recommends the administration of fixed activities. The authors analysed a database of 24 716 [(18)F]FDG administrations performed worldwide in 15 PET centres to assess the degree of heterogeneity, in relation to available technology, operational protocols and reference guidelines. Median activities based on the patients' body weight were 43 % lower than fixed-activity administrations (p < 0.001). When TOF scanners are available, the median activity is lowered, but when comparing centres with the same technology or those that use the same operational protocols, weight-based activities are still significantly lower than fixed activities.

  5. Fiber-Optic System for Dual-Modality Imaging of Glucose Probes 18F-FDG and 6-NBDG in Atherosclerotic Plaques

    PubMed Central

    Zaman, Raiyan T.; Kosuge, Hisanori; Pratx, Guillem; Carpenter, Colin; Xing, Lei; McConnell, Michael V.

    2014-01-01

    Background Atherosclerosis is a progressive inflammatory condition that underlies coronary artery disease (CAD)–the leading cause of death in the United States. Thus, the ultimate goal of this research is to advance our understanding of human CAD by improving the characterization of metabolically active vulnerable plaques within the coronary arteries using a novel catheter-based imaging system. The aims of this study include (1) developing a novel fiber-optic imaging system with a scintillator to detect both 18F and fluorescent glucose probes, and (2) validating the system on ex vivo murine plaques. Methods A novel design implements a flexible fiber-optic catheter consisting of both a radio-luminescence and a fluorescence imaging system to detect radionuclide 18F-fluorodeoxyglucose (18F-FDG) and the fluorescent analog 6-(N-(7-Nitrobenz-2-oxa-1,3-diazol-4-yl)amino)-6-Deoxyglucose (6-NBDG), respectively. Murine macrophage-rich atherosclerotic carotid plaques were imaged ex vivo after intravenous delivery of 18F-FDG or 6-NBDG. Confirmatory optical imaging by IVIS-200 and autoradiography were also performed. Results Our fiber-optic imaging system successfully visualized both 18F-FDG and 6-NBDG probes in atherosclerotic plaques. For 18F-FDG, the ligated left carotid arteries (LCs) exhibited 4.9-fold higher radioluminescence signal intensity compared to the non-ligated right carotid arteries (RCs) (2.6×104±1.4×103 vs. 5.4×103±1.3×103 A.U., P = 0.008). Similarly, for 6-NBDG, the ligated LCs emitted 4.3-fold brighter fluorescent signals than the control RCs (1.6×102±2.7×101 vs. 3.8×101±5.9 A.U., P = 0.002). The higher uptake of both 18F-FDG and 6-NBDG in ligated LCs were confirmed with the IVIS-200 system. Autoradiography further verified the higher uptake of 18F-FDG by the LCs. Conclusions This novel fiber-optic imaging system was sensitive to both radionuclide and fluorescent glucose probes taken up by murine atherosclerotic plaques. In addition, 6

  6. Sphenoid wing meningioma behavior on 11C-PiB and 18F-FDG PET.

    PubMed

    Chaves, Hernan; Bergamo, Yanina; Paz, Santiago; Sanchez, Flavio; Vazquez, Silvia

    2015-01-01

    Two patients with mild cognitive impairment underwent C-PiB and F-FDG brain PET. Both patients had previously gone through a contrast-enhanced MRI scan that revealed extra-axial tumors next to the sphenoid wing, suggestive of meningiomas. C-PiB PET images showed a highly increased uptake by the extra-axial masses. These 2 cases represent 1.2% of our C-PiB population (n = 163). No meningioma was found with negative C-PiB uptake. The F-FDG concentration was not increased within the lesions. C-PiB could be used as a meningioma marker.

  7. Using PET/CT Bone Scan Dynamic Data to Evaluate Tibia Remodeling When a Taylor Spatial Frame Is Used: Short and Longer Term Differences.

    PubMed

    Lundblad, Henrik; Maguire, Gerald Q; Karlsson-Thur, Charlotte; Jonsson, Cathrine; Noz, Marilyn E; Zeleznik, Michael P; Jacobsson, Hans; Weidenhielm, Lars

    2015-01-01

    Eighteen consecutive patients, treated with a Taylor Spatial Frame for complex tibia conditions, gave their informed consent to undergo Na(18)F(-) PET/CT bone scans. We present a Patlak-like analysis utilizing an approximated blood time-activity curve eliminating the need for blood aliquots. Additionally, standardized uptake values (SUV) derived from dynamic acquisitions were compared to this Patlak-like approach. Spherical volumes of interest (VOIs) were drawn to include broken bone, other (normal) bone, and muscle. The SUV m (t) (m = max, mean) and a series of slopes were computed as (SUV m (t i ) - SUV m (t j ))/(t i - t j ), for pairs of time values t i and t j . A Patlak-like analysis was performed for the same time values by computing ((VOI p (t i )/VOI e (t i ))-(VOI p (t j )/VOI e (t j )))/(t i - t j ), where p = broken bone, other bone, and muscle and e = expected activity in a VOI. Paired comparisons between Patlak-like and SUV m slopes showed good agreement by both linear regression and correlation coefficient analysis (r = 84%, r s = 78%-SUVmax, r = 92%, and r s = 91%-SUVmean), suggesting static scans could substitute for dynamic studies. Patlak-like slope differences of 0.1 min(-1) or greater between examinations and SUVmax differences of ~5 usually indicated good remodeling progress, while negative Patlak-like slope differences of -0.06 min(-1) usually indicated poor remodeling progress in this cohort.

  8. Reproducibility of Static and Dynamic 18F-FDG, 18F-FLT, and 18F-FMISO MicroPET Studies in a Murine Model of HER2+ Breast Cancer

    PubMed Central

    Whisenant, Jennifer G.; Peterson, Todd E.; Fluckiger, Jacob U.; Tantawy, Mohammed Noor; Ayers, Gregory D.; Yankeelov, Thomas E.

    2013-01-01

    Purpose The objective of this study is to determine the reproducibility of static 2-deoxy-2-[18F] fluoro-D-glucose (18F-FDG), 3′-deoxy-3′-[18F]fluorothymidine (18F-FLT), and [18F]-fluoromisonidazole (18F-FMISO) microPET measurements, as well as kinetic parameters returned from analyses of dynamic 18F-FLT and 18F-FMISO data. Procedures HER2+ xenografts were established in nude mice. Dynamic data were acquired for 60 min, followed by a repeat injection and second scan 6 h later. Reproducibility was assessed for the percent-injected dose per gram (%ID/g) for each radiotracer, and with kinetic parameters (K1–k4, Ki) for 18F-FLT and 18F-FMISO. Results The value needed to reflect a change in tumor physiology is given by the 95 % confidence interval (CI), which is ±14, ±5, and ±6 % for 18F-FDG (n=12), 18F-FLT (n=11), and 18F-FMISO (n=11) %ID/g, respectively. Vd (=K1/k2), k3, and KFLT are the most reproducible 18F-FLT (n=9) kinetic parameters, with 95 % CIs of ±18, ±10, and ±18 %, respectively. Vd and KFMISO are the most reproducible 18F-FMISO kinetic parameters (n=7) with 95 % CIs of ±16 and ±14 %, respectively. Conclusions Percent-injected dose per gram measurements are reproducible and appropriate for detecting treatment-induced changes. Kinetic parameters have larger threshold values, but are potentially sufficiently reproducible to detect treatment response. PMID:22644988

  9. {sup 18}F-FDG PET Definition of Gross Tumor Volume for Radiotherapy of Lung Cancer: Is the Tumor Uptake Value-Based Approach Appropriate for Lymph Node Delineation?

    SciTech Connect

    Rodriguez, Nuria; Sanz, Xavier; Trampal, Carlos; Foro, Palmira; Reig, Anna; Lacruz, Marti; Membrive, Ismael; Lozano, Joan; Quera, Jaime; Algara, Manuel

    2010-11-01

    Purpose: Positron emission tomography (PET) with the glucose analogue [18F] fluoro-2-deoxy-D-glucose ({sup 18}F-FDG-PET) has been used in radiation treatment planning for non-small-cell carcinoma. To date, lymph nodes have been contoured according to the uptake of the tumor. This prospective study was performed to evaluate if nodal volume delineates according to FDG uptake within the primary tumor (PET-GTVnt) is suitable for nodal target volume delineation or if individualized nodal FDG uptake measure (PET-GTVnn) is necessary to better nodal target definition. Methods and Materials: Forty cases, who underwent a diagnostic {sup 18}F-FDG PET/computed tomography (CT) scan, were included. Two PET-based GTVs for each lymph node were contoured and compared. First, we used an isocontour of 40% of the maximum tumor uptake (PET-GTVnt). Second, an isocontour of 40% of the maximum uptake of each node (PET-GTVnn) was employed. To avoid interobserver variability, this was carried out by the same radiation oncologist. Afterwards, the difference between both lymph node volumes was plotted against the ratio of the maximum uptakes (I{sub n}/I{sub t}) in a linear regression analysis. Results: Compared with CT-based lymph node volume (CT-GTVn), the intraclass correlation coefficient of PET-GTVnn was higher than the coefficient of PET-GTVnt (p < 0.001). All cases could be divided into four groups: undetected (17.5%), detected but overestimated (10%), detected but underestimated (35%), and correctly detected (37.5%). Conclusions: If a method of automatic delineation shall be applied, this method must be applied to every lesion separately. However, to facilitate the delineation in daily practice, when I{sub n}/I{sub t} is {<=}25%, lymph nodes could be delineated in accordance with tumor uptake, keeping an absolute difference in radii <5 mm.

  10. A preliminary investigation into textural features of intratumoral metabolic heterogeneity in 18F-FDG PET for overall survival prognosis in patients with bulky cervical cancer treated with definitive concurrent chemoradiotherapy

    PubMed Central

    Ho, Kung-Chu; Fang, Yu-Hua Dean; Chung, Hsiao-Wen; Yen, Tzu-Chen; Ho, Tsung-Ying; Chou, Hung-Hsueh; Hong, Ji-Hong; Huang, Yi-Ting; Wang, Chun-Chieh; Lai, Chyong-Huey

    2016-01-01

    We examined the role of intratumoral metabolic heterogeneity on 18F-FDG PET during concurrent chemoradiotherapy (CCRT) in predicting survival outcomes for patients with cervical cancer. This prospective study consisted of 44 patients with bulky (≥ 4 cm) cervical cancer treated with CCRT. All patients underwent serial 18F-FDG PET studies. Primary cervical tumor standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) were measured in pretreatment and intra-treatment (2 weeks) PET scans. Regional textural features were analyzed using the grey level run length encoding method (GLRLM) and grey-level size zone matrix. Associations between PET parameters and overall survival (OS) were tested by Kaplan-Meier analysis and Cox regression model. In univariate analysis, pretreatment grey-level nonuniformity (GLNU) > 48 by GLRLM textural analysis and intra-treatment decline of run length nonuniformity < 55% and the decline of TLG (∆TLG) < 60% were associated with significantly worse OS. In multivariate analysis, only ∆TLG was significant (P = 0.009). Combining pretreatment with intra-treatment factors, we defined the patients with a initial GLNU > 48 and a ∆TLG ≤ 60% as the high-risk group and the other patients as the low-risk. The 5-year OS rate for the high-risk group was significantly worse than that for the low-risk group (42% vs. 81%, respectively, P = 0.001). The heterogeneity of intratumoral FDG distribution and the early temporal change in TLG may be an important predictor for OS in patients with bulky cervical cancer. This gives the opportunity to adjust individualized regimens early in the treatment course. PMID:27508103

  11. Dosimetric evaluation of the staff working in a PET/CT department

    NASA Astrophysics Data System (ADS)

    Dalianis, K.; Malamitsi, J.; Gogou, L.; Pagou, M.; Efthimiadou, R.; Andreou, J.; Louizï, A.; Georgiou, E.

    2006-12-01

    The dosimetric literature data concerning the medical personnel working in positron emission tomography/computed tomography (PET/CT) departments are limited. Therefore, we measured the radiation dose of the staff working in the first PET/CT department in Greece at the Diagnostic and Therapeutic Center of Athens HYGEIA—Harvard Medical International. As, for the time being, only 2-deoxy-2-[ 18F]fluoro-d-glucose (FDG) PET studies are performed, radiation dose measurements concern those derived from dispensing of the radiopharmaceutical as well as from the patients undergoing FDG-PET imaging. Our aim is to develop more effective protective measures against radionuclide exposure. To estimate the effective dose from external exposure, all seven members of the staff (two nurses, two medical physicists, two technologists, one secretary) had TLD badges worn at the upper pocket of their overall, TLD rings on the right hand and digital dosimeters at their upper side pocket. In addition, isodose curves were measured with thermoluminescence detectors for distances of 20, 50, 70 and 100 cm away from patients who had been injected with 18F-FDG. Dose values of the PET/CT staff were measured with digital detectors, TLD badges and TLD rings over the first 8 months for a total of 160 working days of the department's operation, consisting of a workload of about 10-15 patients/week who received 250-420 MBq of 18F-FDG each. Whole - body collective doses and hand doses for the staff were the following: Nurse #1 received 1.6 mSv as a whole body dose and 2,1 as a hand dose, Nurse #2 received 1.9 and 2.4 mSv respectively. For medical physicist #1 the dose values were 1.45 mSv whole body and 1.7 mSv hand dose, for medical physicist #2 1.67 mSv wholebody dose and 1.55 mSv hand dose and for technologists #1 & #2 the whole body doses were 0.7 and 0.64 mSv respectively. Lastly, the secretary received 0.1 mSv whole body dose. These preliminary data have shown that the dose levels of our PET/CT

  12. Systematic analysis of 18F-FDG PET and metabolism, proliferation and hypoxia markers for classification of head and neck tumors

    PubMed Central

    2014-01-01

    Background Quantification of molecular cell processes is important for prognostication and treatment individualization of head and neck cancer (HNC). However, individual tumor comparison can show discord in upregulation similarities when analyzing multiple biological mechanisms. Elaborate tumor characterization, integrating multiple pathways reflecting intrinsic and microenvironmental properties, may be beneficial to group most uniform tumors for treatment modification schemes. The goal of this study was to systematically analyze if immunohistochemical (IHC) assessment of molecular markers, involved in treatment resistance, and 18F-FDG PET parameters could accurately distinguish separate HNC tumors. Methods Several imaging parameters and texture features for 18F-FDG small-animal PET and immunohistochemical markers related to metabolism, hypoxia, proliferation and tumor blood perfusion were assessed within groups of BALB/c nu/nu mice xenografted with 14 human HNC models. Classification methods were used to predict tumor line based on sets of parameters. Results We found that 18F-FDG PET could not differentiate between the tumor lines. On the contrary, combined IHC parameters could accurately allocate individual tumors to the correct model. From 9 analyzed IHC parameters, a cluster of 6 random parameters already classified 70.3% correctly. Combining all PET/IHC characteristics resulted in the highest tumor line classification accuracy (81.0%; cross validation 82.0%), which was just 2.2% higher (p = 5.2×10-32) than the performance of the IHC parameter/feature based model. Conclusions With a select set of IHC markers representing cellular processes of metabolism, proliferation, hypoxia and perfusion, one can reliably distinguish between HNC tumor lines. Addition of 18F-FDG PET improves classification accuracy of IHC to a significant yet minor degree. These results may form a basis for development of tumor characterization models for treatment allocation purposes

  13. Comparability of [(18)F]THK5317 and [(11)C]PIB blood flow proxy images with [(18)F]FDG positron emission tomography in Alzheimer's disease.

    PubMed

    Rodriguez-Vieitez, Elena; Leuzy, Antoine; Chiotis, Konstantinos; Saint-Aubert, Laure; Wall, Anders; Nordberg, Agneta

    2017-02-01

    For amyloid positron emission tomography tracers, the simplified reference tissue model derived ratio of influx rate in target relative to reference region (R1) has been shown to serve as a marker of brain perfusion, and, due to the strong coupling between perfusion and metabolism, as a proxy for glucose metabolism. In the present study, 11 prodromal Alzheimer's disease and nine Alzheimer's disease dementia patients underwent [(18)F]THK5317, carbon-11 Pittsburgh Compound-B ([(11)C]PIB), and 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) positron emission tomography to assess the possible use of early-phase [(18)F]THK5317 and R1 as proxies for brain perfusion, and thus, for glucose metabolism. Discriminative performance (prodromal vs Alzheimer's disease dementia) of [(18)F]THK5317 (early-phase SUVr and R1) was compared with that of [(11)C]PIB (early-phase SUVr and R1) and [(18)F]FDG. Strong positive correlations were found between [(18)F]THK5317 (early-phase, R1) and [(18)F]FDG, particularly in frontal and temporoparietal regions. Differences in correlations between early-phase and R1 ([(18)F]THK5317 and [(11)C]PIB) and [(18)F]FDG, were not statistically significant, nor were differences in area under the curve values in the discriminative analysis. Our findings suggest that early-phase [(18)F]THK5317 and R1 provide information on brain perfusion, closely related to glucose metabolism. As such, a single positron emission tomography study with [(18)F]THK5317 may provide information about both tau pathology and brain perfusion in Alzheimer's disease, with potential clinical applications.

  14. Drug-induced pneumonitis detected earlier by 18F-FDG-PET than by high-resolution CT: a case report with non-Hodgkin's lymphoma.

    PubMed

    Yamane, Tomohiko; Daimaru, Osami; Ito, Satoshi; Nagata, Takeshi; Yoshiya, Kazuhiko; Fukaya, Nobuyuki; Ito, Shinichi; Imai, Teruhiko; Uchida, Hideo

    2008-10-01

    Drug-induced pneumonitis is a serious and an unpredictable side effect of chemotherapy in patients with malignant lymphoma. We present the case of a 51-year-old man who developed drug-induced pneumonitis during chemotherapy for non-Hodgkin's lymphoma in which pneumonitis was detected earlier by 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) than by high-resolution computed tomography (HRCT). After five courses of chemotherapy, 18F-FDG-PET was performed for assessing residual lesions, and diffuse lung uptake was incidentally observed. No symptoms were present, and HRCT performed immediately following PET revealed no abnormalities. Mild dyspnea appeared 3 days after PET, and additional HRCT revealed patchy ground-glass opacities disseminated with the appearance of interlobular septum thickening. Drug-induced pneumonitis was finally diagnosed, and treatment was initiated. 18F-FDG-PET can be an imaging modality for detecting drug-induced pneumonitis at an extremely early stage in which HRCT is incapable of revealing any abnormal changes.

  15. Preliminary Monte Carlo study of (18)F-FDG SPECT imaging with LaBr(3):Ce Crystal-based Gamma Cameras.

    PubMed

    Alzimami, Khalid S; Sassi, Salem A; Alkhorayef, Mohammed A; Spyrou, Nicholas M

    2010-01-01

    The utility of (18)F-deoxyglucose ((18)F-FDG) in oncology, cardiology, and neurology has generated great interest in a more economical ways of imaging (18)F-FDG than conventional PET scanners. The main thrust of this work is to investigate the potential use of LaBr(3):Ce materials in a low-cost FDG-SPECT system compared to NaI(Tl) using GATE Monte Carlo simulation. System performance at 140 keV and 511 keV was assessed using energy spectra, system sensitivity and count rate performance. Comparison of the LaBr(3):Ce and NaI(Tl) crystal-based systems showed 4.5% and 8.9% higher system sensitivity for the LaBr(3):Ce at 140 keV and 511 keV, respectively. The LaBr(3):Ce scintillator significantly improves intrinsic count rate performance due to its fast decay time with respect to NaI(Tl). In conclusion, because LaBr(3):Ce crystal combines excellent intrinsic count rate performance with slightly increased system sensitivity, it has the potential to be used for (18)F-FDG -SPECT systems.

  16. Neurobehavioral Abnormalities in the HIV-1 Transgenic Rat Do Not Correspond to Neuronal Hypometabolism on 18F-FDG-PET

    PubMed Central

    Papadakis, Georgios Z.; Muthusamy, Siva; Lee, Dianne E.; Ibrahim, Wael G.; Nair, Anand; Koziol, Deloris; Maric, Dragan; Hammoud, Dima A.

    2016-01-01

    Motor and behavioral abnormalities are common presentations among individuals with HIV-1 associated neurocognitive disorders (HAND). We investigated whether longitudinal motor and behavioral performance in the HIV-1 transgenic rat (Tg), a commonly used neuro-HIV model, corresponded to in vivo neuronal death/dysfunction, by using rotarod and open field testing in parallel to [18F] 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET). We demonstrated that age-matched non-Tg wild type (WT) rats outperformed the HIV-1 Tg rats at most time points on rotarod testing. Habituation to rotarod occurred at 8 weeks of age (fifth weekly testing session) in the WT rats but it never occurred in the Tg rats, suggesting deficits in motor learning. Similarly, in open field testing, WT rats outperformed the Tg rats at most time points, suggesting defective exploratory/motor behavior and increased emotionality in the Tg rat. Despite the neurobehavioral abnormalities, there were no concomitant deficits in 18F-FDG uptake in Tg rats on PET compared to age-matched WT rats and no significant longitudinal loss of FDG uptake in either group. The negative PET findings were confirmed using 14C- Deoxy-D-glucose autoradiography in 32 week-old Tg and WT rats. We believe that the neuropathology in the HIV-1 Tg rat is more likely a consequence of neuronal dysfunction rather than overt neurodegeneration/neuronal cell death, similar to what is seen in HIV-positive patients in the post-ART era. PMID:27010205

  17. SU-E-J-123: Assessing Segmentation Accuracy of Internal Volumes and Sub-Volumes in 4D PET/CT of Lung Tumors Using a Novel 3D Printed Phantom

    SciTech Connect

    Soultan, D; Murphy, J; James, C; Hoh, C; Moiseenko, V; Cervino, L; Gill, B

    2015-06-15

    Purpose: To assess the accuracy of internal target volume (ITV) segmentation of lung tumors for treatment planning of simultaneous integrated boost (SIB) radiotherapy as seen in 4D PET/CT images, using a novel 3D-printed phantom. Methods: The insert mimics high PET tracer uptake in the core and 50% uptake in the periphery, by using a porous design at the periphery. A lung phantom with the insert was placed on a programmable moving platform. Seven breathing waveforms of ideal and patient-specific respiratory motion patterns were fed to the platform, and 4D PET/CT scans were acquired of each of them. CT images were binned into 10 phases, and PET images were binned into 5 phases following the clinical protocol. Two scenarios were investigated for segmentation: a gate 30–70 window, and no gating. The radiation oncologist contoured the outer ITV of the porous insert with on CT images, while the internal void volume with 100% uptake was contoured on PET images for being indistinguishable from the outer volume in CT images. Segmented ITVs were compared to the expected volumes based on known target size and motion. Results: 3 ideal breathing patterns, 2 regular-breathing patient waveforms, and 2 irregular-breathing patient waveforms were used for this study. 18F-FDG was used as the PET tracer. The segmented ITVs from CT closely matched the expected motion for both no gating and gate 30–70 window, with disagreement of contoured ITV with respect to the expected volume not exceeding 13%. PET contours were seen to overestimate volumes in all the cases, up to more than 40%. Conclusion: 4DPET images of a novel 3D printed phantom designed to mimic different uptake values were obtained. 4DPET contours overestimated ITV volumes in all cases, while 4DCT contours matched expected ITV volume values. Investigation of the cause and effects of the discrepancies is undergoing.

  18. Single scan parameterization of space-variant point spread functions in image space via a printed array: the impact for two PET/CT scanners.

    PubMed

    Kotasidis, F A; Matthews, J C; Angelis, G I; Noonan, P J; Jackson, A; Price, P; Lionheart, W R; Reader, A J

    2011-05-21

    Incorporation of a resolution model during statistical image reconstruction often produces images of improved resolution and signal-to-noise ratio. A novel and practical methodology to rapidly and accurately determine the overall emission and detection blurring component of the system matrix using a printed point source array within a custom-made Perspex phantom is presented. The array was scanned at different positions and orientations within the field of view (FOV) to examine the feasibility of extrapolating the measured point source blurring to other locations in the FOV and the robustness of measurements from a single point source array scan. We measured the spatially-variant image-based blurring on two PET/CT scanners, the B-Hi-Rez and the TruePoint TrueV. These measured spatially-variant kernels and the spatially-invariant kernel at the FOV centre were then incorporated within an ordinary Poisson ordered subset expectation maximization (OP-OSEM) algorithm and compared to the manufacturer's implementation using projection space resolution modelling (RM). Comparisons were based on a point source array, the NEMA IEC image quality phantom, the Cologne resolution phantom and two clinical studies (carbon-11 labelled anti-sense oligonucleotide [(11)C]-ASO and fluorine-18 labelled fluoro-l-thymidine [(18)F]-FLT). Robust and accurate measurements of spatially-variant image blurring were successfully obtained from a single scan. Spatially-variant resolution modelling resulted in notable resolution improvements away from the centre of the FOV. Comparison between spatially-variant image-space methods and the projection-space approach (the first such report, using a range of studies) demonstrated very similar performance with our image-based implementation producing slightly better contrast recovery (CR) for the same level of image roughness (IR). These results demonstrate that image-based resolution modelling within reconstruction is a valid alternative to projection

  19. Low-Dose PET/CT and Full-Dose Contrast-Enhanced CT at the Initial Staging of Localized Diffuse Large B-Cell Lymphomas

    PubMed Central

    Sabaté-Llobera, Aida; Cortés-Romera, Montserrat; Mercadal, Santiago; Hernández-Gañán, Javier; Pomares, Helena; González-Barca, Eva; Gámez-Cenzano, Cristina

    2016-01-01

    Computed tomography (CT) has been used as the reference imaging technique for the initial staging of diffuse large B-cell lymphoma until recent days, when the introduction of positron emission tomography (PET)/CT imaging as a hybrid technique has become of routine use. However, the performance of both examinations is still common. The aim of this work was to compare the findings between low-dose 2-deoxy-2-(18F)fluoro-d-glucose (18F-FDG) PET/CT and full-dose contrast-enhanced CT (ceCT) in 28 patients with localized diffuse large B-cell lymphoma according to PET/CT findings, in order to avoid the performance of ceCT. For each technique, a comparison in the number of nodal and extranodal involved regions was performed. PET/CT showed more lesions than ceCT in both nodal (41 vs. 36) and extranodal localizations (16 vs. 15). Disease staging according to both techniques was concordant in 22 patients (79%) and discordant in 6 patients (21%), changing treatment management in 3 patients (11%). PET/CT determined a better staging and therapeutic approach, making the performance of an additional ceCT unnecessary. PMID:27559300

  20. Schmorl’s Nodes can cause increased 68Ga-DOTA-TATE activity on PET/CT, mimicking metastasis in patients with neuroendocrine malignancy

    PubMed Central

    Papadakis, Georgios Z.; Millo, Corina; Bagci, Ulas; Sadowski, Samira M.; Stratakis, Constatntine A.

    2015-01-01

    Schmorl’s node (SN) is the herniation of the nucleus pulposus (NP) through the cartilaginous and bony endplate into the adjacent vertebral body. It is documented that SNs produce areas of moderately increased 18F-FDG uptake. We present a case of a patient with history of neuroendocrine tumor (NET), who underwent 68Ga-DOTA-TATE- PET/CT for follow-up, showing increased focal vertebral uptake suggestive of bone metastasis. Computed tomography (CT) revealed typical findings of a SN. The presented case indicates that SNs should be considered when encountering focally increased skeletal uptake in 68Ga-DOTA-TATE-PET/CT studies, which can mimic metastasis in patients with history of NETs. PMID:26562580

  1. Mixed Phenotypic Acute Leukemia (mixed myeloid/B-cell) with Myeloid Sarcoma of the Thyroid Gland: A Rare Entity with Rarer Asssociation - Detected on FDG PET/CT

    PubMed Central

    Khanna, Gaurav; Damle, Nishikant Avinash; Agarwal, Shipra; Roy, Maitrayee; Jain, Deepali; Mallick, Soumyaranjan; Ahmed, Shamim; Tripathi, Madhavi; Gogia, Ajay

    2017-01-01

    Mixed phenotypic acute leukemia (MPAL) is a rare clinical entity. MPAL associated with myeloidsarcoma (MS) is still rarer with only three cases mentioned in English literature. MS has been described in myriads of location, most commonly in skin, gums and lymph nodes. Although theoritically possible, it is very rare to find MS involving the thyroid gland. The diagnosis of MS can be elusive, very often masquerades and mislabeled as lymphoma. A high index of clinical suspicion coupled with PET/CT findings along with morphological clues and thorough peripheral blood, and bone marrow evaluation is mandatory for arriving at the definitive diagnosis. We report the case of a 58-year-old female presenting with thyroid swelling that was subsequently diagnosed to be MS of the thyroid with underlying MPAL (mixed myeloid/B-cell) only after 18F-FDG PET/CT, which revealed an unusual abnormal pattern of multifocal intense FDG uptake in the thyroid gland. PMID:28242986

  2. Discrepancies and priorities in staging and restaging malignant lymphoma by SPET, SPET/CT, PET/CT and PET/MRI.

    PubMed

    Chavdarova, Lidia Ivanova; Tzonevska, Antonia Dencheva; Piperkova, Elena Nikolova

    2013-01-01

    Due to the rapid development of modern imaging methods and also of medical oncology, there has been a significant progress in diagnosis and treatment of malignant lymphomas in the last few years. Nuclear medicine (NM) imaging methods gained new perspectives via the so called hybrid technologies-single-photon emission tomography combined with computed tomography (SPET/CT), positron emission tomography combined with computed tomography (PET/CT) and recently even positron emission tomography combined with magnetic resonance imaging (PET/MRI), which have led to a better image quality and diagnostic findings. Since SPET/CT evolved later than the "gold standard" 18F-FDG-PET/CT in lymphoma diagnostics, there are fewer studies with it, but it seems to be an excellent alternative to PET/CT. The role of PET/CT is confirmed up-to-date for typically 18F-FDG-avid lymphomas, in staging and restaging diffuse large B-cell and some aggressive follicular lymphomas, in a suspected relapse of treatment of both Hodgkin's and non-Hodgkin's lymphomas. There are many discussions about the "interim-PET" but the recent results indicate its important prognostic role for predicting disease-free survival and the possibility to modify treatment intensity in order to reduce late side effects. On the other hand, the routine and approbated use of conventional morphologic imaging methods CT and MRI serve as a "reference standard" for the newer hybrid technologies not only in diagnostics but also in the cost-benefit ratio analysis and remain the basic imaging modalities when hybrid methods are not available. In conclusion, our review points at the main advantages and disadvantages of each NM method mentioned above in the diagnosis and follow-up of malignant lymphomas. Specifically, problems in differential diagnostics and further possibilities to better optimize the diagnostic and therapeutic algorithm are mentioned.

  3. Prognostic value of interim (18)F-FDG-PET in diffuse large B cell lymphoma treated with rituximab-based immune-chemotherapy: a systematic review and meta-analysis.

    PubMed

    Zhu, Danxia; Xu, Xiao-Li; Fang, Cheng; Ji, Mei; Wu, Jun; Wu, Chang-Ping; Jiang, Jing-Ting

    2015-01-01

    The prognostic value of an interim fluorine-18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) for diffuse large B-cell lymphoma (DLBCL) has been assessed by different groups. However, studies have suggested that the use of rituximab could limit the predictive value of interim (18)F-FDG PET for DLBCL. To clarify the prognostic value of interim (18)F-FDG PET in DLBCL patients treated with rituximab based immunochemotherapy, we searched for relevant studies in PubMed, the Cochrane Library and EMBASE. A random versus fixed effects model was applied according to the heterogeneity. According to the literature search strategies, 11 studies were identified. The pooled HR comparing PFS between patients with positive and negative results was 2.96 (95% CI=2.25-3.89). The patients in interim (18)F-FDG PET negative group had a higher CR rates than that in interim (18)F-FDG PET positive group (RR=5.53, 95% CI=2.59-11.80). Consistent evidence favoring interim (18)F-FDG PET-based treatment assessment should be considered in the management of patients with DLBCL.

  4. Staging of cervical cancer based on tumor heterogeneity characterized by texture features on 18F-FDG PET images

    NASA Astrophysics Data System (ADS)

    Mu, Wei; Chen, Zhe; Liang, Ying; Shen, Wei; Yang, Feng; Dai, Ruwei; Wu, Ning; Tian, Jie

    2015-07-01

    The aim of the study is to assess the staging value of the tumor heterogeneity characterized by texture features and other commonly used semi-quantitative indices extracted from 18F-FDG PET images of cervical cancer (CC) patients. Forty-two patients suffering CC at different stages were enrolled in this study. Firstly, we proposed a new tumor segmentation method by combining the intensity and gradient field information in a level set framework. Secondly, fifty-four 3D texture features were studied besides of SUVs (SUVmax, SUVmean, SUVpeak) and metabolic tumor volume (MTV). Through correlation analysis, receiver-operating-characteristic (ROC) curves analysis, some independent indices showed statistically significant differences between the early stage (ES, stages I and II) and the advanced stage (AS, stages III and IV). Then the tumors represented by those independent indices could be automatically classified into ES and AS, and the most discriminative feature could be chosen. Finally, the robustness of the optimal index with respect to sampling schemes and the quality of the PET images were validated. Using the proposed segmentation method, the dice similarity coefficient and Hausdorff distance were 91.78   ±   1.66% and 7.94   ±   1.99 mm, respectively. According to the correlation analysis, all the fifty-eight indices could be divided into 20 groups. Six independent indices were selected for their highest areas under the ROC curves (AUROC), and showed significant differences between ES and AS (P  <  0.05). Through automatic classification with the support vector machine (SVM) Classifier, run percentage (RP) was the most discriminative index with the higher accuracy (88.10%) and larger AUROC (0.88). The Pearson correlation of RP under different sampling schemes is 0.9991   ±   0.0011. RP is a highly stable feature and well correlated with tumor stage in CC, which suggests it could differentiate ES and AS with high

  5. Metabolic signatures of malignant and non-malignant mass-forming lesions in the periampulla and pancreas in FDG PET/CT scan: an atlas with pathologic correlation.

    PubMed

    Santhosh, Sampath; Mittal, Bhagwant Rai; Rana, Surinder Singh; Srinivasan, Radhika; Bhattacharya, Anish; Das, Ashim; Bhasin, Deepak

    2015-06-01

    Positron emission tomography (PET) has been used for the characterization of pancreatic and periampullary lesions. Pancreatitis-associated inflammation affecting only a portion of the pancreas gives the appearance of a mass lesion on imaging. Consequently, the differential diagnosis between cancer and pancreatitis becomes a commonly encountered problem. Traditionally, PET was interpreted as positive (to denote malignancy) if fluorodeoxyglucose (FDG) activity in the pancreas exceeded background activity and as negative (to denote benign) if activity was less than or equal to background activity. However, the specificity was limited with this method of interpretation. A relatively wide overlap has been reported between semiquantitative uptake values obtained in cancers and those in inflammatory lesions. Also, the qualitative (metabolic patterns) and quantitative variables (standardized uptake values) have been complementary and at sometimes controversial to each other in various clinical situations. There is paucity of data in the literature highlighting the role of FDG PET/CT in characterization of such mass lesions. The primary aim of this pictorial review is to list the various pathologic processes of pancreas and periampulla that could be studied with FDG PET/CT and recognize the different FDG uptake patterns and apply this information to characterize the different lesions affecting the pancreas and periampulla. We have also discussed the limitations of conventional imaging and advantages of FDG PET/CT for the evaluation mass-forming lesions of the pancreas and periampulla.

  6. Exploratory Evaluation of MR Permeability with 18F-FDG PET Mapping in Pediatric Brain Tumors: A Report from the Pediatric Brain Tumor Consortium

    PubMed Central

    Zukotynski, Katherine A.; Fahey, Frederic H.; Vajapeyam, Sridhar; Ng, Sarah S.; Kocak, Mehmet; Gururangan, Sridharan; Kun, Larry E.; Poussaint, Tina Y.

    2014-01-01

    The purpose of this study was to develop a method of registering 18F-FDG PET with MR permeability images for investigating the correlation of 18F-FDG uptake, permeability, and cerebral blood volume (CBV) in children with pediatric brain tumors and their relationship with outcome. Methods Twenty-four children with brain tumors in a phase II study of bevacizumab and irinotecan underwent brain MR and 18F-FDG PET within 2 wk. Tumor types included supratentorial high-grade astrocytoma (n = 7), low-grade glioma (n = 9), brain stem glioma (n = 4), medulloblastoma (n = 2), and ependymoma (n = 2). There were 33 cases (pretreatment only [n = 12], posttreatment only [n = 3], and both pretreatment [n = 9] and posttreatment [n = 9]). 18F-FDG PET images were registered to MR images from the last time point of the T1 perfusion time series using mutual information. Three-dimensional regions of interest (ROIs) drawn on permeability images were automatically transferred to registered PET images. The quality of ROI registration was graded (1, excellent; 2, very good; 3, good; 4, fair; and 5, poor) by 3 independent experts. Spearman rank correlations were used to assess correlation of maximum tumor permeability (Kpsmax), maximum CBV (CBVmax), and maximum 18F-FDG uptake normalized to white matter (T/Wmax). Cox proportional hazards models were used to investigate associations of these parameters with progression-free survival (PFS). Results The quality of ROI registration between PET and MR was good to excellent in 31 of 33 cases. There was no correlation of baseline Kpsmax with CBVmax (Spearman rank correlation =0.018 [P =0.94]) or T/Wmax (Spearman rank correlation = 0.07 [P = 0.76]). Baseline CBVmax was correlated with T/Wmax (Spearman rank correlation = 0.47 [P = 0.036]). Baseline Kpsmax, CBVmax, and T/Wmax were not significantly associated with PFS (P = 0.42, hazard ratio [HR] = 0.97, 95% confidence interval [CI] = 0.90–1.045, and number of events [nevents] = 15 for Kpsmax; P = 0

  7. EGFR mutations are associated with higher incidence of distant metastases and smaller tumor size in patients with non-small-cell lung cancer based on PET/CT scan.

    PubMed

    Guan, Jian; Chen, Min; Xiao, Nanjie; Li, Lu; Zhang, Yue; Li, Qinyang; Yang, Mi; Liu, Laiyu; Chen, Longhua

    2016-01-01

    The study aimed to explore the correlation of epidermal growth factor receptor (EGFR) mutation with tumor node metastasis (TNM) stage in patients with non-small-cell lung cancer (NSCLC) who underwent positron emission tomography/computed tomography (PET/CT) scan. Patients diagnosed with NSCLC who underwent EGFR mutation status testing and PET/CT or PET/CT plus brain magnetic resonance imaging scan at initial diagnosis in Nanfang Hospital between July 2010 and June 2014 were consecutively enrolled. The correlation of EGFR mutation status with TNM stage and distant metastasis organs including brain, bone, liver, pleural, adrenals and contralateral lobe of lung were analyzed. A total of 401 patients were enrolled. Tumor size in EGFR mutation group was significantly smaller than the wild-type group (P < 0.001). Further, patients with EGFR mutations were demonstrated significantly more frequent in patients with distant metastasis than non-metastasis (45.7 vs 32.2 %, P = 0.007). The rates of bone (32.2 vs 22.8 %, P = 0.007) and brain (16.3 vs 9.4 %, P = 0.008) metastasis were significantly higher in EGFR mutation group than the wild-type group. In the subgroup of 199 metastatic NSCLC patients, patients with EGFR mutation were significantly associated with a smaller tumor size (P = 0.013) and earlier N stage (P = 0.033). Of note, compared with the EGFR wild-type group, patients had a higher likelihood of developing brain plus bone metastases at initial diagnosis of EGFR mutation group (20.9 vs 7.5 %, P = 0.018). Taken together, we identify that EGFR mutations might associate with more aggressive tumor progression than the wild types in NSCLC. In addition, patients with tumor having EGFR mutation had a smaller tumor size than without mutation.

  8. Analysis of induced radionuclides in replacement parts and liquid wastes in a medical cyclotron solely used for production of 18F for [18F]FDG.

    PubMed

    Mochizuki, S; Ishigure, N; Ogata, Y; Kobayashi, T

    2013-04-01

    Radioactivities produced in replacement parts and liquid wastes in a medical cyclotron used to produce (18)F for [(18)F]FDG with 10MeV protons were analyzed. Nineteen radionuclides were found in the replacement parts and liquid wastes. Among them, long-lived (56)Co in the Havar foils is critical in terms of radioactive waste management. The estimated dose level of exposure for the operating staff during the replacement of parts was around 310μSv/y, which is smaller than the recommended dose limit for workers.

  9. Clinical applications of choline PET/CT in brain tumors.

    PubMed

    Giovannini, Elisabetta; Lazzeri, Patrizia; Milano, Amalia; Gaeta, Maria Chiara; Ciarmiello, Andrea

    2015-01-01

    Malignant gliomas and metastatic tumors are the most common forms of brain tumors. From a clinical perspective, neuroimaging plays a significant role, in diagnosis, treatment planning, and follow-up. To date MRI is considered the current clinical gold standard for imaging, however, despite providing superior structural detail it features poor specificity in identifying viable tumors in brain treated with surgery, radiation, or chemotherapy. In the last years functional neuroimaging has become largely widespread thanks to the use of molecular tracers employed in cellular metabolism which has significantly improved the management of patients with brain tumors, especially in the post-treatment phase. Despite the considerable progress of molecular imaging in oncology its use in the diagnosis of brain tumors is still limited by a few wellknown technical problems. Because 18F-FDG, the most common radiotracer used in oncology, is avidly accumulated by normal cortex, the low tumor/background signal ratio makes it difficult to distinguish the tumor from normal surrounding tissues. By contrast, radiotracers with higher specificity for the tumor are labeled with a short half-life isotopes which restricts their use to those centers equipped with a cyclotron and radiopharmacy facility. 11C-choline has been reported as a suitable tracer for neuroimaging application. The recent availability of choline labeled with a long half-life radioisotope as 18F increases the possibility of studying this tracer's potential role in the staging of brain tumors. The present review focuses on the possible clinical applications of PET/CT with choline tracers in malignant brain tumors and brain metastases, with a special focus on malignant gliomas.

  10. 18F-FDG PET imaging for identifying the dynamics of intestinal disease caused by SFTSV infection in a mouse model

    PubMed Central

    Hayasaka, Daisuke; Nishi, Kodai; Fuchigami, Takeshi; Shiogama, Kazuya; Onouchi, Takanori; Shimada, Satoshi; Tsutsumi, Yutaka; Morita, Kouichi

    2016-01-01

    Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease that causes fever, enteritis, thrombocytopenia, and leucopenia and can be fatal in up to 30% of cases. However, the mechanism of severe disease is not fully understood. Molecular imaging approaches, such as positron-emission tomography (PET), are functional in vivo imaging techniques that provide real-time dynamics of disease progression, assessments of pharmacokinetics, and diagnoses for disease progression. Molecular imaging also potentially provides useful approaches to explore the pathogenesis of viral infections. Thus, the purpose of this study was to image the pathological features of SFTSV infection in vivo by PET imaging. In a mouse model, we showed that 18F-FDG accumulations clearly identified the intestinal tract site as a pathological site. We also demonstrated that 18F-FDG PET imaging can assess disease progression and response to antiserum therapy within the same individual. This is the first report demonstrating a molecular imaging strategy for SFTSV infection. Our results provide potentially useful information for preclinical studies such as the elucidation of the mechanism of SFTSV infection in vivo and the assessment of drugs for SFTS treatment. PMID:26700962

  11. SU-E-I-100: Heterogeneity Studying for Primary and Lymphoma Tumors by Using Multi-Scale Image Texture Analysis with PET-CT Images

    SciTech Connect

    Li, Dengwang; Wang, Qinfen; Li, H; Chen, J

    2014-06-01

    Purpose: The purpose of this research is studying tumor heterogeneity of the primary and lymphoma by using multi-scale texture analysis with PET-CT images, where the tumor heterogeneity is expressed by texture features. Methods: Datasets were collected from 12 lung cancer patients, and both of primary and lymphoma tumors were detected with all these patients. All patients underwent whole-body 18F-FDG PET/CT scan before treatment.The regions of interest (ROI) of primary and lymphoma tumor were contoured by experienced clinical doctors. Then the ROI of primary and lymphoma tumor is extracted automatically by using Matlab software. According to the geometry size of contour structure, the images of tumor are decomposed by multi-scale method.Wavelet transform was performed on ROI structures within images by L layers sampling, and then wavelet sub-bands which have the same size of the original image are obtained. The number of sub-bands is 3L+1.The gray level co-occurrence matrix (GLCM) is calculated within different sub-bands, thenenergy, inertia, correlation and gray in-homogeneity were extracted from GLCM.Finally, heterogeneity statistical analysis was studied for primary and lymphoma tumor using the texture features. Results: Energy, inertia, correlation and gray in-homogeneity are calculated with our experiments for heterogeneity statistical analysis.Energy for primary and lymphomatumor is equal with the same patient, while gray in-homogeneity and inertia of primaryare 2.59595±0.00855, 0.6439±0.0007 respectively. Gray in-homogeneity and inertia of lymphoma are 2.60115±0.00635, 0.64435±0.00055 respectively. The experiments showed that the volume of lymphoma is smaller than primary tumor, but thegray in-homogeneity and inertia were higher than primary tumor with the same patient, and the correlation with lymphoma tumors is zero, while the correlation with primary tumor isslightly strong. Conclusion: This studying showed that there were effective heterogeneity

  12. SU-E-J-262: Variability in Texture Analysis of Gynecological Tumors in the Context of An 18F-FDG PET Adaptive Protocol

    SciTech Connect

    Nawrocki, J; Chino, J; Das, S; Craciunescu, O

    2015-06-15

    Purpose: This study examines the effect on texture analysis due to variable reconstruction of PET images in the context of an adaptive FDG PET protocol for node positive gynecologic cancer patients. By measuring variability in texture features from baseline and intra-treatment PET-CT, we can isolate unreliable texture features due to large variation. Methods: A subset of seven patients with node positive gynecological cancers visible on PET was selected for this study. Prescribed dose varied between 45–50.4Gy, with a 55–70Gy boost to the PET positive nodes. A baseline and intratreatment (between 30–36Gy) PET-CT were obtained on a Siemens Biograph mCT. Each clinical PET image set was reconstructed 6 times using a TrueX+TOF algorithm with varying iterations and Gaussian filter. Baseline and intra-treatment primary GTVs were segmented using PET Edge (MIM Software Inc., Cleveland, OH), a semi-automatic gradient-based algorithm, on the clinical PET and transferred to the other reconstructed sets. Using an in-house MATLAB program, four 3D texture matrices describing relationships between voxel intensities in the GTV were generated: co-occurrence, run length, size zone, and neighborhood difference. From these, 39 textural features characterizing texture were calculated in addition to SUV histogram features. The percent variability among parameters was first calculated. Each reconstructed texture feature from baseline and intra-treatment per patient was normalized to the clinical baseline scan and compared using the Wilcoxon signed-rank test in order to isolate variations due to reconstruction parameters. Results: For the baseline scans, 13 texture features showed a mean range greater than 10%. For the intra scans, 28 texture features showed a mean range greater than 10%. Comparing baseline to intra scans, 25 texture features showed p <0.05. Conclusion: Variability due to different reconstruction parameters increased with treatment, however, the majority of texture

  13. Correlation Between Radiation Dose to {sup 18}F-FDG-PET Defined Active Bone Marrow Subregions and Acute Hematologic Toxicity in Cervical Cancer Patients Treated With Chemoradiotherapy

    SciTech Connect

    Rose, Brent S.; Liang Yun; Lau, Steven K.; Jensen, Lindsay G.; Yashar, Catheryn M.; Hoh, Carl K.; Mell, Loren K.

    2012-07-15

    Purpose: To test the hypothesis that radiation dose to {sup 18}F-fluorodeoxyglucose positron emission tomography ({sup 18}F-FDG-PET)-defined active bone marrow (BM{sub ACT}) subregions is correlated with hematologic toxicity in cervical cancer patients treated with chemoradiotherapy. Methods and Materials: The conditions of 26 women with cervical cancer who underwent {sup 18}F-FDG-PET before treatment with concurrent cisplatin and intensity-modulated radiation therapy were analyzed. BM{sub ACT} was defined as the subregion of total bone marrow (BM{sub TOT}) with a standardized uptake value (SUV) equal to or above the mean for that individual. Inactive bone marrow (BM{sub INACT}) was defined as BM{sub TOT} - BM{sub ACT}. Generalized linear modeling was used to test the correlation between BM{sub ACT} and BM{sub INACT} dose-volume metrics and hematologic nadirs, particularly white blood cell count (WBC) and absolute neutrophil count (ANC). Results: Increased BM{sub ACT} mean dose was significantly associated with decreased log(WBC) nadir ({beta} = -0.04; 95% CI, -0.07to -0.01; p = 0.009), decreased log(ANC) nadir ({beta} = -0.05; 95% CI, -0.08 to -0.02; p = 0.006), decreased hemoglobin nadir ({beta} = -0.16; 95% CI, -0.27 to -0.05; p = 0.010), and decreased platelet nadir ({beta} = -6.16; 95% CI, -9.37 to -2.96; p < 0.001). By contrast, there was no association between BM{sub INACT} mean dose and log(WBC) nadir ({beta} = -0.01; 95% CI, -0.06 to 0.05; p = 0.84), log(ANC) nadir ({beta} = -0.03; 95% CI, -0.10 to 0.04; p = 0.40), hemoglobin nadir ({beta} = -0.09; 95% CI, -0.31 to 0.14; p = 0.452), or platelet nadir ({beta} = -3.47; 95% CI, -10.44 to 3.50; p = 0.339). Conclusions: Irradiation of BM subregions with higher {sup 18}F-FDG-PET activity was associated with hematologic toxicity, supporting the hypothesis that reducing dose to BM{sub ACT} subregions could mitigate hematologic toxicity. Future investigation should seek to confirm these findings and to identify

  14. Dynamic PET/CT measurements of induced positron activity in a prostate cancer patient after 50-MV photon radiation therapy

    PubMed Central

    2013-01-01

    application, wherein 7 min after treatment was about 5% of that of a standard 18F-FDG PET scan, the distribution of activated tissue elements (15O and 11C) could be calculated from the dynamic PET data. One possible future application of this method could possibly be to measure and determine the tumor tissue composition in order to identify any hypoxic or necrotic region, which is information that can be used in the ongoing therapy planning process. Trial registration The official name of the trial committee of this study is ‘Regionala etikprövningsnämnden i Stockholm’ (FE 289, Stockholm, SE-17177, Sweden). The unique identifying number is 2011/1789-31/2. PMID:23343347

  15. PET/CT in radiation oncology

    SciTech Connect

    Pan, Tinsu; Mawlawi, Osama

    2008-11-15

    PET/CT is an effective tool for the diagnosis, staging and restaging of cancer patients. It combines the complementary information of functional PET images and anatomical CT images in one imaging session. Conventional stand-alone PET has been replaced by PET/CT for improved patient comfort, patient throughput, and most importantly the proven clinical outcome of PET/CT over that of PET and that of separate PET and CT. There are over two thousand PET/CT scanners installed worldwide since 2001. Oncology is the main application for PET/CT. Fluorine-18 deoxyglucose is the choice of radiopharmaceutical in PET for imaging the glucose uptake in tissues, correlated with an increased rate of glycolysis in many tumor cells. New molecular targeted agents are being developed to improve the accuracy of targeting different disease states and assessing therapeutic response. Over 50% of cancer patients receive radiation therapy (RT) in the course of their disease treatment. Clinical data have demonstrated that the information provided by PET/CT often changes patient management of the patient and/or modifies the RT plan from conventional CT simulation. The application of PET/CT in RT is growing and will become increasingly important. Continuing improvement of PET/CT instrumentation will also make it easier for radiation oncologists to integrate PET/CT in RT. The purpose of this article is to provide a review of the current PET/CT technology, to project the future development of PET and CT for PET/CT, and to discuss some issues in adopting PET/CT in RT and potential improvements in PET/CT simulation of the thorax in radiation therapy.

  16. Postinfectious Opsoclonus-Myoclonus Syndrome in a 41-Year-Old Patient-Visualizing Hyperactivation in Deep Cerebellar Nuclei by Cerebral [(18) F]-FDG- PET.

    PubMed

    Mustafa, Mona; Levin, Johannes; Schöberl, Florian; Rominger, Axel

    2015-01-01

    A 41-year-old woman presented with acute onset headache, vertigo, nausea, and gait disorder, initially interpreted as a common cold. Within 2 weeks, she developed a severe opsoclonus-myoclonus syndrome with truncal ataxia. Cerebrospinal fluid examination and serological findings suggested a recent infection with Coxsackie B3 virus. [(18) F]-FDG-PET proved to be the only imaging tool to identify the underlying pathology depicting hyperactivation in the vestibulo- and spinocerebellum as well as hyperactivation of the ocular muscles. At the clinical follow-up 4 months later, the patient's symptoms were considerably improved with only intermittent low-frequency opsoclonus. Corresponding PET findings were able to depict the response to therapy in the ocular muscles and the inferior vermis, whereas the deep cerebellar nuclei were still hyperactivated, however, to a lesser extent. This finding highlights the usefulness of functional/metabolic brain imaging to study the pathophysiology of this type of disorder.

  17. [Positron emission tomography (PET) with [18F]-FDG in bronchopulmonary cancer and its impact on medical decision at the time of diagnosis, staging, or recurrence evaluation].

    PubMed

    Grahek, D; Montravers, F; Mayaud, C; Regnard, J F; Kerrou, K; Younsi, N; Talbot, J N

    2001-12-01

    Clinical usefulness of [18F]-FDG imaging, performed by means of a dedicated or a "hybrid" PET machine, has been recognised in France since November 1998. Among the clinical indications, three major clinical settings of lung cancer have been included: characterisation, staging and detection of recurrences. After a brief presentation of the PET scintigraphic imaging modality, authors report on the experience of the nuclear medicine team of Hôspital Tenon and summarise the results in literature. For tumour characterisation, a recent meta-analysis obtained a 96% sensitivity, a 73% specificity, a 91% positive predictive value and a 90% negative predictive value, the performances being better for lesions greater than 1 cm. For staging, an increase greater than 15% both in sensitivity and specificity has been observed with dedicated or "hybrid" PET versus CT for N staging. Detection of distant metastases was also more accurate using [18F]-FDG. A similar increase was observed in the detection of recurrence, in accordance with our study; some authors described even better results. A better anatomical delineation of the lesions detected with FDG can be achieved by means of image fusion with CT; this technique is likely to develop as a routine tool in the near future. Finally, FDG imaging led to modification of patient's management in 37% of the cases according to a recent meta-analysis versus 53% of the cases in our retrospective survey concerning the first year of installation of a dedicated PET machine. This rate was equal with dedicated PET and with CDET. In 46% of the cases an inter-modality change occurred, and in 7% an intra-modality change consisting mainly in adaptation of the surgical procedure. As soon as the FDG examination became available, its clinical impact, in the French medical context, appeared to reach the highest values that were published internationally.

  18. 18F-FDG PET-Derived Textural Indices Reflect Tissue-Specific Uptake Pattern in Non-Small Cell Lung Cancer

    PubMed Central

    Orlhac, Fanny; Soussan, Michaël; Chouahnia, Kader; Martinod, Emmanuel; Buvat, Irène

    2015-01-01

    Purpose Texture indices (TI) calculated from 18F-FDG PET tumor images show promise for predicting response to therapy and survival. Their calculation involves a resampling of standardized uptake values (SUV) within the tumor. This resampling can be performed differently and significantly impacts the TI values. Our aim was to investigate how the resampling approach affects the ability of TI to reflect tissue-specific pattern of metabolic activity. Methods 18F-FDG PET were acquired for 48 naïve-treatment patients with non-small cell lung cancer and for a uniform phantom. We studied 7 TI, SUVmax and metabolic volume (MV) in the phantom, tumors and healthy tissue using the usual relative resampling (RR) method and an absolute resampling (AR) method. The differences in TI values between tissue types and cancer subtypes were investigated using Wilcoxon’s tests. Results Most RR-based TI were highly correlated with MV for tumors less than 60 mL (Spearman correlation coefficient r between 0.74 and 1), while this correlation was reduced for AR-based TI (r between 0.06 and 0.27 except for RLNU where r = 0.91). Most AR-based TI were significantly different between tumor and healthy tissues (pvalues <0.01 for all 7 TI) and between cancer subtypes (pvalues<0.05 for 6 TI). Healthy tissue and adenocarcinomas exhibited more homogeneous texture than tumor tissue and squamous cell carcinomas respectively. Conclusion TI computed using an AR method vary as a function of the tissue type and cancer subtype more than the TI involving the usual RR method. AR-based TI might be useful for tumor characterization. PMID:26669541

  19. Rare Sites of Metastases in Prostate Cancer Detected on Ga-68 PSMA PET/CT Scan—A Case Series

    PubMed Central

    Dureja, Sugandha; Thakral, Parul; Pant, Vineet; Sen, Ishita

    2017-01-01

    Ga-68 labeled prostate-specific membrane antigen (PSMA) whole body PET/CT scan is a novel upcoming modality for the evaluation of prostate cancer. We present three cases of prostate cancer showing rare sites of metastases like brain, penis, and liver detected on Ga-68 PSMA PET/CT scan thus emphasizing its role in lesion detection and staging. PMID:28242977

  20. Early changes in [18F]FDG incorporation by breast cancer cells treated with trastuzumab in normoxic conditions: role of the Akt-pathway, glucose transport and HIF-1α.

    PubMed

    Fleming, Ian N; Andriu, Alexandra; Smith, Tim A D

    2014-04-01

    HER-2 overexpression does not guarantee response to HER2-targeting drugs such as trastuzumab, which is cardiotoxic and expensive, so early detection of response status is crucial. Factors influencing [(18)F]FDG incorporation in the timeframe of cell signalling down-regulation subsequent to trastuzumab treatment are investigated to provide a better understanding of the relationship between growth response and modulation of [(18)F]FDG incorporation. HER-2-overexpressing breast tumour cell lines, MDA-MB-453, SKBr3 and BT474 and MDA-MB-468 (HER2 non-over-expressor) were treated with trastuzumab (4 h) and probed for AKT, pAKT, ERK1/2, pERK1/2 and HIF-1α to determine early signalling pathway inhibitory effects of trastuzumab. Cells incubated with trastuzumab and/or PI3K inhibitor LY294002 and ERK1/2 inhibitor U0126 and glucose transport and [(18)F]FDG incorporation measured. Cell lines expressed AKT, pAKT, ERK1/2 and pERK1/2 but not HIF-1α. Trastuzumab treatment decreased pAkt but not pERK1/2 levels. Trastuzumab did not further inhibit AKT when maximally inhibited with LY294002. Treatment with LY294002 and trastuzumab for 4 h decreased [(18)F]FDG incorporation in BT474 and MDA-MB-453 but not SKBr3 cells. LY294002 inhibited glucose transport by each cell line, but the glucose transport rate was tenfold higher by SKBr3 cells than BT474 and MDA-MB-453 cells. AKT-induced uptake of [(18)F]FDG was found to be HIF-1α independent in breast cancer cell lines. AKT inhibition level and tumour cell glucose transport rate can influence whether or not PI3K inhibitors affect [(18)F]FDG incorporation which may account for the variation in preclinical and clinical findings associated with [(18)F]FDG-PET in response to trastuzumab and other HER-2 targeting drugs.

  1. SU-E-J-251: Incorporation of Pre-Therapy 18F-FDG Uptake with CT Texture Features in a Predictive Model for Radiation Pneumonitis Development

    SciTech Connect

    Anthony, G; Cunliffe, A; Armato, S; Al-Hallaq, H; Castillo, R; Pham, N; Guerrero, T

    2015-06-15

    Purpose: To determine whether the addition of standardized uptake value (SUV) statistical variables to CT lung texture features can improve a predictive model of radiation pneumonitis (RP) development in patients undergoing radiation therapy. Methods: Anonymized data from 96 esophageal cancer patients (18 RP-positive cases of Grade ≥ 2) were retrospectively collected including pre-therapy PET/CT scans, pre-/posttherapy diagnostic CT scans and RP status. Twenty texture features (firstorder, fractal, Laws’ filter and gray-level co-occurrence matrix) were calculated from diagnostic CT scans and compared in anatomically matched regions of the lung. The mean, maximum, standard deviation, and 50th–95th percentiles of the SUV values for all lung voxels in the corresponding PET scans were acquired. For each texture feature, a logistic regression-based classifier consisting of (1) the average change in that texture feature value between the pre- and post-therapy CT scans and (2) the pre-therapy SUV standard deviation (SUV{sub SD}) was created. The RP-classification performance of each logistic regression model was compared to the performance of its texture feature alone by computing areas under the receiver operating characteristic curves (AUCs). T-tests were performed to determine whether the mean AUC across texture features changed significantly when SUV{sub SD} was added to the classifier. Results: The AUC for single-texturefeature classifiers ranged from 0.58–0.81 in high-dose (≥ 30 Gy) regions of the lungs and from 0.53–0.71 in low-dose (< 10 Gy) regions. Adding SUVSD in a logistic regression model using a 50/50 data partition for training and testing significantly increased the mean AUC by 0.08, 0.06 and 0.04 in the low-, medium- and high-dose regions, respectively. Conclusion: Addition of SUVSD from a pre-therapy PET scan to a single CT-based texture feature improves RP-classification performance on average. These findings demonstrate the potential for

  2. False-positive hypermetabolic lesions on post-treatment PET-CT after influenza vaccination.

    PubMed

    Kim, Jeong-Eun; Kim, Eun Kyoung; Lee, Dae Ho; Kim, Sang-We; Suh, Cheolwon; Lee, Jung-Shin

    2011-06-01

    We report a case of a 59-year-old man with testicular germ cell tumor who showed new hypermetabolic lesions at the left axillary lymph nodes on a post-treatment positron emission tomography-computed tomography (PET-CT) scan. The hypermetabolic lesions were found to be caused by an influenza vaccination 10 days prior to the PET-CT scan and disappeared without additional treatment. To date, he is alive with complete remission.

  3. Prediction of positron emission tomography/computed tomography (PET/CT) positivity in patients with high-risk primary melanoma.

    PubMed

    Danielsen, Maria; Kjaer, Andreas; Wu, Max; Martineau, Lea; Nosrati, Mehdi; Leong, Stanley Pl; Sagebiel, Richard W; Iii, James R Miller; Kashani-Sabet, Mohammed

    2016-01-01

    Positron emission tomography/computed tomography (PET/CT) is an important tool to identify occult melanoma metastasis. To date, it is controversial which patients with primary cutaneous melanoma should have staging PET/CT. In this retrospective analysis of more than 800 consecutive patients with cutaneous melanoma, we sought to identify factors predictive of PET/CT positivity in the setting of newly-diagnosed high-risk primary melanoma to determine those patients most appropriate to undergo a PET/CT scan as part of their diagnostic work up. 167 patients with newly-diagnosed high-risk primary cutaneous melanoma underwent a PET/CT scan performed as part of their initial staging. Clinical and histologic factors were evaluated as possible predictors of melanoma metastasis identified on PET/CT scanning using both univariate and multivariate logistic regression. In all, 32 patients (19.2%) had a positive PET/CT finding of metastatic melanoma. In more than half of these patients (56.3%), PET/CT scanning identified disease that was not detectable on clinical examination. Mitotic rate, tumor thickness, lymphadenopathy, and bleeding were significantly predictive of PET/CT positivity. A combinatorial index constructed from these factors revealed a significant association between number of high-risk factors observed and prevalence of PET/CT positivity, which increased from 5.8% (with the presence of 0-2 factors) to 100.0%, when all four factors were present. These results indicate that combining clinical and histologic prognostic factors enables the identification of patients with a higher likelihood of a positive PET/CT scan.

  4. Prediction of positron emission tomography/computed tomography (PET/CT) positivity in patients with high-risk primary melanoma

    PubMed Central

    Danielsen, Maria; Kjaer, Andreas; Wu, Max; Martineau, Lea; Nosrati, Mehdi; Leong, Stanley PL; Sagebiel, Richard W; III, James R Miller; Kashani-Sabet, Mohammed

    2016-01-01

    Positron emission tomography/computed tomography (PET/CT) is an important tool to identify occult melanoma metastasis. To date, it is controversial which patients with primary cutaneous melanoma should have staging PET/CT. In this retrospective analysis of more than 800 consecutive patients with cutaneous melanoma, we sought to identify factors predictive of PET/CT positivity in the setting of newly-diagnosed high-risk primary melanoma to determine those patients most appropriate to undergo a PET/CT scan as part of their diagnostic work up. 167 patients with newly-diagnosed high-risk primary cutaneous melanoma underwent a PET/CT scan performed as part of their initial staging. Clinical and histologic factors were evaluated as possible predictors of melanoma metastasis identified on PET/CT scanning using both univariate and multivariate logistic regression. In all, 32 patients (19.2%) had a positive PET/CT finding of metastatic melanoma. In more than half of these patients (56.3%), PET/CT scanning identified disease that was not detectable on clinical examination. Mitotic rate, tumor thickness, lymphadenopathy, and bleeding were significantly predictive of PET/CT positivity. A combinatorial index constructed from these factors revealed a significant association between number of high-risk factors observed and prevalence of PET/CT positivity, which increased from 5.8% (with the presence of 0-2 factors) to 100.0%, when all four factors were present. These results indicate that combining clinical and histologic prognostic factors enables the identification of patients with a higher likelihood of a positive PET/CT scan. PMID:27766186

  5. A Unique Case of Increased 18F-FDG Metabolic Activity in the Soft Tissues of the Bilateral Upper Thighs Due to Immunizations in a Pediatric Patient

    PubMed Central

    Galloway, Terrel L.; Johnston, Mickaila J.; Starsiak, Michael D.; Silverman, Eugene D.

    2017-01-01

    A case of a 7-month-old white female who was referred for 18F-fluorodeoxyglucose (FDG) Positron emission tomography/computed tomography (PET/CT) initial evaluation of a lytic skull lesion with presumed diagnosis of Langerhans cell histiocytosis is described. Incidentally, she was found to have hypermetabolic nodules in the soft tissues of her anterior thighs. PMID:28217022

  6. 68Ga-PSMA PET/CT in Osteosarcoma in Fibrous Dysplasia.

    PubMed

    Sasikumar, Arun; Joy, Ajith; Pillai, M R A; Alex, Tony M; Narayanan, Geetha

    2017-03-24

    Fibrous dysplasia (FD) is a benign bone lesion with a rare but potential for malignant transformation. Neither Tc-MDP nor F-FDG PET/CT can differentiate between FD and areas of malignant transformation in FD. We described a case of osteosarcoma developing in FD with selective uptake of tracer in malignant transformation areas demonstrated on a Ga-PSMA PET/CT scan. Our case highlights the ability of Ga-PSMA PET/CT to map tumor neoangiogenesis in osteosarcoma arising in FD, which can have potential implications in prognostication, possibility of antiangiogenesis-based therapeutic options, and in response assessment following chemotherapy.

  7. The role of 18F-FDG PET/CT in the follow-up of well-differentiated thyroid cancer with negative thyroglobulin but positive and/or elevated antithyroglobulin antibody.

    PubMed

    Liu, Yiyan

    2016-06-01

    Thyroglobulin measurement is the most sensitive and important indicator of persistent and/or recurrent disease in the follow-up of well-differentiated thyroid cancer (DTC) after total thyroidectomy and radioiodine ablation therapy. However, positive or elevated thyroglobulin autoantibody (TgAb) interferes with the accurate measurement of serum thyroglobulin and may mask the presence of a recurrent and/or metastatic disease. It was reported that persistently positive TgAb could be viewed as evidence of the continued presence of functional thyroid cells, either benign or malignant, and elevated TgAb might indicate the recurrent and/or metastatic disease and could be used as an alternative of the tumor marker for DTC. However, the clinical application and usefulness of TgAb for the follow-up of DTC are uncertain. Imaging studies such as the neck ultrasound and whole-body radioiodine are still used widely for the detection of the lesions. Although it is not used routinely in DTC, limited clinical observations showed that fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography could be an additive valuable imaging modality in the detection of recurrent and/or metastatic disease in these patients, with promising sensitivity and specificity. A negative F-FDG PET/computed tomography result was associated with the absence of active disease and disappearing TgAb over time, and F-FDG-avid residual/recurrent/metastatic lesions were associated with aggressive disease, poor outcome, and persistently increased TgAb levels.

  8. Influence of Software Tool and Methodological Aspects of Total Metabolic Tumor Volume Calculation on Baseline [18F]FDG PET to Predict Survival in Hodgkin Lymphoma

    PubMed Central

    Kanoun, Salim; Tal, Ilan; Berriolo-Riedinger, Alina; Rossi, Cédric; Riedinger, Jean-Marc; Vrigneaud, Jean-Marc; Legrand, Louis; Humbert, Olivier; Casasnovas, Olivier; Brunotte, François; Cochet, Alexandre

    2015-01-01

    Aim To investigate the respective influence of software tool and total metabolic tumor volume (TMTV0) calculation method on prognostic stratification of baseline 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography ([18F]FDG-PET) in newly diagnosed Hodgkin lymphoma (HL). Methods 59 patients with newly diagnosed HL were retrospectively included. [18F]FDG-PET was performed before any treatment. Four sets of TMTV0 were calculated with Beth Israel (BI) software: based on an absolute threshold selecting voxel with standardized uptake value (SUV) >2.5 (TMTV02.5), applying a per-lesion threshold of 41% of the SUVmax (TMTV041) and using a per-patient adapted threshold based on SUVmax of the liver (>125% and >140% of SUVmax of the liver background; TMTV0125 and TMTV0140). TMTV041 was also determined with commercial software for comparison of software tools. ROC curves were used to determine the optimal threshold for each TMTV0 to predict treatment failure. Results Median follow-up was 39 months. There was an excellent correlation between TMTV041 determined with BI and with the commercial software (r = 0.96, p<0.0001). The median TMTV0 value for TMTV041, TMTV02.5, TMTV0125 and TMTV0140 were respectively 160 (used as reference), 210 ([28;154] p = 0.005), 183 ([-4;114] p = 0.06) and 143ml ([-58;64] p = 0.9). The respective optimal TMTV0 threshold and area under curve (AUC) for prediction of progression free survival (PFS) were respectively: 313ml and 0.70, 432ml and 0.68, 450ml and 0.68, 330ml and 0.68. There was no significant difference between ROC curves. High TMTV0 value was predictive of poor PFS in all methodologies: 4-years PFS was 83% vs 42% (p = 0.006) for TMTV02.5, 83% vs 41% (p = 0.003) for TMTV041, 85% vs 40% (p<0.001) for TMTV0125 and 83% vs 42% (p = 0.004) for TMTV0140. Conclusion In newly diagnosed HL, baseline metabolic tumor volume values were significantly influenced by the choice of the method used for determination of volume. However, no significant

  9. Pretreatment 18F-FDG PET Textural Features in Locally Advanced Non–Small Cell Lung Cancer: Secondary Analysis of ACRIN 6668/RTOG 0235

    PubMed Central

    Ohri, Nitin; Duan, Fenghai; Snyder, Bradley S.; Wei, Bo; Machtay, Mitchell; Alavi, Abass; Siegel, Barry A.; Johnson, Douglas W.; Bradley, Jeffrey D.; DeNittis, Albert; Werner-Wasik, Maria; El Naqa, Issam

    2016-01-01

    In a secondary analysis of American College of Radiology Imaging Network (ACRIN) 6668/RTOG 0235, high pretreatment metabolic tumor volume (MTV) on 18F-FDG PET was found to be a poor prognostic factor for patients treated with chemoradiotherapy for locally advanced non–small cell lung cancer (NSCLC). Here we utilize the same dataset to explore whether heterogeneity metrics based on PET textural features can provide additional prognostic information. Methods Patients with locally advanced NSCLC underwent 18F-FDG PET prior to treatment. A gradient-based segmentation tool was used to contour each patient’s primary tumor. MTV, maximum SUV, and 43 textural features were extracted for each tumor. To address over-fitting and high collinearity among PET features, the least absolute shrinkage and selection operator (LASSO) method was applied to identify features that were independent predictors of overall survival (OS) after adjusting for MTV. Recursive binary partitioning in a conditional inference framework was utilized to identify optimal thresholds. Kaplan–Meier curves and log-rank testing were used to compare outcomes among patient groups. Results Two hundred one patients met inclusion criteria. The LASSO procedure identified 1 textural feature (SumMean) as an independent predictor of OS. The optimal cutpoint for MTV was 93.3 cm3, and the optimal Sum-Mean cutpoint for tumors above 93.3 cm3 was 0.018. This grouped patients into three categories: low tumor MTV (n = 155; median OS, 22.6 mo), high tumor MTV and high SumMean (n = 23; median OS, 20.0 mo), and high tumor MTV and low SumMean (n = 23; median OS, 6.2 mo; log-rank P < 0.001). Conclusion We have described an appropriate methodology to evaluate the prognostic value of textural PET features in the context of established prognostic factors. We have also identified a promising feature that may have prognostic value in locally advanced NSCLC patients with large tumors who are treated with chemoradiotherapy

  10. PET/CT: underlying physics, instrumentation, and advances.

    PubMed

    Torres Espallardo, I

    2017-01-12

    Since it was first introduced, the main goal of PET/CT has been to provide both PET and CT images with high clinical quality and to present them to radiologists and specialists in nuclear medicine as a fused, perfectly aligned image. The use of fused PET and CT images quickly became routine in clinical practice, showing the great potential of these hybrid scanners. Thanks to this success, manufacturers have gone beyond considering CT as a mere attenuation corrector for PET, concentrating instead on design high performance PET and CT scanners with more interesting features. Since the first commercial PET/CT scanner became available in 2001, both the PET component and the CT component have improved immensely. In the case of PET, faster scintillation crystals with high stopping power such as LYSO crystals have enabled more sensitive devices to be built, making it possible to reduce the number of undesired coincidence events and to use time of flight (TOF) techniques. All these advances have improved lesion detection, especially in situations with very noisy backgrounds. Iterative reconstruction methods, together with the corrections carried out during the reconstruction and the use of the point-spread function, have improved image quality. In parallel, CT instrumentation has also improved significantly, and 64- and 128-row detectors have been incorporated into the most modern PET/CT scanners. This makes it possible to obtain high quality diagnostic anatomic images in a few seconds that both enable the correction of PET attenuation and provide information for diagnosis. Furthermore, nowadays nearly all PET/CT scanners have a system that modulates the dose of radiation that the patient is exposed to in the CT study in function of the region scanned. This article reviews the underlying physics of PET and CT imaging separately, describes the changes in the instrumentation and standard protocols in a combined PET/CT system, and finally points out the most important

  11. Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study

    NASA Astrophysics Data System (ADS)

    Bowen, S. R.; Nyflot, M. J.; Herrmann, C.; Groh, C. M.; Meyer, J.; Wollenweber, S. D.; Stearns, C. W.; Kinahan, P. E.; Sandison, G. A.

    2015-05-01

    Effective positron emission tomography / computed tomography (PET/CT) guidance in radiotherapy of lung cancer requires estimation and mitigation of errors due to respiratory motion. An end-to-end workflow was developed to measure patient-specific motion-induced uncertainties in imaging, treatment planning, and radiation delivery with respiratory motion phantoms and dosimeters. A custom torso phantom with inserts mimicking normal lung tissue and lung lesion was filled with [18F]FDG. The lung lesion insert was driven by six different patient-specific respiratory patterns or kept stationary. PET/CT images were acquired under motionless ground truth, tidal breathing motion-averaged (3D), and respiratory phase-correlated (4D) conditions. Target volumes were estimated by standardized uptake value (SUV) thresholds that accurately defined the ground-truth lesion volume. Non-uniform dose-painting plans using volumetrically modulated arc therapy were optimized for fixed normal lung and spinal cord objectives and variable PET-based target objectives. Resulting plans were delivered to a cylindrical diode array at rest, in motion on a platform driven by the same respiratory patterns (3D), or motion-compensated by a robotic couch with an infrared camera tracking system (4D). Errors were estimated relative to the static ground truth condition for mean target-to-background (T/Bmean) ratios, target volumes, planned equivalent uniform target doses, and 2%-2 mm gamma delivery passing rates. Relative to motionless ground truth conditions, PET/CT imaging errors were on the order of 10-20%, treatment planning errors were 5-10%, and treatment delivery errors were 5-30% without motion compensation. Errors from residual motion following compensation methods were reduced to 5-10% in PET/CT imaging, <5% in treatment planning, and <2% in treatment delivery. We have demonstrated that estimation of respiratory motion uncertainty and its propagation from PET/CT imaging to RT planning, and RT

  12. Economical aspect of PET/CT-guided diagnosis of suspected infective endocarditis in a patient with implantable cardioverter-defibrillator.

    PubMed

    Farkowski, Michal M; Milkowski, Maciej; Dziuk, Mirosław; Pytkowski, Mariusz; Marciniak, Marta; Kraska, Alicja; Szwed, Hanna; Sterlinski, Maciej

    2014-01-01

    We present a case report of potential reduction of hospitalization costs due to utilization of PET/CT in a diagnostic work-up of a patient with an implantable cardioverter-defibrillator and suspicion of infective endocarditis. The PET/CT scan would have shorten hospital stay, prevented clinical complications and reduced the cost of hospitalization by 45%.

  13. [Impact of [18F]-FDG-PET on medical decision making in oncology: evaluation by the referring physicians during the opening year].

    PubMed

    Talbot, Jean-No l; Rain, Jean-Didier; Meignan, Michel; Askienazy, Serge; Grall, Yvon; Bok, Bernard; Misset, Jean-Louis

    2002-03-01

    The first study evaluating directly by the referring physician the clinical impact of [18F]-FDG-PET on modification of patient's management was performed only recently in California by means of a questionnaire. We have used the same methodology to evaluate this clinical impact during the opening year of our PET centre in France. A questionnaire was sent to the referring physician of each of the 476 patients who had at least one routine FDG-PET examination during the year 2000. Of 348 responses (response rate = 73%), the disease was upstaged in 26% of the cases and down-staged in 9%. Intermodality management changes (change from a scheduled therapeutic modality for a different one) were reported in 37% of the cases and intramodality changes in 9%. Those modification rates were respectively 38% and 7% in recurrence of colorectal cancer (153 patients), 47% and 7% in lung cancer (118 patients), 16% and 23% in lymphoma (43 patients), 25% and 6% in the staging of head and neck cancers (32 patients). When comparing with the corresponding studies performed in California, there were no significant differences between the rates of intermodality management changes. In contrast, intramodality management changes were less frequent in our survey, except for lymphoma. Globally, the clinical impact of FDG PET was similar with a higher response rate in our study (73% versus 35%); it was above the mean rate derived from a recent meta-analysis in more than 5,000 patients.

  14. External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography (PET-CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma.

    PubMed

    Blom, R L G M; Vliegen, R F A; Schreurs, W M J; Belgers, H J; Stohr, I; Oostenbrug, L E; Sosef, M N

    2012-08-01

    One of the objectives of preoperative imaging in esophageal cancer patients is the detection of cervical lymph node metastases. Traditionally, external ultrasonography of the neck has been combined with computed tomography (CT) in order to improve the detection of cervical metastases. In general, integrated positron emission tomography-computed tomography (PET-CT) has been shown to be superior to CT or PET regarding staging and therefore may limit the role of external ultrasonography of the neck. The objective of this study was to determine the additional value of external ultrasonography of the neck to PET-CT. This study included all patients referred our center for treatment of esophageal carcinoma. Diagnostic staging was performed to determine treatment plan. Cervical lymph nodes were evaluated by external ultrasonography of the neck and PET-CT. In case of suspect lymph nodes on external ultrasonography or PET-CT, fine needle aspiration (FNA) was performed. Between 2008 and 2010, 170 out of 195 referred patients underwent both external ultrasonography of the neck and PET-CT. Of all patients, 84% were diagnosed with a tumor at or below the distal esophagus. In 140 of 170 patients, the cervical region was not suspect; no FNA was performed. Seven out of 170 patients had suspect nodes on both PET-CT and external ultrasonography. Five out of seven patients had cytologically confirmed malignant lymph nodes, one of seven had benign nodes, in one patient FNA was not performed; exclusion from esophagectomy was based on intra-abdominal metastases. In one out of 170 patients, PET-CT showed suspect nodes combined with a negative external ultrasonography; cytology of these nodes was benign. Twenty-two out of 170 patients had a negative PET-CT with suspect nodes on external ultrasonography. In 18 of 22 patients, cervical lymph nodes were cytologically confirmed benign; in four patients, FNA was not possible or inconclusive. At a median postoperative follow-up of 15 months

  15. Clinical utility of (18)F-fluoride PET/CT in benign and malignant bone diseases.

    PubMed

    Li, Yuxin; Schiepers, Christiaan; Lake, Ralph; Dadparvar, Simin; Berenji, Gholam R

    2012-01-01

    (18)F labeled sodium fluoride is a positron-emitting, bone seeking agent with more favorable skeletal kinetics than conventional phosphate and diphosphonate compounds. With the expanding clinical usage of PET/CT, there is renewed interest in using (18)F-fluoride PET/CT for imaging bone diseases. Growing evidence indicates that (18)F fluoride PET/CT offers increased sensitivity, specificity, and diagnostic accuracy in evaluating metastatic bone disease compared to (99m)Tc based bone scintigraphy. National Oncologic PET Registry (NOPR) has expanded coverage for (18)F sodium fluoride PET scans since February 2011 for the evaluation of osseous metastatic disease. In this article, we reviewed the pharmacological characteristics of sodium fluoride, as well as the clinical utility of PET/CT using (18)F-fluoride in both benign and malignant bone disorders.

  16. Use of Molecular Imaging Markers of Glycolysis, Hypoxia and Proliferation (18F-FDG, 64Cu-ATSM and 18F-FLT) in a Dog with Fibrosarcoma: The Importance of Individualized Treatment Planning and Monitoring

    PubMed Central

    Zornhagen, Kamilla Westarp; Clausen, Malene M.; Hansen, Anders E.; Law, Ian; McEvoy, Fintan J.; Engelholm, Svend A.; Kjær, Andreas; Kristensen, Annemarie T.

    2015-01-01

    Glycolysis, hypoxia, and proliferation are important factors in the tumor microenvironment contributing to treatment-resistant aggressiveness. Imaging these factors using combined functional positron emission tomography and computed tomography can potentially guide diagnosis and management of cancer patients. A dog with fibrosarcoma was imaged using 18F-FDG, 64Cu-ATSM, and 18F-FLT before, during, and after 10 fractions of 4.5 Gy radiotherapy. Uptake of all tracers decreased during treatment. Fluctuations in 18F-FDG and 18F-FLT PET uptakes and a heterogeneous spatial distribution of the three tracers were seen. Tracer distributions partially overlapped. It appears that each tracer provides distinct information about tumor heterogeneity and treatment response. PMID:26854160

  17. Clinical application of in vivo treatment delivery verification based on PET/CT imaging of positron activity induced at high energy photon therapy

    NASA Astrophysics Data System (ADS)

    Janek Strååt, Sara; Andreassen, Björn; Jonsson, Cathrine; Noz, Marilyn E.; Maguire, Gerald Q., Jr.; Näfstadius, Peder; Näslund, Ingemar; Schoenahl, Frederic; Brahme, Anders

    2013-08-01

    20 times lower than that of a patient undergoing standard 18F-FDG treatment. When using a combination of short lived nuclides such as 15O (half-life: 2 min) and 11C (half-life: 20 min) with low activity it is not optimal to use clinical reconstruction protocols. Thus, it might be desirable to further optimize reconstruction parameters as well as to address hardware improvements in realizing in vivo treatment verification with PET/CT in the future. A significant improvement with regard to 15O imaging could also be expected by having the PET/CT unit located close to the radiation treatment room.

  18. SU-E-J-124: 18F-FDG PET Imaging to Improve RT Treatment Outcome for Locally Advanced Lung Cancer

    SciTech Connect

    Shusharina, N; Khan, F; Sharp, G; Choi, N

    2015-06-15

    Purpose: To investigate spatial correlation between high uptake regions of pre- and 10-days-post therapy{sup 1} {sup 8}F-FDG PET in recurrent lung cancer and to evaluate the feasibility of dose escalation boosting only regions with high FDG uptake identified on baseline PET. Methods: Nineteen patients with stages II– IV inoperable lung cancer were selected. Volumes of interest (VOI) on pre-therapy FDG-PET were defined using an isocontour at ≥50% of SUVmax. VOI of pre- and post-therapy PET images were correlated for the extent of overlap. A highly optimized IMRT plan to 60 Gy prescribed to PTV defined on the planning CT was designed using clinical dose constraints for the organs at risk. A boost of 18 Gy was prescribed to the VOI defined on baseline PET. A composite plan of the total 78 Gy was compared with the base 60 Gy plan. Increases in dose to the lungs, spinal cord and heart were evaluated. IMRT boost plan was compared with proton RT and SBRT boost plans. Results: Overlap fraction of baseline PET VOI with the VOI on 10 days-post therapy PET was 0.8 (95% CI: 0.7 – 0.9). Using baseline VOI as a boosting volume, dose could be escalated to 78 Gy for 15 patients without compromising the dose constraints. For 4 patients, the dose limiting factors were V20Gy and Dmean for the total lung, and Dmax for the spinal cord. An increase of the dose to OARs correlated significantly with the relative size of the boost volume. Conclusion: VOI defined on baseline 18F-FDG PET by the SUVmax-≥50% isocontour may be a biological target volume for escalated radiation dose. Dose escalation to this volume may provide improved tumor control without breaching predefined dose constraints for OARs. The best treatment outcome may be achieved with proton RT for large targets and with SBRT for small targets.

  19. Prognostic value of interim and restaging PET/CT in Hodgkin lymphoma. Results of the CHEAP (Chemotherapy Effectiveness Assessment by PET/CT) study - long term observation.

    PubMed

    Miltenyi, Z; Barna, S; Garai, I; Simon, Z; Jona, A; Magyari, F; Gergely, M; Nagy, Z; Keresztes, K; Pettendi, P; Illes, A

    2015-01-01

    Very few studies have determined the prognostic value of interim and restaging PET/CT in patients with Hodgkin lymphoma using current standard of care therapy outside clinical trials. We analyzed the effect of the results of interim and restaging PET/CT on the survival (overall- and relapse-free) in patients who received standard first-line treatment based on the stage of disease and risk factors. We investigated the differences between the relapse and non-relapse groups based on the clinical pathological characteristics of patients who had positive interim PET/CT results.Between January 1, 2007 and December 31, 2011, the staging, interim and restaging PET/CT scans of patients with Hodgkin lymphoma were analyzed. The Deauville criteria were used for the evaluation of interim PET/CT scans. One hundred and thirteen Hodgkin lymphoma patients underwent staging, interim and restaging PET/CT scans. None of the therapy was modified based on the interim PET/CT results. The median follow-up time was 43.5 months. A total of 62 early stage patients and 51 advanced stage patients were identified. The five-year overall survival rates were 93.4% in the interim PET negative group and 58% in the interim PET positive group (p<0.001). The five-year relapse-free survival rates for the negative and positive groups were 92.7% and 40.8%, respectively (p<0.001). The negative predictive value was 100% in the early stage group and 82.35% in the advanced stage group. By comparison, the positive predictive values were 53.8% and 58.8%, respectively, in these two groups. In the interim PET positive group, patients over 40 years of age had a significantly higher probability of relapse (p=0.057).The routine clinical use of interim PET/CT is highly recommended based on our investigation. However, patients with positive interim PET/CT results required frequent additional evaluations.

  20. FDG PET/CT dataset for navigation on femoral bone: a feasibility study.

    PubMed

    Militz, Matthias; Uhde, Jörg; Christian, Georg; Linke, Rainer; Morgenstern, Mario; Hungerer, Sven

    2015-12-01

    FDG PET/CT has become a valuable tool in the diagnosis of the activity of chronic osteomyelitis. The surgical strategy in the treatment of chronic osteomyelitis is the identification of the bone focus and radical debridement of sequesters. The aim of the current study was the registration and use of the FDG PET/CT imaging datasets on a navigation system to provide diagnostic imaging based feedback during surgical procedures. For the present study, FDG PET/CT scans were acquired from artificial bones and cadaver bones with a local focus of activity. The DICOM data sets were merged using a navigation system. The referenced regions of interest were matched with fluoroscopic pictures to register the PET/CT DICOM datasets to the bone and direct visual control. Navigated targeting led to accurate results when verified with fluoroscopic images by targeting previously inserted reference points in artificial and cadaver bone. FDG PET/CT datasets are suitable for navigation and compatible with conventional planning and navigation software. The combination of diagnostic FDG PET/CT imaging with surgical navigation techniques could be a valuable tool for the accurate treatment of chronic osteomyelitis.

  1. TBCRC 008: Early Change in 18F-FDG Uptake on PET Predicts Response to Preoperative Systemic Therapy in Human Epidermal Growth Factor Receptor 2–Negative Primary Operable Breast Cancer

    PubMed Central

    Connolly, Roisin M.; Leal, Jeffrey P.; Goetz, Matthew P.; Zhang, Zhe; Zhou, Xian C.; Jacobs, Lisa K.; Mhlanga, Joyce; Joo, H O; Carpenter, John; Storniolo, Anna Maria; Watkins, Stanley; Fetting, John H.; Miller, Robert S.; Sideras, Kostandinos; Jeter, Stacie C.; Walsh, Bridget; Powers, Penny; Zorzi, Jane; Boughey, Judy C.; Davidson, Nancy E.; Carey, Lisa A.; Wolff, Antonio C.; Khouri, Nagi; Gabrielson, Edward; Wahl, Richard L.; Stearns, Vered

    2015-01-01

    Epigenetic modifiers, including the histone deacetylase inhibitor vorinostat, may sensitize tumors to chemotherapy and enhance outcomes. We conducted a multicenter randomized phase II neo-adjuvant trial of carboplatin and nanoparticle albumin-bound paclitaxel (CP) with vorinostat or placebo in women with stage II/III, human epidermal growth factor receptor 2 (HER2)–negative breast cancer, in which we also examined whether change in maximum standardized uptake values corrected for lean body mass (SULmax) on 18F-FDG PET predicted pathologic complete response (pCR) in breast and axillary lymph nodes. Methods Participants were randomly assigned to 12 wk of preoperative carboplatin (area under the curve of 2, weekly) and nab-paclitaxel (100 mg/m2 weekly) with vorinostat (400 mg orally daily, days 1–3 of every 7-d period) or placebo. All patients underwent 18F-FDG PET and research biopsy at baseline and on cycle 1 day 15. The primary endpoint was the pCR rate. Secondary objectives included correlation of change in tumor SULmax on 18F-FDG PET by cycle 1 day 15 with pCR and correlation of baseline and change in Ki-67 with pCR. Results In an intent-to-treat analysis (n = 62), overall pCR was 27.4% (vorinostat, 25.8%; placebo, 29.0%). In a pooled analysis (n = 59), we observed a significant difference in median change in SULmax 15 d after initiating preoperative therapy between those achieving pCR versus not (percentage reduction, 63.0% vs. 32.9%; P = 0.003). Patients with 50% or greater reduction in SULmax were more likely to achieve pCR, which remained statistically significant in multivariable analysis including estrogen receptor status (odds ratio, 5.1; 95% confidence interval, 1.3–22.7; P = 0.023). Differences in baseline and change in Ki-67 were not significantly different between those achieving pCR versus not. Conclusion Preoperative CP with vorinostat or placebo is associated with similar pCR rates. Early change in SULmax on 18F-FDG PET 15 d after the

  2. Tumor Metabolism and Perfusion in Head and Neck Squamous Cell Carcinoma: Pretreatment Multimodality Imaging With {sup 1}H Magnetic Resonance Spectroscopy, Dynamic Contrast-Enhanced MRI, and [{sup 18}F]FDG-PET

    SciTech Connect

    Jansen, Jacobus F.A.; Schoeder, Heiko; Lee, Nancy Y.; Stambuk, Hilda E.; Wang Ya; Fury, Matthew G.; Patel, Senehal G.; Pfister, David G.; Shah, Jatin P.; Koutcher, Jason A.; Shukla-Dave, Amita

    2012-01-01

    Purpose: To correlate proton magnetic resonance spectroscopy ({sup 1}H-MRS), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and {sup 18}F-labeled fluorodeoxyglucose positron emission tomography ([{sup 18}F]FDG PET) of nodal metastases in patients with head and neck squamous cell carcinoma (HNSCC) for assessment of tumor biology. Additionally, pretreatment multimodality imaging was evaluated for its efficacy in predicting short-term response to treatment. Methods and Materials: Metastatic neck nodes were imaged with {sup 1}H-MRS, DCE-MRI, and [{sup 18}F]FDG PET in 16 patients with newly diagnosed HNSCC, before treatment. Short-term patient radiological response was evaluated at 3 to 4 months. Correlations among {sup 1}H-MRS (choline concentration relative to water [Cho/W]), DCE-MRI (volume transfer constant [K{sup trans}]; volume fraction of the extravascular extracellular space [v{sub e}]; and redistribution rate constant [k{sub ep}]), and [{sup 18}F]FDG PET (standard uptake value [SUV] and total lesion glycolysis [TLG]) were calculated using nonparametric Spearman rank correlation. To predict short-term responses, logistic regression analysis was performed. Results: A significant positive correlation was found between Cho/W and TLG ({rho} = 0.599; p = 0.031). Cho/W correlated negatively with heterogeneity measures of standard deviation std(v{sub e}) ({rho} = -0.691; p = 0.004) and std(k{sub ep}) ({rho} = -0.704; p = 0.003). Maximum SUV (SUVmax) values correlated strongly with MRI tumor volume ({rho} = 0.643; p = 0.007). Logistic regression indicated that std(K{sup trans}) and SUVmean were significant predictors of short-term response (p < 0.07). Conclusion: Pretreatment multimodality imaging using {sup 1}H-MRS, DCE-MRI, and [{sup 18}F]FDG PET is feasible in HNSCC patients with nodal metastases. Additionally, combined DCE-MRI and [{sup 18}F]FDG PET parameters were predictive of short-term response to treatment.

  3. SU-E-J-249: Characterization of Gynecological Tumor Heterogeneity Using Texture Analysis in the Context of An 18F-FDG PET Adaptive Protocol

    SciTech Connect

    Nawrocki, J; Chino, J; Craciunescu, O; Das, S

    2015-06-15

    Purpose: We propose a method to examine gynecological tumor heterogeneity using texture analysis in the context of an adaptive PET protocol in order to establish if texture metrics from baseline PET-CT predict tumor response better than SUV metrics alone as well as determine texture features correlating with tumor response during radiation therapy. Methods: This IRB approved protocol included 29 women with node positive gynecological cancers visible on FDG-PET treated with EBRT to the PET positive nodes. A baseline and intra-treatment PET-CT was obtained. Tumor outcome was determined based on RECIST on posttreatment PET-CT. Primary GTVs were segmented using 40% threshold and a semi-automatic gradient-based contouring tool, PET Edge (MIM Software Inc., Cleveland, OH). SUV histogram features, Metabolic Volume (MV), and Total Lesion Glycolysis (TLG) were calculated. Four 3D texture matrices describing local and regional relationships between voxel intensities in the GTV were generated: co-occurrence, run length, size zone, and neighborhood difference. From these, 39 texture features were calculated. Prognostic power of baseline features derived from gradientbased and threshold GTVs were determined using the Wilcoxon rank-sum test. Receiver Operating Characteristics and logistic regression was performed using JMP (SAS Institute Inc., Cary, NC) to find probabilities of predicting response. Changes in features during treatment were determined using the Wilcoxon signed-rank test. Results: Of the 29 patients, there were 16 complete responders, 7 partial responders, and 6 non-responders. Comparing CR/PR vs. NR for gradient-based GTVs, 7 texture values, TLG, and SUV kurtosis had a p < 0.05. Threshold GTVs yielded 4 texture features and TLG with p < 0.05. From baseline to intra-treatment, 14 texture features, SUVmean, SUVmax, MV, and TLG changed with p < 0.05. Conclusion: Texture analysis of PET imaged gynecological tumors is an effective method for early prognosis and should

  4. Askin tumor: CT and FDG-PET/CT imaging findings and follow-up.

    PubMed

    Xia, Tingting; Guan, Yubao; Chen, Yongxin; Li, Jingxu

    2014-07-01

    The aim of the study was to describe the imaging findings of Askin tumors on computed tomography (CT) and fluorine 18 fluorodeoxyglucose-positron emission tomography (FDG-PET/CT).Seventeen cases of Askin tumors confirmed by histopathology were retrospectively analyzed in terms of CT (17 cases) and FDG-PET/CT data (6 cases).Fifteen of the tumors were located in the chest wall and the other 2 were in the anterior middle mediastinum. Of the 15 chest wall cases, 13 demonstrated irregular, heterogeneous soft tissue masses with cystic degeneration and necrosis, and 2 demonstrated homogeneous soft tissue masses on unenhanced CT scans. Two mediastinal tumors demonstrated the irregular, heterogeneous soft tissue masses. Calcifications were found in 2 tumors. The tumors demonstrated heterogeneously enhancement in 16 cases and homogeneous enhancement in 1 case on contrast-enhanced scans. FDG-PET/CT images revealed increased metabolic activity in all 6 cases undergone FDG-PET/CT scan, and the lesion SUVmax ranged from 4.0 to 18.6. At initial diagnosis, CT and FDG-PET/CT scans revealed rib destruction in 9 cases, pleural effusion in 9 cases, and lung metastasis in 1 case. At follow-up, 12 cases showed recurrence and/or metastases, 4 cases showed improvement or remained stable, and 1 was lost to follow-up.In summary, CT and FDG-PET/CT images of Askin tumors showed heterogeneous soft tissue masses in the chest wall and the mediastinum, accompanied by rib destruction, pleural effusion, and increased FDG uptake. CT and FDG-PET/CT imaging play important roles in the diagnosis and follow-up of patients with Askin tumors.

  5. Modeling Pathologic Response of Esophageal Cancer to Chemoradiation Therapy Using Spatial-Temporal {sup 18}F-FDG PET Features, Clinical Parameters, and Demographics

    SciTech Connect

    Zhang, Hao; Tan, Shan; Chen, Wengen; Kligerman, Seth; Kim, Grace; D'Souza, Warren D.; Suntharalingam, Mohan; Lu, Wei

    2014-01-01

    Purpose: To construct predictive models using comprehensive tumor features for the evaluation of tumor response to neoadjuvant chemoradiation therapy (CRT) in patients with esophageal cancer. Methods and Materials: This study included 20 patients who underwent trimodality therapy (CRT + surgery) and underwent {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) both before and after CRT. Four groups of tumor features were examined: (1) conventional PET/CT response measures (eg, standardized uptake value [SUV]{sub max}, tumor diameter); (2) clinical parameters (eg, TNM stage, histology) and demographics; (3) spatial-temporal PET features, which characterize tumor SUV intensity distribution, spatial patterns, geometry, and associated changes resulting from CRT; and (4) all features combined. An optimal feature set was identified with recursive feature selection and cross-validations. Support vector machine (SVM) and logistic regression (LR) models were constructed for prediction of pathologic tumor response to CRT, cross-validations being used to avoid model overfitting. Prediction accuracy was assessed by area under the receiver operating characteristic curve (AUC), and precision was evaluated by confidence intervals (CIs) of AUC. Results: When applied to the 4 groups of tumor features, the LR model achieved AUCs (95% CI) of 0.57 (0.10), 0.73 (0.07), 0.90 (0.06), and 0.90 (0.06). The SVM model achieved AUCs (95% CI) of 0.56 (0.07), 0.60 (0.06), 0.94 (0.02), and 1.00 (no misclassifications). With the use of spatial-temporal PET features combined with conventional PET/CT measures and clinical parameters, the SVM model achieved very high accuracy (AUC 1.00) and precision (no misclassifications)—results that were significantly better than when conventional PET/CT measures or clinical parameters and demographics alone were used. For groups with many tumor features (groups 3 and 4), the SVM model achieved significantly higher

  6. Asymptomatic Mesenchymal Hamartoma of the Chest Wall in Child With Fluorodeoxyglucose Uptake on PET/CT-Report of a Case.

    PubMed

    Okamoto, Kentaro; Tani, Yukiko; Yamaguchi, Takeshi; Ogino, Kei; Tsuchioka, Takashi; Nakajima, Masanobu; Yamaguchi, Satoru; Sasaki, Kinro; Kato, Hiroyuki; Ohya, Toshiki

    2015-05-01

    We had experience with a case of mesenchymal hamartoma of the chest wall (MHCW) with fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT). We reported the first case of asymptomatic MHCW in a child with preoperative PET/CT. Mesenchymal hamartoma of the chest wall is a rare benign tumor that usually presents as a visible chest wall mass or respiratory problems secondary to compression of the lung in early infancy. It is often reported that malignant transformation is extraordinarily rare. Positron emission tomography/CT is useful for diagnosis of malignancy. There is no report of MHCW in a child with preoperative PET/CT before. We examined an asymptomatic 1-year-old girl with an incidental finding on a chest x-ray. Scans of CT and PET/CT were performed before surgical resection. After surgery, the resected tumor was examined histologically. Chest x-ray and CT scan of the chest confirmed a 25- × 20-mm round shaped intrapleural mass containing calcification and destructing the rib, arising from the third rib. Scan of PET/CT demonstrated the mass with light FDG accumulation. Histologically, the mass was homogenous, with thick funicular of hyaline cartilage interdigitating with scattered fiber. There were no malignant cells. No malignant MHCW was demonstrated in the mass, with light FDG accumulation by PET/CT. PET/CT might be a useful tool to distinguish malignant MHCW in children.

  7. 18F-fluorodeoxyglucose positron-emission tomography-computed tomography to diagnose recurrent cancer

    PubMed Central

    You, J J; Cline, K J; Gu, C-S; Pritchard, K I; Dayes, I S; Gulenchyn, K Y; Inculet, R I; Dhesy-Thind, S K; Freeman, M A; Chan, A M; Julian, J A; Levine, M N

    2015-01-01

    Background: Sometimes the diagnosis of recurrent cancer in patients with a previous malignancy can be challenging. This prospective cohort study assessed the clinical utility of 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (18F-FDG PET-CT) in the diagnosis of clinically suspected recurrence of cancer. Methods: Patients were eligible if cancer recurrence (non-small-cell lung (NSCL), breast, head and neck, ovarian, oesophageal, Hodgkin's or non-Hodgkin's lymphoma) was suspected clinically, and if conventional imaging was non-diagnostic. Clinicians were asked to indicate their management plan before and after 18F-FDG PET-CT scanning. The primary outcome was change in planned management after 18F-FDG PET-CT. Results: Between April 2009 and June 2011, 101 patients (age, median 65 years; 55% female) were enroled from four cancer centres in Ontario, Canada. Distribution by primary tumour type was: NSCL (55%), breast (19%), ovarian (10%), oesophageal (6%), lymphoma (6%), and head and neck (4%). Of the 99 subjects who underwent 18F-FDG PET-CT, planned management changed after 18F-FDG PET-CT in 52 subjects (53%, 95% confidence interval (CI), 42–63%); a major change in plan from no treatment to treatment was observed in 38 subjects (38%, 95% CI, 29–49%), and was typically associated with 18F-FDG PET-CT findings that were positive for recurrent cancer (37 subjects). After 3 months, the stated post-18F-FDG PET-CT management plan was actually completed in 88 subjects (89%, 95% CI, 81–94%). Conclusion: In patients with suspected cancer recurrence and conventional imaging that is non-diagnostic, 18F-FDG PET-CT often provides new information that leads to important changes in patient management. PMID:25942398

  8. Utility of FDG-PET/CT in follow-up of children treated for Hodgkin and non-Hodgkin lymphoma.

    PubMed

    Rhodes, Melissa M; Delbeke, Dominique; Whitlock, James A; Martin, William; Kuttesch, John F; Frangoul, Haydar A; Shankar, Sadhna

    2006-05-01

    Positron emission tomography using F-flurodeoxyglucose (FDG-PET) is considered an excellent tool for staging and monitoring disease status in adults with lymphoma. We retrospectively reviewed results of PET/CT and diagnostic computed tomography (CT) scans performed during follow-up after completion of therapy in 41 children <18 years of age with Hodgkin lymphoma and non-Hodgkin lymphoma. PET/CT scan with uptake greater than that of the liver was considered positive. Uptake that increased over the background but less than in the liver was equivocal. Clinical outcomes were obtained from medical records. Thirteen (32%) had a positive PET/CT scan and an equal number had equivocal scans in a median follow-up of 2.3 years. Diagnostic CT scans revealed new findings in 13 (32%) and persistent abnormalities in 21 (51%) of the children. Five children developed recurrent disease, and one developed a second cancer. No children with equivocal positivity developed recurrent disease. PET/CT scan was 95% sensitive, with a positive predictive value (PPV) of 53%. Diagnostic CT was 79% sensitive, with a PPV of 52%. We conclude that a negative PET/CT scan during routine follow-up for lymphoma in children strongly suggests absence of recurrence but a positive PET/CT and diagnostic CT scans have low PPV and should be interpreted with caution in this setting.

  9. Quantitative evaluation of two scatter correction techniques for (18)F-FDG brain PET/MR imaging in regard to MR-based attenuation correction.

    PubMed

    Teuho, Jarmo; Saunavaara, Virva; Tolvanen, Tuula; Tuokkola, Terhi; Karlsson, Antti; Tuisku, Jouni; Teräs, Mika

    2017-03-23

    minimal in non-time-of-flight (TOF) (18)F-FDG PET/MR brain imaging. The SSS algorithm was not affected significantly by MRAC. The performance of MCSSS algorithm is comparable but not superior to SSS, warranting further investigations of algorithm optimization and performance with different radiotracers and TOF imaging.

  10. Safety and Efficacy of 68Ga-DOTATATE PET/CT for Diagnosis, Staging, and Treatment Management of Neuroendocrine Tumors

    PubMed Central

    Deppen, Stephen A.; Liu, Eric; Blume, Jeffrey D.; Clanton, Jeffrey; Shi, Chanjuan; Jones-Jackson, Laurie B.; Lakhani, Vipul; Baum, Richard P.; Berlin, Jordan; Smith, Gary T.; Graham, Michael; Sandler, Martin P.; Delbeke, Dominique; Walker, Ronald C.

    2017-01-01

    Our purpose was to evaluate safety and efficacy of 68Ga-DOTATATE PET/CT compared with 111In-pentetreotide imaging for diagnosis, staging, and restaging of pulmonary and gastroenteropancreatic neuroendocrine tumors. Methods 68Ga-DOTATATE PET/CT and 111In-pentetreotide scans were obtained for 78 of 97 consecutively enrolled patients with known or suspected pulmonary or gastroenteropancreatic neuroendocrine tumors. Safety and toxicity were measured by comparing vital signs, serum chemistry values, or acquisition-related medical complications before and after 68Ga-DOTATATE injection. Added value was determined by changes in treatment plan when 68Ga-DOTATATE PET/CT results were added to all prior imaging, including 111In-pentetreotide. Interobserver reproducibility of 68Ga-DOTATATE PET/CT scan interpretation was measured between blinded and nonblinded interpreters. Results 68Ga-DOTATATE PET/CT and 111In-pentetreotide scans were significantly different in impact on treatment (P < 0.001). 68Ga-DOTATATE PET/CT combined with CT or liver MRI changed care in 28 of 78 (36%) patients. Interobserver agreement between blinded and nonblinded interpreters was high. No participant had a trial-related event requiring treatment. Mild, transient events were tachycardia in 1, alanine transaminase elevation in 1, and hyperglycemia in 2 participants. No clinically significant arrhythmias occurred. 68Ga-DOTATATE PET/CT correctly identified 3 patients for peptide-receptor radiotherapy incorrectly classified by 111In-pentetreotide. Conclusion 68Ga-DOTATATE PET/CT was equivalent or superior to 111In-pentetreotide imaging in all 78 patients. No adverse events requiring treatment were observed. 68Ga-DOTATATE PET/CT changed treatment in 36% of participants. Given the lack of significant toxicity, lower radiation exposure, and improved accuracy compared with 111In-pentetreotide, 68Ga-DOTATATE imaging should be used instead of 111In-pentetreotide imaging where available. PMID:26769865

  11. A pilot study of the prognostic significance of metabolic tumor size measurements in PET/CT imaging of lymphomas

    NASA Astrophysics Data System (ADS)

    Kallergi, Maria; Botsivali, Maria; Politis, Nikolaos; Menychtas, Dimitrios; Georgakopoulos, Alexandros; Chatziioannou, Sofia

    2015-03-01

    This study explores changes in metabolic tumor volume, metabolic tumor diameter, and maximum standardized uptake value (SUVmax), for earlier and more accurate identification of lymphomas' response to treatment using 18F- FDG PET/CT. Pre- and post-treatment PET/CT studies of 20 patients with Hodgkin disease (HL) and 7 patients with non- Hodgkin lymphoma (NHL) were retrospectively selected for this study. The diameter and volume of the metabolic tumor was determined by an in-house developed adaptive local thresholding technique based on a 50% threshold of the maximum pixel value within a region. Statistical analysis aimed at exploring associations between metabolic size measurements and SUVmax and the ability of the three biomarkers to predict the patients' response to treatment as defined by the four classes in the European Organization for Research and Treatment of Cancer (EORTC) guidelines. Results indicated moderate correlations between % change in metabolic tumor volume and % change in metabolic tumor maximum diameter (R=0.51) and between % change in maximum diameter and % change in SUVmax (R=0.52). The correlation between % change in tumor volume and % change in SUVmax was weak (R=0.24). The % change in metabolic tumor size, either volume or diameter, was a "very strong" predictor of response to treatment (R=0.89), stronger than SUVmax (R=0.63). In conclusion, metabolic tumor volume could have important prognostic value, possibly higher than maximum metabolic diameter or SUVmax that are currently the standard of practice. Volume measurements, however, should be based on robust and standardized segmentation methodologies to avoid variability. In addition, SUV-peak or lean body mass corrected SUV-peak may be a better PET biomarker than SUVmax when SUV-volume combinations are considered.

  12. Contribution of nonattenuation-corrected images on FDG-PET/CT in the assessment of solitary pulmonary nodules.

    PubMed

    Şahin, Ertan; Kara, Ahmet; Elboğa, Umut

    2016-12-01

    In this study, we aim to determine the diagnostic performance of nonattenuation-corrected (NAC) and attenuation-corrected (AC) FDG-PET/CT images in the assessment of solitary pulmonary nodule (SPN). We reviewed the images of 41 patients who underwent FDG-PET/CT to diagnose SPNs. The visual analysis of FDG uptake intensity in SPN on AC and NAC PET images was made using a four-point score from 1 to 4 on both AC and NAC PET images. The cutoff value of SUVmax and visual uptake scores for malignancy were defined as ≥2.5 and ≥3, respectively. The significant visual uptake (≥2 visual point score) on AC and NAC PET images was considered to be positive 18F-FDG PET findings for lesion detectability. The sensitivity, specificity and diagnostic accuracy were calculated for AC and NAC PET images. Based on the histopathology and imaging data, 22 of the SPNs (54 %) were malignant and 19 of them (46 %) were benign. The sensitivity and NPV were found to be 100 % in the detection of SPNs for AC and NAC PET images. For all SPNs and SPNs ≤2 cm, NAC PET image had a higher diagnostic performance for the SPN characterization as malignant or benign, when compared with AC PET image. The success rates of AC and NAC PET images were found to be similar for the detection of SPNs. NAC PET image had a higher diagnostic performance for the SPN characterization. It is thought that NAC PET image may provide additional contributions for characterization of SPNs.

  13. Dosimetry of a (90)Y-hydroxide liquid brachytherapy treatment approach to canine osteosarcoma using PET/CT.

    PubMed

    Zhou, Jien Jie; Gonzalez, Arnulfo; Lenox, Mark W; Fossum, Theresa W; Frank, R Keith; Simon, Jaime; Stearns, Stan; Ruoff, Catherine M; Wendt, Richard E; Akabani, Gamal

    2015-03-01

    A new treatment strategy based on direct injections of (90)Y-hydroxide into the tumor bed in dogs with osteosarcoma was studied. Direct injections of the radiopharmaceutical into the tumor bed were made according to a pretreatment plan established using (18)F-FDG images. Using a special drill, cannulas were inserted going through tissue, tumor and bone. Using these cannulas, direct injections of the radiopharmaceutical were made. The in vivo biodistribution of (90)Y-hydroxide and the anatomical tumor bed were imaged using a time-of-flight (TOF) PET/CT scanner. The material properties of the tissues were estimated from corresponding CT numbers using an electron-density calibration. Radiation absorbed dose estimates were calculated using Monte Carlo methods where the biodistribution of the pharmaceutical from PET images was sampled using a collapsing 3-D rejection technique. Dose distributions in the tumor bed and surrounding tissues were calculated, showing significant heterogeneity with multiple hot spots at injection sites. Dose volume histograms showed that approximately 33.9% of bone and tumor and 70.2% of bone marrow and trabecular bone received an absorbed dose over 200Gy; approximately 3.2% of bone and tumor and 31.0% of bone marrow and trabecular bone received a total dose of over 1000Gy.

  14. A Rare Case of Omentum Invasive Prostate Cancer: Staging With PSMA PET/CT Imaging and Response to Systemic Therapy.

    PubMed

    Ladwa, Rahul; Gustafson, Sonja; McCaffrey, Elizabeth; Miles, Kenneth; O'Byrne, Kenneth

    2017-02-24

    The omentum is a rare metastatic site for prostatic adenocarcinoma. We present a case of metastatic castrate-resistant prostate cancer, with progressive omentum invasive prostate cancer identified on prostate-specific membrane antigen (PSMA) PET/CT scan. Omental biopsy revealed metastatic prostate adenocarcinoma, and cabazitaxel chemotherapy was instituted with a prostate-specific antigen biochemical response. Repeat PSMA PET/CT imaging revealed increased avidity in omental metastasis. Despite prostate-specific antigen response, PSMA PET/CT did not correlate with a therapeutic response.

  15. Simultaneous hyperpolarized 13C-pyruvate MRI and 18F-FDG-PET in cancer (hyperPET): feasibility of a new imaging concept using a clinical PET/MRI scanner

    PubMed Central

    Gutte, Henrik; Hansen, Adam E; Henriksen, Sarah T; Johannesen, Helle H; Ardenkjaer-Larsen, Jan; Vignaud, Alexandre; Hansen, Anders E; Børresen, Betina; Klausen, Thomas L; Wittekind, Anne-Mette N; Gillings, Nic; Kristensen, Annemarie T; Clemmensen, Andreas; Højgaard, Liselotte; Kjær, Andreas

    2015-01-01

    In this paper we demonstrate, for the first time, the feasibility of a new imaging concept - combined hyperpolarized 13C-pyruvate magnetic resonance spectroscopic imaging (MRSI) and 18F-FDG-PET imaging. This procedure was performed in a clinical PET/MRI scanner with a canine cancer patient. We have named this concept hyper PET. Intravenous injection of the hyperpolarized 13C-pyruvate results in an increase of 13C-lactate, 13C-alanine and 13C-CO2 (13C-HCO3) resonance peaks relative to the tissue, disease and the metabolic state probed. Accordingly, with dynamic nuclear polarization (DNP) and use of 13C-pyruvate it is now possible to directly study the Warburg Effect through the rate of conversion of 13C-pyruvate to 13C-lactate. In this study, we combined it with 18F-FDG-PET that studies uptake of glucose in the cells. A canine cancer patient with a histology verified local recurrence of a liposarcoma on the right forepaw was imaged using a combined PET/MR clinical scanner. PET was performed as a single-bed, 10 min acquisition, 107 min post injection of 310 MBq 18F-FDG. 13C-chemical shift imaging (CSI) was performed just after FDG-PET and 30 s post injection of 23 mL hyperpolarized 13C-pyruvate. Peak heights of 13C-pyruvate and 13C-lactate were quantified using a general linear model. Anatomic 1H-MRI included axial and coronal T1 vibe, coronal T2-tse and axial T1-tse with fat saturation following gadolinium injection. In the tumor we found clearly increased 13C-lactate production, which also corresponded to high 18F-FDG uptake on PET. This is in agreement with the fact that glycolysis and production of lactate are increased in tumor cells compared to normal cells. Yet, most interestingly, also in the muscle of the forepaw of the dog high 18F-FDG uptake was observed. This was due to activity in these muscles prior to anesthesia, which was not accompanied by a similarly high 13C-lactate production. Accordingly, this clearly demonstrates how the Warburg Effect directly

  16. Simultaneous hyperpolarized (13)C-pyruvate MRI and (18)F-FDG-PET in cancer (hyperPET): feasibility of a new imaging concept using a clinical PET/MRI scanner.

    PubMed

    Gutte, Henrik; Hansen, Adam E; Henriksen, Sarah T; Johannesen, Helle H; Ardenkjaer-Larsen, Jan; Vignaud, Alexandre; Hansen, Anders E; Børresen, Betina; Klausen, Thomas L; Wittekind, Anne-Mette N; Gillings, Nic; Kristensen, Annemarie T; Clemmensen, Andreas; Højgaard, Liselotte; Kjær, Andreas

    2015-01-01

    In this paper we demonstrate, for the first time, the feasibility of a new imaging concept - combined hyperpolarized (13)C-pyruvate magnetic resonance spectroscopic imaging (MRSI) and (18)F-FDG-PET imaging. This procedure was performed in a clinical PET/MRI scanner with a canine cancer patient. We have named this concept hyper PET. Intravenous injection of the hyperpolarized (13)C-pyruvate results in an increase of (13)C-lactate, (13)C-alanine and (13)C-CO2 ((13)C-HCO3) resonance peaks relative to the tissue, disease and the metabolic state probed. Accordingly, with dynamic nuclear polarization (DNP) and use of (13)C-pyruvate it is now possible to directly study the Warburg Effect through the rate of conversion of (13)C-pyruvate to (13)C-lactate. In this study, we combined it with (18)F-FDG-PET that studies uptake of glucose in the cells. A canine cancer patient with a histology verified local recurrence of a liposarcoma on the right forepaw was imaged using a combined PET/MR clinical scanner. PET was performed as a single-bed, 10 min acquisition, 107 min post injection of 310 MBq (18)F-FDG. (13)C-chemical shift imaging (CSI) was performed just after FDG-PET and 30 s post injection of 23 mL hyperpolarized (13)C-pyruvate. Peak heights of (13)C-pyruvate and (13)C-lactate were quantified using a general linear model. Anatomic (1)H-MRI included axial and coronal T1 vibe, coronal T2-tse and axial T1-tse with fat saturation following gadolinium injection. In the tumor we found clearly increased (13)C-lactate production, which also corresponded to high (18)F-FDG uptake on PET. This is in agreement with the fact that glycolysis and production of lactate are increased in tumor cells compared to normal cells. Yet, most interestingly, also in the muscle of the forepaw of the dog high (18)F-FDG uptake was observed. This was due to activity in these muscles prior to anesthesia, which was not accompanied by a similarly high (13)C-lactate production. Accordingly, this clearly

  17. First-In-Human Study Demonstrating Tumor-Angiogenesis by PET/CT Imaging with 68Ga-NODAGA-THERANOST, a High-Affinity Peptidomimetic for αvβ3 Integrin Receptor Targeting

    PubMed Central

    Baum, Richard P.; Kulkarni, Harshad R.; Müller, Dirk; Danthi, Narasimhan; Kim, Young-Seung; Brechbiel, Martin W.

    2015-01-01

    Abstract 68Ga-NODAGA-THERANOST™ is an αvβ3 integrin antagonist and the first radiolabeled peptidomimetic to reach clinical development for targeting integrin receptors. In this first-in-human study, the feasibility of integrin receptor peptidomimetic positron emission tomography/computed tomography (PET/CT) imaging was confirmed in patients with non-small-cell lung cancer and breast cancer. Methods: Patients underwent PET/CT imaging with 68Ga NODAGA-THERANOST. PET images were analyzed qualitatively and quantitatively and compared to 2-deoxy-2-(18F) fluoro-d-glucose (18F-FDG) findings. Images were obtained 60 minutes postinjection of 300–500 MBq of 68Ga-NODAGA-THERANOST. Results: 68Ga-NODAGA-THERANOST revealed high tumor-to-background ratios (SUVmax=4.8) and uptake at neoangiogenesis sites. Reconstructed fused images distinguished cancers with high malignancy potential and enabled enhanced bone metastasis detection. 18F-FDG-positive lung and lymph node metastases did not show uptake, indicating the absence of neovascularization. Conclusions: 68Ga-NODAGA-THERANOST was found to be safe and effective, exhibiting in this study rapid blood clearance, stability, rapid renal excretion, favorable biodistribution and PK/PD, low irradiation burden (μSv/MBq/μg), and convenient radiolabeling. This radioligand might enable theranostics, that is, a combination of diagnostics followed by the appropriate therapeutics, namely antiangiogenic therapy, image-guided presurgical assessment, treatment response evaluation, prediction of pathologic response, neoadjuvant-peptidomimetic-radiochemotherapy, and personalized medicine strategies. Further clinical trials evaluating 68Ga-NODAGA-THERANOST are warranted. PMID:25945808

  18. Preclinical evaluation of the anti-tumor effects of the natural isoflavone genistein in two xenograft mouse models monitored by [18F]FDG, [18F]FLT, and [64Cu]NODAGA-cetuximab small animal PET

    PubMed Central

    Honndorf, Valerie S.; Wiehr, Stefan; Rolle, Anna-Maria; Schmitt, Julia; Kreft, Luisa; Quintanilla-Martinez, Letitia; Kohlhofer, Ursula; Reischl, Gerald; Maurer, Andreas; Boldt, Karsten; Schwarz, Michael; Schmidt, Holger; Pichler, Bernd J.

    2016-01-01

    The natural phytoestrogen genistein is known as protein kinase inhibitor and tumor suppressor in various types of cancers. We studied its antitumor effect in two different xenograft models using positron emission tomography (PET) in vivo combined with ex vivo histology and nuclear magnetic resonance (NMR) metabolic fingerprinting. Procedures A431 and Colo205 tumor-bearing mice were treated with vehicle or genistein (500 mg/kg/d) over a period of 12 days. Imaging was performed with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) and 3′-deoxy-3′-[18F]fluorothymidine ([18F] FLT). In a second study A431 tumor-bearing mice were treated with vehicle, genistein (500 mg/kg/d), cetuximab (1mg/3d) or a combination of the compounds and imaged using [18F]FDG, [18F]FLT and [64Cu]NODAGA-cetuximab. Data were compared to histology and principal components analysis (PCA) of NMR fingerprinting data. Results Genistein reduced tumor growth significantly in both xenografts. [18F] FLT uptake was consistent in both models and corresponded to histological findings and also PCA whereas [18F]FDG and [64Cu]NODAGA-cetuximab were not suitable for therapy monitoring. Conclusions As mono-therapy the natural isoflavone genistein has a powerful therapeutic effect in vivo on A431 and Colo205 tumors. [18F]FLT has superior consistency compared to the other tested tracers in therapy monitoring, while the treatment effect could be shown on the molecular level by histology and metabolic fingerprinting. PMID:27070087

  19. [PET/CT for diagnostics and therapy stratification of lung cancer].

    PubMed

    Kratochwil, C; Haberkorn, U; Giesel, F L

    2010-08-01

    With the introduction of positron emission tomography (PET) and more recently the hybrid systems PET/CT, the management of cancer patients in the treatment strategy has changed tremendously. The combination of PET with multidetector CT scanning enables the integration of metabolic and high resolution morphological image information. PET/CT is nowadays an established modality for tumor detection, characterization, staging and response monitoring. The increased installation of PET/CT systems worldwide and also the increased scientific publications underline the importance of this imaging modality. PET/CT is particular the imaging modality of choice in lung cancer staging and re-staging (T, N and M staging). The possible increased success of surgery in lung cancer patients and also the expected reduction in additional invasive diagnostics lead to benefits for both the individual patient and the healthcare system. In this review article PET and PET/CT is presented for diagnostic and therapeutic stratification in lung cancer. The fundamentals of glucose metabolism, staging, tumor recurrence and therapeutic monitoring are presented.

  20. Initial experience of Fag-PET/CT guided Imr of head-and-neck carcinoma

    SciTech Connect

    Wang Dian . E-mail: dwang@radonc.mcw.edu; Schultz, Christopher J.; Jursinic, Paul A.; Bialkowski, Mirek; Zhu, X. Ronald; Brown, W. Douglas; Rand, Scott D.; Michel, Michelle A.; Campbell, Bruce H.; Wong, Stuart; Li, X. Allen; Wilson, J. Frank

    2006-05-01

    Purpose: The purpose of this study is to evaluate the impact of {sup 18}F-fluorodeoxyglucose positron emission tomography (Fag-PET) fused with planning computed tomography (CT) on tumor localization, which guided intensity-modulated radiotherapy (Imr) of patients with head-and-neck carcinoma. Methods and Materials: From October 2002 through April 2005, we performed Fag-PET/CT guided Imr for 28 patients with head-and-neck carcinoma. Patients were immobilized with face masks that were attached with five fiducial markers. Fag-PET and planning CT scans were performed on the same flattop table in one session and were then fused. Target volumes and critical organs were contoured, and Imr plans were generated based on the fused images. Results: All 28 patients had abnormal increased uptake in Fag-PET/CT scans. PET/CT resulted in CT-based staging changes in 16 of 28 (57%) patients. PET/CT fusions were successfully performed and were found to be accurate with the use of the two commercial planning systems. Volume analysis revealed that the PET/CT-based gross target volumes (GTVs) were significantly different from those contoured from the CT scans alone in 14 of 16 patients. In addition, 16 of 28 patients who were followed for more than 6 months did not have any evidence of locoregional recurrence in the median time of 17 months. Conclusion: Fused images were found to be useful to delineate GTV required in IMRT planning. PET/CT should be considered for both initial staging and treatment planning in patients with head-and-neck carcinoma.

  1. Positive and Negative Predictive Value of PET-CT in Skull Base Lesions: Case Series and Systematic Literature Review.

    PubMed

    Hines, John Peyton; Howard, Brittany E; Hoxworth, Joseph M; Lal, Devyani

    2016-03-01

    Objectives To study positive (PPV) and negative predictive value (NPV) of positron emission tomography with computed tomography (PET-CT) scans in determining malignancy in skull base lesions and perform a systematic literature review for optimal PET-CT interpretation. Design Retrospective case series and systematic literature review of the current English literature. Setting Tertiary referral academic medical center. Participants All patients with skull base lesions that underwent PET-CT and tissue biopsy from 2010 to 2013. Main Outcome Measures PPV and NPV of radiologist's report and standardized uptake value (SUV) cutoff of 2.5 and 3, biopsy with pathologic interpretation, clinical follow-up. Results A total of 31 PET-CT scans of 16 patients were studied; 10 PET-CT were performed upfront for diagnostic purposes and 21 were post-treatment surveillance scans. The PPV of radiologist's interpretation, SUV cutoff of 2.5, and SUV cutoff of 3.0 was 80%, 60%, and 68.4%, with a NPV of 100%, 83.3%, and 75%, respectively. Literature search yielded 500 abstracts; 7 studies met inclusion criteria for detailed review. No consensus or guidelines for optimal SUV cutoff value was found. Conclusions PET-CT based on SUV cutoff criteria alone has high NPV but low PPV in determining malignancy in skull base lesions. Interpretation by a radiologist experienced in nuclear medicine and neuroradiology, synthesizing clinical, SUV, and radiologic data are of superior value.

  2. Brain tissue segmentation in PET-CT images using probabilistic atlas and variational Bayes inference.

    PubMed

    Xia, Yong; Wang, Jiabin; Eberl, Stefan; Fulham, Michael; Feng, David Dagan

    2011-01-01

    PET-CT provides aligned anatomical (CT) and functional (PET) images in a single scan, and has the potential to improve brain PET image segmentation, which can in turn improve quantitative clinical analyses. We propose a statistical segmentation algorithm that incorporates the prior anatomical knowledge represented by probabilistic brain atlas into the variational Bayes inference to delineate gray matter (GM), white matter (WM) and cerebrospinal fluid (CSF) in brain PET-CT images. Our approach adds an additional novel aspect by allowing voxels to have variable and adaptive prior probabilities of belonging to each class. We compared our algorithm to the segmentation approaches implemented in the expectation maximization segmentation (EMS) and statistical parametric mapping (SPM8) packages in 26 clinical cases. The results show that our algorithm improves the accuracy of brain PET-CT image segmentation.

  3. PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study.

    PubMed

    Barrington, Sally F; Kirkwood, Amy A; Franceschetto, Antonella; Fulham, Michael J; Roberts, Thomas H; Almquist, Helén; Brun, Eva; Hjorthaug, Karin; Viney, Zaid N; Pike, Lucy C; Federico, Massimo; Luminari, Stefano; Radford, John; Trotman, Judith; Fosså, Alexander; Berkahn, Leanne; Molin, Daniel; D'Amore, Francesco; Sinclair, Donald A; Smith, Paul; O'Doherty, Michael J; Stevens, Lindsey; Johnson, Peter W

    2016-03-24

    International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard