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Rippstein, Karen. "PET/CT Scan." Journal of Poetry Therapy 22, no. 2 (June 2009): 115–16. http://dx.doi.org/10.1080/08893670903072943.
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Yi, J., S. Kim, S. Lee, S. Park, Y. Ko, J. Choi, and W. Kim. "Clinical usefulness of PET/CT in initial staging and response evaluation of primary gastric lymphoma." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e19541-e19541. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e19541.
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e19541 Background: Positron emission tomography (PET)/computed tomography (CT) scan has a well-established role in the management of non-Hodgkin's lymphoma (NHL). However, in case of the primary gastric lymphoma, which is the most frequent extranodal NHL, the role of PET/CT scan is still controversial. Methods: We retrospectively analyzed 42 patients with primary gastric lymphoma who underwent PET/CT scans; 32 patients with diffuse large B-cell lymphoma (DLBCL) and 10 patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) were analyzed. The PET/CT scans were compared with clinicopathologic features and the results of CT and endoscopy. After corresponding treatment, response was evaluated by conventional CT scans or PET/CT scans and endoscopy with biopsy Results: Nine patients were up-staged based on the results of their PET/CT scan compared to CT (7 DLBCL, 2 MALT lymphomas) while six patients were down-staged by the PET/CT scan. The high SUVmax group, defined as SUVmax ≥ median value, was significantly associated with an advanced Lugano stage (P < 0.001). Three patients with DLBCL, who showed an initially high SUVmax, died of disease progression. Although not statistically significant, there was a tendency of inferior outcome in the group with high SUVmax. Among 24 patients for whom follow-up PET/CT scan with endoscopy was performed, 11 patients with ulcerative or mucosal lesions showed residual FDG uptake. All of these gastric lesions were grossly and pathologically benign lesions without evidence of lymphoma cells. Conclusions: PET/CT scan can help staging patients with primary gastric lymphoma, and the maximum SUV has possibility to have prognostic value. However, the residual FDG uptake observed during follow-up should be interpreted cautiously in association with the results of endoscopy and multiple gastric biopsies. No significant financial relationships to disclose.
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Shah, S. A., V. Rangarajan, N. C. Purandare, A. R. Sharma, A. C. Arora, and D. S. Parasar. "A pilot study to compare 8 - FDG and F18 PET/CT study in delineating metastases in suspected skeletal disease." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e22052-e22052. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e22052.
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e22052 Title: A pilot study to compare the 18 - FDG and F18 PET/CT study in delineating metastases in suspected skeletal disease. Background: Flourodeoxy glucose (FDG), positron emission tomography/computed tomography (PET/CT) scans have been used to identify metastatic disease including skeletal lesions. But the advent of Flourine -18 (F - 18), has necessitated a need to identify its accuracy over FDG scans. Aim: To evaluate and compare FDG PET/CT and F18 PET/CT studies in locating skeletal metastases in patients with suspected disease. Methods: A pilot study was carried out on 27 patients who were referred for a FDG PET/CT study for suspected skeletal disease. A whole body (skull to ankle) FDG PET/CT study followed by a F18 PET/CT bone scan within a period of 1 week was performed. A total of 150 lesions with increased tracer concentration on FDG and F18 scan were analyzed and the characteristics of the lesion on corresponding CT images were noted. Results: Of the 150 lesions noted, 49 were seen in both FDG and F18 scans. 11 were sclerotic,16 lytic, 17 mixed while CT was normal in 5 lesion. 95 of the 101 mismatched lesions were seen on F18 scan alone & were not appreciated on the FDG scan. 40% were sclerotic, 12% mixed and 11.5% were lytic. Degenerative changes comprised 12% lesions. Only 6 mismatched lesions were seen on FDG and not appreciated on F18 study.They showed no morphological abnormality on CT. 9 patients with a negative FDG scan showed lesions ranging from solitary to 16 on F18 scan, while 5 patients who had a single metastasis on FDG showed more than 6 lesions on a F18 scan. Conclusions: A F18 PET/CT study detects more skeletal lesions than FDG PET and can thus has a potential to impact patient management . Sclerotic lesions missed on FDG scans seem to be better picked on F18 scans. This pilot study provides the feasibility of a prospective study in a larger patient population to validate the impact of F18 scan in identifying skeletal metastases in various malignancies with a predisposition to bone spread. No significant financial relationships to disclose.
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Murphy, Philip, Siobhan Glavey, Oscar Breathnach, Philip W. Murphy, Liam Grogan, Patrick Morris, and John Quinn. "Non Double-Hit Diffuse Large B Cell Lymphoma Treated with R-CHOP Has Excellent Overall Survival If Interim Scan Shows Partial or Complete Response." Blood 136, Supplement 1 (November 5, 2020): 10. http://dx.doi.org/10.1182/blood-2020-138402.
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R-CHOP chemoimmunotherapy is first line therapy for diffuse large B cell non Hodgkin lymphoma (DLBCL), although R-CHOP may be suboptimal treatment for some subtypes of DLBCL, in particular double-hit (DH) or triple-hit (TH) lymphoma. For assessment of response to chemoimmunotherapy, it has been proposed that PET-CT scan may be superior to CT scan and, in particular, demonstration of metabolic complete response (CR) by PET-CT scan at end of treatment (EOT) may be an important indicator of long term survival. However, the usefulness of follow up scans in asymptomatic patients remains debatable. We wished to assess the role of an interim CT or PET-CT scan (after 3-4 courses of chemoimmunotherapy) in predicting overall survival in patients at our centre with stage II- IV DLCBCL (Lugano Modification of Ann Arbor Classification) who received chemoimmunotherapy with curative intent. We also recorded results of scans at EOT and any further follow up scans. Between 1/7/15 and 1/7/19, 43 consecutive patients receiving R-CHOP had an interim CT or PET-CT scan. 3 of 4 patients with DH lymphoma by FISH testing changed to dose adjusted R-EPOCH after one course of R-CHOP. 39 patients had no evidence of DH, with 37 showing either partial response (PR) (N = 11) or CR (N=26) on interim CT or PET-CT scan. Of these 37 cases, one patient died of neutropenic sepsis, whilst 36 remain alive with 35 in complete remission. 30 of these 37 patients had CT scan and/or PET-CT scan at EOT: 27 were in CR, 2 were in stable PR and 1 patient (in CR on interim PET -CT scan) showed relapse on PET-CT scan. 16 patients in CR at EOT had 55 follow up surveillance scans (median 2, range 1-8) -two further relapses were detected on PET-CT scan, both 4 months after EOT. Two of the relapsed cases are in CR following further chemoimmunotherapy and allogeneic stem cell transplant whilst the other relapsed case is currently responding to further chemoimmunotherapy. 2 patients without evidence of DH showed disease progression on interim scan and were refractory to further chemotherapy, dying within 3 months and 18 months of diagnosis. All 4 patients with DH lymphoma had PR or CR at interim scan but relapsed within 5 to 8 months after diagnosis and proved chemotherapy refractory with death in 3. One patient with DH lymphoma remains in CR following local radiation and maintenance therapy with rituximab, lenalidomide and metformin. In our experience, patients with DLBCL, without DH or TH, who have evidence of response to R-CHOP at interim scan have an excellent prognosis. In this patient cohort, 85 EOT and follow up scans detected 3 relapses, suggesting that the detection rate of follow up scans in asymptomatic patients in this good prognosis group is low and of questionable usefulness. The 3 relapsed patients were readily salvageable by further chemoimmunotherapy with or without allogeneic stem cell transplant. In contrast, patients with DH lymphoma or evidence of disease progression on interim scan have very poor prognosis and urgently require alternative therapy approaches. Disclosures No relevant conflicts of interest to declare.
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Parsons, Susan K., Kristina S. Yu, Nicholas Liu, Supriya Kumar, Michelle A. Fanale, Katie Holmes, Carlos Flores, Andy Surinach, Darcy R. Flora, and Andrew M. Evens. "Classical Hodgkin Lymphoma; Real-World Observations from Physicians, Patients, and Caregivers on the Disease and Its Treatment (CONNECT): Observations of Physicians on Treatment and Interim PET-Adapted Regimens." Blood 138, Supplement 1 (November 5, 2021): 1390. http://dx.doi.org/10.1182/blood-2021-151143.
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Abstract Background Current NCCN guidelines recommend 1 of 3 first-line (1L) regimens for stage III or IV classical Hodgkin lymphoma (cHL): ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine), or escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone); preferred regimens vary by region (e.g., North America vs Europe). The NCCN recommends positron emission tomography/computerized tomography (PET/CT) imaging after cycle 2 (interim PET2) to guide ABVD escalation or de-escalation. We surveyed physicians on their cHL treatment decision-making process and how PET/CT scan access, reimbursement, and comprehension influence their choices as part of CONNECT, the first real-world survey of physicians, patients, and caregivers in cHL. Methods Medical oncologists, hematologist/oncologists, or hematologists who treat cHL were invited to participate in an Institutional Review Board-approved, 30-minute online anonymous survey. Eligible participants had ≥2 years of practice experience in the United States (US) and treated ≥1 adult (aged ≥18 years) with stage III or IV cHL and ≥1 adult with cHL in the 1L setting within the prior 12 months. Surveys were completed from October 19, 2020-November 16, 2020. Results Of 301 participating physicians, 80% were hematologist/oncologists with a median practice duration of 15 years; 62% practiced in community and 38% in academic settings. Participants were located in the US (South, 34%; Northeast, 26%; West, 21%; Midwest, 20%) and spent 90% of their professional time in direct patient care. In the preceding 12 months, participants treated a median (interquartile range) of 16 (7-40) patients with active cHL (stage III [median], 4; stage IV, 5) and 15 (8-40) cHL survivors. When treating cHL, 88% of participants reported giving NCCN guidelines somewhat/significant consideration. Overall, 94% of participants (n=284) reported using a PET/CT combined scan to diagnose/stage cHL, in line with current guideline recommendations. Of these participants, 97% reported typically getting an interim PET/CT scan for stage III or IV cHL with 65% typically getting the scan after cycle 2 (Figure A). Participants reported both escalating and de-escalating treatment based on interim PET/CT results (Figure B) with 61% making decisions after cycle 2. Of participants using a PET/CT scan, 42% reported receiving both a Deauville score and a standardized uptake value (SUV; Figure C) with 62% of participants noting that the Deauville score was the primary system used for reviewing PET/CT results (Figure D). However, 19% of participants reported challenges interpreting PET/CT results. Among participants using a Deauville score (n=209), consensus was limited on what defined a positive scan (≥3, 44%; ≥4, 37%). Challenges obtaining PET/CT scans were reported by 16% of participants using PET/CT scans. However, despite not reporting challenges 55% of participants on average were unable to obtain a PET/CT scan 20% of the time. Of participants using PET/CT scans, 86% reported typically receiving results within 2 business days and 14% within 3-5 business days. Twenty-one percent of participants reported that delays in PET/CT results affected their ability to use a PET-adaptive approach. Forty-nine percent of those using PET/CT scans reported increased difficulty in PET/CT access for stage III or IV cHL due to lack of insurance coverage. In absence of a PET/CT scan, 36% of participants reported using an interim biopsy and 63% an interim CT scan to inform treatment choices. Among all participants, 36% reported increased difficulty in getting patients with cHL access to PET/CT scans due to COVID-19. Conclusions Although participants consider NCCN guidelines when treating cHL, interim PET scans are not universally obtained after cycle 2 for stage III or IV cHL, with 65% of participants who use PET/CT scans obtaining an interim PET scan after cycle 2 for stage III or IV cHL. When PET/CT scans are obtained, Deauville scores are commonly provided; however, there is variability in what is termed a positive or negative Deauville score. Challenges in obtaining PET/CT scans, with increased difficulty during COVID-19, were reported. Also, there are other barriers, such as lack of insurance, that may prohibit the optimal adherence to guidelines on interim PET/CT utilization. Figure 1 Figure 1. Disclosures Parsons: SeaGen: Consultancy. Yu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Kumar: Seagen, Inc: Consultancy. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Flora: Seagen, Inc: Research Funding.
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Short, Susan C., Russell Frood, David Broadbent, Sharon Fernandez, Garry McDermott, Bashar Al-Qaisieh, David Buckley, Stuart Currie, Louise Murray, and Andrew Scarsbrook. "NIMG-16. FEASIBLITY OF FLUORINE-18 FLUCICLOVINE PET-CT AND MRI FOR MONITORING OF CHEMO-RADIATION IN GLIOBLASTOMA: INITIAL RESULTS FROM A PILOT STUDY." Neuro-Oncology 21, Supplement_6 (November 2019): vi164—vi165. http://dx.doi.org/10.1093/neuonc/noz175.688.
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Abstract BACKGROUND Glioblastoma has a poor prognosis despite treatment with surgery and chemo-radiotherapy (CRT). Monitoring early response to CRT is challenging and conventional imaging is sub-optimal for stratifying poorly responding patients for novel agents. Also, imaging is not routinely performed during CRT and consequently, personalised treatment through individualised radiation dose adaption is not possible. AIMS: To evalutate the feasibility of Fluorine-18 Fluciclovine PET-CT for early response assessment during and post-treatment in patients with glioblastoma undergoing standard-of-care CRT. METHODS Patients with confirmed glioblastoma and macroscopic residual tumour post-surgery were consented for PET-CT and MRI prior to CRT (scan 1), after completing 2 weeks (10 fractions) of CRT (scan 2) and 6 weeks after completing treatment (scan 3). For each scan, patients were immobilised in a radiotherapy treatment mask. PET-CT and MRI scans were performed at each timepoint within a few days of each other. Patients were treated and followed up according to local guidelines. RESULTS 6 patients were recruited to the study between June 2018 and May 2019. All patients tolerated the additional imaging without problems. 2 patients were unable to attend their post-treatment PET-CT scan due to clinical deterioration. Fluciclovine PET-CT highlighted potentially active disease beyond the surgical cavity pre-radiotherapy (scan 1) in 3 patients. In 4/6, PET signal persisted after 2 weeks of radiotherapy with stable MRI appearances (scan 2). Frank disease progression was seen in 1 patient on both MRI and PET-CT mid-treatment. 3/4 patients with persistent activity at scan 2, showed disease progression post-treatment on both PET-CT and MRI (scan 3). Another had progressive changes on MRI but stable PET-CT appearances possibly representing pseudoprogression. CONCLUSION These preliminary results suggest that Fluciclovine PET-CT could help in monitoring treatment and further work to assess the ability to guide individualised treatment planning in glioblastoma is warranted.
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Volkow, Nora D., and Laurence Tancredi. "Neural Substrates of Violent Behaviour a Preliminary Study with Positron Emission Tomography." British Journal of Psychiatry 151, no. 5 (November 1987): 668–73. http://dx.doi.org/10.1192/bjp.151.5.668.
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Brain function was evaluated in four psychiatric patients with a history of repetitive purposeless violent behaviour, using EEG, CT scan, and positron emission tomography (PET). Three patients showed spiking activity in left temporal regions, and two showed CT scan abnormalities characterised by generalised cortical atrophy. The PET scans for the four cases showed evidence of blood flow and metabolic abnormalities in the left temporal lobe. Two patients also had derangement in the frontal cortex. The patients showing the largest defects with the PET scans were those whose CT scans were reported as normal. This paper shows the utility of PET in investigating possible brain derangements that could lead to violent behaviour.
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Durani, Urshila, Dennis Asante, Thorvardur Halfdanarson, Herbert C. Heien, Lindsey Sangaralingham, Carrie A. Thompson, Prema Peethambaram, Fernando J. Quevedo, and Ronald S. Go. "Use of Imaging During Staging and Surveillance of Localized Colon Cancer in a Large Insured Population." Journal of the National Comprehensive Cancer Network 17, no. 11 (November 2019): 1355–61. http://dx.doi.org/10.6004/jnccn.2019.7315.
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Background: Adherence to surveillance guidelines in resected colon cancer has significant implications for patient morbidity, cost of care, and healthcare utilization. This study measured the underuse and overuse of imaging for staging and surveillance in stage I–II colon cancer. Methods: The OptumLabs database was queried for administrative claims data on adult patients with stage I–II colon cancer who underwent surgery alone in 2008 through 2016. Use of PET and CT imaging was evaluated during both initial staging (n=6,921) and surveillance for patients with at least 1 year of follow-up (n=5,466). “High use” was defined as >2 CT abdominal/pelvic (CT A/P) or PET scans per year during surveillance. Results: Overall, 27% of patients with stage I–II colon cancer did not have a staging CT A/P or PET scan and 95% did not have a CT chest scan. However, rates of staging CT A/P and CT chest scans increased from 62.0% (2008) to 74.8% (2016) and from 2.3% (2008) to 7.1% (2016), respectively. Staging PET use was overall very low (5.2%). During surveillance, approximately 30% of patients received a CT A/P or PET and 5% received a CT chest scan within the first year after surgery. Of patients who had surveillance CT A/P or PET scans, the proportion receiving >2 scans within the first year (high use) declined from 32.4% (2008) to 9.6% (2016) (P = .01). Conclusions: Although PET use remains appropriately low, many patients with stage I–II colon cancer do not receive appropriate staging and surveillance CT chest scans. Among those who do receive these scans during surveillance, high use has declined significantly over time.
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Kodzo-Grey Venyo, Anthony. "The Role of Positron Emission Tomography - Computed Tomography (PET - CT) Scan in the Assessment and Management of Carcinoma of the Prostate Gland: A Review and Update." Clinical Research and Clinical Trials 4, no. 2 (August 24, 2021): 01–17. http://dx.doi.org/10.31579/2693-4779/054.
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Background: PET CT Scan has been used on numerous occasions in the assessment and management of various malignancies but it is only occasionally used in the assessment management of carcinoma of the prostate gland globally. There is the need to establish whether or not PET/CT scan is a useful imaging technique which should be used more often in the investigation of biochemical failure following treatment of carcinoma of prostate gland with curative intent Aim: To investigate the suggestion that PET/CT scan would be a useful and reliable imaging option for the investigation of biochemical recurrence resulting following the treatment of prostate cancer with curative intent by reviewing the literature relating to the use of PET / CT scan in carcinoma of the prostate gland. Method: Various internet data bases were searched including: Google, Google Scholar, Yahoo, and PUBMED. The search words that were used included: PET/CT Scan in carcinoma of the prostate, PET/CT scan in prostate cancer, PET/CT scan and prostate cancer, PET/CT scan and carcinoma of the prostate. Results: Fifty two manuscripts that have been published relating to the use of a form of PET/CT scan in relationship to investigation of carcinoma of the prostate gland were utilized to write the article. One of the articles published in Dutch was a review article. Another paper reported the use of PET CT scan in the diagnosis of Hurtle tumour (a benign tumour) in association with carcinoma of the prostate gland. The remaining manuscripts contained case reports and studies regarding the use of various types of PET/CT scan in the investigation of biochemical failure as well as in the treatment and follow-up of some cases of metastasis. On the whole almost all of the papers had confirmed the high sensitivity and high specificity of PET/CT scan in detecting localized and distant metastatic lesions in the scenario of slight elevations of serum PSA. There have been reports of PET/CT scan being able to detect localized and distant metastasis when conventional computed tomography scan and isotope bone scan failed to detect metastases. In one case when the serum PSA level was high isotope bone scan and CT scan failed to detect bone metastases but PET/CT scan detected bone metastases. Conclusions: PET/CT Scan is a very useful imaging modality that detects localized and distant metastases in biochemical recurrence of prostate cancer and this modality of imaging should be used more often from now onwards. CT scan would usually detect nodes/lesions that measure 1 cm or larger but PET/CT scan would detect smaller sized lesions at slightly raised levels of serum PSA. The detection of small localized metastasis at a slightly elevated serum PSA values would make it easier for the undertaking of a second-line treatment of curative intent in the form of salvage lymphadenectomy or salvage radiotherapy targeted at the lesion. Perhaps PET/CT scan should be the first-line imaging modality which should be used in investigating biochemical recurrence and this should be done when the serum PSA is slightly elevated.
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Ho, Maria Yi, Tarnjit Parhar, Don Wilson, Winson Y. Cheung, and Howard John Lim. "A population-based study of the effect of FDG PET/CT in the management of liver-limited colorectal adenocarcinoma (CRC) metastases." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 3610. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.3610.
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3610 Background: PET/CT scans are publically funded in British Columbia for staging in liver limited metastatic CRC. However, past studies have been equivocal about the utility of PET/CT as some report as high as a 20-30% change in management while others report <10% change in management. Our primary objective was to assess the effect of the addition of PET/CT to CT scanning for the management of liver limited colorectal cancer. Methods: Patients who underwent PET/CT scan for de novo liver limited metastatic disease from 2005-2011 in the province of British Columbia were identified using the PET/CT database. Patients recently completed or currently on chemotherapy were excluded. We determined the concordance rates between CT and PET/CT scans with respect to the extra-hepatic disease, the number of lesions in the liver and the location of liver lesions. Results: 349 patients were identified. The most common indications for PET/CT scans after an initial CT scan were: detection of extrahepatic disease (77%), confirmation of the malignant nature of the liver lesions (8%) and the extent of extrahepatic disease (15%). PET/CT and CT were discordant in 39% of cases for the extent of metastatic disease. PET/CT revealed extrahepatic disease in 27% of the cases for which CT only detected liver limited disease. In contrast, 13% of patients were downstaged when CT liver lesions were demonstrated not to be FDG avid. Concordance of PET/CT and CT scans on the number and location of liver lesions was 52% and 85%, respectively. PET/CT revealed additional number of liver lesions and multilobar disease in 26% and 12% of cases, respectively. Furthermore, the median time between PET/CT and CT were 64.3 days and 64.1 days for concordant and discordant cases (p=0.88). Conclusions: PET/CT scans provided additional information compared to CT scans which could have implications for surgical management. Our study supports the utility and public funding of PET/CT in addition to CT in patients with potentially surgically curable metastatic CRC involving the liver.
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Gültekin, Aziz, Mustafa Çağdaş Çayır, Ayşe Uğur, Ferda Bir, and Doğangün Yüksel. "Detection of Pulmonary Embolism with Gallium-68 Macroaggregated Albumin Perfusion PET/CT: An Experimental Study in Rabbits." Contrast Media & Molecular Imaging 2020 (June 30, 2020): 1–8. http://dx.doi.org/10.1155/2020/5607951.
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This study was designed to evaluate the accuracy of detecting pulmonary embolism (PE) using the Technegas SPECT/CT combined with 68Ga PET/CT in a rabbit model. One hour after artificial PE (n = 6) and sham (n = 6) models were created, Technegas SPECT/CT ventilation and 68Ga-MAA PET/CT perfusion scan (V/Q scan) were performed. Ventilation imaging was performed first on all cases. Technegas SPECT/CT and 68Ga-MAA PET/CT images were evaluated by a nuclear medicine physician who recorded the presence, number, and location of PE on a per-lobe basis. The sensitivity, specificity, and accuracy of Technegas SPECT/CT and 68Ga-MAA PET/CT for detecting PE were calculated using a histopathological evaluation as a reference standard. A total of 60 lung lobes were evaluated in 12 rabbits, and PE was detected in 20 lobes in V/Q scans and histopathological analysis. The overall sensitivity, specificity, and accuracy were 100%, 100%, and 100%, respectively, for both the Technegas SPECT/CT and 68Ga-MAA PET/CT V/Q scans. Technegas/68Ga-MAA V/Q scans have good sensitivity, specificity, and accuracy in the detection of PE in this animal model study.
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Conte, Michael J., Deborah Bowen, Kari G. Rabe, Susan Schwager, Susan L. Slager, and Clive S. Zent. "Clinical Utility of PET/CT Scanning in Patients with Chronic Lymphocytic Leukemia." Blood 120, no. 21 (November 16, 2012): 3903. http://dx.doi.org/10.1182/blood.v120.21.3903.3903.
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Abstract Abstract 3903 The clinical utility of 2-deoxy-2-[18F] fluoro-D-glucose (FDG) positron emission tomography-computed tomography (PET-CT) scans in the management of patients with chronic lymphocytic leukemia (CLL) has not been clearly defined. CLL cells typically have low FDG avidity and the addition of the PET component has not been shown to improve the utility of CT scans in the management of patients with CLL. However, patients with CLL are at increased risk of developing FDG avid complications including more aggressive lymphomas, other second malignancies, and infections for which FDG PET-CT scans are a useful imaging modality. We hypothesized that FDG PET-CT scans are sensitive tests for evaluation of these complications in patients with CLL. Patients and Methods: This observational study was performed with IRB approval. We studied all 4030 CLL patients seen at least once in the Division of Hematology at Mayo Clinic Rochester between January 1, 2006 and December 31, 2011 using data prospectively collected into the Mayo Clinic CLL database. We reviewed the clinical and radiological records of the 272 (7%) patients who underwent 526 FDG PET-CT scans of the trunk during this time period to determine the indication for PET-CT scan, results of imaging, and the effects of the use of PET/CT scan on management. Results: Four hundred and seventy two (90%) of the 526 PET-CT scans were reported as abnormal. Of these, 78 (17%) scans were useful in directing a tissue biopsy of high FDG avidity lesions. Of the 37 (8%) positive PET-CT scans that facilitated the diagnosis of new complications of CLL, 21 (4%) scans led to a diagnosis of diffuse large B cell lymphoma and 9 (2%) scans led to a diagnosis of a solid malignancy. The FDG component of 22 PET-CT scans done because of clinical suspicion of complications of CLL were negative, and thus useful in management of these patients. PET-CT scans showed progressive CLL in 138 (29%) studies but in these patients, the PET component of the scan did not provide additional information about the status of the patients' CLL compared to the CT component alone. Conclusions: FDG PET-CT scans are not of proven value in staging CLL or determining response to treatment. However, our data suggest that they could be of considerable value in evaluation for complications, especially more aggressive lymphomas, other cancers, and infections that complicate the course of CLL. Disclosures: Off Label Use: Phase I study using PGG beta glucan in CLL. Zent:Biothera: Research Funding; Genzyme: Research Funding; Genentech: Research Funding; Novartis: Research Funding; GlaxoSmithKline: Research Funding.
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Faisal, Arif. "Positron Emission Tomography." Jurnal Radiologi Indonesia 1, no. 2 (September 1, 2015): 121–30. http://dx.doi.org/10.33748/jradidn.v1i2.16.
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The aim of this study to evaluate the positron emission tomography (PET) scan technology and its role as a diagnostic tool in health care. New PET technology provide the integrated PET and CT or MRI scan have been applicated globally.
In performing PET scan, a small amount of a radioactive substance (18F-FDG is widely used) is injected into a vein, and this substance is absorbed mainly by organs and tissues that use the most energy.The patients recieve internal radiation exposure from injected radiotracer and external radiation from CT component technology. PET and integrated PET seem to be used in oncology for diagnosis, tumor staging, evaluation after therapy and fnding recurrent cancer.
An integrated PET/CT scan combines images from PET scan reveals any abnormal activity that might be going on tissues and organs inside the body, while a CT scan provides detailed pictures ofthere. In general, PET/CT can be considered similarly accurate to PET/MRI as whole-body staging approach. But PET/MRI will be indicated and performed superiorly to PET/CT that require high soft tissue contrast. The average specifc activity of 18F-FDG was equal to 3.5 to 4.3 MBq/kg. In PET/CT examination,the injected18F-FDG activity was on an average 300 MBq for adult patient, and by using TOF technology the average activity decreased to 250 MBq.The average e?ective dose related to whole body PET/CT was about 14.3 mSv (8.6 mSv due to CT scan, 5.7 mSv due to PET-FDG component). Another center reported the average e?ective dose was 4.4 mSv for PET component alone and totally 13.5 mSv for PET/CT examination. A PET technology and integrated PET with CT or MRI as new machine for diagnostic imaging can be used mainly for oncologic patients. The PET/MRI technology is superior to PET/CT in detecting soft tissue contrast of organs and tissues.
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Huang, Chung-Jen, Dong-Ling You, Pei-Ing Lee, Li-Han Hsu, Chia-Chuan Liu, Chih-Shiun Shih, Chiang-Ching Shih, and Hsiu-Chin Tseng. "Characteristics of integrated 18F-FDG PET/CT in pulmonary cryptococcosis." Acta Radiologica 50, no. 4 (May 2009): 374–78. http://dx.doi.org/10.1080/02841850902756532.
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Background: Pulmonary cryptococcosis is an uncommon cause of pulmonary nodules found by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans. It is rarely reported but may mislead interpretation. Purpose: To describe the 18F-FDG PET/CT findings of pulmonary cryptococcosis. Material and Methods: The 18F-FDG PET/CT images of seven patients with pulmonary cryptococcosis were evaluated. Results: The 18F-FDG PET/CT exams showed single or multiple nodular lesions. The standardized uptake values (SUV) in early images varied significantly for the seven patients (ranging from 2.2 to 11.6). Delayed SUVs showed significant increases in four patients. Conclusion: Pulmonary cryptococcosis mimics primary or metastatic lung cancer on 18F-FDG PET/CT scan. Tissue confirmation should be considered for any suspicious pulmonary nodules found on 18F-FDG PET/CT scan with an SUV score higher than 2.5, in order to avoid overdiagnosis or overstaging.
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Patel, M., S. Saha, R. Sehgal, L. Gallardo, K. Doan, B. Berman, D. Wiese, S. Weiner, M. Arora, and T. Singh. "Comparative analysis of CT-scan and PET-scan with intraoperative ultrasound (IOUS) in detecting liver metastases." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 3632. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.3632.
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3632 Background: Open, laparoscopic or percutaneous radiofrequency ablation (RFA) has been used for the surgical treatment of liver metastases (mets). However, it requires accurate preoperative (preop) localization of liver mets. CT scan and PET scan have been widely used for such preop evaluation. However, intraoperative ultrasound (IOUS) remains the gold standard. Very little data is available comparing IOUS with preop CT and/or PET scan. Thus, a retrospective study was done to compare the efficacy of IOUS with preop CT and/or PET scan in detecting the number of liver mets. Methods: A retrospective chart review was done that included all patients (pts) who underwent surgical treatment for liver mets. Data was obtained from medical records, radiology, intraop reports. Results: 53 pts including 57% men and 43% women with a median age of 62years (age range 35–80 years) were included in the study. Imaging data was available for CT, PET and IOUS in 53, 24 and 39 pts respectively. CT, PET, and IOUS detected 2.4, 1.7 and 2.6 lesions/ pt respectively. In 24 patients, both CT and PET scan report was available. Of these, the imaging study detecting the maximum number of lesions was selected for comparison of preop evaluation with IOUS. A comparison between preop imaging (CT/PET scan) vs. IOUS in these 24 pts revealed an average of 2.3 vs. 2.8 lesions/pt respectively ( Table ). When compared with preop imaging (CT/PET scan), IOUS detected additional lesions in 33% pts; fewer lesions in 17% pts and similar number of lesions in 50% pts. Comparison between CT and IOUS in 39 patients revealed 1.9 vs. 2.6 lesions/pt respectively and that between PET and IOUS in 24 patients revealed 1.7 vs. 2.8 lesions/pt respectively. Conclusions: Although CT scan and PET scan remains effective modalities for preop evaluation of liver mets, IOUS is found to be superior for planning accurate surgical treatment. Thus, the efficacy of percutaneous RFA may be limited due to inability to perform IOUS. [Table: see text] No significant financial relationships to disclose.
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Hougen, Helen Y., Nadine Mallak, Yiyi Chen, Catherine Degnin, Ryan P. Kopp, Jen-Jane Liu, Sudhir Isharwal, and Arthur Hung. "Predictors of positive lesions in 18F-fluciclovine PET/CT." Journal of Clinical Oncology 37, no. 7_suppl (March 1, 2019): 231. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.231.
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231 Background: The 18F-Fluciclovine (FACBC) PET/CT scan has higher sensitivity than traditional imaging modalities for detection of prostate cancer (PCa) recurrence. We aim to identify the PSA characteristics as predictors of positive FACBC scan. Methods: Seventy-eight patients who underwent FACBC scan in 2018 at our institution were identified. Patient demographics, prior PSA, clinical information including prior treatment was recorded. Scans were deemed positive if definitive lesions were noted at the prostate bed, pelvic lymph nodes, or skeletal level. Detection rate was the ratio of positive over total scans and was calculated for PSA ranges. PSA velocity (PSAV) was calculated for patients who did not initiate androgen-deprivation therapy 12 months prior to the scan. The baseline PSA and PSAV were modeled as predictors of having a positive scan using logistic regression. Results: The median baseline PSA is 2.7 (range 0.2 - 226.5). The rates of positivity increased with increasing baseline PSA (Table 1). Positive scans had higher median baseline PSA (3.0, range 0.2-226.5 vs. 1.2, range 0.2-26.0; p = 0.0015) and higher PSAV (median 2.3, range -0.6-1478.7 vs. 1.0, range -0.5-31.9; p = 0.025). Baseline PSA (AUC = 0.712) was better predictor than PSAV (AUC = 0.656) of a positive scan. Combining the two variables does not improve their predictive ability (AUC = 0.719). There is a 50% detection rate in post-radical prostatectomy (RP) patients (Table 2). Conclusions: FACBC PET’s detection rate increases with increasing baseline PSA. While higher PSAV is associated with higher rate of positive scan, it did not increase the predictive ability of baseline PSA for a positive scan in prostate cancer recurrence patients. [Table: see text][Table: see text]
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Pusuwan, Pawana, Tawatchai Ekjeen, Chiraporn Tocharoenchai, Kobkun Maungsomboon, Kanyalak Wiyaporn, Chulalak Komoltri, Ananya Ruangma, and Ruentip Tiparoj. "A Comparison of Bone Scan Using between F-18 NaF PET/CT and Tc-99m MDP." ASEAN Journal of Radiology 19, no. 2 (March 11, 2019): 77–87. http://dx.doi.org/10.46475/aseanjr.v19i2.25.
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Objective: To study bone scintigraphy using between F-18 NaF PET/CT and Tc-99m MDP scan for detecting bone metastases.
Material and Methods: Thirteen patients (5 males, mean age 55.4 years, range 34-74 years) who were suspected bone metastases with single or two equivocal lesions on Tc-99m MDP bone scan were recruited between October 2010 and October 2012. All these patients underwent F-18 NaF PET/CT scan within one week after Tc-99m MDP bone scan. The sensitivity, specificity and accuracy of Tc-99m MDP bone scan and F-18 NaF PET/CT in differentiating metastatic bone lesion from benign lesion by patientbased and lesion-based analyses were studied.
Results: F-18 NaF PET/CT could identify all seven patients with malignant bone metastases that Tc-99m MDP bone scan was interpreted as malignancy in only three patients (42.9%) and equivocal in the rest of these patients. For lesion-based analysis of the overall 75 lesions, the sensitivity, specificity and accuracy of Tc-99m MDP bone scan were 48%, 83.3% and 70.7% and F-18 NaF PET/CT were 100% for all parameters. Besides the ability of F-18 NaF PET/CT to accurately identify malignancy from benign lesion, unenhanced CT portion of PET/CT can show extra-osseous findings that may change patient management.
Conclusion: F-18 NaF PET/CT provides an excellent bone image quality and higher accuracy than Tc-99m MDP bone scan. Then F-18 NaF PET/CT is a good choice for evaluating bone metastases.
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Jehl, Markus, Ekaterina Mikhaylova, Valerie Treyer, Marlena Hofbauer, Martin Hüllner, Philipp A. Kaufmann, Alfred Buck, et al. "Attenuation Correction Using Template PET Registration for Brain PET: A Proof-of-Concept Study." Journal of Imaging 9, no. 1 (December 21, 2022): 2. http://dx.doi.org/10.3390/jimaging9010002.
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NeuroLF is a dedicated brain PET system with an octagonal prism shape housed in a scanner head that can be positioned around a patient’s head. Because it does not have MR or CT capabilities, attenuation correction based on an estimation of the attenuation map is a crucial feature. In this article, we demonstrate this method on [18F]FDG PET brain scans performed with a low-resolution proof of concept prototype of NeuroLF called BPET. We perform an affine registration of a template PET scan to the uncorrected emission image, and then apply the resulting transform to the corresponding template attenuation map. Using a whole-body PET/CT system as reference, we quantitively show that this method yields comparable image quality (0.893 average correlation to reference scan) to using the reference µ-map as obtained from the CT scan of the imaged patient (0.908 average correlation). We conclude from this initial study that attenuation correction using template registration instead of a patient CT delivers similar results and is an option for patients undergoing brain PET.
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Grilo, Ana, Lina Vieira, Elisabete Carolino, Cátia Oliveira, Carolina Pacheco, Maria Castro, and Juan Alonso. "Anxiety in Cancer Patients during18F-FDG PET/CT Low Dose: A Comparison of Anxiety Levels before and after Imaging Studies." Nursing Research and Practice 2017 (2017): 1–9. http://dx.doi.org/10.1155/2017/3057495.
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Objective. Assessing the level of anxiety in oncology patients who underwent18F-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 the18F-FDG PET/CT low dose scan. Patients filled in the Scan Experience Questionnaire and the State-Trait Anxiety Inventory (STAI) before and after18F-FDG PET/CT low dose scan.Results. Substantial levels of anxiety were detected both before and after18F-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, andMedianpos= 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 the18F-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=0.004andrS=0.528,p= 0.000, resp.), but not with anxiety levels.Conclusions. Patients perceive high levels of anxiety during the18F-FDG PET/CT low dose scan and the concern with scan results was pointed out as the main factor for that emotional reaction.
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Duell, Johannes, Andreas Rosenwald, Franziska Krummenast, Andreas Buck, Hermann Einsele, Max S. Topp, and Constantin Lapa. "CXCR4 PET/CT Scan Is Superior to FDG PET/CT Scan in Accurately Defining Marginal Zone Lymphoma Nodal and Extranodal Involvement." Blood 132, Supplement 1 (November 29, 2018): 2881. http://dx.doi.org/10.1182/blood-2018-99-118339.
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Abstract Introduction: Imaging by PET/CT scan with FDG is the gold standard for initial staging for malignant lymphoma. This sequence is very robust for Hodgkin lymphoma, aggressive lymphomas and follicular lymphoma but lacks sensitivity for marginal zone lymphoma (MZL), irrespectively of the different MZL subsets e.g. mucosa-associated lymphoid tissue (MALT), and nodal marginal lymphoma (NMZL ), splenic marginal zone lymphoma (sMZL) and extranodal marginal zone lymphoma (eNMZL). Limited disease of MZL (Stage I/II) are commonly treated by irradiation. Extensive disease (Stage III/IV) is either followed by watch and wait if clinically asymptomatic and or treated with anti-CD20 directed immune chemotherapy if clinically prudent. Hence, better diagnostic procedure are highly warranted to improve the accuracy of the Ann Arbor staging in MZL for Stage adapted treatment of MZL patients. Method: Nineteen patients with newly diagnosed MZL (13 MALT, 5 NMZL, 1 sMZL) received a PET/CT scan with FDG as tracer and bone biopsy as standard staging procedures. All patients with MALT MZL were further subject to gastric endoscopy and coloscopy with tissue biopsy. All patients received in addition a CXCR4-directed radiotracer [68Ga] Pentixafor PET/CT scan, which has shown to be of diagnostic value in multiple myeloma patients. If a lesion was negative by FDG PET scan but positive by CXCR4 PET, additional tissue was acquired to confirm MZL infiltration by immunohistochemistry in selected patients. Results: From 05/2017 to 05/2018 nineteen newly diagnosed MZL were staged by conventional PET/CT scan resulting in 2 patients with limited disease status and 12 in extensive disease status. 5 patients had no lesions with FDG PET confirmed as a false negative readout. Utilizing CXCR4 PET/CT SCAN 4 had limited disease and 15 had extensive disease. Only 1 patient with a minimal gastral infiltration and low proliferation frequency was not detected. All bone marrow infiltrations could be detected by CXCR4 (3 out of 3) but none with FDG PET scan. For intestinal involvement of the lymphoma 2 out of 3 patients were true positive (confirmed by biopsy) with CXCR4 PET scan but 0 out of 3 patients with FDG PET scan. 12 out of 13 patients with MALT Lymphoma were PET CXCR4 positive in all leasions. In contrast, only 6 out 13 patients with MALT could be detected with FDG PET scan. In the group of NMZL 5/5 patients demonstrated CXCR4 PET positivity. In contrast only 5 out 5 had a FDG uptake. For the single case of sMZL, the CXCR4 PET was positive but on FDG PET negative. Taken together, 94.7% of the MZL patients were positive by CXCR4 PET/CT scan but only 42.1% with FDG PET CT scans. In addition, CXCR4 PET showed also uptake in the bone marrow and GI tract in most cases with corresponding involvement whereas FDG/PET missed this involvement all patients. Conclusion: CXCR4 PET adapted staging of newly diagnosed marginal zone lymphoma has the potential of becoming the new standard for MZL staging and allocating MZL to the respective front line therapy algorithms. Larger studies are highly warranted to confirm these findings in the future. Figure. Figure. Disclosures Topp: Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Research Funding; F. Hoffmann-La Roche Ltd: Membership on an entity's Board of Directors or advisory committees, Research Funding; Boehringer Ingelheim: Research Funding; Regeneron Pharmaceuticals, Inc.: Honoraria, Research Funding.
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Branagan, Jennifer Mary Rose, Charlotte Halle, Stephen Falk, Ganesh Radhakrishna, Rajarshi Roy, Thomas Crosby, Chris Hurt, Thomas B. Brunner, and Somnath Mukherjee. "Reduction of interobserver variability (IOV) by FDG-PET–based tumor volume delineation (TVD) in radiotherapy planning for pancreatic cancer." Journal of Clinical Oncology 31, no. 4_suppl (February 1, 2013): 229. http://dx.doi.org/10.1200/jco.2013.31.4_suppl.229.
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229 Background: Wide IOV has been reported for CT-based TVD during radiotherapy planning for pancreatic cancer (Yamazaki, Anticancer Research 27: 2965-2972, 2007). PET-CT has been successfully incorporated into treatment planning in other tumour sites and has been shown to reduce IOV, but no study has looked at its role in pancreatic radiotherapy. Methods: Six radiation oncologists from 6 oncology centers in the UK were asked to outline GTVs in two cases with pancreatic head tumors. DICOM data set of planning CT, diagnostic CT and FDG-PET-CT scans were made available. GTV was first outlined using the information on the diagnostic CT scan alone, without access to PET scans (GTV_CT). The GTVs were then re-outlined using additional information from the PET scan (GTV_PET). A PTV was grown from the GTV, using a margin of 2cm sup-inf and 1.5cm radially from the GTV, as per standard UK practice. Results: A total of 48 countours (24 GTV contours and 24 PTV contours) were analysed, and the results are presented below (Table). Conclusions: The incorporation of PET scan resulted in a prominent reduction in standard deviation around tumor volumes, smaller largest:smallest GTV ratios and a larger percentage of overlap between investigator volumes, suggesting a reduction in Inter-Observer Variability. PET based RT planning should be considered in multicenter radiotherapy trials in pancreatic cancer to reduce IOV. [Table: see text]
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Gühne, Falk, Robert Drescher, Philipp Seifert, and Martin Freesmeyer. "Minimal-activity PET/CT for efficacy control after SIRT (MAPECSI) – clinical implementation of a resource-saving, liver-focused protocol." Nuklearmedizin 58, no. 05 (August 14, 2019): 363–70. http://dx.doi.org/10.1055/a-0985-3954.
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Abstract Aim SIRT is an established treatment option for liver malignancies. Metabolic information can provide additional knowledge about tumoral characteristics and treatment response. FDG-PET/CT was shown to be advantageous for pre-/post-SIRT evaluation. However, whole-body PET/CT is an elaborate procedure. The aim of the study was to optimize clinical efficacy assessment after SIRT with a low-dose, low-cost protocol for focused diagnostic work-up. Methods An abdomen-only minimal-activity FDG-PET/CT protocol (MA-PET) was established as an alternative for clinically indicated whole-body PET/CT scans. After administering 40 MBq of F-18-FDG one bed position was scanned for 15 minutes. Scans were acquired before (initial scan), one month after (interim scan) and three months after SIRT (follow-up scan). Metabolic tumor activity was evaluated and was compared to standard CT follow-up results. Results 50 lobar SIRT procedures in 37 patients were analysed. HCC (28), hepatic metastases (15) and CCC (7) were treated. In 18 liver lobes initial MA-PET did not show hypermetabolic lesions, 32 liver lobes underwent interim and follow-up MA-PET. All 114 MA-PET were technically feasible. Mean radiation dose was 1.9 mSv. 64 % of HCC presented low metabolism at baseline, whereas metastases and CCC were all clearly PET-positive. Majority of radiated liver tumors showed at least partial metabolic response. PET/CT results diverged from follow-up CT in 63 % of cases. Conclusion Minimal-Activity FDG-PET/CT of the liver is a feasible tool for efficacy assessment after SIRT with low financial and radiation burden. It provides additional information to morphologic imaging modalities, which can be helpful in response appraisal and treatment planning.
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Blaes, Anne H., Adina M. Cioc, Jerry Froelich, Bruce A. Peterson, and Jordan Dunitz. "Positron Emission Tomography (PET) Scanning in the Setting of Post-Transplant Lymphoproliferative Disorders (PTLD)." Blood 110, no. 11 (November 16, 2007): 4411. http://dx.doi.org/10.1182/blood.v110.11.4411.4411.
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Abstract PTLD is a serious complication in patients following solid organ or bone marrow transplantation (BMT) with a high mortality rate after conventional therapies. With pathology ranging from plasmacytic hyperplasia to monomorphic PTLD, identifying specific sites of disease for definitive diagnosis can be challenging. We examined the role of PET scanning in the staging and follow-up of PTLD. We retrospectively reviewed all patients treated for PTLD at the University of Minnesota from 2001–2006 who also underwent PET scans. Pathology was confirmed by a hematopathologist. PET scans were reviewed by a nuclear medicine radiologist. 21 patients with PTLD had PET scans at diagnosis or relapse. 20/21 of these PET scans were available for review. In these 20 patients, the type of transplant was lung(4), kidney/pancreas(5), kidney(4), small bowel(1), BMT(2), liver(2), heart/lung(1), and lung/kidney(1). Histology was polymorphic PTLD (n=1), diffuse large B-cell lymphoma (DLBCL) (n=12), DLBCL/polymorphic PTLD (n=2), DLBCL/plasmacytic PTLD (n=1), anaplastic large cell lymphoma (n=1), and mixed cellularity Hodgkin lymphoma (n=1). The median time from transplantation to PTLD diagnosis was 66 months (range, 4–192 mos). At diagnosis, stage of disease was I(3), II(6), III(3), IV(6) and two patients had primary central nervous system lymphoma (PCNSL). 16 patients had extranodal involvement. 17/20 patients had PET scans for staging at the time of diagnosis. The two patients with PCNSL and 1 patient with only bone marrow involvement after complete surgical resection of a bowel lesion were PET negative at the time of diagnosis. All of the remaining patients with measurable disease by CT scan were PET positive at diagnosis. The median maximum standard uptake value (SUV) was 8.8 (range 3–30). 14/20 patients had one or more PET scans following treatment. 10 patients had a complete response with both negative PET and CT scans following therapy. 4 patients had measurable disease by both CT scan and PET scan (2 persistent disease, 1 partial response, 1 relapsed disease). The two patients with persistent disease died. The patients with a partial response and relapsed disease received additional therapy, had a complete response with a negative follow-up PET scan, and currently remain in complete remission at 16 mos and 12 mos, respectively. Of the 10 patients with complete responses documented by PET scan, 7 patients remain in complete remission for a median of 11 mos (range 5–50 mos). 3 patients relapsed shortly thereafter at 1, 4, and 5 months after PET scan. At the time of relapse, PET scan confirmed disease. On each occasion in which there was measurable disease by CT scan at the time of relapse, the PET scans were positive with median maximum SUV 6.8 (range 2.2–10.8). All biopsy confirmed sites of PTLD demonstrated uptake on PET scan, regardless of underlying histology. Due to the small number of patients, it was not possible to correlate SUV uptake with histologic subtype. These findings suggest that PET scans have a role in the staging and follow-up of PTLD. PET scans can identify sites of disease. Maximum SUV may vary at the time of presentation. Regardless of the underlying histology, PET scans are useful in the management of this aggressive disease.
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Xiang, Z. "PET/CT fusion in radiotherapy treatment planning for head and neck cancer." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e17046-e17046. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e17046.
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e17046 Background: Positron emission tomography/computerized emission tomography (PET/CT) creates fusion images which are a combination of tissue function (PET) and anatomy (CT). It is playing an increasingly important role in radiotherapy of cancer. Aim of this report is to investigate the value of PET/CT fusion in radiotherapy treatment planning for head and neck cancer. Methods: 17 patients with head and neck cancer underwent 18F-FDG PET/CT imaging. The primary lesions were all proved by pathology. PET/CT fusion images, PET images and CT images of the same patient were analyzed frame by frame. TNM stage was analyzed based on PET/CT and CT. PET/CT-GTV and CT-GTV volume were analyzed. Results: 59 malignant lesions were detected by PET/CT in the 17 patients. Among 59 lesions, 31 lesions were detected and displayed definitely by both PET and the plain scan of CT; 23 lesions were detected definitely by PET but not by the plain scan of CT; while 5 lesions were negative by PET but definitely by the plain scan of CT. The sensitivity of PET/CT was higher than PET and the plain scan of CT alone. Changes in TNM stage occurred in 7 patients (41%), based on PET/CT. The median PET/CT-GTV and CT-GTV volume was 84.3 cm3 (range, 46∼364 cm3) and 116.2 cm3 (range, 58∼472 cm3), respectively, showed significant differences (p = 0.0005). Conclusions: PET/CT can increase the accuracy of the staging and defining target volumes for radiation therapy fields for head and neck cancer. No significant financial relationships to disclose.
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Li, Yuhao, Lisha Jiang, Haitao Wang, Huawei Cai, Yongzhao Xiang, and Lin Li. "EFFECTIVE RADIATION DOSE OF 18F-FDG PET/CT: HOW MUCH DOES DIAGNOSTIC CT CONTRIBUTE?" Radiation Protection Dosimetry 187, no. 2 (May 31, 2019): 183–90. http://dx.doi.org/10.1093/rpd/ncz153.
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Abstract The aim was to estimate the effective doses associated with different types of scanning protocols and how much the diagnostic computed tomography (DCT) scan contributed to the total dose of the dual-modality positron emission tomography/computed tomography (PET/CT) examinations. The results showed that an average radiation dose of 8.19 ± 0.83 mSv and 13.44 ± 5.14 mSv for the PET and CT components, respectively, resulting in a total dose of 21.64 ± 5.20 mSv. Approximately 92.7% (980 of 1057) of the patients underwent additional DCT protocols. The DCT protocols contributed 42% of the overall effective radiation doses, which was larger than the percentage contributed by the PET component (38%) and LCT protocols (20%). Reducing the diagnostic area of the DCT scans that patients undergo and decreasing the use of chest-abdomen-pelvis (CAP), abdomen-pelvis (AP) and chest DCT protocols, especially the CAP protocol, will be helpful in decreasing the effective radiation doses of PET/CT scan.
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Yu, J. M., X. J. Zhong, B. J. Zhang, D. B. Mu, A. Q. Han, X. D. Sun, S. H. Yuan, P. P. Song, H. Li, and Z. Fu. "Comparison of gross tumor volume delineated by anatomic imaging and FDG PET/CT for esophageal carcinoma and validation with pathological specimen." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 15090. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.15090.
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15090 Background: Although results of clinical studies have demonstrated FDG PET/CT improved target volume delineation in various tumors, only few studies compared delineation based on PET/CT with pathologic examination. Aim of our study was to compare anatomic imaging modalities including computed tomography (CT), esophagram, endoscopy with FDG PET/CT for delineation of gross tumor volume (GTV) in esophageal carcinoma and to validate the results with the pathologic examination. Methods: Thirty patients with stages II-III squamous cell carcinoma underwent transthoracic esophagectomy were enrolled. PET/CT, esophagram and endoscopy were performed with patients before operations. The length of the lesion on the PET/CT scan and on the CT portion of the PET/CT and the PET scan alone was determined independently by 3 separate investigative groups. PET/CT scan was evaluated by visual inspection for abnormality. A standard uptake value (SUV) of 2.5 was used in the PET scan to delineate the tumor extent. The lengths of GTVs determined with the five modalities (PET/CT, PET, CT, esophagram and endoscopy) were compared quantitatively and validated with the pathologic specimen. The sizes of the tumors were measured by pathologic examination which was considered as the gold standard. Results: Of the 30 patients, 9 had T2 tumors, 20 had T3 tumors and 1 had T4 tumor with an involvement of pleura. Three tumors were located at the upper esophagus, 14 at the middle esophagus, 13 at the lower esophagus. The mean length of the carcinoma was 5.85cm(SD 2.50cm) measured by pathologic examination, 5.79cm (SD 2.04cm) as determined by PET scan, 5.14cm (SD 1.65cm) by PET/CT scan, 5.42 cm(SD 2.42cm)by CT scan, 5.50cm(SD 2.79cm) by endoscopy, and 6.07cm(SD 2.75cm) by esophagram respectively. Although the lengths of the tumors as measured by the five imaging modalities were no significant difference, the result of PET was the most accurate. Conclusions: Compared with tumor lengths measured by pathologic examination, PET with a SUV 2.5 was found to be the most accurate modality and can help the radiation oncologist delineate the GTV of esophageal carcinoma precisely. No significant financial relationships to disclose.
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Sehn, Laurie H., Paul Hoskins, Richard Klasa, Tamara Shenkier, Randy D. Gascoyne, Francois Benard, Don Wilson, et al. "FDG-PET Scan Guided Consolidative Radiation Therapy Optimizes Outcome In Patients with Advanced-Stage Diffuse Large B-Cell Lymphoma (DLBCL) with Residual Abnormalities on CT Scan Following R-CHOP." Blood 116, no. 21 (November 19, 2010): 854. http://dx.doi.org/10.1182/blood.v116.21.854.854.
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Abstract Abstract 854 Background: Residual abnormalities of uncertain significance are frequently seen on post-therapy CT scans in patients (pts) with advanced-stage diffuse large B-cell lymphoma (DLBCL) following treatment with R-CHOP. However, the value of consolidative radiation therapy (XRT) to these sites is unknown. FDG-PET scanning may allow for the discriminate use of XRT to eradicate sites of residual disease. Method: Since 2005, pts with advanced-stage DLBCL in British Columbia (BC) have been treated with a systematic policy recommending a post-chemotherapy PET scan for pts with residual abnormalities ≥2cm on CT scan, followed by XRT to PET-positive sites that are amenable to radiation. Pts with a negative PET scan are observed (regardless of initial or residual bulk), while pts with a PET scan that is widely positive and not suitable for XRT are treated at the discretion of individual physicians. All PET scans are performed in a central location using a combined PET/CT scanner; staging PET scans are not routinely performed. Using the databases of the BC Cancer Agency Centre for Lymphoid Cancer and Department of Functional Imaging, we identified all pts with newly diagnosed advanced-stage DLBCL between January 2005 and June 2009 treated with R-CHOP who underwent a post-treatment PET scan based on this management algorithm. This analysis does not include pts with primary progressive disease; pts with a complete remission on post-treatment CT scan; pts who were HIV positive; or those with transformed lymphoma. Results: 196 pts were identified with the following baseline characteristics: median age 64 y (range 18–89 y); 61% male; 62% stage III/IV; 41% PS>1; 21% >1 extranodal site; 57% elevated LDH; 46% bulky site ≥10cm; 56% IPI 0–2, 44% IPI 3–5. All pts received 3-weekly R-CHOP (6-8 cycles) with curative intent. Median follow-up for living pts is 32 mos (range 5–65 mos). 121/196 (62%) had a negative post-therapy PET (PET-Neg), 66/196 (34%) had a positive PET (PET-Pos), and 9 (4%) were indeterminate. Median SUV of PET-Pos scans was 3.4 (range 1.8–25). None of the PET-Neg pts received XRT. 51/66 (77%) of PET-Pos pts received XRT (3000-4000 cGy) to sites of PET positivity (46 single field, 5 multiple fields), with only 7 relapses to date. 15/66 (23%) PET-Pos pts did not receive XRT due to: multiple sites not amenable to XRT 11; physician choice 3; biopsy negative 1. Only 3/9 pts (33%) with an indeterminate PET received XRT. There was no difference in the 3-y PFS (80% v 75%, p=0.41) and 3-y OS (84% v 77%, p=0.10) between the PET-Neg and PET-Pos pts, respectively. The 3-y PFS was similar for PET-Pos pts who received XRT (84%) and PET-Neg pts (80%) and was superior to PET-Pos pts who did not receive XRT (42%). Pts with an indeterminate scan had a favorable outcome with a 3-y PFS of 89%. Conclusion: Pts with advanced-stage DLBCL who have residual abnormalities on CT scan following R-CHOP and receive consolidative radiation to sites of PET positivity have an outcome similar to pts with a negative post-therapy PET. The favorable outcome observed in the PET-positive cohort treated with XRT is higher than expected from historical reports, suggesting a benefit for the rational use of PET-guided XRT following chemotherapy for DLBCL. Pts who have residual abnormalities on CT scan that are PET-negative should be spared indiscriminate exposure to radiation as the majority have been cured with systemic therapy. Disclosures: No relevant conflicts of interest to declare.
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Ulijn, E., A. Den Broeder, N. Boers, M. Gotthardt, C. Bouman, R. B. M. Landewé, N. Den Broeder, and N. Van Herwaarden. "POS0125 EXTRA-ARTICULAR FINDINGS WITH FDG-PET/CT IN RHEUMATOID ARTHRITIS PATIENTS: MORE HARM THAN BENEFIT." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 288.1–288. http://dx.doi.org/10.1136/annrheumdis-2022-eular.2106.
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BackgroundWhole-body Positron Emission Tomography with CT-scanning using fluorine-18 fluorodeoxyglucose (18F-FDG) is occasionally used in Rheumatoid Arthritis (RA) patients. Reasons to use FDG-PET/CT-scans are to diagnose arthritis or guide decisions on systemic therapy, as FDG uptake in affected joints may reflect disease activity [1]. FDG-PET/CT might also detect malignancies, but the frequency of incidental findings and the proportion of relevant malignant disease that could be missed are currently unknown.ObjectivesTo study the malignancy screening performance of whole-body FDG-PET/CT in longstanding RA patients with low disease activity.MethodsFDG-PET/CT-scanning was done in the intervention arm of the Dose REduction Strategy of Subcutaneous TNF-inhibitors (DRESS) study, a randomized controlled trial on dose-tapering of biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) [3]. Baseline and if applicable follow up whole-body FDG-PET/CT-scans were performed in consenting patients in the tapering arm to assess predictive value of subclinical PET-arthritis for risk of flaring [4]. The scans were also read by experienced nuclear medicine specialists immediately after they were performed for any unexpected extra-articular finding, conform routine clinical care.The reference standard was clinical diagnosis of malignancy during the 3 year follow-up. Prevalence of extra-articular abnormalities, follow-up, and received treatments were summarized post-hoc.Results121 scans were made in 79 patients. Extra-articular abnormalities were found in 59/121 (48.8%) scans (Table 1) in 45/79 (57%) patients.Table 1.Abnormalities found on FDG-PET/CT scans# abnormal results found on scans (%)No PET/CT result obtained3 (2.5)No abnormalities found on any scan59 (48.8)One or more abnormalities found per scan*59 (48.8)Total number of scans121 Inflammatory7 (5.7) Suspected malignancies9 (7.4) Cardiovascular2 (1.6) Pulmonary7 (5.8) Gastrointestinal10 (8.3) Muscles/tendons3 (2.5) Bone-related3 (2.5) Hypermetabolic lymph nodes (non-specific)16 (13.2) Thyroid4 (3.3)* Fifteen of these abnormalities were found on the second PET/CT, the rest was found on the first scan. 11 abnormalities on the second PET/CT were the same as the one seen on the first scan, and 7 abnormalities resolved after the first scan. One scan can show multiple abnormalities, from different categories.Follow-up action occurred in 21 (26.6%) patients, consisting of referral to a specialist or reassessing and/or scheduling diagnostics directly by the treating rheumatologist. In 5 (6.3%) patients, the rheumatologist followed-up. In 17 (21.5%) patients a consultation with a different specialist was scheduled. In five patients surgical/invasive intervention took place. In one patient a hemi-thyroidectomy was performed revealing a follicular adenoma. This resection was complicated by persistent recurrent laryngeal nerve paresis and hoarseness. In a second, an intra-uterine myomectomy took place. In a third, a colonoscopy was performe revealing two low-grade adenomas. In a fourth a benign cyst in the neck was extracted. A fifth patient underwent spinal marginal myotomy which turned out to be a benign schwannoma.Nine patients (7.4%) were suspected of malignancy, none turned out to be malignant. Six clinical malignancies (bladder, penile, lymphoma, 2x melanoma and prostate) that developed during follow-up were all negative on baseline FDG-PET/CT. The malignancies were diagnosed after an interval of between 5 and 34 months (mean 13 months).ConclusionWhole-body FDG-PET/CT-scanning for arthritis imaging in RA patients results in frequent incidental extra-articular findings, while some who apparently had normal scans developed malignancies.References[1]Mandl P. et al. RMD open 2019;5:e000950.[2]Van Herwaarden N. et al. BMJ 2015;350:1–8. doi:10.1136/bmj.h1389[3]Bouman C.A.M et al. Rheumatology 2021.Disclosure of InterestsNone declared
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Moya-Alvarado, Patricia, Alejandro Fernandez Leon, Maria Emilia Corica, Valle Camacho Marti, Diego Alfonso López-Mora, Ivan Castellví, and Hèctor Corominas. ""The added value of 18f-FDG PET/CT in the assessment of onset and steroid resistant polimyalgia rheumatica"." PLOS ONE 16, no. 9 (September 24, 2021): e0255131. http://dx.doi.org/10.1371/journal.pone.0255131.
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PMR is a common inflammatory rheumatic disease. Although its clinical characteristics are fully recognized, no specific test for its diagnosis has been established to date. Several studies have described a wide variety of diseases that present with polymyalgic symptoms. A 18FDG-PET/CT scan could help to deal with these differential diagnoses. The goal of our study is to describe the findings of the 18FDG-PET/CT scan in a cohort of PMR patients and to detail how the 18FDG-PET/CT scan improves accuracy when diagnosing other underlying conditions. This cross-sectional study enrolled patients with a diagnosis of PMR who underwent to a 18FDG-PET/CT scan to rule out other diagnosis. The 18FDG-PET/CT scan was performed either following clinical criteria at the onset of clinical symptoms or when the patient became PMR steroid resistant. Patients’ demographic, clinical and analytical data at the moment of the 18FDG-PET/CT scan were recorded. The final diagnosis was confirmed according to clinical judgement. A total of 103 patients with PMR were included. In 49.51% of patients, the 18FDG-PET/CT scan was ordered to study resistance to steroid therapy. The final diagnoses of patients were PMR in 70.9% patients, large vessel vasculitis in 15.5%, neoplasms 4.8% and another diagnosis in the rest. The 18FDG-PET/CT scan is a very useful technique for the study of Polymyalgia Rheumatica, not only to help in the diagnostic process, but also due to its role in the identification of a variety of PMR-like patrons.
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Brown, Gina. "Imaging of liver metastases (CT scan, MRI, PET scan)." European Journal of Cancer Supplements 5, no. 5 (September 2007): 297–300. http://dx.doi.org/10.1016/s1359-6349(07)70056-3.
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Nagle, D., D. Henry, A. Iagaru, J. Mastoris, L. Chmielewski, and J. Rosenstock. "The utility of PET scanning in the management of squamous cell carcinoma of the anus." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 4152. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.4152.
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4152 Background: PET scanning is an established modality that is useful in the clinical management of squamous cell carcinoma (SCC) of the head and neck and esophagus. This study evaluates the usefulness of PET scans in the management of anal SCC. Methods: Prospective case series of all patients treated for SCC of the anus between 2002 and 2006 in a multi-disciplinary oncology practice group. All patients had staging studies at diagnosis of anal SCC that included CT scan of the chest/abdomen/pelvis and PET scan. All patients with palpable inguinal adenopathy or PET scans positive for inguinal adenopathy underwent fine needle aspiration (FNA) of inguinal nodes. All patients were evaluated by physical exam (PE) and biopsy (Bx), when appropriate, within 3 months of completing treatment. All patients who completed combined chemoradiation for anal SCC and had a post-treatment PET scan were included in this study. Results: 14 of 20 treated patients met criteria for this study. Sensitivity of pre-treatment PET scan was 100% for primary tumor. Extra-pelvic sites with PET SUV<4.0 were uniformly negative for tumor. 66% of inguinal nodes identified by PET scan were FNA positive for metastatic disease. Post-treatment, combined PE and Bx accurately predicted presence or absence of disease in 93%. Post-treatment scans were obtained a mean of 7.6 months after chemoradiation (range 1 to 42 months). In these patients, PET scan sensitivity = 50%, specificity = 72%, predictive value positive (PVP) = 50%, predictive value negative = 80%. 64% of scans were performed within 6 months of treatment; in these, PVP = 33% and PVN = 66%. Conclusions: PET scanning for anal SCC provides accurate staging of disease at presentation and may alter treatment planning by identifying inguinal node involvement not apparent on clinical examination. In this series, PET scan results did not change post-chemoradiation management in any case. Importantly, resolution of primary tumor defined by PET scan was accurate only 80% of the time. PE and Bx within 3 months of treatment were more accurate than PET scan in assessing disease. Post-treatment evaluation of anal SCC should continue to include careful PE, CT scan and Bx when appropriate. No significant financial relationships to disclose.
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Demonaco, N. A., M. Wu, J. Osborn, T. Evans, K. A. Foon, S. Swerdlow, J. Kant, J. Joyce, S. Land, and S. A. Jacobs. "Imaging results after CHOP-rituximab followed by 90Y ibritumomab tiuxetan and rituximab (R) in patients with previously-untreated follicular lymphoma (FL)." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 7589. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.7589.
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7589 Background: There has been some question regarding the predictive value of 111In scans in FL. We report imaging results with fusion PET-CT scans and 111In scans in a single-institution, non-randomized, phase II trial in patients with FL treated with CHOP-R followed by 90Y ibritumomab tiuxetan (Zevalin (Z)) and R. Methods: Eligible patients have CD20 positive FL, Grade 1–3 or transformed, Stage II-IV, no prior treatment with monoclonal antibody or chemotherapy, and symptomatic disease (if grade 1–2). CHOP-R is given every 21 days for 3 cycles. Four weeks after the last dose of CHOP-R, patients receive the Zevalin regimen, which includes 111In imaging and 90Y therapy. One week after Z, patients receive R 375 mg/m2 IV weekly for 4 doses. Bone marrow examination and fusion PET-CT scans are performed at baseline, after CHOP-R, and 12 weeks after Z. The primary endpoint is CR, and responses are reported using the International Working Group (IWG) criteria with the additional requirement of a negative PET scan for CR/CRu. Results: Thirty-six FL patients have been accrued, and 16 patients have completed therapy and follow-up studies. One patient did not have a positive PET scan at baseline. Following therapy, the proportion with a negative PET scan improved from 8 of 15 (53.3%) after CHOP-R to 15 of 15 (100%) after Z. Using IWG criteria in combination with PET scan results, the CR rate increased from 4 of 15 (26.7%) after CHOP-R to 12 of 15 (80%) after Z. Five of 6 patients (83%) with tumor uptake by 111In scan and 7 of 9 (78%) with a 111In scan negative for tumor achieved a CR. Conclusions: There was no significant difference in CR between those patients with 111In tumor uptake versus patients with a negative 111In scan. Functional imaging with PET-CT may be a more sensitive method than CT alone in determining residual disease in FL. This trial continues to accrue patients, and more time is needed to determine the duration of response and time to next therapy. No significant financial relationships to disclose.
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Iovoli, Austin J., Mark K. Farrugia, Sung Jun Ma, Jon M. Chan, Michael R. Markiewicz, Ryan McSpadden, Kimberly E. Wooten, et al. "Role of Repeat PET/CT Imaging in Head and Neck Cancer Following Initial Incomplete PET/CT Response to Chemoradiation." Cancers 13, no. 6 (March 23, 2021): 1461. http://dx.doi.org/10.3390/cancers13061461.
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Despite waiting 13 weeks to perform a PET/CT scan after completion of chemoradiation for head and neck squamous cell carcinoma (HNSCC), equivocal findings are often found that make assessing treatment response difficult. This retrospective study examines the utility of a repeat PET/CT scan in HNSCC patients following an incomplete response on initial post-treatment imaging. For this cohort of 350 patients, initial PET/CT was performed 13 weeks after completion of treatment. For select patients with an incomplete response, repeat PET/CT was performed a median of 91 days later. Primary endpoints were conversion rate to complete response (CR) and the predictive values of repeat PET/CT imaging. Of 179 patients who did not have an initial complete response, 57 (32%) received a repeat PET/CT scan. Among these patients, 26 of 57 (48%) had a CR on repeat PET/CT. In patients with CR conversion, there were no cases of disease relapse. The sensitivity, specificity, PPV, and NPV for the repeat PET/CT for locoregional disease were 100%, 59%, 42%, and 100%. Repeat PET/CT in HNSCC patients with an incomplete post-treatment scan can be valuable in obtaining diagnostic clarity. This can reduce the incidence of unnecessary biopsies and neck dissections.
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Siddique, Abu Bakker, Mohammad Simoon Salekin, Fatima Begum, and Shamim MF Begum. "Evaluation of Active Disease in a Patient of non-Hodgkin Lymphoma by PET-CT scan over non Significant CT, MRI Findings: a case report." Bangladesh Journal of Nuclear Medicine 21, no. 2 (August 5, 2019): 125–28. http://dx.doi.org/10.3329/bjnm.v21i2.40369.
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Imaging modalities like computed tomography (CT) and MRI (magnetic resonance imaging) have been used as diagnostic tools for decades for screening as well as staging for any malignancies but these scans provide anatomical information only. After introduction of 18 Flurodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) hybrid imaging modality as molecular imaging technique by measuring glucose metabolism has revolutionized the detection capability of tumor. PET-CT scan has been used in localization and staging of lymphoma for two decades worldwide. Here, a case of 52 years male, diagnosed case of non-Hodgkin lymphoma (NHL) and received chemotherapy. At the end of therapy results of conventional imaging by CT, MRI suggested complete response of the disease. However, simultaneous PET-CT scan showed extensive active disease. PET-CT hybrid imaging provides additive information about location and extent of the active tumor over CT & MRI, which have limitation to define functional lesion.
Bangladesh J. Nuclear Med. 21(2): 125-128, July 2018
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Pham, Anthony Q., Stephen Broski, Thomas M. Habermann, Dragan Jevremovic, Gregory Wiseman, Andrew L. Feldman, Matthew J. Maurer, Kay Ristow, and Thomas E. Witzig. "Tissue Is the Issue: Accuracy of PET Imaging to Detect Bone Marrow Clearance in Patients with Peripheral T-Cell Lymphoma." Blood 126, no. 23 (December 3, 2015): 3947. http://dx.doi.org/10.1182/blood.v126.23.3947.3947.
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Abstract INTRODUCTION: Adult mature T- and NK-cell neoplasms are a heterogeneous group of aggressive lymphomas comprising approximately 10% to 20% of all non-Hodgkin lymphomas (NHL) with an estimated 5-year overall survival of 40%. Staging and treatment strategies are guided by malignant involvement on PET/CT scan and bone marrow (BM) biopsy. The Lugano Criteria, established in 2014, suggested that focal FDG uptake within the bone marrow was highly sensitive for both Hodgkin (HL) and diffuse large B-cell lymphoma (DLBCL) potentially obviating the need for a bone marrow biopsy if no lesions were seen. Limited data exist regarding the sensitivity of PET for BM involvement in T-cell lymphoma. This study compares PET/CT scans and repeat BM biopsy in patients who have undergone treatment for peripheral T-cell lymphomas (PTCL) by evaluating BM avidity on PET scans. METHODS: This is a single institution study using the Mayo Clinic Lymphoma Database between January 1, 2001 and January 1, 2015. We retrospectively identified all patients with a diagnosis of PTCL, biopsy proven BM involvement at diagnosis, and a concomitant PET for staging. Patients were then reviewed to assess completion of induction therapy and availability of both PET/CT and bone marrow results post-therapy. Evaluation for concordance and discordant BM involvement were then determined using BM biopsy as the gold standard. RESULTS: Sixteen patients had both PET/CT and BM biopsy after completing induction therapy. Median age at diagnosis was 63 years (range 34-72) and 69% were male. PTCL subtype was peripheral T-cell lymphoma, not otherwise specified in seven patients; ALK negative anaplastic large cell lymphoma in one patient; and angioimmunoblastic in 8 patients. Pre-treatment PET/CT scans demonstrated eight patients (50%) with false negative scans. Post-treatment biopsy results demonstrated that ten (62.5%) had biopsy proven residual bone marrow involvement after induction. Eight patients (50%) were found to have BM biopsy proven disease with a negative PET scan. Two patients (12.5%) had both positive BM biopsy and PET scans; 5 patients (31.3%) had negative BM biopsies and PET scans. One patient (6.25%) had a negative BM biopsy, but had a PET scan that revealed positive disease. This patient was considered to have had a false positive PET scan and indeed has remained in remission since April 2009 without any further relapse or treatment. Sensitivity of PET for BM involvement was very poor at 20% (2/10) with a specificity of 50% (2/4) (Table 1 and 2). CONCLUSIONS: This study in PTCL indicates that PET scans at the completion of therapy have a 50% false negative rate. These patients should not be assumed to have negative bone marrow involvement based solely on PET/CT scans. A bone marrow biopsy at the end of therapy is necessary in PTCL patients to confirm complete response. Table 1. Bone Marrow Involvement Pre-Therapy PET Scan Imaging PET Negative PET Positive Total Patients Bone Marrow Negative NA NA NA Bone Marrow Positive 8 8 16 Total Patients 8 (50%) 8 (50%) 16 Abbreviations: NA, not applicable. The study defined that all patients had to have a positive bone marrow at baseline to be eligible for the study. Table 2. Bone Marrow Involvement PET Negative PET Positive Total Patients Bone Marrow Negative 4 2 6 (37.5%) Bone Marrow Positive 8 2 10 (62.5%) Total Patients 12 (75%) 4 (25%) 16 Table 1 and 2. Involvement of bone marrow with peripheral T-cell lymphoma based on evaluation by PET scans versus bone marrow biopsy. Disclosures Maurer: Kite Pharma: Research Funding.
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von Eyben, Finn Edler, Cigdem Soydal, and Rie von Eyben. "68Ga-PSMA PET/CT for Patients with PSA Relapse after Radical Prostatectomy or External Beam Radiotherapy." Diagnostics 11, no. 4 (March 30, 2021): 622. http://dx.doi.org/10.3390/diagnostics11040622.
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The study aimed to summarize clinical characteristics associated with Gallium-68-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (68Ga-PSMA PET/CT) scans as patients were restaged for prostate-specific antigen (PSA) relapse after radical prostatectomy (RP) or external beam radiotherapy (EBRT). Our analyses included multiple cox regression analyses. The study evaluated 95 patients with rising values of PSAs after RP and after EBRT. Sixty 63% of patients had a positive 68Ga-PSMA PET/CT scan. Twelve patients (13%) had a positive site in the prostate bed, 29 patients (30%) had a positive site in the regional lymph nodes, and 19 (20%) had positive sites in distant organs. After four years follow-up, 21 patients (22%) died. Using multiple Cox regression analyses, the number of positive sites on the 68Ga-PSMA PET/CT scan significantly predicted overall survival (OS) (p = 0.0001), whereas risk score and regional locations of the positive sites were not significant in the multiple Cox regression analyses. Our study indicates that the specific findings of 68Ga-PSMA PET/CT scans are important because detailed findings of the scans predict the outcome after salvage treatment of patients with PSA relapse examined with 68Ga-PSMA PET/CT scans.
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Rusconi, Chiara, Cristina Gabutti, Erika Ravelli, Vittorio Ruggero Zilioli, Erika Meli, Emma Gay, Simone Renato Marcelli, Claudio Rossetti, and Enrica Morra. "Role of Positron Emission Tomography In Mantle Cell Lymphoma." Blood 116, no. 21 (November 19, 2010): 3120. http://dx.doi.org/10.1182/blood.v116.21.3120.3120.
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Abstract Abstract 3120 Introduction Fluorodeoxyglucose positron emission tomography (FDG-PET) is a functional imaging tool routinely used for staging and response assessment in aggressive lymphomas. Even if mantle cell lymphoma (MCL) is considered FDG avid, current data on the use of PET in this histotype are scant. We retrospectively analysed 43 PET scans in 22 MCL patients (pts) and compared the results to standard contrast-enhanced computerized tomography (CT) in order to define PET sensitivity and specificity in this rare lymphoma. Patients and methods Twenty-two pts with biopsy proven diagnosis of MCL underwent PET in different phases of disease for a total of 43 scans. PET scans were co-registrated with a simultaneous CT and compared to standard contrast-enhanced CT performed within 4 weeks. Nineteen PET (44.2%) were performed for disease staging at diagnosis or relapse, while 24 (55.8%) for response assessment. Negative PET were included in the analysis for response assessment only if a previous positive scan was available. Results PET and standard CT results were concordant in 16/43 cases (37.2%). Discrepancies were found in 27/43 cases (62.8%) and were grouped in four categories: false negative PET (5 cases), PET positive with a disease extension minor or major than CT (7 and 9 cases, respectively) and PET positive with negative CT (6 cases). At staging PET was concordant with CT in 4/19 (21%) cases. In 5/19 cases (26.3%) PET was negative in all disease sites documented by standard CT. In the remaining 10 cases (52.7%) PET was positive but discordant with disease extension evaluation by CT, determining upstaging and downstaging in 5 scans (26.3%) each. Involvement of gastro-intestinal tract was detected only in 4/19 cases (21%). PET performed for response assessment was concordant with CT in 12/24 cases (50%). In 6/12 concordant cases (25%) both CT and PET were negative; in the remaining 6/12 cases (25%) PET was positive and disease extension evaluation was concordant with standard CT. Six out of 12 discordant cases (25%) presented different disease extension evaluation; in the other six cases standard CT was negative while PET documented minimal residual disease (MRD). PET sensitivity and specificity in the entire cohort were 86.5% and 100%, respectively; positive predictive value was 100%, while negative predictive value was 54.5%. No difference in PET sensitivity was found in nodal and extra-nodal sites. No statistical significant correlation was found between PET sensitivity and proliferation index; nevertheless, no pts with Mib-1>50% presented either false negative PET scan or disease extension underestimated by functional imaging. Conclusion This analysis shows a PET sensitivity (86.5%) lower than expected if compared with other aggressive lymphomas. High specificity registered in this cohort is likely to be ascribed to simultaneous CT co-registration, that allows identification of false positive cases. A false negative PET scan at initial staging was registered in 21% of cases. A gastro-intestinal tract involvement, expected to be near universal in advanced stage MCL, was detected by functional imaging only in 21% of pts at disease onset or relapse. Either downstaging or upstaging of disease burden seldom result in different therapeutic approach since localized MCL is a rare entity. Minimal residual disease, detected by functional imaging in half of standard CT negative pts at response assessment, has uncertain role in MCL, since the disease remains incurable and there is no clear evidence that MRD positivity requires treatment. All these findings advise against utilization of functional imaging for routine management of MCL. Considering heterogeneity of FDG-uptake in MCL, PET is likely to be more reliable in pts presenting high proliferation index. Moreover, current data suggest a prognostic value of baseline FDG-avidity. Further investigations are needed to confirm these preliminary data in larger prospective trial, separating MCL from other aggressive histotypes. Disclosures: No relevant conflicts of interest to declare.
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Kaddoura, Marcella, David Dingli, Francis K. Buadi, Martha Q. Lacy, Morie A. Gertz, Angela Dispenzieri, Prashant Kapoor, et al. "Prognostic impact of posttransplant FDG PET/CT scan in multiple myeloma." Blood Advances 5, no. 13 (July 9, 2021): 2753–59. http://dx.doi.org/10.1182/bloodadvances.2020004131.
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Abstract Multiple myeloma (MM) is a heterogeneous disease that may be evaluated by a broad array of imaging and laboratory techniques to measure disease activity and predict prognosis. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scanning has been shown to be predictive of patient outcomes throughout the disease course. We sought to corroborate these findings by examining the prognostic impact of PET/CT scanning in the posttransplant setting. We retrospectively analyzed PET/CT scans in 229 MM patients receiving an autologous stem cell transplant (ASCT) near day 100, and correlated these findings with time to progression(TTP) and overall survival (OS) to assess the impact of day 100 PET/CT scan findings as an independent prognostic factor. The median OS for the entire cohort was 61.5 months (95% confidence interval [CI], 49-75) and the median TTP was 18.5 months (95% CI, 15.4-21.8). Among patients with abnormal day 100 PET findings (PET+), median TTP was 12.4 months vs 24 months among those with normal PET findings (PET−) (P < .0001). The median OS in the PET+ group was 46 months compared with 99 months in the PET− group (P < .0001). We conclude that an abnormal PET/CT scan near day 100 post-ASCT is predictive of shorter TTP and OS, with prognostic significance retained after adjusting for disease response and other prognostic variables in MM.
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Pasticier, Gilles, Marine Chicart, Marine Gross-Goupil, Laurence Donon, Gregoire Robert, Jean-Marie Ferriere, Philippe Ballanger, et al. "Impact of the 18F- PET/CT scan in the management of patients with high-risk or intermediate-risk prostate cancer at initial diagnosis or at recurrence." Journal of Clinical Oncology 33, no. 7_suppl (March 1, 2015): 87. http://dx.doi.org/10.1200/jco.2015.33.7_suppl.87.
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87 Background: It is reported that a Fcholine Positron Emission Tomography (PET/CT) scan can change the management of the patients with prostate cancer up to 20% of the cases. The aim of this study was to evaluate the impact of 18FCholine PET/CT when its indication was taken by a multi-disciplinary staff in case of initial diagnosis or in case of recurrence. Methods: This retrospective study involved 84 patients between May 2013 and July 2014. After a selective approach 86 18F-PET/CT were performed consecutively: 37 (43%) for the initial staging and 49 (57%) in biochemical failure. The acquisition protocol included a pelvic dynamic scan after injection of 4 MBq/kg of 18FCholine followed by a whole-body scan. Mean age, PSA level and Gleason score were respectively in relapse and initial staging: 71 years (59-82), 4.9 (0.12-32.8), 7 (6-9) and 63 years (48-76), 16 (2.42-55) and 8 (6-10). Results: In initial diagnosis, prostate cancer was identified in all the patients on PET/CT. Local disease was seen in 23/37 scans (62.2%); loco-regional node involvement in 8 (21.6%) and metastatic disease in 6 (16.2%). PET/CT confirmed the therapeutic decision in 48.6% of cases and led to a therapeutic modification in 43.2% of cases,avoiding radical prostatectomy and lymphadenectomy in 25% of cases or modifying the extend of radiotherapy (25%) . In biochemical recurrence, PET/CT showed relapse in the prostatic area in 14 patients (28.6%); abnormal pelvic lymph nodes in 10 cases (20.4%) and distant metastases in 18 patients (36.7%). It failed to identify the cause of relapse in 7 cases (14.3%). PET/CT confirmed the therapeutic approach in 24.5% and led to a therapeutic change in 61.2% of cases The diagnostic performance of the FCholine PET/CT scan on nodes, according to the pathological results were: sensitivity 80 %, specificity 84.6%, positive predictive value 66.7% and negative predictive value 91.7 % Conclusions: A rigorous selection of the patients before the realization of a FCholine PET/CT scan in the management of a prostate cancer can increase the diagnostic performance and provide a better impact. In this study the treatment modification affected 54.8% of the patients.
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Couvillon, Anna, Baris Turkbey, Maria Liza Lindenberg, Peter L. Choyke, Mirna Martinez, Yolanda McKinney, Aradhana Kaushal, et al. "Association of NaF PET/CT findings with PSA and alkaline phosphatase in untreated castration-sensitive prostate cancer." Journal of Clinical Oncology 33, no. 7_suppl (March 1, 2015): 122. http://dx.doi.org/10.1200/jco.2015.33.7_suppl.122.
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122 Background: NaF PET/CT is an emerging imaging technique with potentially high sensitivity in detecting bone metastasis (mets), however, its role in castration-‐sensitive prostate cancer (CSPC) is undefined and it remains unclear which CSPC patients should have NaF PET/CT. Methods: We retrospectively reviewed NaF PET/CT scans done on 45 patients with untreated, high risk CSPC with the goal of determining which disease features were associated with positive findings. Two blinded radiologists reviewed each scan and determined by consensus if findings were negative for metastasis (0% liklihood of mets), possible (50%), probable (75%), or consistent with mets (90%). Prostate specific antigen (PSA) and alkaline phosphatase (AP) values were then evaluated at time of NaF scan when available. Results: Of the 45 patients 2 were Gleason 6, 5 were Gleason 7, 36 were Gleason 8 to 10, 2 unknown. When grouped by findings on NaF PET/CT, there were no substantial differences seen between median PSA or AP values. When patients with both PSA and AP values > median were evaluated, there was no clear association with NaF PET/CT findings. Conclusions: Preliminary findings from this small retrospective analysis suggest that there may be limited associations between PSA and/or AP with findings on NaF PET/CT scan in untreated patients with CSPC. Further analysis in larger cohorts of pts is required. [Table: see text]
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Dierickx, Daan, Gregor Verhoef, Olivier Gheysens, Thomas Tousseyn, Christiane De Wolf-Peeters, Iwona Wlodarska, and Lieselot Brepoels. "The Accuracy of PET in the Detection of Posttransplant Lymphoproliferative Disorder (PTLD)." Blood 118, no. 21 (November 18, 2011): 2657. http://dx.doi.org/10.1182/blood.v118.21.2657.2657.
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Abstract Abstract 2657 Introduction. PET scan has emerged as a powerful tool in the diagnosis and staging of both Hodgkin and different subtypes of aggressive non-Hodgkin lymphoma. We investigated the accuracy of PET scan in 170 patients with suspected posttransplant lymphoproliferative disorder (PTLD). Material and methods. We retrospectively reviewed all patients in our center between 2003 and 2010 for whom a PET-scan was requested for the indication PTLD. 170 PET-scans in 150 patients were eligible for evaluation. In 45 cases, the patient had already a biopsy proven PTLD before PET-scanning and PET was considered a staging tool in these patients. In the remaining 125 PET-scans, PLTD was only suspected at the time PET was performed. In 73 (43%) and 97 (57%) cases PET scan without CT and combined PET/CT scan were ordered respectively. Because the aim of this study was to determine the accuracy of PET scan in diagnosis of PTLD, we evaluated only results of the PET scans. PET-scans were blindly scored on a four-point scale. Results were compared with biopsy as the gold standard. Results. The majority of PET scans were performed in kidney transplant recipients (35%), followed by liver (15%), lung (15%), heart (15%), hematopoietic stem cell (15%), combined (5%) and bowel (1%) transplantation. In 119 (70%) patients a biopsy was available. We found a sensitivity of PET of 89%, specificity of 89%, positive predictive value (PPV) of 91% and negative predictive value (NPV) of 87%. In a subanalysis of the 125 scans performed for differential diagnosis PTLD versus other diseases, sensitivity, specificity, PPV and NPV were 90%, 89%, 85% and 93% respectively. FDG-uptake in PTLD was generally high with a median mean and maximal standardized uptake value (SUV) of 9.0 and 17.4. False positive results were mainly due to infectious or inflammatory conditions, whereas false negative results were mainly reported in limited stage PTLD. Atypical extrandodal presentation was a frequent finding including diffuse pulmonary involvement and gastro-intestinal lesions. Conclusions. From these data, we can conclude that PET is highly sensitive for the detection of lesions of PTLD, and that PET has an excellent ability to differentiate PTLD from other diseases. Disclosures: No relevant conflicts of interest to declare.
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Meijer, Dennie, Rosemarijn H. Ettema, Pim J. van Leeuwen, Pepijn M. J. Oosterholt, Yves J. L. Bodar, Henk G. van der Poel, N. Harry Hendrikse, et al. "Impact van de 18F-DCFPyL PET/CT-scan op het behandeladvies voor patiënten met prostaatkanker en een biochemisch recidief na curatieve therapie." Tijdschrift voor Urologie 11, no. 5 (July 2, 2021): 89–100. http://dx.doi.org/10.1007/s13629-021-00330-1.
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SamenvattingHet doel van deze studie was te onderzoeken of de bevindingen op een 18F‑DCFPyL PET/CT-scan leiden tot een verandering van het behandeladvies voor patiënten met een biochemisch recidief (BCR) prostaatkanker. 253 patiënten met BCR-prostaatkanker bij wie een 18F‑DCFPyL PET/CT-scan werd gemaakt ter herstadiëring, werden geïncludeerd. Twee urologen formuleerden een voorgestelde behandeling voor elke patiënt voor- en nadat zij kennis hadden genomen van de uitslagen van de 18F‑DCFPyL PET/CT-scan. Bij 103/253 patiënten (40,7%) werd een verandering van het behandeladvies beschreven. Een positieve 18F‑DCFPyL PET/CT-scan (p < 0,001) en een positieve pathologische lymfeklierstatus (pN1; p = 0,024) waren significante voorspellers van een voorgenomen beleidswijziging, terwijl een positieve chirurgische marge (p = 0,022) negatief geassocieerd was met een voorgenomen beleidswijziging. De conclusie luidt dat bevindingen op een 18F‑DCFPyL PET/CT-scan een significante impact hebben op het voorgestelde beleid bij patiënten met BCR-prostaatkanker.
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Gorin, Michael A., Steven P. Rowe, Margarita Mana-ay, Zsolt Szabo, Edward M. Schaeffer, Phuoc T. Tran, Mohamad E. Allaf, et al. "Study of PSMA-targeted 18F-DCFPyL PET/CT in the evaluation of men with an elevated PSA following radical prostatectomy." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 299. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.299.
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299 Background: Positron emission tomography/x−ray computed tomography (PET/CT) utilizing radiotracers targeting prostate membrane specific antigen (PSMA) offer the promise of improved sensitivity for visualizing low volume sites of prostate cancer. In this study we evaluated the sensitivity of PET/CT using 18F-DCFPyL, a novel small molecule ligand of PSMA, for imaging sites of disease in men with an elevated PSA following radical prostatectomy. Methods: Patients with an elevated PSA following radical prostatectomy (defined as ≥ 0.2 ng/mL) were imaged with CT or magnetic resonance imaging (MRI) of the abdomen and pelvis, 99mTc-methylene diphosphonate bone scan and 18F-DCFPyL PET/CT. Conventional imaging studies (CT, MRI and boen scan) were clinically reviewed by readers blinded to the PET/CT scan results. Similarly, PET/CT scans were blindly reviewed and then the sensitivity of this novel imaging test was compared to that of conventional imaging. Results: In total, 12 men with a median PSA of 0.34 ng/mL (range 0.2 to 11) were imaged as part of this study. 2 (16.7%) patients had persistently elevated PSA values after surgery and 10 (83.3%) had values which were initially undetectable but then rose to ≥ 0.2 ng/mL. On conventional imaging, only 4 (25.0%) patients had at least 1 detectable site of disease. This included 1 patient with a local recurrence detected on MRI and 3 patients with bony lesions detected on bone scan. In contrast, 9 (75.0%) patients had areas of detectable disease on PET/CT. This included 3 (25.0%) patients with a local recurrence, 3 (25.0%) with lymph node metastases, 2 (16.7%) with bony lesions and 1 (8.3%) with both lymph node and bone findings. All lesions detected on conventional imaging had corresponding areas of radiotracer uptake on PET/CT. Conclusions: 18F-DCFPyL PET/CT appears to be more sensitive for detecting areas of prostate cancer recurrence in patients with an elevated PSA following radical prostatectomy. Future work aims to more precisely define the sensitivity of this imaging test in a larger patient cohort. Clinical trial information: NCT02523924.
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Brown, Jennifer R., Iryna Rastarhuyeva, Jyothi Jagannathan, Kristen Stevenson, Donna Neuberg, Yulia Melenevsky, Kimberly S. Phillips, et al. "Prospective Evaluation of FDG-PET Imaging of Treatment Response in Relapsed Follicular Lymphoma." Blood 110, no. 11 (November 16, 2007): 2331. http://dx.doi.org/10.1182/blood.v110.11.2331.2331.
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Abstract Follicular lymphoma is the most common low-grade lymphoma and incurable with conventional therapies. In recent years, increased use of FDG-PET (PET) scanning in aggressive lymphomas has led to its application in follicular lymphoma, despite a lack of information on its predictive value. We undertook a prospective study to evaluate PET scanning prior to and following therapy (tx) in relapsed follicular lymphoma patients. Eligibility criteria included follicular grade I or II disease in 1st or 2nd relapse, with planned tx for at least stage 2 disease. Pre- and post-tx PET and CT scans were read by different blinded radiologists. 24 pts were enrolled; of these, two were ineligible and one was later found to have lung cancer. 21 pts were therefore analyzed. The median age at diagnosis was 57 (34–72), with a median time from diagnosis to pre-treatment PET scan of 2.8 yrs (0.6–9.0); 15 pts were in 1st relapse (71%), and 13 had follicular grade 1 (62%). By clinical staging, 4 were stage 2 (19%), 8 stage 3 (38%) and 9 stage 4 (43%). PET resulted in upstaging compared to CT in 5 pts (24%), 3 due to bone lesions and 2 due to nodal sites; however 3 of these 5 pts were also upstaged by bone marrow biopsy. The median of the highest SUVmax on the pre-tx PET scans was 12.1 (1.9–20.7). The mean SUVmax of all identified lesions on each pre-tx PET scan had a median value of 5.7 (1.9–8.4). A trend toward a correlation between the highest SUVmax on the initial PET scan and the bidimensional area of the largest CT lesion was observed (p=0.059). The tx received during the study included chemotherapy for 8 pts (38%) and antibody tx for 13 pts (62%). The objective response rate using Cheson criteria was 52%, with 5 CR/CRu, 6 PR, 7 SD and 3 PD. Using EORTC PET response criteria, 4 CR, 12 PR, 1 SD and 1 PD were observed. Thus 84% had evidence of response by PET, but 79% remained PET positive on their post-tx scan. The median value of the highest residual SUVmax on the post-tx scans was 5.13 (0.5–18.1); no correlation of residual SUVmax and bidimensional area of the largest residual CT lesion was observed. At 1-year follow-up, 48% of pts have relapsed, with a median time to relapse of 0.7 years (0.07–1.6). No pt who was PET negative on the post-tx scan has relapsed; of these 4 pts, 3 were also CRs by CT, and one had SD by CT criteria. PFS was not predicted by age, stage, or follicular subtype; a trend toward shorter PFS for pts in 2nd relapse was observed (p=0.055). Of CT and PET measures on initial and post-tx scans, only a residual SUVmax ≥ 5 predicted shorter PFS (p=0.0009); bidimensional area of the largest residual CT lesion was not predictive of PFS. Among pts with PR by PET criteria, CT responses by Cheson criteria (CRu, PR, SD) were not predictive of PFS (p=0.18). We conclude that PET imaging is highly sensitive for detection of follicular lymphoma, which commonly has high SUVmax values. A large fraction of relapsed follicular NHL pts who respond to tx by standard criteria have evidence of residual disease on FDG-PET, and positive lesions with SUVmax ≥ 5 are associated with a shorter PFS. The overall value of FDG-PET imaging in the management of pts with relapsed follicular lymphoma remains to be determined.
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Ujjani, Chaitra S., Elizabeth Hill, Samer Nassif, Hongkun Wang, Yiru Wang, Metin Ozdemirli, Giuseppe Esposito, and Bruce D. Cheson. "The Utility Of 18f-FDG PET/CT In Assessing Bone Marrow Involvement In Lymphoma." Blood 122, no. 21 (November 15, 2013): 2981. http://dx.doi.org/10.1182/blood.v122.21.2981.2981.
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Abstract Background Determining bone marrow involvement (BMI) is a crucial element for staging of lymphoma. While the standard procedure to evaluate BMI has traditionally been bone marrow biopsy, biopsies are subject to sampling error, particularly if the involvement is focal and outside the pelvis. 18F-FDG PET/CT scans have become an increasingly popular component of the pretreatment evaluation to assess nodal and extramedullary disease. Their ability to accurately detect BMI has been suggested in Hodgkin's lymphoma, but is less well established in other histologies. This retrospective study evaluated whether 18F-FDG PET/CT scans are useful in detecting BMI in different types of lymphoma and, thus, may replace trephine biopsies as part of staging. Methods Between 2005 and 2013, 222 patients (pts) seen at our center underwent coinciding bone marrow biopsies and whole body 18F-FDG PET/CT scans. The most common lymphoma subtypes represented were diffuse large B-cell (DLBCL), follicular, and Hodgkin's lymphoma. Ninety-two pts were referred to our center for a new diagnosis and retrospectively enrolled on study. Unilateral bone marrow biopsy of the iliac crest was used as the standard for detecting BMI. 18F-FDG PET/CT scan was interpreted as positive for BMI when bone marrow 18F-FDG uptake was not otherwise explained by CT findings. Results Of the 92 newly diagnosed pts, there were 44 DLBCL, 28 follicular, and 20 Hodgkin's lymphoma. Most pts underwent 18F-FDG PET/CT scan prior to biopsy (47), as opposed to the same day (13) or after (32). The median age at diagnosis was 48 years (Range 22-89). Fifty-one of the patients were male and 41 were female. Seven of the 44 DLBCL patients had BMI documented by biopsy; 5 DLBCL, 2 follicular. When evaluating for only DLBCL marrow involvement, the sensitivity, specificity, and accuracy (concordance) of 18F-FDG PET/CT scan was 80% (CI 0.28, 0.99), 97% (CI 0.86, 1.00), and 95% (CI 0.84, 0.99) respectively. 18F-FDG PET/CT scan failed to identify 1 patient with focal DLBCL involvement. This pt already had advanced stage disease based on imaging, and would have received the same treatment regimen regardless of the extra information provided by bone marrow biopsy. When accounting for any kind of lymphomatous involvement, the sensitivity dropped to 57% (CI 0.18, 0.90) as 18F-FDG PET/CT scan failed to identify the 2 pts with follicular lymphoma of the marrow. Specificity and accuracy, however, remained high at 97% and 91%. When evaluating pts with relapsed disease, all DLBCL pts in our cohort had negative BMI by both biopsy and 18F-FDG PET/CT. In follicular lymphoma, however, the sensitivity of 18F-FDG PET/CT was 43% (CI 0.21, 0.73), specificity 93% (CI 0.64, 1.00), and accuracy 68% (CI 0.48, 0.84). Of the 9 pts with discordant results, 18F-FDG PET/CT failed to identify 8 pts with marrow involvement, 6 of whom had focal involvement. In the remaining pt, 18F-FDG PET/CT scan indicated appendicular skeletal and vertebral involvement. The bone marrow biopsy was negative in this pt, presumably due to the lack of iliac involvement. Information provided by bone marrow biopsy upstaged one of the 9 pts from limited to advanced stage disease. In the 12 pts with relapsed disease, the sensitivity was 47%, specificity 93%, and accuracy 68% based on 22 coinciding studies. In Hodgkin's lymphoma, the sensitivity, specificity, and accuracy of 18F-FDG PET/CT at diagnosis was 67% (CI 0.09, 0.99), 71% (CI 0.44, 0.90), and 70% (CI 0.46, 0.88) respectively. Of the 5 Hodgkin's pts with discordant results, 18F-FDG PET/CT scans detected marrow involvement in 4 pts with negative bone marrow biopsies. One pt had evidence of marrow involvement by biopsy but not by 18F-FDG PET/CT. As the pt was already stage III by 18F-FDG PET/CT, this information did not impact the treatment regimen. Conclusions In our cohort, 18F-FDG PET/CT was a highly accurate tool for detecting BMI in DLBCL and Hodgkin's lymphoma. As most pts underwent imaging first, the subsequent biopsy was unnecessary. In Hodgkin's, 18F-FDG PET/CT demonstrated the ability to detect BMI in pts who would have otherwise been considered to be negative by biopsy alone. 18F-FDG PET/CT was not as accurate in follicular lymphoma, presumably due to the low-grade nature of the disease. Further evaluation in a prospective manner is warranted, and may eliminate the need for a costly and painful procedure in many pts with lymphoma. Disclosures: No relevant conflicts of interest to declare.
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Davarpanah, Nicole N., Liza Lindenberg, Dereck W. Paul, Seth M. Steinberg, Deneise C. Francis, Marilise Anne Berniger, Juanita Weaver, et al. "18F-FDG-PET/CT imaging to assess response to treatment with cabozantinib at 4 weeks versus 8 weeks of therapy in patients (pts) with metastatic urothelial carcinoma (mUC)." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 317. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.317.
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317 Background: This study investigates whether changes in 18F-FDG-PET/CT correlate with response to cabozantinib at an early time point (4 wks) versus the conventional time point of restaging (8 wks) in pts with mUC, using Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST). Methods: 68 pts with mUC in a single arm phase II clinical trial of cabozantinib underwent FDG-PET/CT scans at baseline, 4 and 8 wks. Up to 5 lesions with the highest Standard Uptake Value (SUV) were designated as target lesions. Response was determined using 2 versions of PERCIST (1 lesion vs top 5 lesions with highest FDG uptake) for FDG-PET/CT at 4 and 8 wks. PERCIST response classifications were compared to RECIST v1.1 at 8 wks. Results: 54 pts had evaluable disease. The single lesion 4 wk response by PERCIST showed 40% partial metabolic response (PMR), 33% stable metabolic disease (SMD), and 27% progressive metabolic disease (PMD). The single lesion 8 wk response by PERCIST showed 31% PMR, 31% SMD, and 38% PMD. The single lesion analysis coincided with multiple lesion PERCIST analysis in 86% of pts at 4 wks and 89% at 8 wks. The 4 wk PET/CT was predictive of the 8 wk PET/CT in 75% of single lesion and 76% of multiple lesion analyses. In lesion-based analysis, the 4 wk PET/CT was predictive of the 8 wk PET/CT in 74% of bone, 89% of lung, 77% of lymph node, 74% of soft tissue, and 58% of liver lesions. Only 42% of the 8 wk PERCIST and RECIST classifications coincided. At 8 wks, 40% showed response in FDG PET-CT restaging vs 7% complete/partial response by RECIST. Conclusions: The 4 wk PET/CT scan predicts the therapy response at the 8 wk PET/CT scan however the 4 wk scan overestimates the 8 wk response. The single lesion analysis by PERCIST correlates with the multiple lesion analysis and may have more clinical utility. In the lesion-based analysis, the 4 wk PET/CT scan is predictive of the 8 wk PET/CT for bone, lung, lymph node and soft tissue but not for liver lesions. Response classifications by PERCIST are not in agreement with response classifications by RECIST. Although the methods may be complementary, they are not interchangeable. Further studies are required to validate these findings. Clinical trial information: NCT01688999.
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Okamoto, Kentaro, Yukiko Tani, Takeshi Yamaguchi, Kei Ogino, Takashi Tsuchioka, Masanobu Nakajima, Satoru Yamaguchi, Kinro Sasaki, Hiroyuki Kato, and Toshiki Ohya. "Asymptomatic Mesenchymal Hamartoma of the Chest Wall in Child With Fluorodeoxyglucose Uptake on PET/CT—Report of a Case." International Surgery 100, no. 5 (May 1, 2015): 915–19. http://dx.doi.org/10.9738/intsurg-d-14-00083.1.
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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.
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Faoury, Morad, Beth Shepherd, Christopher John Dare, and Fabian Sipaul. "Late infection six years post cervical arthroplasty detected following referral to a 2 week-wait head and neck cancer clinic: a case report." International Journal of Otorhinolaryngology and Head and Neck Surgery 5, no. 2 (February 23, 2019): 486. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20190484.
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<p class="abstract">Late infection after anterior cervical spine surgery (ACSS) is a rare phenomenon and can be extremely challenging to diagnose. Clinical presentation vary and may not present with classical features of fever, pain, malaise or discharge. It can easily be mistaken for a head and neck tumour due to its ambiguous symptoms and signs. We report a case of a 57 years old lady whom was initially referred to the 2 week-wait (2 ww) head and neck cancer clinic. She complained of painless neck lump and dysphagia. She subsequently underwent various investigations including flexible nasendoscopy, ultrasound scan guided biopsy, eosophagogastroduodenoscopy (OGD), CT scan, PET-CT scan and MRI scan. Initial investigations failed to clinch the diagnosis. US and CT scans findings were suspicious for malignancy. All blood results were in normal ranges. It was only after PET-CT scan was done that the diagnosis pathway switched from possible malignancy to purely inflammatory. It showed significant high activity process tracking back to the 6 years old spinal surgery area. This precluded the patient from a planned open biopsy. Radiological imaging such as PET-CT and MRI are essential in both diagnosis and treatment planning.</p>
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Mion, M., F. Chierichetti, G. Liessi, S. Bissoli, E. Milan, F. Oniga, L. Sartor, et al. "Diagnosis of recurrent breast cancer: 18F-FDG PET/TAC as first choice." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 10681. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.10681.
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10681 Background: we began using PET diagnosis in 1994 and since the beginning of 2000 we started with a PET/CT system. Aim of our study was to evaluate if this new imaging modality may be the first step in the detection of recurrence in patients with a history of breast tumors. Methods: we reviewed retrospectively 22 patients (mean age 60, range 46–76 years) already treated for a breast cancer. A total of 32 PET/CT scans were performed (repeated in 10 patients). All patients were submitted to other examinations, such as bone scintigraphy and liver ecography, but also mammography and CT scan. Results: 14/32 PET/CT were negative for recurrence in 10 patients (4 scans as a second one). In a mean follow up of 10 months, 1 case is not yet clear: in presence of relevant increase of Ca15.3 (up to 176 ng/ml) the first scan was negative and the second one evidentiated a pattern of lung inflammation. Among the other 13/14 negative scans, 3 patients presented ambiguous/positive bone scintigraphy for metastases, not assessed at the final diagnosis. 18/32 PET/CT scans were positive for local recurrence or distant metastases. Among these positive cases, a patient with normal bone scintigraphy presented a mild uptake of FDG in the right omerus. The second scan (5 months later) showed focal increased uptake of FDG in the same bone site, not evident in the CT images, and many small lung nodules, 1–2 mm size. In 3 patients PET localized muliple bone lesions, in 2 CT was completely normal. Finally, 1 out of the 18 positive results was false positive: a patients with a single lung nodule (1.5 cm) was submitted to surgery and the final diagnosis was benign lesion. PET/CT was crucial for the patient’s management in 19 out of 22 patients. Conclusions: recurrent breast cancer is generally characterized by multiple sites of metastases and few cases take advantage of surgical resection. In our group of 22 patients just 2 out of them received surgery (for local relapse and lung metastases). Therefore, in most cases a whole body examination, like PET/CT may be more useful respect to other modalities to assess how spread is the recurrence. Further data are needed but, in our preliminary experience, PET/CT seems to be the first choice to evaluate patients with previous breast cancer. No significant financial relationships to disclose.
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Piccardo, A., M. Puntoni, G. Treglia, L. Foppiani, F. Bertagna, F. Paparo, M. Massollo, et al. "Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET/CT, multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy and histology." European Journal of Endocrinology 174, no. 5 (May 2016): 693–703. http://dx.doi.org/10.1530/eje-15-1199.
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Purpose To evaluate the role of 18F-flurodeoxiglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in predicting malignancy of thyroid nodules with indeterminate cytology. Patients and methods We analysed 87 patients who have been scheduled to undergo surgery for thyroid nodule with indeterminate cytology. All patients underwent 18F-FDG-PET/CT, multiparametric neck ultrasonography (MPUS), and 99mTc-methoxyisobutylisonitrile scintigraphy (99mTc-MIBI-scan). Histopathology was the standard of reference. We compared the sensitivity (SE), specificity (SP), accuracy (AC), positive (PPV) and negative predictive (NPV) values of 18F-FDG-PET/CT with those of 99mTc-MIBI-scan and MPUS in detecting cancer. Univariate and multivariate analyses evaluated the association between each diagnostic tool and histopathology. Results On histopathology, 69 out of 87 nodules were found to be benign and 18 to be malignant. The SE, SP, AC, PPV and NPV of 18F-FDG-PET/CT were 94, 58, 66, 37 and 98% respectively. The SE, AC and NPV of 18F-FDG-PET/CT were significantly higher than those of MPUS and 99mTc-MIBI-scan. The association of both positive 18F-FDG-PET/CT and MPUS (FDG+/MPUS+) showed significantly lower SE (61% vs 94%) and NPV (88% vs 98%) than 18F-FDG-PET/CT alone, but significantly higher SP (77% vs 58%). On univariate analysis, 18F-FDG-PET/CT and the combination of FDG+/MPUS+ and of FDG+/MIBI− were all significantly associated with histopathology. On multivariate analysis, only FDG+/MIBI− was significantly associated with histopathology. Conclusion The AC of 18F-FDG-PET /CT in detecting thyroid malignancy is higher than that of 99mTc-MIBI-scan and MPUS. A negative 18F-FDG-PET/CT correctly predicts benign findings on histopathology. The association of FDG+/MPS+ is significantly more specific than 18F-FDG-PET/CT alone in identifying differentiated thyroid cancer. A positive 18F-FDG-PET/CT is significantly associated with malignancy when qualitative 99mTc-MIBI-scan is rated as negative.