Objective
The aim of this study was to compare the diagnostic ability of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with that of 99mTc-methylene diphosphonate (99mTc-MDP) bone scan for bone metastasis in staging patients with small cell lung cancer (SCLC).Methods
Ninety-five patients with SCLC who underwent both 18F-FDG PET/CT and 99mTc-MDP bone scan for initial staging work-up were retrospectively enrolled. All 18F-FDG PET/CT and bone scan images were visually assessed. Bone metastasis was confirmed by histopathological results and all available clinical information.Results
Of 95 patients with SCLC, metastatic bone lesions were found in 30 patients, and 84 metastatic lesions were evaluated on a lesion-basis analysis. The sensitivity of 18F-FDG PET/CT was 100?% on a per-patient basis and 87?% on a per-lesion basis, and there was no false-positive lesion on PET/CT images. In contrast, the sensitivity of the bone scan was 37?% on a per-patient basis and 29?% on a per-lesion basis. The bone scan showed 11 false-positive lesions. The bone scan detected two metastatic lesions that were not detected by PET/CT, which were outside the region scanned by PET/CT. On follow-up bone scan, 21 lesions that were not detected by the initial bone scan but were detected by PET/CT were newly detected.Conclusions
In patients with SCLC, 18F-FDG PET/CT showed higher detection rate of bone metastasis than 99mTc-MDP bone scan. Thus, 18F-FDG PET/CT can replace bone scan in staging patients with SCLC. 相似文献Purpose
Bone metastasis is an important factor for the treatment and prognosis of breast cancer patients. Whole-body bone scintigraphy (WBBS) can evaluate skeletal metastases, and 18F-FDG PET/CT seems to exhibit high specificity and accuracy in detecting bone metastases. However, there is a limitation of 18F-FDG PET in assessing sclerotic bone metastases because some lesions may be undetectable. Recent studies showed that 18F-fluoride PET/CT is more sensitive than WBBS in detecting bone metastases. This study aims to evaluate the usefulness of 18F-fluoride PET/CT by comparing it with WBBS and 18F-FDG PET/CT in breast cancer patients with osteosclerotic skeletal metastases.Materials and Methods
Nine breast cancer patients with suspected bone metastases (9 females; mean age ± SD, 55.6 ± 10.0 years) underwent 99mTc-MDP WBBS, 18F-FDG PET/CT and 18F-fluoride PET/CT. Lesion-based analysis of five regions of the skeletons (skull, vertebral column, thoracic cage, pelvic bones and long bones of extremities) and patient-based analysis were performed.Results
18F-fluoride PET/CT, 18F-FDG PET/CT and WBBS detected 49, 20 and 25 true metastases, respectively. Sensitivity, specificity, positive predictive value and negative predictive value of 18F-fluoride PET/CT were 94.2 %, 46.3 %, 57.7 % and 91.2 %, respectively. Most true metastatic lesions on 18F-fluoride PET/CT had osteosclerotic change (45/49, 91.8 %), and only four lesions showed osteolytic change. Most lesions on 18F-FDG PET/CT also demonstrated osteosclerotic change (17/20, 85.0 %) with three osteolytic lesions. All true metastatic lesions detected on WBBS and 18F-FDG PET/CT were identified on 18F-fluoride PET/CT.Conclusion
18F-fluoride PET/CT is superior to WBBS or 18F-FDG PET/CT in detecting osteosclerotic metastatic lesions. 18F-fluoride PET/CT might be useful in evaluating osteosclerotic metastases in breast cancer patients. 相似文献Purpose
We investigated the potential value of 11C-acetate (ACT) PET/CT in characterizing multiple myeloma (MM) compared with 18F-FDG PET/CT. Bone marrow histological and whole-body (WB) MRI findings served as the reference standards.Methods
In this prospective study, 15 untreated MM patients (10 men and 5 women, age range 48?69 years) underwent dual-tracer 11C-ACT and 18F-FDG PET/CT and WB MRI for pretreatment staging, and 13 of them had repeated examinations after induction therapy. Diffuse and focal bone marrow uptake was assessed by visual and quantitative analyses, including measurement of the maximum standardized uptake value (SUVmax). Between-group differences and correlations were assessed with the Mann-Whitney U test and the Pearson test.Results
At staging, all 15 patients had diffuse myeloma involvement upon bone marrow examination with 30–90 % of plasma cell infiltrates. Diffuse infiltration was detected in all of them (100 %) using 11C-ACT with a positive correlation between bone marrow uptake values and percentages of plasma cell infiltrates (r = +0.63, p?=?0.01). In contrast, a diagnosis of diffuse infiltration could be established using 18F-FDG in only six patients (40 %). Focal lesions were shown in 13 patients on both 11C-ACT PET/CT and WB MRI, and in 10 patients on 18F-FDG PET/CT. Focal lesions demonstrated 11C-ACT uptake with a mean SUVmax of 11.4 ± 3.3 (range 4.6?19.6, n?=?59), which was significantly higher than the 18F-FDG uptake (mean SUVmax 6.6 ± 3.1, range 2.3?13.7, n?=?29; p?<?0.0001). After treatment, the diffuse bone marrow 11C-ACT uptake showed a mean SUVmax reduction of 66 % in patients with at least a very good partial response versus 34 % in those with at most a partial response only (p?=?0.01).Conclusion
PET/CT using 11C-ACT as a biomarker showed a higher detection rate for both diffuse and focal myeloma lesions at diagnosis than using 18F-FDG, and may be valuable for response assessment. 相似文献Objective
L-3-[18F]-fluoro-α-methyl tyrosine (18F-FAMT) is an amino acid tracer for positron emission tomography/computed tomography (PET/CT) which specifically transported into cancer cells by L-type amino acid transporter 1 (LAT1). LAT1 overexpression in tumors is significantly correlated with cell proliferation and angiogenesis. 18F-FAMT PET/CT, fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT and magnetic resonance imaging (MRI) were compared for their diagnostic performance in the detection of bone marrow invasion in patients with oral squamous cell carcinoma (OSCC).Methods
Twenty-seven patients with OSCC on the upper or lower alveolar ridge underwent staging by MRI, 18F-FDG PET/CT and 18F-FAMT PET/CT studies before surgery. Post-surgical pathologic examination was used as the standard to determine the final diagnoses. The possibility of bone marrow invasion on MRI, 18F-FDG PET/CT and 18F-FAMT PET/CT were usually graded retrospectively into five-point score. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated according to the obtained scores.Results
As the sensitivity of 18F-FDG PET/CT was highest (100 %) among that of MRI (95 %) and 18F-FAMT PET/CT (90 %), the specificity of 18F-FAMT PET/CT was highest (85.7 %) among that of MRI (57 %) and 18F-FDG PET/CT (14.3 %). The size of pathological tumor was accorded with that detected by 18F-FAMT PET/CT and was smaller than that detected by 18F-FDG PET/CT (P < 0.01). Significant difference was not found between 18F-FAMT PET tumor volume and pathological tumor volume.Conclusions
18F-FAMT PET/CT was useful and more specific than MRI or 18F-FDG PET/CT in the detection of bone marrow invasion of OSCC and may contribute to minimize the extent of resection in oral surgery patient. 相似文献Purpose
To retrospectively evaluate and compare 18F-FDG, 18F-DOPA and 68Ga-somatostatin analogues for PET/CT in patients with residual/recurrent medullary thyroid carcinoma (MTC) suspected on the basis of elevated serum calcitonin levels.Methods
Included in the study were 18 patients with recurrent MTC in whom functional imaging with the three tracers was performed. The PET/CT results were compared on a per-patient basis and on a per-lesion-basis.Results
At least one focus of abnormal uptake was observed on PET/CT in 13 patients with 18F-DOPA (72.2% sensitivity), in 6 patients with 68Ga-somatostatin analogues (33.3%) and in 3 patients with 18F-FDG (16.7%) (p?0.01). There was a statistically significant difference in sensitivity between 18F-DOPA and 18F-FDG PET/CT (p?0.01) and between 18F-DOPA and 68Ga-somatostatin analogue PET/CT (p?=?0.04). Overall, 72 lesions were identified on PET/CT with the three tracers. 18F-DOPA PET/CT detected 85% of lesions (61 of 72), 68Ga-somatostatin analogue PET/CT 20% (14 of 72) and 18F-FDG PET/CT 28% (20 of 72). There was a statistically significant difference in the number of lymph node, liver and bone lesions detected with the three tracers (p?0.01). In particular, post-hoc tests showed a significant difference in the number of lymph node, liver and bone lesions detected by 18F-DOPA PET/CT and 18F-FDG PET/CT (p?0.01 for all the analyses) and by 18F-DOPA PET/CT and 68Ga-somatostatin analogue PET/CT (p?0.01 for all the analyses). The PET/CT results led to a change in management of eight patients (44%).Conclusion
18F-DOPA PET/CT seems to be the most useful imaging method for detecting recurrent MTC lesions in patients with elevated serum calcitonin levels, performing better than 18F-FDG and 68Ga-somatostatin analogue PET/CT. 18F-FDG may complement 18F-DOPA in patients with an aggressive tumour. 相似文献Aim
The aim of this study was to assess the combined use of the radiotracers 18F-FDG and 18F-NaF in treatment response evaluation of a group of multiple myeloma (MM) patients undergoing high-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) by means of static (whole-body) and dynamic PET/CT (dPET/CT).Patients and methods
Thirty-four patients with primary, previously untreated MM scheduled for treatment with HDT followed by ASCT were enrolled in the study. All patients underwent PET/CT scanning with 18F-FDG and 18F-NaF before and after therapy. Treatment response by means of PET/CT was assessed according to the European Organization for Research and Treatment of Cancer (EORTC) 1999 criteria. The evaluation of dPET/CT studies was based on qualitative evaluation, semi-quantitative (SUV) calculation, and quantitative analysis based on two-tissue compartment modelling and a non-compartmental approach leading to the extraction of fractal dimension (FD).Results
An analysis was possible in 29 patients: three with clinical complete response (CR) and 26 with non-CR (13 patients near complete response-nCR, four patients very good partial response-VGPR, nine patients partial response-PR). After treatment, 18F-FDG PET/CT was negative in 14/29 patients and positive in 15/29 patients, showing a sensitivity of 57.5 % and a specificity of 100 %. According to the EORTC 1999 criteria, 18F-FDG PET/CT-based treatment response revealed CR in 14 patients (18F-FDG PET/CT CR), PR in 11 patients (18F-FDG PET/CT PR) and progressive disease in four patients (18F-FDG PET/CT PD). In terms of 18F-NaF PET/CT, 4/29 patients (13.8 %) had a negative baseline scan, thus failed to depict MM. Regarding the patients for which a direct lesion-to-lesion comparison was feasible, 18F-NaF PET/CT depicted 56 of the 129 18F-FDG positive lesions (43 %). Follow-up 18F-NaF PET/CT showed persistence of 81.5 % of the baseline 18F-NaF positive MM lesions after treatment, despite the fact that 64.7 % of them had turned to 18F-FDG negative. Treatment response according to 18F-NaF PET/CT revealed CR in one patient (18F-NaF PET/CT CR), PR in five patients (18F-NaF PET/CT PR), SD in 12 patients (18F-NaF PET/CT SD), and PD in seven patients (18F-NaF PET/CT PD). Dynamic 18F-FDG and 18F-NaF PET/CT studies showed that SUVaverage, SUVmax, as well as the kinetic parameters K1, influx and FD from reference bone marrow and skeleton responded to therapy with a significant decrease (p?<?0.001).Conclusion
F-FDG PET/CT demonstrated a sensitivity of 57.7 % and a specificity of 100 % in treatment response evaluation of MM. Despite its limited sensitivity, the performance of 18F-FDG PET/CT was satisfactory, given that 6/9 false negative patients in follow-up scans (66.7 %) were clinically characterized as nCR, a disease stage with very low tumor mass. On the other hand, 18F-NaF PET/CT does not seem to add significantly to 18F-FDG PET/CT in treatment response evaluation of MM patients undergoing HDT and ASCT, at least shortly after therapy.Purpose
Accurate staging of Hodgkin’s lymphoma (HL) is necessary in selecting appropriate treatment. Bone marrow trephine biopsy (BMB) is the standard procedure for depicting bone marrow involvement. BMB is invasive and explores a limited part of the bone marrow. 18F-FDG PET/CT is now widely used for assessing response to therapy in HL and a baseline study is obtained to improve accuracy. The aim of this retrospective analysis was to assess whether routine BMB remains necessary with concomitant 18F-FDG PET/CT.Methods
Data from 83 patients (newly diagnosed HL) were reviewed. All patients had received contrast-enhanced CT, BMB and 18F-FDG PET/CT. Results of BMB were not available at the time of 18F-FDG PET/CT imaging.Results
Seven patients had lymphomatous involvement on BMB. Four patients had bone involvement on conventional CT (two with negative BMB). All patients with bone marrow and/or bone lesions at conventional staging were also diagnosed on 18F-FDG PET/CT scan. PET/CT depicted FDG-avid bone/bone marrow foci in nine additional patients. Four of them had only one or two foci, while the other had multiple foci. However, the iliac crest, site of the BMB, was not involved on 18F-FDG PET/CT. Osteolytic/sclerotic lesions matching FDG-avid foci were visible on the CT part of PET/CT in three patients. MRI ordered in three other patients suggested bone marrow involvement. Interim and/or end-therapy 18F-FDG PET/CT documented response of FDG-avid bone/bone marrow foci to chemotherapy in every patient.Conclusion
18F-FDG PET/CT highly improves sensitivity for diagnosis of bone/bone marrow lesions in HL compared to conventional staging. 相似文献Objective
The aim of this prospective study is to evaluate the combined use of fluorine-18 fluorodeoxyglucose (18?F-FDG) and fluorine-18 sodium fluoride (18?F-NaF) PET/CT in the skeletal assessment of patients with multiple myeloma (MM) and to compare the efficacy of these two PET tracers regarding detection of myeloma-indicative osseous lesions.Patients and methods
The study includes 60 patients with multiple myeloma (MM) diagnosed according to standard criteria. All patients underwent dynamic (dPET/CT) scanning of the pelvis as well as whole body PET/CT studies with both tracers. The interval between the two exams was one day. Sites of focal increased 18?F-FDG uptake were considered as highly suspicious of myelomatous involvement. The lesions detected on the 18?F-NaF PET/CT scans were then correlated with those detected on 18?F-FDG PET/CT, which served as a reference. Moreover, the 18?F-FDG PET/CT results were also correlated with the low-dose CT findings. The evaluation of dPET/CT studies was based on qualitative evaluation, SUV calculation, and quantitative analysis based on a 2-tissue compartment model and a non-compartmental approach.Results
Whole body 18?F-FDG PET/CT revealed approximately 343 focal lesions while 18?F-NaF PET/CT revealed 135 MM-indicative lesions (39 % correlation). CT demonstrated 150 lesions that correlated with those in 18?F-FDG PET/CT (44 % correlation). Six patients demonstrated a diffuse pattern of disease with 18?F-FDG, while 15 of them had a mixed (diffuse and focal) pattern of skeletal 18?F-FDG uptake. A high number of degenerative, traumatic and arthritic disease lesions were detected with 18?F-NaF PET/CT. In three patients with multiple focal 18?F-FDG-uptake, 18?F-NaF PET/CT failed to demonstrate any bone lesion. The dPET/CT scanning of the pelvic area with 18?F-FDG and 18?F-NaF revealed 77 and 24 MM-indicative lesions, respectively. Kinetic analysis of 18?F-FDG revealed the following mean values: SUVaver?=?5.1, k1?=?0.37 (1/min), k3?=?0.10 (1/min), VB?=?0.06, influx?=?0.04 (1/min), FD?=?1.28; the respective values for 18?F-NaF were SUVaverage?=?10.7, k1?=?0.25 (1/min), k3?=?0.34 (1/min), VB?=?0.02, influx?=?0.10 (1/min), FD?=?1.37. Apart from the correlation between VB of 18?F-FDG and k1 of 18?F-NaF (r?=?0.54), no other significant correlation was observed between the two tracers’ kinetic parameters. We found a significant correlation between FD and SUVaverage (r?=?0.93), FD and SUVmax (r?=?0.80), FD and influx ( r?=?0.85), as well as between influx and SUVaverage (r?=?0.74) for 18?F-FDG. In 18?F-NaF we observed the most significant correlations between FD and SUVaverage (r?=?0.97), FD and SUVmax (r?=?0.87), and between influx and k1 (r?=?0.72).Conclusion
The combined use of 18?F-FDG PET/CT and 18?F-NaF PET/CT provides different molecular information regarding the biological processes that take place in a MM osseous lesion. 18?F-FDG PET/CT proved to be a more specific biomarker than 18?F-NaF PET/CT in multiple myeloma skeletal assessment. 相似文献Objectives
To compare [18?F]FDG PET/MRI with PET/CT for the assessment of bone lesions in oncologic patients.Methods
This prospective study included 67 patients with solid tumours scheduled for PET/CT with [18?F]FDG who also underwent a whole-body PET/MRI scan. The datasets (PET/CT, PET/MRI) were rated by two readers regarding lesion conspicuity (four-point scale) and diagnostic confidence (five-point scale). Median scores were compared using the Wilcoxon test.Results
Bone metastases were present in ten patients (15 %), and benign bone lesions in 15 patients (22 %). Bone metastases were predominantly localized in the pelvis (18 lesions, 38 %) and the spine (14 lesions, 29 %). Benign bone lesions were exclusively osteosclerotic and smaller than the metastases (mean size 6 mm vs. 23 mm). While PET/CT allowed identification of 45 of 48 bone metastases (94 %), PET/MRI allowed identification of all bone metastases (100 %). Conspicuity of metastases was high for both modalities with significantly better results using PET/MRI (p?<?0.05). Diagnostic confidence in lesion detection was high for both modalities without a significant difference. In benign lesions, conspicuity and diagnostic confidence were significantly higher with PET/CT (p?<?0.05).Conclusions
[18?F]FDG PET/MRI shows high potential for the assessment of bone metastases by offering superior lesion conspicuity when compared to PET/CT. In hypersclerotic, benign bone lesions PET/CT still sets the reference.Key Points
? PET/MRI and PET/CT are of equal value for the identification of disease-positive patients ? PET/MRI offers higher lesion conspicuity as well as diagnostic confidence ? PET/MRI is an attractive new alternative for the assessment of bone metastases 相似文献To compare the diagnostic performance of whole-body magnetic resonance imaging (WBMRI) versus 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for determination of remission status in patients with multiple myeloma (MM) after stem cell transplantation (SCT).
MethodsThirty-one patients were examined by both WBMRI and PET/CT after SCT. Imaging results and clinical remission status as determined by the clinical gold standard (Uniform Response Criteria) were compared.
ResultsOne hundred four lesions were detected in 21 patients. PET/CT had a sensitivity of 50.0 %, a specificity of 85.7 %, a positive predictive value of 62.5 %, a negative predictive value of 78.3 %, and an overall accuracy of 74.2 % for determination of remission status. MRI had a sensitivity of 80.0 %, a specificity of 38.1 %, a positive predictive value of 38.1 %, a negative predictive value of 80 %, and an overall accuracy of 51.6 %. Concordant results were observed in only 12 (11.5 %) of the 104 lesions.
ConclusionsIn the post-treatment setting, both FDG PET/CT and WBMRI provide information about the extent of disease, allowing for a more comprehensive evaluation of persisting or recurrent myeloma. MRI may often be false positive because of persistent non-viable lesions. Therefore, PET/CT might be more suitable than MRI for determination of remission status.
Key Points• Both whole-body MRI and 18 F-FDG PET/CT are now used for assessing multiple myeloma
• Both investigations may visualise residual or recurrent disease after stem cell transplantation
• MRI may give false-positive results because of persistent inactive lesions
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