Prospective Comparison of FDG and FET PET/CT in Patients with Head and Neck Squamous Cell Carcinoma

Aim  The clinical usefulness of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) in head and neck squamous cell carcinoma (HNSCC) is now well-documented. However, its sensitivity is greater than its specificity due to false-positive results in inflammatory or infectious lesions, which are frequent in this area, in particular after treatment by surgery and/or radiotherapy. O-2-fluoro-(18F)-ethyl-L-thyrosine (FET) has been reported not to be taken up by such lesions, and a preliminary study indicated that this may be clinically useful in HNSCC. We performed a prospective study to compare the diagnostic performances of FDG and FET PET/CT in the different settings of HNSCC. Materials and Methods  Twenty-seven patients (20 men and seven women, aged 48–76, among 30 patients included) and 69 suspected cancer sites are now evaluable on basis of postsurgical histology and/or follow-up greater than 6 months; 15 patients were referred for initial staging and 12 during posttherapy follow-up, a recurrence being suspected in eight of them. FDG and FET PET/CT were performed on two different days, the patient fasting for 6 h, 1 h after injection of 5 MBq/kg of body mass of each radiopharmaceutical. Both PET/CT examinations were blind read more than 6 months after the end of inclusions in a random order for each tracer and with a time interval greater than 1 month between FDG and FET PET/CT blind readings. Results  Overall diagnostic performances, derived from blind reading: FDG PET/CT on a per patient basis: sensitivity 100%, specificity 71%, accuracy 93%; FDG PET/CT on a per site basis: sensitivity 95%, specificity 63%, accuracy 83%; FET PET/CT on a per patient basis: sensitivity 70%, specificity 100%, accuracy 78%; FET PET/CT on a per site basis: sensitivity 64%, specificity 100%, accuracy 78%. At site level, sensitivity was significantly greater with FDG (p < 0.02) and specificity with FET (p < 0.01). The statistical level of significance was not reached at patient level. Conclusion  Although its good specificity was confirmed, FET did not appear to be suited as a first-line PET tracer in HNSCC imaging and cannot replace FDG for staging due to insufficient sensitivity. However, it was useful in a few selected cases to favor a wait and see attitude when a FDG+ FET− focus was discovered in patients referred for systematic FDG PET during follow-up. In contrast, second primary cancers should not be ruled out if FDG was clearly positive in the lungs or the digestive tract.     

FDG-PET/CT of Head and Neck Squamous Cell Carcinoma in a Rat Model

Purpose  The aim of this study was to demonstrate the ability to use human clinical positron emission tomography/computed tomography (PET/CT) to detect and investigate head and neck cancers chemically induced by 4-nitroquinoline-1-oxide (4-NQO) in a rat model. Study design  The study design was prospective animal research. Procedures  A head and neck squamous cell carcinoma was established in 20 immunocompetent rats, who drank a 4-NQO solution during 16 weeks. 2-Deoxy-2-[F-18]fluoro-d-glucose (FDG)-PET/CT was performed for five of them, 34 weeks after the start of the experiment to characterize the tumors. A day following the FDG-PET/CT, rats were euthanized and pathological features were evaluated by hematoxylin–eosin staining. Results  All rats had head and neck tumor at various locations at 34 weeks. Among the five rats selected for having FDG-PET/CT, the clinical examination detected exophytic tumors grown in the oral cavity for three of them (one on the inferior lip, one on the hard palate, and one on the internal side of the cheek). FDG-PET/CT confirmed the presence of those tumors and detected ones located on the base of tongue for three of them. Tumor extensions were characterized and tumor metabolic volumes were measured. The smallest lesion detected measured 3 × 3 × 4 mm. Pathologic examination using hematoxylin–eosin staining confirmed squamous cell carcinoma. Conclusions  This study demonstrated that FDG-PET/CT is a feasible examination to detect occult primary tumors in rat models. It is useful to follow tumor progression and evaluate therapeutics efficacy.     

Therapy of Head and Neck Squamous Cell Carcinoma with an Oncolytic Adenovirus Expressing HSV-tk

Currently available therapeutic modalities for advanced head and neck squamous cell carcinoma (HNSCC), such as radical surgery, high-dose radiotherapy, and chemotherapy, are of limited efficacy. Overall survival has not significantly improved over the past 30 years; thus, HNSCC represents a promising target for new therapeutic approaches, such as gene therapy. A major obstacle to the development of effective suicide gene therapy strategies that rely on in situ transduction of tumor cells is the poor distribution of the vector throughout the tumor. To address this problem we evaluated the use of Ad.OW34, an E1b 55 kD and HSV-tk-carrying, replication-competent adenoviral vector that has a wild-type adenovirus phenotype in replicating cells, in combination with ganciclovir (GCV) as a treatment for HNSCC xenografts in nude mice and compared its efficacy with that of a standard replication-deficient adenovirus expressing HSV-tk (Ad.TK). In this model, Ad.OW34 had a significantly greater antitumor effect than the traditional Ad.TK vector, administered alone or in combination with GCV. Interestingly, GCV did not further enhance the oncolytic efficacy of Ad.OW34. GCV also aborts viral replication and thus represents a fail-safe feature of this vector not found in wild-type adenovirus.     

脑内占位病变18F-FET PET显像初步研究与18F-FDG PET对照

目的:通过O-(2-18F-氟代乙基)-L-酪氨酸(18F-FET)和18F-氟脱氧葡萄糖(18F-FDG)2种PET显像剂的对照研究,探讨18F-FET能否起到弥补18F-FDG脑显像不足的作用。方法:14例脑占位病变患者(13例胶质瘤,1例鼻咽癌放疗后出现脑占位病变)1周内行18F-FET和18F-FDG PET2次脑显像。半定量分析:用感兴趣区(ROI)法计算标准摄取值(SUV)及T/NT。结果:①12例脑胶质瘤,无论术前原发灶或术后残存/复发18F-FET显像均显示病灶,T/NT=2.34±0.70,阳性率100%;18F-FDG显像,2例摄取高于皮层,病灶显示清晰,10例病灶摄取低于正常皮层,T/NT=0.59±0.18,阳性率75%;②1例胶质瘤术后疑有复发者,18F-FET及18F-FDG均未见异常,随访10个月,临床无进展;③1例鼻咽癌患者放射治疗后左颞叶占位病变,18F-FET图像病灶呈环形,周边高摄取,中心减低,T/NT=1.86;18F-FDG显像也显示为轻度环形摄取,T/NT=0.77。结论:①18F-FET显像不论肿瘤恶性程度如何均可清晰检出病灶,优于18F-FDG;②放射治疗后坏死1例,18F-FET为高摄取,其鉴别肿瘤和放射治疗后坏死的能力尚待进一步研究。     

Sequential FDG-PET/CT after Neoadjuvant Chemotherapy is a Predictor of Histopathologic Response in Patients with Head and Neck Squamous Cell Carcinoma

Molecular Imaging and Biology - To evaluate whether 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) more accurately predicts the histopathologic...     

Preclinical Comparison of Near-Infrared-Labeled Cetuximab and Panitumumab for Optical Imaging of Head and Neck Squamous Cell Carcinoma

Purpose

Though various targets have been proposed and evaluated, no agent has yet been investigated in a clinical setting for head and neck cancer. The present study aimed to compare two fluorescently labeled anti-epidermal growth factor receptor (EGFR) antibodies for detection of head and neck squamous cell carcinoma (HNSCC).

Procedures

Antigen specificities and in vitro imaging of the fluorescently labeled anti-EGFR antibodies were performed. Next, immunodeficient mice (n?=?22) bearing HNSCC (OSC-19 and SCC-1) tongue tumors received systemic injections of cetuximab-IRDye800CW, panitumumab-IRDye800CW, or IgG-IRDye800CW (a nonspecific control). Tumors were imaged and resected using two near-infrared imaging systems, SPY and Pearl. Fluorescent lymph nodes were also identified, and all resected tissues were sent for pathology.

Results

Panitumumab-IRDye800CW and cetuximab-IRDye800CW had specific and high affinity binding for EGFR (K _D?=?0.12 and 0.31 nM, respectively). Panitumumab-IRDye800CW demonstrated a 2-fold increase in fluorescence intensity compared to cetuximab-IRDye800CW in vitro. In vivo, both fluorescently labeled antibodies produced higher tumor-to-background ratios compared to IgG-IRDye800CW. However, there was no significant difference between the two in either cell line or imaging modality (OSC-19: p?=?0.08 SPY, p?=?0.48 Pearl; SCC-1: p?=?0.77 SPY, p?=?0.59 Pearl; paired t tests).

Conclusions

There was no significant difference between the two fluorescently labeled anti-EGFR monoclonal antibodies in murine models of HNSCC. Both cetuximab and panitumumab can be considered suitable targeting agents for fluorescent intraoperative detection of HNSCC.     

Autoimmune pancreatitis: whole-body 18F-FDG PET/CT findings

Purpose

The study aimed to investigate the function of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in diagnosing of autoimmune pancreatitis (AIP) and whole-body evaluation.

Methods

Seven AIP patients who underwent ¹⁸F-FDG PET/CT systemic examination in our hospital from August 2010 to March 2012 were analyzed retrospectively. Systemic PET/CT routine scanning and pancreatic delayed scanning were performed in all patients.

Results

The mean age of 7 AIP patients (6 male and 1 female) was 54.2 years (range from 42 to 71 years). The pancreas showed diffuse enlargement in 6 cases, and segmental enlargement in 1 case. Fluorodeoxyglucose (FDG) uptake was increased in diseased region. The maximum standardized uptake value (SUVmax) was 4.38 ± 0.90 and increased to 5.31 ± 1.08 after delayed scanning, of which small amounts of inflammatory exudate around pancreas was observed in 4 cases. Extrapancreatic lesions (EPLs) were observed in all 7 cases: lymphadenectasis (n = 5), lymphadenectasis with increased FDG uptake (n = 4); associated sialosis with metabolism enlargement (n = 4); associated cholangitis (n = 4); associated interstitial pneumonia (n = 3); inverted “V” shaped high FDG uptake foci in prostate (n = 5).

Conclusions

AIP is a systemic disease. ¹⁸F-FDG PET/CT can exhibit the characteristics of AIP pancreatic lesions, and also better reflect the changes and metabolic characteristics of extrapancreatic organs. It plays a distinct role in diagnosis, differentiating of AIP and whole-body evaluation.     

Extraovarian primary peritoneal carcinoma: staging with 18F-FDG PET/CT

A 69-year-old woman who presented with left lower quadrant abdominal pain and elevated serum cancer antigen 125 (CA-125) levels was referred for an MRI and an ¹⁸F-FDG PET/CT to evaluate a suspicious abdominal mass seen on ultrasound. PET/CT showed extensive, intensely FDG-avid, omental and pelvic peritoneal thickening with no suspicious ovarian or colon masses. Based on the PET/CT results, the patient had extensive debulking surgery and histopathological evaluation revealed an extraovarian primary peritoneal carcinoma (EOPPC). ¹⁸F-FDG PET/CT may be useful in differentiating EOPPC from other types of peritoneal carcinomatosis, and in determining the extent of the disease to better guide surgical management and improve long term outcomes.     

18F-FDG PET或PET/CT显像在淋巴瘤中的应用

淋巴瘤是一组起源于淋巴造血组织的恶性实体瘤，在我国发病率居恶性肿瘤第11～13位，死亡率为1．56／10万人口。恶性淋巴瘤的分类复杂，病理特点多变，病变范围广泛，大致可分为霍奇金病（Hodgkin’s disease，HD）和非霍奇金淋巴瘤（non-Hodgkin’slymphoma，NHL）两大类。中国人淋巴瘤多为NHL，HD仅占10％左右（国外为40％）；发病年龄集中于40岁左右（国外为20～24岁，75～84岁两个年龄段）。     

Survival Patterns in Squamous Cell Carcinoma of the Head and Neck: Pain as an Independent Prognostic Factor for Survival

Survival outcomes in patients with squamous cell carcinoma of the head and neck (HNSCC) vary by extent of disease, behavioral factors, and socioeconomic factors. We assessed the extent to which pretreatment pain influences survival in 2,340 newly diagnosed patients with HNSCC, adjusting for disease stage, symptoms, pain medications, comorbidities, smoking, alcohol consumption, age, sex, and race/ethnicity. Patients rated their pain at presentation to the cancer center (0 = “no pain” and 10 = “pain as bad as you can imagine”). Survival time was calculated from the date of diagnosis to the date of death of any cause or last follow-up. Five-year overall survival was calculated for all the variables assessed in the study. Severe pain (≥7) was most prevalent among those with oral cancer (20.4%; pharynx = 18.8%; larynx = 16.1%) and significantly varied by tumor stage, fatigue severity, smoking status, comorbid lung disease, and race (all P < .05) across cancer diagnoses. Overall 5-year survival varied by pain for oral (severe pain = 31% vs nonsevere pain = 52%; P < .001) and pharyngeal cancer (severe pain = 33% vs nonsevere pain = 53%; P < .001). Multivariable analyses showed that pain persisted as an independent prognostic factor for survival. Pain reported prior to treatment should be considered in understanding survival outcomes in HNSCC patients.     

Relationship Between Clinicopathological Characteristics and PET/CT Uptake in Esophageal Squamous Cell Carcinoma: [18F]Alfatide versus [18F]FDG

Molecular Imaging and Biology - To assess a novel radiotracer aluminum [18F]fluoride-1,4,7-triazacyclononane-triacetic acid-pegylated dimeric RGD ([18F]ALF-NOTA-PRGD2, denoted as [18F]Alfatide) for...     

18F-FDG PET/CT和纤维支气管镜检查对肺癌诊断价值的对比研究

目的 探讨18氟(18F)-脱氧葡萄糖(fluorodeoxygluCose,FDG)正电子发射计算机断层显像(positron emission tomography,PET)/计算机X线断层显像(computer tomograPhy,CT)对肺癌的诊断价值,并与纤维支气管镜检查结果进行比较.方法 对39例X线或CT检查发现肺部占位性肿块的患者进行18F-FDGPET/CT显像,同时做纤维支气管镜检查(纤支镜)及手术取组织进行病理学检查.结果 39例患者中,经纤维支气管镜检查32例为肺癌,4例为良性病变,包括2例炎性假瘤,1例结核瘤及1例肺结节病,另外3例纤支镜检查阴性者经手术切除病理检查证实为肺癌,纤维支气管镜检查对肺癌的敏感性、特异性及准确性分别为91%、100%及92%.18F-FDG PET/CT显像发现34例肺部影像有异常浓聚显像剂的病灶,平均的标准摄取值(mean standardized uptake value,SUVmean)为(7.8±3.6)(5.7～12.1),病理学检查证实其中1例为结核瘤,余均为肺癌.另外5例18F-FDG PET/CT显像为阴性结果,病理检查证实其中2例炎性假瘤,1例肺结节病,另外2例分别为细支气管肺泡癌和高分化乳突状腺癌,18F-FDG PET/CT显像对肺癌的敏感性、特异性及准确性分别为94%、75%及92‰结论18F-FDG PET/CT显像对于肺癌有重要的临床诊断价值.PET/CT显像的敏感性稍高于纤维支气管镜检查,前者特异性低于后者,两者的准确性接近.     

原发乳腺淋巴瘤的~(18)F-FDG PET/CT表现

目的探讨原发乳腺淋巴瘤(PBL)的18F-FDG PET/CT显像特征,提高对该病的认识。方法回顾性分析经病理证实的15例PBL的18F-FDG PET/CT显像资料。结果 15例PBL,4例双侧乳腺受侵,11例单侧发病。PET/CT表现主要有三种类型:(1)单发结节或肿块型最常见,占66.7%(10/15),病灶境界清晰,边缘光滑,均为软组织密度;乳头均未见凹陷,邻近皮肤增厚,乳后间隙未见侵犯,乳腺病灶SUV_(max)为16.39(5.92,31.60)。(2)多发结节、肿块型3例,多为数个病灶融合所致;病灶形态、轮廓及密度与单发结节、肿块型相似,而占位效应较后者明显。病灶SUVmax分别为6.95、7.01、33.29。(3)弥漫型2例,范围广,占位效应最明显,乳腺病灶SUVmax分别为8.18、11.52。三种类型间乳腺病灶的SUVmax差异无统计学意义(χ~2=0.737,P=0.692)。临床分期ⅠE期4例,ⅡE期11例;ⅠE期及ⅡE期乳腺病灶的SUV_(max)分别为21.27(7.01,31.60)、11.52(5.92,33.29),差异无统计学意义(Z=-1.044,P=0.296)。结论 PBL的18F-FDG PET/CT表现具有一定特征性:境界清晰、边缘光滑的软组织结节或肿块,18F-FDG摄取较高,有助于PBL的诊断。     

PET/CT显像在胃癌转移灶诊断中的应用

目的 评价18F-FDG PET/CT显像在胃癌转移灶诊断中的应用价值.方法 回顾性分析80例胃癌患者PET/CT的影像学资料,并与胃镜的细胞学检查,手术病理检查和临床表现做比较,所有病例均经过2年以上的随访.探讨18F-FDG PET/CT显像在胃癌转移灶诊断中的价值.结果 80例胃癌患者中,PET/CT显示43例有淋巴结高摄取(SUV＞2.5),经手术病理或临床随访2年证实42例为淋巴结转移;l例为淋巴结反应性增生.PET/CT对胃癌淋巴结转移诊断的敏感性为100％,特异性97.4％,准确性98.8％.80例患者中,PET/CT提示远处器官转移12例(部分患者有多器官转移),其中肝转移5例,胰腺转移1例,腹膜转移4例,肠系膜及子宫附件转移各2例,PET/CT对胃癌远处器官转移诊断的敏感性为92.3％,特异性100％,准确性98.8％.结论 18F-FDG PET/CT显像对于胃癌转移灶的诊断及胃癌的分期有较大的临床意义.     

~(18)F-FDG PET/CT在皮肤淋巴瘤中的初步应用

目的皮肤淋巴瘤是较常见的结外淋巴瘤,本文初步探讨PET/CT在皮肤淋巴瘤中的价值。方法回顾性分析我院近5年来的12例皮肤淋巴瘤患者PET/CT图像,根据治疗情况分为治疗组(A组)及未治疗组(B组),比较皮肤病变与PET/CT结果的关系。结果 A组中6例行PET/CT随访及再分期,其中2例PET/CT显像未见FDG高代谢病变;3例患者复发的皮肤病变具有不同程度的FDG摄取,1例患者肺部转移。B组中6例皮肤淋巴瘤PET均有阳性病变,但2例患者皮损或皮下结节无FDG摄取。综合分析10例PET/CT显像阳性者,8例患者有皮肤红斑和皮下结节,其中2例皮肤病变未见FDG摄取,2例仅部分皮肤病变摄取FDG。10例分期及再分期的淋巴瘤中,与常规方法比较PET/CT使2例(20%)分期上调。结论 FDGPET/CT对皮肤淋巴瘤的诊治有一定的临床价值。