Value of ~（18）F-FDG PET/CT and MRI in diagnosing primary endometrial small cell carcinoma

Primary small cell carcinoma（SCC） is a group of aggressive neoplasms that mainly arise from the lung and digestive tract. Endometrial small cell carcinoma（ESCC） is extremely rare. To our knowledge, less than 90 cases have been reported, and most of these reports were dedicated to describing the clinicopathologic or immunochemical features of ESCC. Herein, we present a new case of ESCC involving a 51-year-old woman and mainly focus on the magnetic resonance imaging（MRI） and positron emission tomography/computed tomography（PET/CT） findings. MRI showed that the uterus was significantly enlarged（11.6 cm × 11.1 cm × 14.4 cm）, and a giant irregular mass（7.5 cm × 8.4 cm × 8.5 cm） was observed in the uterine cavity. The lesion demonstrated an extremely low apparent diffusion coefficient（ADC） value [（0.553±0.088）×10^–3 mm^2/s] and a high FDG uptake value（22.7）. Multiple metastatic lymph nodes（LNs） were identified at different positions, with diameters ranging from 0.3 to 2.8 cm and a maximum standardized uptake value（SUV max） ranging from 6.9 to 19.3.     

Preliminary PET/CT Study of ~(18)F-FDG Uptake in Cervical and Supraclavicular Brown Adipose Tissue

OBJECTIVE The clinical use of PET/CT in oncology has led to the realization that 18F-FDG uptake in brown adipose tissue(BAT) can be a common cause of potentially misleading false-positive PET scans.The goal of this study was to study 18F-FDG uptake in cervical and supraclavicular regions and its characteristics with PET/CT.METHODSAll the PET/CT scans obtained at our institutionfrom July 2007 to January 2008 were retrospectively reviewed forincreased 18F-FDG uptake in BAT.The cases in which increased18F-FDG in cervical and supraclavicular regions was not localizedto a so -tissue mass or lymph node or muscle on the CT images,were included in this study.The following features were recorded:body weight,body mass index(BMI) and maximal standardizeduptake value(SUVmax).In these selected patients,the BAT uptake in other area of the body was also recorded.RESULTS PET/CT scans were obtained in 457 patients(259 males and 198 females).In all of the scans,cervical and supraclavicular BAT uptake was observed in 12 patients(2 males and 10 females) and was typically bilateral,symmetric and intense.The range of the SUVmax was 3.6～12.82(mean 6.9 ± 2.6).BAT uptake was more common in females than in males,showing a significant difference(P = 0.004).Although 18F-FDG uptake in BAT occurred more o en in underweight patients with low BMI,there was no difference in the body weight(P = 0.607) or BMI(P = 0.491) of these patients with hypermetabolic BAT compared with controls.CONCLUSION Hypermetabolic BAT uptake can be localized in cervical and supraclavicular regions with it occurring more commonly in females compared to males.Knowledge of this potential pitfall with PET/CT is important in improving diagnostic interpretation and accurate staging.     

Retrospective analysis of 116 patients and diagnostic value of 18 F-FDG PET/CT in hepatic tumor北大核心CSCD

Objective: To evaluate the diagnostic value of 18F-fluorodeoxy glucose (FDG) positron emission tomography (PET)/CT in patients with hepatic tumor. Methods: One hundred and sixteen patients with clinical diagnosis of hepatic tumor (85 males, 31 females; average age was 56 years old) had undergone 18F FDG PET/CT scan before treatment from January 2010 to June 2017, and the imaging characteristics were retrospectively analyzed. The pathological results were used as a gold standard for evaluating the diagnostic value of 18F FDG PET/CT. The maximum diameter (dmax), the maximum standardized uptake value (SUVmax) and the tumor to non-tumor SUV ratio (TNR) were measured. Two-sample t test, one-way ANOVA, paired Chi-square test and receiver operating characteristic (ROC) curve were used for data analysis. Results: Of the 116 patients, 11 patients had benign tumor, and 105 patients had malignant tumor. The dmax, SUVmax and TNR of 105 patients with malignant tumor were significant higher than those of 11 patients with benign tumor (all P < 0.05). The sensitivity and specificity of visual analysis in the diagnosis of benign tumors were 84.8% and 54.5%, respectively. The sensitivity and specificity of the SUVmax method were 83.8% and 63.6%, respectively. The sensitivity and specificity of the TNR method were 57.1% and 90.9%, respectively. From the perspective of positive rate, visual analysis and SUVmax were better than TNR. The areas under receiver operating characteristic curve for diagnosis of intrahepatic cholangiocarcinoma and liver metastases by SUVmax and TNR methods were larger. Conclusion: 18F-FDG PET/CT is a useful examination in hepatic tumor, especially for intrahepatic cholangiocarcinoma and metastatic carcinoma. Copyright © 2018 by TUMOR. All rights reserved.     

Pre-chemotherapy 18F-FDG PET/CT upstages nodal stage in stage II–III breast cancer patients treated with neoadjuvant chemotherapy

In breast cancer patients treated with neoadjuvant chemotherapy (NAC) the number of tumor-positive nodes can no longer reliably be determined. Furthermore, ultrasound (US) seems suboptimal for the detection of N3-disease. Therefore we assessed the proportion of breast cancer patients treated with NAC in which pre-chemotherapy 18F-FDG PET/CT detected ≥4 axillary nodes or occult N3-disease, upstaging nodal status and changing risk estimation for locoregional recurrence (LRR). Conventional regional staging consisted of US with fine needle aspiration and/or sentinel lymph node biopsy. Patients were classified as low-risk (cT2N0), intermediate-risk (cT0N1, cT1N1, cT2N1, cT3N0), or high-risk (cT3N1, cT4, cN2–3) for LRR. The presence and number of FDG-avid nodes were evaluated and the proportion of patients that would be upstaged by PET/CT, based on detection of ≥4 FDG-avid axillary nodes defined as cN2(4+) or occult N3-disease, was calculated. In total, 87 of 278 patients were considered high-risk based on conventional staging. PET/CT detected occult N3-disease in 5 (11 %) of 47 low-risk patients. In 144 intermediate-risk patients, PET/CT detected ≥4 FDG-avid nodes in 24 (17 %) patients and occult N3-disease in 22 (15 %) patients, thereby finally upstaging 38 (26 %) of intermediate-risk patients. Of 43 (23 %) upstaged patients, 18 were ypN0, 12 were ypN1, and 13 were ypN2–3. Pre-chemotherapy PET/CT is valuable for selection of breast cancer patients at high risk for LRR. In our population, 23 % of patients treated with NAC were upstaged to the high-risk group based on PET/CT information, potentially benefiting from regional radiotherapy.     

18F-FDG PET及PET/CT 在食管癌复发转移的诊断与术后慢性炎症鉴别诊断中的应用:Meta分析

目的:系统评价18F-FDG PET及PET/CT 在食管癌治疗后复发转移及术后慢性炎症鉴别诊断中的应用。方法:　系统检索PubMed、EMBASE、Ovid、Web of Science、EBSCO、Cochrane图书馆、万方、维普及中国期刊网（CNKI）数据库,获得符合纳入标准的相关文献。采用诊断试验质量评价标准第二版评价纳入文献质量。采用Meta-disc 1.4软件进行统计分析,得到合并效应量,并绘制汇总受试者工作特征曲线,得到曲线下面积和Q值。采用Stata 14.0软件绘制Deek's漏斗图,对合并文献进行发表偏倚的估计。结果:　共纳入8篇文献,合并的敏感度、特异度、阳性似然比、阴性似然比和诊断比值比分别为0.95（0.92~0.97）、0.75（0.67~0.82）、3.85（2.87~5.16）、0.07（0.04~0.11）和61.18（31.43~119.07）;绘制汇总受试者工作特征曲线后得到曲线下面积和Q值分别为0.95和0.89;Deek's漏斗图未见明显发表偏倚。结论:18F-FDG PET及PET/CT 在食管癌治疗后复发转移的诊断及术后慢性炎症鉴别诊断中有广泛应用。     

Incidental Breast Lesions Identified by 18F-FDG PET/CT: Which Clinical Variables Differentiate between Benign and Malignant Breast Lesions?

Purpose

The aim of our study was to evaluate the risk of malignancy and to determine which clinical variables differentiate between benign and malignant focal breast lesions found incidentally on ¹⁸F-flourodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT).

Methods

From March 2005 to October 2011, 21,224 women with no history of breast cancer underwent FDG PET/CT at three university-affiliated hospitals. We retrospectively identified 214 patients with incidental focal hypermetabolic breast lesions and grouped them into benign and malignant lesion groups. Of the 214 patients, 82 patients with 91 lesions were included in this study. All lesions were confirmed histologically or were assessed by follow-up imaging for greater than 2 years. The patient age, maximum standardized uptake value (SUV_max), lesion size on ultrasonography (US), and Breast Imaging-Reporting and Data System (BI-RADS) category on US in conjunction with mammography were compared between the groups. Multivariate logistic regression analysis was used to identify independent factors associated with malignancy.

Results

The risk of malignancy was 29.7% (27/91) in breast incidentalomas detected by FDG PET/CT. The univariate analysis showed that the patient age, SUV_max, tumor size, and BI-RADS category differed significantly between the malignant and benign groups. The multivariate analysis showed that the BI-RADS category was the only significant factor differentiating benign from malignant lesions (p=0.002).

Conclusion

BIRADS category based on US in conjunction with mammography was the only useful tool to differentiate between malignant and benign lesions in breast incidentalomas on FDG PET/CT.     

Prognostic significance of interim ¹⁸F-FDG PET/CT after three or four cycles of R-CHOP chemotherapy in the treatment of diffuse large B-cell lymphoma

Purpose

¹⁸F-fluoro-2-dexoy-d-glucose-positron emission tomography (FDG-PET)/computerised tomography (CT) has been used for staging and monitoring responses to treatment in patients with diffuse large B cell lymphoma (DLBCL). The sequential interim PET/CT was prospectively investigated to determine whether it provided additional prognostic information and could be a positive predictable value within patients with the same international prognostic index (IPI) after the use of rituximab in DLBCL.

Methods

One hundred and sixty-one patients with newly diagnosed DLBCL were enroled; the assessment of the PET/CT was performed at the time of diagnosis and mid-treatment of rituxibmab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP).

Results

Sixty-seven patients (41.6%) presented with advanced stage disease and 27 (16.8%) had bulky lesions. Forty-three patients (26.7%) continued to have positive metabolic uptakes with a significantly high relapse rate (62.8%) compared to the patients with a negative interim PET/CT (12.1%) (P < 0.01). After a median follow-up of 30.8 months, the positivity of interim PET/CT was found to be a prognostic factor for both overall survival (OS) and progression-free survival (PFS), with a hazard ratio of 4.07 (2.62-6.32) and 5.46 (3.49-8.52), respectively. In the low-risk IPI group, the 3-year OS and PFS rates were significantly different in the patients with positive (53.3% and 52.5%) and negative (93.8% and 88.3%) interim PET/CT, respectively (P < 0.01). These significant prognostic differences of interim PET/CT responses were consistent with the results of the patients with high-risk IPI group (P < 0.01).

Conclusions

Interim PET/CT scanning had a significant predictive value for disease progression and survival of DLBCL in post-rituximab treatment; it might be the single most important determinant of clinical outcome in patients with the same IPI risk.     

68Ga-PSMA PET/CT Replacing Bone Scan in the Initial Staging of Skeletal Metastasis in Prostate Cancer: A Fait Accompli?

Purpose

⁶⁸Ga ligands targeting prostate-specific membrane antigen (PSMA) are rapidly emerging as a significant step forward in the management of prostate cancer. PSMA is a type II transmembrane protein with high expression in prostate carcinoma cells. We prospectively evaluated the use of ⁶⁸Ga-PSMA positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer and compared the results to those for technetium-99m (^99mTc)-10-metacyloyloxydecyl dihydrogen phosphate (MDP) bone scintigraphy (BS).

18F-FDG PET/CT surveillance at 3–6 and 12 months for detection of recurrence and second primary cancer in patients with head and neck squamous cell carcinoma

Background:

Early detection of recurrence of head and neck squamous cell carcinoma (HNSCC), which is often obscured by surgical or radiotherapy-induced tissue distortion, is essential for proper patient management.

Methods:

A total of 143 consecutive patients with previously untreated HNSCC were evaluated by whole-body fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and regular clinical follow-up after curative treatment. The ¹⁸F-FDG PET/CT was performed ∼3–6 and 12 months after treatment and findings suspicious for recurrence or SPC were confirmed using histopathology.

Results:

The sensitivities of 3–6- and 12-month PET/CT scans at patient level were 96% and 93%, respectively, and those of regular clinical follow-up were 11% and 19%, respectively (McNemar test, P<0.001). In patients with no clinical suspicion, PET/CT detected 95% and 91% of recurrent patients at 3–6 and 12 months, respectively. The sensitivity of PET/CT for the identification of SPC was 29% and 80% at 3–6 and 12 months, respectively. A positive interpretation of PET/CT was significantly associated with poor overall survival (log-rank test, P<0.001).

Conclusion:

The ¹⁸F-FDG PET/CT surveillance is beneficial for the detection of recurrence that may be missed by regular follow-up physical and endoscopic examinations of the head and neck area after curative treatment for HNSCC.     

Follow-up with 18FDG-PET–CT after radical radiotherapy with or without chemotherapy allows the detection of potentially curable progressive disease in non-small cell lung cancer patients: A prospective study

BackgroundFollow-up of patients treated with curative intent for non-small cell lung cancer (NSCLC) with X-ray or CT-scans is of unproven value. Furthermore, most patients with progressive disease present with symptoms outside of follow-up visits. Because the accuracy of ¹⁸FDG-PET–CT is superior to CT, we hypothesised that FDG-PET–CT scans 3 months post-treatment could lead to early detection of progressive disease (PD) amenable for radical treatment.Patients and methodsHundred patients with NSCLC, treated with curative intent with (chemo) radiation, were prospectively evaluated. All patients underwent a planned FDG-PET–CT scan 3 months after the start of radiotherapy.ResultsTwenty four patients had PD 3 months post-treatment. 16/24 patients were symptomatic. No curative treatment could be offered to any of these patients. In 3/8 asymptomatic patients progression, potentially amenable for radical therapy was found, which were all detected with PET, not with CT only.ConclusionsPET-scanning after curative treatment for NSCLC led to the detection of progression potentially amenable for radical treatment in a small proportion (3%) of patients. Selectively offering a PET–CT scan to the patient group without symptoms could possibly lead to an effective follow-up method.     

Differential diagnosis of Warthin’s tumor complicated with lung adenocarcinoma by 18F- FDG PET/CT imaging and radioisotope scanning with Tc-99m pertechnetate: A case report and literature review

A seventy eight years old male patient underwent a whole body 18F- FDG PET/CT imaging to diagnose the lesion which was showed in the right lung by a chest X ray test and CT scan before. Besides the intense 18F- FDG uptake of the lesion in the right lung, a lesion in the left parotid gland also showed intense 18F- FDG uptake. To evaluate the pathology of the lesion in the left parotid gland, a parotid gland scintigraphy imaging with Tc-99m pertechnetate was done and revealed a Warthin's tumor. Later a fine needle aspiration(FNA) confirmed that it was a Warthin's tumor.