FDG-PET/CT in Cancers of the Head and Neck: What is the Definition of Whole Body Scanning?

Purpose  

The role of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) was studied in a variety of cancers, including head and neck squamous cell carcinomas (HNSCC) and nasopharyngeal carcinomas (NPC), with several presentations indicating that for these clinical entities a “whole-body” (i.e., eyes to thighs) may yield little additional information. Therefore, we were prompted to review our experience with PET/computed tomography (CT) in the management of patients with HNSCC and NPC.     

Integrated PET/CT Fusion Imaging and Endoscopic Ultrasound in the Pre-operative Staging and Evaluation of Esophageal Cancer

Purpose  

Accurate staging of esophageal cancer (ECA) is critical in determining appropriate therapy. Endoscopic ultrasound (EUS), computed tomography (CT) and positron emission tomography (PET) scanning can be used, but limited data exists regarding the use of combined PET/CT fusion imaging and EUS in ECA staging. The objective of this study is to evaluate the role of integrated PET/CT imaging and EUS in the staging of ECA.     

Management of local recurrence of colorectal cancer: the role of PET/CT

Aim  

The aim was to examine the clinical applicability of positron-emission tomography/computed tomography (PET/CT) for diagnosing local recurrence of colorectal cancer.     

Initial Results with 11C-Acetate Positron Emission Tomography/Computed Tomography (PET/CT) in the Staging of Urinary Bladder Cancer

Purpose  

To investigate the utility of ¹¹C-acetate positron emission tomography/computed tomography (PET/CT) for staging of bladder cancer and response assessment after neoadjuvant chemotherapy.     

Performance of Integrated FDG-PET/Contrast-enhanced CT in the Diagnosis of Recurrent Pancreatic Cancer: Comparison with Integrated FDG-PET/Non-contrast-enhanced CT and Enhanced CT

Purpose  

The purpose of this study is to evaluate the accuracy of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) with intravenous contrast for depiction of recurrent pancreatic cancer, compared with PET/non-enhanced CT and CT.     

PET/CT in Cancer: Moderate Sample Sizes may Suffice to Justify Replacement of a Regional Gold Standard

Purpose  

For certain cancer indications, the current patient evaluation strategy is a perfect but locally restricted gold standard procedure. If positron emission tomography/computed tomography (PET/CT) can be shown to be reliable within the gold standard region and if it can be argued that PET/CT also performs well in adjacent areas, then sample sizes in accuracy studies can be reduced.     

Clinical Utility of Positron Emission Tomography/Computed Tomography in Inflammatory Bowel Disease

Purpose  

The clinical utility of positron emission tomography/computed tomography (PET/CT) in comparison to standard workup in patients with known or suspected inflammatory bowel disease (IBD) is unknown.     

Early Treatment Response Evaluation in Patients with Diffuse Large B-Cell Lymphoma—A Pilot Study Comparing Volumetric MRI and PET/CT

Purpose  

The purpose of this study is to evaluate the time course of early chemotherapy response in patients with aggressive non-Hodgkin's lymphoma (NHL) by magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT).     

Monitoring the Effect of Targeted Therapies in a Gastrointestinal Stromal Tumor Xenograft Using a Clinical PET/CT

Purpose  

The purpose of this study is to assess treatment responses induced by the two tyrosine kinase inhibitors, Imatinib and Sunitinib, in a gastrointestinal stromal tumor (GIST) xenograft using a clinical positron emission tomography/computed tomography (PET/CT) scanner.     

Detection of Hepatic Metastases Using Dual-Time-Point FDG PET/CT Scans in Patients with Colorectal Cancer

Purpose  

The purpose of this study was to determine the most useful parameter of dual-time-point 2-deoxy-2-[¹⁸F]fluoro-d-glucose positron emission tomography/computed tomography (PET/CT) for detection of hepatic metastases in patients with colorectal cancer.     

Utility of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Fever of Unknown Origin Diagnosed as Lymphoma

Objective

To assess the efficacy of fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET)/computed tomography (CT) in the diagnosis of patients with fever of unknown origin (FUO), who were finally diagnosed as lymphoma.

Subjects and Methods

A retrospective study was performed in the First Affiliated Hospital, School of Medicine of Zhejiang University, China, from March 2009 to March 2012. The PET/CT images of consecutive patients with FUO were analyzed. Within 1 week of PET/CT scanning, additional histological tests were also performed if clinically needed.

Results

A total of 73 consecutive patients were included. Of these, 34 (47s%) had a PET/CT finding suggestive of the presence of lymphoma and 29 (85s%) had a diagnosis of confirmed lymphoma; 39 (53s%) had a PET/CT result revealing the absence of lymphoma and 4 (10s%) were diagnosed by biopsy as having lymphoma. The most frequent lymphoma diagnosis was peripheral T cell lymphoma (n = 16; 55s%), followed by diffuse large B cell lymphoma (n = 9; 31s%). The accuracy of PET/CT was 88s%.

Conclusion

In this study, PET/CT had high diagnostic accuracy in patients with FUO resulting from lymphoma, which indicated that PET/CT scanning was a valuable diagnostic tool for these groups of patients with FUO.Key Words: Fever of unknown origin, Positron emission tomography, Computed tomography, Diagnosis, Lymphoma     

On the Significance of Defective Block Detectors in Clinical <Superscript>18</Superscript>F-FDG PET/CT Imaging

Introduction  

Clinical positron emission tomography (PET) systems based on block detector designs suffer occasional block detector failures, which can result in patient scan cancelations. In this study, we examine the effect of defective block detectors on measurements of maximum standard uptake value (SUV_max) and clinical image quality in 3D 2-deoxy-2-[¹⁸F]fluoro-d-glucose (FDG) PET/computed tomography (CT) imaging.     

The Relationship between Patients’ Serum Glucose Levels and Metabolically Active Brown Adipose Tissue Detected by PET/CT

Purpose  

To compare blood glucose levels in patients with or without “detectable” brown adipose tissue (BAT) using 2-deoxy-2-[¹⁸F]fluoro-d-glucose positron emission tomography/computed tomography (FDG PET/CT).     

Prospective Evaluation of 99mTc MDP Scintigraphy, 18F NaF PET/CT, and 18F FDG PET/CT for Detection of Skeletal Metastases

Introduction  

Technetium (Tc) methylene diphosphonate (MDP) has been the standard method for bone scintigraphy for three decades. ¹⁸F sodium fluoride (¹⁸F NaF) positron emission tomography (PET)/computed tomography (CT) has better resolution and is considered superior. The role of 2-deoxy-2-[¹⁸F]fluoro-D-glucose (¹⁸F FDG) PET/CT is proven in a variety of cancers, for which it has changed the practice of oncology. There are few prospective studies comparing these three methods of detection of skeletal metastases. Thus, we were prompted to initiate this prospective pilot trial.     

Improvements in PET Image Quality in Time of Flight (TOF) Simultaneous PET/MRI

Purpose

An integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) scanner with time of flight (TOF) technology is now available for clinical use. The aim of this study is to evaluate the potential of TOF PET in PET/MRI to reduce artifacts in PET images when compared to non-TOF PET/MRI, TOF PET/X-ray computed tomography (CT), and non-TOF PET/CT.

Procedures

All patients underwent a single 2-deoxy-2-[¹⁸F]fluoro-d-glucose ([¹⁸F]FDG) injection, followed first by PET/CT, and subsequently by PET/MRI. PET/CT exams were requested as standard-of-care for oncological indications. Using the PET acquisitions datasets, 4 series of images (TOF PET/CT, non-TOF PET/CT, TOF PET/MRI, and non-TOF PET/MRI) were reconstructed. These image series were visually evaluated for: (1) dental metal artifacts, (2) breathing artifacts, and (3) pelvic artifacts due to scatter correction errors from high bladder [¹⁸F]FDG concentration. PET image quality was assessed by a 3-point scale (1—clinically significant artifact, 2—non clinically significant artifact, and 3—no artifact).

Results

Twenty-five patients (mean?±?SD age: 56?±?13 years old; female: 10, male: 15) were enrolled. TOF PET/MRI, non-TOF PET/MRI, TOF PET/CT, and non-TOF PET/CT scores 2.8, 2.5, 2.4, and 2.3, respectively for the presence of dental artifacts, 2.8, 2.5, 2.2, and 1.9, respectively, for the presence of breathing artifacts, and 2.7, 1.7, 2.0, and 1.3, respectively, for the presence of pelvic artifacts TOF PET/MRI images showed the highest image quality scores among the 4 datasets of PET images.

Conclusion

The superior timing resolution and resulting TOF capability of the new PET/MRI scanner improved PET image quality in this cohort by reducing artifacts compared to non-TOF PET/MRI, TOF PET/CT, and non-TOF PET/CT.

     

Incremental Value of Integrated FDG-PET/CT in Evaluating Indeterminate Solitary Pulmonary Nodule for Malignancy

Objectives

The objective of this study was to evaluate the increased diagnostic benefit of integrated positron emission tomography/computed tomography (PET/CT) interpretation in evaluating solitary pulmonary nodules for malignancy.

Methods

One hundred seventeen patients (67 men and 50 women; mean age ± SD, 61.7?±?13.6 years, range, 31–86 years) with indeterminate solitary pulmonary nodules and no previous history of malignancy were analyzed. PET/CT was performed with an integrated PET/CT scanner (Siemens Biograph BGO duo) 1 h after an intravenous injection of 370 MBq (10 mCi) ¹⁸F-fluorodeoxyglucose. Patients fasted for 6 h before imaging. PET was interpreted alone or combined with CT and was graded according to a five-point scale. A malignant diagnosis was based on histological findings or a clinical and radiological follow-up after at least 24 months. The diagnostic performances of PET alone and integrated PET/CT interpretation were evaluated using discriminant analysis.

Results

PET alone correctly classified 85% of nodules and integrated PET/CT interpretation increased the correct classification to 89%, with similar sensitivity and specificity of 88% and 89%, respectively. False-positive PET results mainly resulted from granulomatous disorders. Four (50%) of the eight cases deemed indeterminate on PET alone were resolved with combined PET/CT interpretation.

Conclusions

Although the benefit attributable to the CT component was limited when integrated PET/CT was used, PET and CT acted synergistically to significantly increase the diagnostic veracity for PET-indeterminate nodules.

     

Radionuclide Imaging of Cardiac Device Infection

Purpose of Review

Accurate diagnosis of cardiac device infection is critical for clinical decision-making and represents a challenge for current diagnostic methods. A non-invasive test with sufficient sensitivity and specificity to confirm or exclude infection would be desirable. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been emerging as a promising diagnostic tool for cardiac implantable electrophysiological devices (CIED) infection and its complications. The aim of this review is to describe the role of radionuclide imaging in cardiac device infection according to the different clinical presentations.

Recent Findings

¹⁸F-FDG PET/CT plays an important role in the diagnosis of CIED infection. It has been demonstrated that PET/CT imaging can accurately diagnose and distinguish deep pocket infection from superficial soft tissue infection. In lead infection, this technique has high specificity and is helpful when transthoracic echocardiography (TTE) does not detect vegetation. In addition, PET/CT may be useful in patients with suspected prosthesis valve endocarditis, in whom the initial TEE is negative or indeterminate.

Summary

The use of ¹⁸F-FDG PET/CT in the diagnosis of CIED infection has been implemented to respond to specific clinical needs. Different studies provided important data on the optimal conditions of PET/CT acquisition to better discriminate the infection. However, multicenter trials performed under standardized protocols for both acquisition and quantification of FDG uptake are needed. These efforts could help to achieve the level of evidence allowing FDG PET/CT to be included in clinical guidelines.

     

FDG-Accumulating Atherosclerotic Plaques Identified with 18F-FDG-PET/CT in 141 Patients

Purpose  

The aim of this study was to describe the prevalence of atherosclerotic plaques based on [¹⁸F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in a large population characterized by high risk of cardiovascular disease.     

Lymph node staging in esophageal adenocarcinoma with PET-CT based on a visual analysis and based on metabolic parameters

Background  

In order to investigate the value of FDG positron emission tomography-computed tomography (PET-CT), FDG PET (reviewed side-by-side with CT), and metabolic parameters in the assessment of lymph node status and prognosis.     

Feasibility of integrated CT-liver perfusion in routine FDG-PET/CT

Objective  

To integrate CT-perfusion into a routine, clinical contrast-enhanced (ce) PET/CT protocol for the evaluation of liver metastases and to compare functional CT and PET parameters.