Established, emerging and future applications of FDG-PET/CT in the uterine cancer

Integrated positron emission tomography/computed tomography (PET/CT) with 2-[1?F]fluoro-2-deoxy-D-glucose (FDG) is a useful technique to acquire both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session and has opened a new field in clinical oncologic imaging. FDG-PET/CT has been used successfully for the staging, optimization of treatment, re-staging, therapy monitoring, and prognostic prediction of uterine cervical cancer and endometrial cancer as well as various malignant tumours. The present review discusses the current role of FDG-PET/CT in the management of uterine cancer, discussing its usefulness and limitations in the imaging of these patients.     

Stellenwert der PET/CT zur Bildgebung des kolorektalen Karzinoms

CLINICAL/METHODICAL ISSUE: Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has emerged as a very useful imaging modality in the management of colorectal carcinoma. Data from the literature regarding the role of PET/CT in the initial diagnosis, staging, radiotherapy planning, response monitoring and surveillance of colorectal carcinoma is presented. Future directions and economic aspects are discussed. STANDARD RADIOLOGICAL METHODS: Computed tomography (CT), magnetic resonance imaging (MRI) and FDG-PET for colorectal cancer and endorectal ultrasound for rectal cancer. METHODICAL INNOVATIONS: Combined FDG-PET/CT. PERFORMANCE: While other imaging modalities allow superior visualization of the extent and invasion depth of the primary tumor, PET/CT is most sensitive for the detection of distant metastases of colorectal cancer. ACHIEVEMENTS: We recommend a targeted use of PET/CT in cases of unclear M staging, prior to metastasectomy and in suspected cases of residual or recurrent colorectal carcinoma with equivocal conventional imaging. The role of PET/CT in radiotherapy planning and response monitoring needs to be determined. Currently there is no evidence to support the routine use of PET/CT for colorectal screening, staging or surveillance. PRACTICAL RECOMMENDATIONS: To optimally exploit the synergy between morphologic and functional information, FDG-PET should generally be performed as an integrated FDG-PET/CT with a contrast-enhanced CT component in colorectal carcinoma.     

Present and future role of FDG-PET/CT imaging in the management of gynecologic malignancies

Integrated positron emission tomography/computed tomography (PET/CT) with 2-[18F]fluoro-2-deoxy-d-glucose (FDG) is a useful technique for acquiring both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session, and has opened up a new field of clinical oncologic imaging. FDG-PET/CT has been used successfully for the staging, treatment optimization, re-staging, therapy monitoring, and prognostication of uterine and ovarian cancers as well as various malignant tumors. The present review discusses the current role of FDG-PET/CT in the management of gynecologic malignancies, focusing on its usefulness and limitations for imaging such patients.     

PET/CT and breast cancer

During the past decade, the application of positron emission tomography with [(18)F]fluoro-2-deoxy-D-glucose (FDG-PET) has remarkably improved the management of cancer patients. Nevertheless, the clinical interpretation of FDG-PET scan can be difficult for two main reasons: (1) anatomical localisation of FDG uptake is not easy, (2) normal physiological accumulation of FDG can be misinterpreted as a pathologic area. It has been demonstrated that the visual correlation of PET with morphological procedures, such as computed tomography or magnetic resonance imaging, can improve the accuracy of PET alone. However, the time interval between the two scans, the time employed by the operator and difficulties in co-registering imaging of the abdomen and pelvis make the co-registration of separately obtained images clinically difficult. A novel combined PET/CT system has been built that improves the capacity to correctly localise and interpret FDG uptake. To date only a few studies have been conducted on the potential role of PET/CT in the management of breast cancer patients, but the better performance of this technique compared with PET alone should also be relevant for breast cancer application. In this review, we evaluate the possible impact on breast cancer diagnosis of PET/CT compared with PET alone, with respect to disease re-staging, treatment monitoring, preoperative staging and primary diagnosis. In addition, the possible role of PET/CT for radiotherapy planning is evaluated.     

PET/CT for the staging and follow-up of patients with malignancies

Positron emission tomography (PET) and computed tomography (CT) complement each other's strengths in integrated PET/CT. PET is a highly sensitive modality to depict the whole-body distribution of positron-emitting biomarkers indicating tumour metabolic activity. However, conventional PET imaging is lacking detailed anatomical information to precisely localise pathologic findings. CT imaging can readily provide the required morphological data. Thus, integrated PET/CT represents an efficient tool for whole-body staging and functional assessment within one examination. Due to developments in system technology PET/CT devices are continually gaining spatial resolution and imaging speed. Whole-body imaging from the head to the upper thighs is accomplished in less than 20 min. Spatial resolution approaches 2–4 mm. Most PET/CT studies in oncology are performed with ¹⁸F-labelled fluoro-deoxy-d-glucose (FDG). FDG is a glucose analogue that is taken up and trapped within viable cells. An increased glycolytic activity is a characteristic in many types of cancers resulting in avid accumulation of FDG. These tumours excel as “hot spots” in FDG-PET/CT imaging. FDG-PET/CT proved to be of high diagnostic value in staging and restaging of different malignant diseases, such as colorectal cancer, lung cancer, breast cancer, head and neck cancer, malignant lymphomas, and many more. The standard whole-body coverage simplifies staging and speeds up decision processes to determine appropriate therapeutic strategies. Further development and implementation of new PET-tracers in clinical routine will continually increase the number of PET/CT indications. This promotes PET/CT as the imaging modality of choice for working-up of the most common tumour entities as well as some of the rare malignancies.     

PET/CT appearance of desmoid tumour of the chest wall

Desmoid tumours are rare, poorly circumscribed tumours that have a firm consistency and, although benign, have a remarkable tendency to infiltrate into surrounding structures. Extra-abdominal desmoid tumours involve mainly the extremities or the chest wall and are usually managed by wide radical resection. Moreover, desmoid tumours involving the chest wall are locally aggressive tumours with a high recurrence rate. We report a case of a pathologically proven desmoid tumour of the chest wall in a patient with a history of bilateral breast cancer and oesophageal cancer. We discuss the imaging appearances of this tumour on positron emission tomography combined with computed tomography (PET/CT) and magnetic resonance imaging.Desmoid tumours are poorly circumscribed tumours that are firm, rubbery and have a remarkable tendency to infiltrate into surrounding structures with a strong propensity to recur locally after resection [1]. Desmoid tumours of the chest wall are uncommon tumours that have been described extensively in the pathological and surgical literature.¹⁸F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography combined with computed tomography (FDG-PET/CT) has been shown to be very useful in the staging of patients with breast cancer and oesophageal cancer, as well as in the evaluation of treatment response [2]. It has a specific ability to discriminate responders from non-responders more accurately and earlier than conventional imaging methods [2]. PET/CT also plays an important role in the assessment of malignant soft-tissue tumours of the chest wall, such as sarcoma, by improving the accuracy of staging and helping to determine the appropriate therapy [3]. The PET/CT imaging characteristics of chest wall desmoid fibromatosis, a benign condition that may clinically mimic metastatic disease or sarcomatous degeneration, has not yet been reported to our knowledge.We describe the PET/CT and MRI appearances of a biopsy-proven desmoid tumour of the chest wall in a patient with a history of bilateral breast cancer and oesophageal cancer.     

FDG-PET/CT in re-staging of patients with lymphoma

The aim of this study was to evaluate the clinical significance of combined fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) in patients with lymphoma, and to compare the FDG-PET/CT staging results with those of FDG-PET and CT alone. Twenty-seven patients were studied. Each patient had clinical follow-up for >12 months and entered complete follow-up evaluation. Patient-based evaluation showed a sensitivity of 78% for CT alone, 86% for FDG-PET alone, 93% for CT and FDG-PET read side by side, and 93% for combined FDG-PET/CT imaging. Region-based evaluation showed a sensitivity for regional lymph node involvement of 61%, 78%, 91% and 96% respectively. FDG-PET/CT imaging is superior to CT alone (P=0.02) and has additional benefit over FDG-PET alone due to exact anatomical localisation. We conclude that FDG-PET/CT imaging is accurate in re-staging lymphoma and offers advantages over separate FDG-PET and CT imaging.     

A preliminary report of breast cancer screening by positron emission mammography

Objective

Fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) and PET/computed tomography (PET/CT) have had a considerable impact on the detection of various malignancies. PET and PET/CT are minimally invasive methods that can provide whole-body imaging at one time. Therefore, an FDG-PET cancer screening program has been widely used in Japan. However, the breast cancer detection rate of FDG-PET cancer screening is relatively low. Therefore, FDG-PET screening is not recommended for breast cancer screening. Positron emission mammography (PEM) is a high-resolution molecular breast imaging technology. PEM can detect small breast cancers that cannot be detected on PET or PET/CT images due to limited spatial resolution. We have performed opportunistic breast cancer screening using PEM since 2011. To the best of our knowledge, this is the first report regarding PEM breast cancer screening.

Methods

This study enrolled 265 women. PEM images were analyzed by agreement of 2 experienced nuclear medicine physicians. The readers were given information from medical interview sheet. US findings were interpreted holistically. The number of participants, patient recall rate, further examination rate, and cancer detection rate by year were calculated.

Results

The overall recall rate was 8.3 %; the work-up examination rate was 77.3 %, and cancer detection rate was 2.3 %. The positive predictive value of PEM was 27.3 %. Six cancers were found by PEM screening. Five were invasive cancers and one was ductal carcinoma in situ. Histological tumor sizes were reported in three cases: 0.7, 1.2, and 2 cm.

Conclusion

PEM screening appears to have potential for breast cancer screening.

     

FDG-PET/CT response evaluation during EGFR-TKI treatment in patients with NSCLC

Over recent years, [18F]-fluorodeoxyglucose positron emission tomography acquired together with low dose computed tomography (FDG-PET/CT) has proven its role as a staging modality in patients with non-small cell lung cancer (NSCLC). The purpose of this review was to present the evidence to use FDG-PET/CT for response evaluation in patients with NSCLC, treated with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI). All published articles from 1 November 2003 to 1 November 2013 reporting on 18F-FDG-PET response evaluation during EGFR-TKI treatment in patients with NSCLC were collected. In total 7 studies, including data of 210 patients were eligible for analyses. Our report shows that FDG-PET/CT response during EGFR-TKI therapy has potential in targeted treatment for NSCLC. FDG-PET/CT response is associated with clinical and radiologic response and with survival. Furthermore FDG-PET/CT response monitoring can be performed as early as 1-2 wk after initiation of EGFR-TKI treatment. Patients with substantial decrease of metabolic activity during EGFR-TKI treatment will probably benefit from continued treatment. If metabolic response does not occur within the first weeks of EGFR-TKI treatment, patients may be spared (further) unnecessary toxicity of ineffective treatment. Refining FDG-PET response criteria may help the clinician to decide on continuation or discontinuation of targeted treatment.     

Thyroid cancer--indications and opportunities for positron emission tomography/computed tomography imaging

Although thyroid cancer is a comparatively rare malignancy, it represents the vast majority of endocrine cancers and its incidence is increasing. Most differentiated thyroid cancers have an excellent prognosis if diagnosed early and treated appropriately. Aggressive histologic subtypes and variants carry a worse prognosis. During the last 2 decades positron emission tomography (PET) and PET/computed tomography (CT), mostly with fluorodeoxyglucose (FDG), has been used increasingly in patients with thyroid cancers. Currently, the most valuable role FDG-PET/CT exists in the work-up of patients with differentiated thyroid cancer status post thyroidectomy who present with increasing thyroglobulin levels and a negative (131)I whole-body scan. FDG-PET/CT is also useful in the initial (post thyroidectomy) staging of high-risk patients with less differentiated (and thus less iodine-avid and clinically more aggressive) subtypes, such as tall cell variant and Hürthle cell carcinoma, but in particular poorly differentiated and anaplastic carcinoma. FDG-PET/CT may help in defining the extent of disease in some patients with medullary thyroid carcinoma and rising postoperative calcitonin levels. However, FDOPA has emerged as an alternate and more promising radiotracer in this setting. In aggressive cancers that are less amenable to treatment with (131)iodine, FDG-PET/CT may help in radiotherapy planning, and in assessing the response to radiotherapy, embolization, or experimental systemic treatments. (124)Iodine PET/CT may serve a role in obtaining lesional dosimetry for better and more rationale planning of treatment with (131)iodine. Thyroid cancer is not a monolithic disease, and different stages and histologic entities require different approaches in imaging and individualized therapy.     

FDG-PET and CT in Evaluation of Chemotherapy in Advanced Head and Neck Cancer

Purpose: To compare [18F]2-deoxy-2-fluoro-D-glucose-positron emission tomography (FDG-PET) and computed tomography (CT) scans in assessment of response to neoadjuvant chemotherapy in advanced head and neck cancer.Materials and Methods: In a prospective clinical study, advanced head and neck cancer patients were enrolled in a neoadjuvant organ preservation protocol and received CT and FDG-PET scans prior to and after 2 or 3 rounds of chemotherapy. All patients had prechemotherapy and postchemotherapy tissue biopsies within the tumor region. Patients were then classified as pathologic complete response (PCR) or residual disease (RD) based on biopsies. Analysis of the tumor activity, using FDG-PET, was performed using standardized uptake ratios (SUR) in the region of the primary tumor. Analysis of the tumor size, using contrast enhanced CT, was performed using measurements of the primary tumor in 3 dimensions.Results: Nineteen of the 28 patients with stage III and IV cancer of the head and neck enrolled between December 1994 and May 1996 completed the study. Three patients were PCR and had a mean SUR reduction of 82% by positron emission tomography (PET) and volume reduction of 80% by CT. Sixteen patients had RD after chemotherapy, their SUR and volume reductions were 32% and 41%, respectively. Reduction in SUR with PET was significant. The mean tumor volume reduction by CT approached statistical significance. There was a positive correlation between the percent reduction in tumor volume and SUR (P < 0.004).Conclusion: FDG-PET and CT imaging are at least equivalent in correctly assessing tumor response to chemotherapy with a trend toward better performance by PET.     

FDG-PET delayed imaging for the detection of head and neck cancer recurrence after radio-chemotherapy: comparison with MRI/CT

In advanced head and neck cancer, an organ-sparing approach comprising radiation therapy combined with intra-arterial chemotherapy has become an important technique. However, the high incidence of residual masses after therapy remains a problem. In this study, we prospectively evaluated the use of 2-[¹⁸F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) delayed imaging for the detection of recurrence of head and neck cancer after radio-chemotherapy, and compared the FDG-PET results with those of magnetic resonance imaging (MRI) or computed tomography (CT). Forty-three lesions from 36 patients with head and neck cancer suspected to represent recurrence after radio-chemotherapy (median interval from therapy, 4 months) were studied. PET was performed at 2 h after FDG injection, and evaluated. The results were compared to those of contrast studies with MRI or CT performed within 2 weeks of the PET study, and to histological diagnosis (in all patients suspected of having recurrence) or clinical diagnosis. The lesion-based sensitivity (visual interpretation) and negative predictive value of FDG-PET (88% and 91%, respectively) were higher than those of MRI/CT (75% and 67% respectively). The specificity, accuracy and positive predictive value of FDG-PET (78%, 81% and 70%, respectively) were significantly (P<0.05) higher than those of MRI/CT (30%, 47% and 39% respectively). Three of six patients with false positive findings had post-therapy inflammation. Receiver operating characteristic (ROC) analysis showed that retrospective evaluation with the standardised uptake ratio yielded the best results (sensitivity 87.5%, specificity 81.5%), followed by visual interpretation and then the tumour/neck muscle ratio. An FDG-PET delayed imaging protocol yielded significantly better results for the detection of recurrence of head and neck cancer after radio-chemotherapy than MRI/CT. Because of the high negative predictive value of FDG-PET (91.3%), if PET is negative, further invasive procedures may be unnecessary.     

The potential of FDG-PET/CT for detecting prostate cancer in patients with an elevated serum PSA level

Purpose  

The aim of this study is to evaluate the potential and limitation of FDG-PET/CT for detecting prostate cancer in subjects with an elevated serum prostate-specific antigen (PSA) level. Although [¹⁸F]-2-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) has limited value in detecting prostate cancer, the potential of PET/CT has not been precisely evaluated, since positron emission tomography/computed tomography (PET/CT) provides accurate localization of functional findings obtained by PET.     

Diagnosis of recurrent and metastatic disease using f-18 fluorodeoxyglucose-positron emission tomography in breast cancer

One of the major strengths of F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) in breast cancer imaging is in the evaluation of patients who have suspected loco-regional recurrence or distant metastasis. In general, FDG-PET is more sensitive than conventional imaging for the detection of recurrent disease. Because of its ability to more accurately stage patients who have advanced breast cancer, FDG-PET has a significant impact on choice of treatment and management in this patient group.     

Positron emission tomography and bone metastases

The use of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in the evaluation and management of patients with malignancy continues to increase. However, its role in the identification of bone metastases is far from clear. FDG has the advantage of demonstrating all metastatic sites, and in the skeleton it is assumed that its uptake is directly into tumor cells. It is probable that for breast and lung carcinoma, FDG-PET has similar sensitivity, although poorer specificity, when compared with the isotope bone scan, although there is conflicting evidence, with several articles suggesting that it is less sensitive than conventional imaging in breast cancer. There is convincing evidence that for prostate cancer, FDG-PET is less sensitive than the bone scan and this may be tumor specific. There is very little data relating to lymphoma, but FDG-PET seems to perform better than the bone scan. There is an increasing body of evidence relating to the valuable role of FDG-PET in myeloma, where it is clearly better than the bone scan, presumably because FDG is identifying marrow-based disease at an early stage. There are, however, several other important variables that should be considered. The morphology of the metastasis itself appears to be relevant. At least in breast cancer, different patterns of FDG uptake have been shown in sclerotic, lytic, or lesions with a mixed pattern, Furthermore, the precise localization of a metastasis in the skeleton may be important with regard to the extent of the metabolic response induced. Previous treatment is highly relevant and it has been found that although the majority of untreated bone metastases are positive on PET scans and have a lytic pattern on computed tomography (CT), after treatment, incongruent CT-positive/PET-negative lesions are significantly more prevalent and generally are blastic, which presumably reflects a direct effect of treatment. Finally, the aggressiveness of the tumor itself may be relevant. The most important question, however, is irrespective of whether a lesion is seen on x-ray, CT, or bone scan and irrespective of lytic of blastic morphology: if the FDG-PET study is negative, what is the clinical relevance of that lesion?     

Imaging for lung cancer restaging

Diagnostic imaging plays an important role in the monitoring of tumor response during lung cancer restaging to evaluate the efficacy of chemotherapy and/or radiation therapy during treatment, and in the detection of recurrent or metastatic neoplasm after treatment has been completed. While CT represents the primary imaging modality for lesion evaluation during restaging and for surveillance imaging once therapy has been completed, studies evaluating the role of 18-fluoro-2 deoxyglucose positron emission tomography (FDG-PET) in lung cancer restaging have shown promise regarding the detection of residual and recurrent neoplasm, and in evaluating for early response to first line therapy. With both CT and FDG-PET, residual or recurrent disease should, when possible, be differentiated from therapy-related changes in the lungs. We review the role of imaging in lung cancer restaging with attention to CT and FDG-PET for treatment assessment and the detection of recurrent or metastatic disease.     

Analysis of various malignant neoplasms detected by FDG-PET cancer screening program: based on a Japanese Nationwide Survey

Objective

The most distinctive feature of FDG-PET cancer screening program is the ability to find various kinds of malignant neoplasms in a single test. The aim of this survey is to clarify the range and frequency of various malignant neoplasms detected by FDG-PET cancer screening performed in Japan.

Methods

“FDG-PET cancer screening” was defined as FDG-PET or positron emission tomography and computed tomography (PET/CT) scan with or without other tests performed for cancer screening of healthy subjects. This survey was based on a questionnaire regarding FDG-PET cancer screening. We analyzed the situation of 9 less frequently found malignant neoplasms including malignant lymphoma, malignancy of head and neck, esophagus, hepatobiliary and gallbladder, pancreas, kidney, cervical and uterine, ovary, and bladder.

Results

The detailed information of subjects with the suspected 9 kinds of malignant neoplasms mentioned above in the FDG-PET cancer screening program was studied in a total of 1,219 cases from 212 facilities. A statistical significance between PET/CT and PET was found in relative sensitivity and PPV for renal cell cancer. Malignant lymphoma was frequently of indolent type, suspected head and neck cancers had many false-positive results, and pancreatic cancer detected in this program was often in the advanced stage even in asymptomatic subjects. The recommendation of combined screening modality to PET or PET/CT was as follows: gastric endoscopy for assessing early esophageal cancer; abdominal ultrasound for screening hepatobiliary and gallbladder cancer; pelvic magnetic resonance imaging for assessing gynecological and pelvic cancers; and the CA125 blood test for screening ovarian cancer. Delayed image was helpful depending on the type of suspected malignant neoplasm.

Conclusion

We analyzed various types of malignant neoplasms detected by the FDG-PET cancer screening program and presented recommended combination of examinations to cover FDG-PET and PET/CT.     

Breast cancer with low FDG uptake: characterization by means of dual-time point FDG-PET/CT

Background

Malignant breast lesions usually are differentiated by FDG-PET with a semiquantitative FDG standardized uptake value (SUV) of 2.5. However, the frequency of breast cancer with an SUV of less than or equal to 2.5 is noteworthy, and often present diagnostic challenges. This study was undertaken to evaluate the accuracy of dual-time point FDG-PET/CT with FDG standardized uptake value (SUV) calculation in the characterization of such breast tumors.

Methods

Forty-nine female patients with newly diagnosed breast cancer were found to have primary breast cancer with minimally increased FDG uptake and met the criteria for inclusion in this study by having borderline levels of increased FDG uptake (SUVmax less than or equal to 2.5) in the initial FDG-PET/CT images. Consequently, they underwent further delayed phase FDG-PET/CT scan for better evaluation of the disease.

Results

Of the 49 cancer lesions; the majority were found to have rising or unvarying dual-time changes in SUVmax (75.5%). The median value of SUVmax increases by 25% between the early and delayed scan. The means ± S.D. of the SUVmax1, the SUVmax2, and the ΔSUVmax% were 1.2 ± 0.6%, 1.3 ± 0.9%, and 5.1 ± 22.4%, respectively. The receiver-operating-characteristic (ROC) analysis proved that the highest accuracy for characterization of malignant breast lesions was obtained when a ΔSUVmax% cut-off value 0.0% was used as criteria for malignant FDG uptake-change over time with sensitivity 75.5%, and false-positive rate 20.4%.

Conclusion

These results suggested that dual-time FDG-PET/CT imaging with standardized uptake value (SUV) estimation can improve the accuracy of the test in the evaluation of breast cancer with low FDG uptake.     

STIR turbo SE MR imaging vs. coregistered FDG-PET/CT: quantitative and qualitative assessment of N-stage in non-small-cell lung cancer patients

PURPOSE: To conduct a prospective comparison of the accuracy of short inversion time (TI) inversion-recovery (STIR) turbo spin-echo (SE) imaging and coregistered 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) with computed tomography (CT) (coregistered FDG-PET/CT) to assess the N-stage in non-small-cell lung cancer (NSCLC) patients. MATERIALS AND METHODS: A total of 115 consecutive NSCLC patients prospectively underwent CT, STIR turbo SE imaging, and FDG-PET, as well as surgical and pathological examinations. All STIR turbo SE images were obtained with a 0.9% saline phantom, which was placed alongside the chest wall of each patient, and coregistered FDG-PET/CTs were reconstructed using commercially available software. For quantitative assessments, the ratio of signal intensity (SI) of each lymph node to that of 0.9% saline phantom (lymph node-saline ratio [LSR]) and maximal standardized uptake value (SUV(max)) of each lymph node were calculated. Feasible threshold values were determined by using the receiver operating characteristic (ROC) curve-based positive test, and diagnostic capabilities of N-stage were compared by McNemar's test on a per patient basis. RESULTS: When feasible, threshold values were adopted, quantitative sensitivity (90.1%) and accuracy (92.2%) of STIR turbo SE imaging were significantly higher than those of quantitative and qualitative sensitivities (76.7% and 74.4%) and accuracies (83.5% and 82.6%) of coregistered FDG-PET/CT on a per patient basis (P < 0.05). CONCLUSION: STIR turbo SE imaging is at least as valid as coregistered FDG-PET/CT for quantitative and qualitative assessment of the N-stage for NSCLC patients.     

Current status of nuclear medicine clinical application of FDG-PET for cancer diagnosis. Head and neck cancer

Accurate detection of head and neck cancer is crucial in patients' quality of life. The head and neck area consists of many complicated anatomical structures. Conventional imaging procedures such as CT and MRI provide much detailed information, but accurate estimation of the spread of cancer is still limited. Positron emission tomography (PET) using 2-deoxy-2-[18F]fluoro-D-glucose (FDG) is clinically useful in detecting head and neck cancer, providing accurate estimates of head and neck primary cancer especially in cases that are equivocal on CT and/or MRI. FDG-PET is able to show metastatic lymph nodes that may appear normal on CT and/or MRI. Further, whole body FDG-PET makes it possible to detect distant metastases. The clinical usefulness of FDG-PET in head and neck cancer is discussed in this review.