Prognostic value of PET using 18F-FDG in Hodgkin's disease for posttreatment evaluation.

Detection of relapse after completion of therapy in patients with Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NHL) constitutes an important challenge in modern medical imaging. An accurate assessment of the presence of residual disease is essential to determine which patients would benefit from additional therapy. The objective of this study was to assess the diagnostic accuracy of (18)F-FDG PET in detecting residual disease or relapse during the posttherapy period in patients with HD in comparison with CT. We also established different predictive values for (18)F-FDG PET according to the time interval between the end of therapy and the PET study. METHODS: Forty-eight patients with HD underwent (18)F-FDG PET after the completion of chemotherapy (median, 58 d) between March 1999 and April 2002. Disease-free intervals and proportions were calculated using the Kaplan-Meier method. Standardized uptake values of the most active lesion in each patient with a positive study were also measured. PET and CT results were compared with clinical follow-up, with relapse being defined by a positive biopsy or the introduction of a second-line treatment. RESULTS: Thirty-four patients were still disease-free during a mean follow-up of 605 d. Fourteen patients relapsed during a mean follow-up of 197 d. The sensitivity and specificity of (18)F-FDG PET to predict relapse were 79% and 97%, respectively. The positive predictive value and the negative predictive value were both equal to 92%. The diagnostic accuracy of (18)F-FDG PET (92%) was significantly higher than the accuracy of CT (56%) (P < 0.0005). Patients with positive (18)F-FDG PET also had a far shorter median disease-free interval (79 d) than those with positive CT (disease-free proportion of 52% at 1,143 d) (P = 0.0046). The 3 cases of false-negative (18)F-FDG PET studies that we observed occurred in patients who underwent their PET study within the first 49 d after the end of chemotherapy. CONCLUSION: Positive (18)F-FDG PET after the end of therapy in HD patients is a strong predictor of relapse. A negative PET study is also an excellent predictor of good prognosis. The diagnostic accuracy of (18)F-FDG PET to assess the presence of residual disease after therapy is superior to that of CT.     

Early prediction of response to chemotherapy in metastatic breast cancer using sequential 18F-FDG PET.

Chemotherapy is currently the treatment of choice for patients with high-risk metastatic breast cancer. Clinical response is determined after several cycles of chemotherapy by changes in tumor size as assessed by conventional imaging procedures including CT, MRI, plain film radiography, or ultrasound. The aim of this study was to evaluate the use of sequential 18F-FDG PET to predict response after the first and second cycles of standardized chemotherapy for metastatic breast cancer. METHODS: Eleven patients with 26 metastatic lesions underwent 31 (18)F-FDG PET examinations (240-400 MBq of 18F-FDG; 10-min 2-dimensional emission and transmission scans). Clinical response, as assessed by conventional imaging after completion of chemotherapy, served as the reference. 18F-FDG PET images after the first and second cycles of chemotherapy were analyzed semiquantitatively for each metastatic lesion using standardized uptake values (SUVs) normalized to patients' blood glucose levels. In addition, whole-body 18F-FDG PET images were viewed for overall changes in the 18F-FDG uptake pattern of metastatic lesions within individual patients and compared with conventional imaging results after the third and sixth cycles of chemotherapy. RESULTS: After completion of chemotherapy, 17 metastatic lesions responded, as assessed by conventional imaging procedures. In those lesions, SUV decreased to 72% +/- 21% after the first cycle and 54% +/- 16% after the second cycle, when compared with the baseline PET scan. In contrast, 18F-FDG uptake in lesions not responding to chemotherapy (n = 9) declined only to 94% +/- 19% after the first cycle and 79% +/- 9% after the second cycle. The differences between responding and nonresponding lesions were statistically significant after the first (P = 0.02) and second (P = 0.003) cycles. Visual analysis of 18F-FDG PET images correctly predicted the response in all patients as early as after the first cycle of chemotherapy. As assessed by 18F-FDG PET, the overall survival in nonresponders (n = 5) was 8.8 mo, compared with 19.2 mo in responders (n = 6). CONCLUSION: In patients with metastatic breast cancer, sequential 18F-FDG PET allowed prediction of response to treatment after the first cycle of chemotherapy. The use of 18F-FDG PET as a surrogate endpoint for monitoring therapy response offers improved patient care by individualizing treatment and avoiding ineffective chemotherapy.     

Role of 18F-FDG PET/CT in staging and follow-up of lymphoma in pediatric and young adult patients

OBJECTIVE: To assess the role of 18F-Fluorodeoxyglucose (18F-FDG) PET/CT in pediatric patients with Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL). MATERIALS AND METHODS: 31 patients, mean age 12.9 +/- 5.1, HD (n = 24), and NHL (n = 7) underwent 18F-FDG PET/CT at diagnosis (n = 31 studies) and later in the course of the disease (n = 75 studies). The findings of PET/CT were correlated with diagnostic CT and clinical follow-up. RESULTS: PET/CT findings resulted in a change of disease staging in 10 patients (32.3%), upstaging in 7 (22.6%) and downstaging in 3 (9.6%). On a lesion analysis, 164 disease sites were detected by PET/CT of which 38 were overlooked by DCT.At mid-treatment, PET was negative in 28 out of 31 patients (90%) with negative predictive value of 96% as all latter patients except for 1, were disease free (mean 15.4 +/- 8.8 months). The positive predictive value of persistent increased 18F-FDG uptake was 100% as 3 patients with latter findings had active disease. On the CT part, 76 residual masses were identified in 22 patients. Increased 18F-FDG uptake was detected in 11 masses in 4 patients who had active disease. Remaining 65 PET negative masses were false positive findings. The positive predictive value of residual CT mass was 14%. CONCLUSIONS: PET/CT is associated with change in staging in approximately 1 out of 3 pediatric patients with HD and NHL. When used for monitoring response to treatment, a negative study is associated with disease-free period, even when residual mass is detected. A positive PET study indicates residual malignant disease.     

The Feasibility of 18F-FDG PET scans 1 month after completing radiotherapy of squamous cell carcinoma of the head and neck.

Our purpose was to prospectively evaluate the efficacy of PET with (18)F-FDG 1 mo after the completion of radiotherapy in patients with squamous cell carcinoma of the head and neck (SCCHN). METHODS: Ninety-seven patients underwent (18)F-FDG PET scans before and after radiotherapy for nondisseminated SCCHN. The first scans were obtained no more than 4 wk before the start of radiotherapy, and follow-up scans were obtained 1 mo after the completion of radiotherapy. (18)F-FDG PET images were analyzed using standardized uptake values (SUVs). All patients were followed for at least 6 mo or until death. RESULTS: The median SUVs of preradiotherapy primary sites and nodes were 6.5 (range, 2.3-23.0) and 5.6 (range, 1.2-16.8), respectively. The median SUVs of postradiotherapy primary sites and nodes were 1.8 (range, basal status value to 9.7) and 1.8 (range, basal status value to 8.6), respectively. Evaluation of the postradiotherapy status of tumors in these SCCHN patients showed the sensitivity of (18)F-FDG PET to be 88%, the specificity to be 95%, and the overall diagnostic accuracy to be 94.9%. CONCLUSION: Our results indicate that (18)F-FDG PET might be a valuable imaging method for evaluating the response to radiotherapy in patients with SCCHN. One month after the completion of radiotherapy is not too early for follow-up (18)F-FDG PET to be performed to evaluate the response to radiotherapy.     

18F-FDG PET for posttherapy assessment of Hodgkin's disease and aggressive Non-Hodgkin's lymphoma: a systematic review.

Although studies have shown that (18)F-FDG PET, when used to assess the response of malignant lymphoma after treatment, has a strong ability to predict relapse, its diagnostic accuracy in clinical practice remains unclear. The aim of this study was to systematically review the diagnostic accuracy of (18)F-FDG PET in detecting residual disease at the completion of first-line therapy of Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL). METHODS: We searched relevant articles from 1966 to July 2006 using MEDLINE, EMBASE, SCOPUS, Biological Abstracts, bibliographies, review articles, and textbooks without language restriction. One assessor (for non-English-language studies) or 2 assessors (for English-language studies) independently reviewed each article to abstract relevant study characteristics and results. Relevant individual patient data or subgroup data were provided by the investigators if they were unavailable from the publications. We estimated summary receiver operating characteristic curves and confidence regions for summary sensitivity and specificity. RESULTS: Nineteen studies consisting of 474 HD and 254 aggressive NHL patients were included. These studies had heterogeneity and suboptimal methodologic quality and reporting. Reported ranges for the sensitivity and specificity of (18)F-FDG PET in predicting disease relapse were 0.50-1.00 and 0.67-1.00, respectively, for HD and 0.33-0.77 and 0.82-1.00, respectively, for NHL. These estimates were similar when conventional imaging tests showed a residual mass. For HD studies, the summary receiver operating characteristic curves were similar irrespective of whether a residual mass was detected by conventional tests. Factors explaining the variability of diagnostic estimates were not identified. CONCLUSION: Although currently available evidence is still limited, (18)F-FDG PET seems to have good diagnostic accuracy for assessing residual HD at the completion of first-line treatment. Clinical data on this use of (18)F-FDG PET for aggressive NHL are more limited. Prospective studies with a more rigorous research design, conduct, and reporting would more reliably reveal the clinical diagnostic accuracy of this imaging modality.     

自体干细胞移植前后18F-FDG符合线路显像对非霍奇金淋巴瘤预后的评估价值

目的 探讨非霍奇金淋巴瘤(NHL)患者在自体干细胞移植(ASCT)前后行18F-脱氧葡萄糖(FDG)符合线路显像对于预测患者无进展生存期(PFS)的价值,并将结果 与CT检查进行对比分析.方法 29例经病理检查证实的NHL患者在ASCT前后均进行18F-FDG符合线路显像与CT检查,ASCT后随访时间均>1年.分别计算18F-FDG符合线路显像与CT检查的阳性预测值(PPV)、阴性预测值(NPV)和准确性,采用X2检验比较两者的结果 ,并采用Kaplan-Meier生存分析法行PFS分析.结果 ASCT前,18F-FDG显像的PPV、NPV和准确性分别为85.7%(12/14)、73.3%(11/15)和79.3%(23/29),高于CT检查的55.6%(10/18),45.5%(5/11)和51.7%(15/29);而在ASCT后,18F-FDG显像的PPV、NPV和准确性分别为92.3%(12/13)、75.0%(12/16)和82.8%(24/29),也分别高于CT检查的62.5%(10/16),53.8%(7/13)和58.6%(17/29);18?F-FDG显像和CT两者评价准确性差异有统计学意义(X2值分别为4.884和4.077,P均<0.05).ASCT前后18F-FDG显像阴性与阳性病例的PFS差异也有统计学意义(X2值分别为15.839和20.219,P均<0.005),而同期CT检查的阴性与阳性病例PFS差异无统计学意义(X2=2.468,P=0.116).ASCT前后,18F-FDG显像阴性和阳性患者的1年无进展生存率分别为86.7%(13/15)、87.5%(14/16)和28.6%(4/14)、23.1%(3/13).结论 ASCT前后18F-FDG符合线路显像均具有预测NHL预后的价值,且均优于CT检查.     

18F-FDG PET for evaluation of the treatment response in patients with gastrointestinal tract lymphomas.

(18)F-FDG PET is highly sensitive and specific for evaluation of the treatment response of nodal and extranodal diseases in patients with malignant lymphomas. However, no data are available in the literature with regard to (18)F-FDG PET for evaluation of the treatment response in patients with lymphomas with gastrointestinal tract (GIT) involvement. This study was undertaken to investigate the usefulness of (18)F-FDG PET in monitoring the response to the treatment of lymphomas in this setting. METHODS: We retrospectively analyzed 19 patients with different types of lymphomas (10 diffuse large B-cell lymphomas, 4 follicular lymphomas, 3 mantle cell lymphomas, and 2 Hodgkin's disease) involving GIT. Among 19 patients, 4 had gastric involvement, 13 had small bowel involvement, and 2 had small bowel plus colon involvement by lymphomas. All patients underwent (18)F-FDG PET before and after the completion of therapy. The results of (18)F-FDG PET were compared with the results of CT and clinical outcome; the presence of relapse was determined on the basis of positive biopsy results or clinical follow-up data. RESULTS: Of the 19 posttreatment PET scans, 13 showed no pathologic (18)F-FDG uptake, whereas 6 showed persistent (18)F-FDG uptake. Among the 13 patients who had negative PET scans, only 1 patient (7.7%) relapsed, whereas all 6 patients (100%) who had persistent abnormal (18)F-FDG uptake on posttherapy PET scans relapsed. Posttreatment CT scans were negative for 10 patients but showed persistent disease in the remaining 9 patients. Among the 10 patients who had negative CT scans, 9 remained in remission and 1 (10%) relapsed. Of the 9 patients who showed persistent disease, 6 (67%) relapsed and 3 (33%) remained in remission after the mean follow-up of 20 mo. The sensitivity, specificity, positive and negative predictive values, and accuracy of posttherapy (18)F-FDG PET were 86%, 100%, 100%, 92%, and 95%, respectively. The corresponding values for CT were 67%, 75%, 75%, 90%, and 79%, respectively. Patients with positive (18)F-FDG PET results had statistically significantly lower disease-free survival (DFS) (0%) than did those with positive CT results (33%) (P = 0.04). There was no statistically significant difference in DFS between patients with negative (18)F-FDG PET results and patients with negative CT results. CONCLUSION: A positive (18)F-FDG PET scan after the completion of chemotherapy in patients with lymphomas with GIT involvement is a strong predictor of relapse. (18)F-FDG PET has higher diagnostic accuracy than CT in the detection of residual disease after therapy. Despite the mild physiologic (18)F-FDG uptake in the GIT, (18)F-FDG PET has potential value in monitoring the response to treatment in patients with GIT lymphomas, particularly when pretreatment PET results are positive.     

Whole-body 18F-FDG PET in recurrent or metastatic nasopharyngeal carcinoma.

The aim of this retrospective study was to evaluate the sensitivity and prognostic significance of whole-body (18)F-FDG PET for nasopharyngeal carcinoma (NPC) patients for whom there was a suspicion of recurrence or metastasis by conventional radiologic or clinical findings during their follow-up examinations. METHODS: Whole-body (18)F-FDG PET examinations were performed on 64 Taiwanese NPC patients (14 female, 50 male; mean age +/- SD, 45.8 +/- 13.0 y; age range, 16-75 y) 4-70 mo (mean +/- SD, 14.1 +/- 13.5 mo) after radiotherapy or induction chemotherapy followed by concurrent chemoradiotherapy from February 1997 to May 2001. The accuracy of (18)F-FDG PET detection for each patient was determined by the histopathologic results or other clinical evidence. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of (18)F-FDG PET images in the diagnosis of NPC recurrence or metastases and secondary primary cancers were 92%, 90%, 92%, 90%, and 91%, respectively. Furthermore, the presence of (18)F-FDG hypermetabolism was highly correlated with the survival time of NPC patients. CONCLUSION: Whole-body (18)F-FDG PET is a sensitive follow-up diagnostic tool for the evaluation of NPC recurrences and metastases. It is also an effective prognostic indicator for NPC patients. To determine the optimized utilization of (18)F-FDG PET in the follow-up for NPC patients, further cost-effectiveness analysis of (18)F-FDG PET in combination with conventional management is necessary.     

Differential roles of 18F-FDG PET in patients with locoregional advanced nasopharyngeal carcinoma after primary curative therapy: response evaluation and impact on management.

This prospective study compares the efficacies of whole-body (18)F-FDG PET and a conventional work-up (CWU) in evaluating the treatment response for patients with locoregional advanced nasopharyngeal carcinoma (NPC) after primary curative therapy and investigates the impact of PET on patient management. METHODS: Patients who had locoregional advanced NPC (stages III and IVa-b, staged by (18)F-FDG PET and CWU) and who had completed primary curative therapy for 3 mo were enrolled. The curative therapy consisted of concurrent chemoradiotherapy with or without induction chemotherapy. All of the patients also underwent (18)F-FDG PET and CWU to evaluate the response. The criteria for final diagnosis were based on pathology or subsequent follow-up for at least 6 mo. Rates of detection by (18)F-FDG PET and CWU and the impact on management were determined on site and patient bases, respectively. RESULTS: From January 2002 to August 2005, 131 patients with NPC were eligible, including 71 patients with stage III NPC (group A) and 60 patients with stage IVa-b NPC (group B). Twelve patients were proven to have residual tumors. (18)F-FDG PET had a higher overall sensitivity than CWU in group A (100% vs. 25%) and group B (91.7% vs. 58.3%). The overall specificity of PET was significantly higher than that of CWU in group B (97.6% vs. 91.7%; P = 0.019) but was slightly lower in group A (95.7% vs. 96.7%). The overall accuracy of PET also was significantly higher than that of CWU in group B (97.2% vs. 89.4%; P = 0.002) but was similar to that of CWU in group A (95.8% vs. 95.3%). PET resulted in management changes in 11 patients (15.4%; 11/71) in group A, with positive and negative impacts on 3 and 8 patients, respectively. In group B, the management of 26 of 60 patients (43%) was changed as a result of PET and included positive impacts on 23 patients and negative impacts on 3 patients. CONCLUSION: (18)F-FDG PET plays differential roles in patients with stage III NPC and stage IVa-b NPC after primary curative therapy. PET has higher sensitivity and specificity in evaluating the response and results in better management of patients with stage IVa-b NPC. PET has a less prominent impact on patient management but higher sensitivity in patients with stage III NPC.     

The value of <Superscript>18</Superscript>F-FDG PET before and after induction chemotherapy for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy in oesophageal adenocarcinoma

Purpose

The purpose of our study was to determine the value of ¹⁸F-FDG PET before and after induction chemotherapy in patients with oesophageal adenocarcinoma for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy (CRT).

Methods

In 70 consecutive patients receiving a three-step treatment strategy of induction chemotherapy and preoperative chemoradiotherapy for oesophageal adenocarcinoma, ¹⁸F-FDG PET scans were performed before and after induction chemotherapy (before preoperative CRT). SUV_max, SUV_mean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were determined at these two time points. The predictive potential of (the change in) these parameters for a poor pathologic response, progression-free survival (PFS) and overall survival (OS) was assessed.

Results

A poor pathologic response after induction chemotherapy and preoperative CRT was found in 27 patients (39 %). Patients with a poor pathologic response experienced less of a reduction in TLG after induction chemotherapy (p?<?0.01). The change in TLG was predictive for a poor pathologic response at a threshold of ?26 % (sensitivity 67 %, specificity 84 %, accuracy 77 %, PPV 72 %, NPV 80 %), yielding an area-under-the-curve of 0.74 in ROC analysis. Also, patients with a decrease in TLG lower than 26 % had a significantly worse PFS (p?=?0.02), but not OS (p?=?0.18).

Conclusions

¹⁸F-FDG PET appears useful to predict a poor pathologic response as well as PFS early after induction chemotherapy in patients with oesophageal adenocarcinoma undergoing a three-step treatment strategy. As such, the early ¹⁸F-FDG PET response after induction chemotherapy could aid in individualizing treatment by modification or withdrawal of subsequent preoperative CRT in poor responders.

     

The role of 18F-FDG PET in staging and early prediction of response to therapy of recurrent gastrointestinal stromal tumors.

Gastrointestinal stromal tumors (GISTs) are gaining the interest of researchers because of impressive metabolic response to the targeted molecular therapeutic drug imatinib mesylate. Initial reports suggest an impressive role for (18)F-FDG PET in follow-up of therapy for these tumors. However, the role of (18)F-FDG PET versus that of CT has not been established. Therefore, we compared the roles of (18)F-FDG PET and CT in staging and evaluation of early response to imatinib mesylate therapy in recurrent or metastatic GIST. METHODS: The study included 54 patients who underwent (18)F-FDG PET and CT scans within 3 wk before initiation of imatinib mesylate therapy. Forty-nine of these patients underwent repeat scans 2 mo after therapy. The numbers of sites or organs containing lesions on (18)F-FDG PET and CT scans were compared. Corresponding lesions on (18)F-FDG PET and CT scans or those confirmed to be malignant in appearance by other imaging modalities or on follow-up were considered true positives. Lesions seen on (18)F-FDG PET or CT scans but not seen or confirmed to be of benign appearance with other imaging modalities or on follow-up were considered false positives. Measurements of the maximum standard uptake value (SUV) on (18)F-FDG PET scans and tumor size on CT scans were used for quantitative evaluation of early tumor response to therapy. RESULTS: A total of 122 and 114 sites and/or organs were involved on pretherapy (18)F-FDG PET and CT scans, respectively. The sensitivity and positive predictive values (PPVs) for CT were 93% and 100%; whereas these values for (18)F-FDG PET were 86% and 98%. However, the differences between these values for CT and (18)F-FDG PET were not statistically significant (P = 0.27 for sensitivity and 0.25 for PPV). This suggests comparable performance of (18)F-FDG PET and CT in staging GISTs. Repeat scans at 2 mo after therapy showed agreement between (18)F-FDG PET and CT scans in 71.4% of patients (57.1% having a good response to therapy and 14.3% lacking a response). Discrepant results between (18)F-FDG PET and CT were recorded for 28.6% of the patients. (18)F-FDG PET predicted response to therapy earlier than did CT in 22.5% of patients during a longer follow-up interval (4-16 mo), whereas CT predicted lack of response to therapy earlier than (18)F-FDG PET in 4.1%. One patient did not undergo long-term follow-up. These findings suggest that (18)F-FDG PET is superior to CT in predicting early response to therapy in recurrent or metastatic GIST patients. CONCLUSION: The performances of (18)F-FDG PET and CT are comparable in staging GISTs before initiation of imatinib mesylate therapy. However, (18)F-FDG PET is superior to CT in predicting early response to therapy. Thus, (18)F-FDG PET is a better guide for imatinib mesylate therapy.     

Early prediction of response to chemotherapy and survival in malignant pleural mesothelioma using a novel semiautomated 3-dimensional volume-based analysis of serial 18F-FDG PET scans.

The aim of chemotherapy for mesothelioma is to palliate symptoms and improve survival. Measuring response using CT is challenging because of the circumferential tumor growth pattern. This study aims to evaluate the role of serial (18)F-FDG PET in the assessment of response to chemotherapy in patients with mesothelioma. METHODS: Patients were prospectively recruited and underwent both (18)F-FDG PET and conventional radiological response assessment before and after 1 cycle of chemotherapy. Quantitative volume-based (18)F-FDG PET analysis was performed to obtain the total glycolytic volume (TGV) of the tumor. Survival outcomes were measured. RESULTS: Twenty-three patients were suitable for both radiological and (18)F-FDG PET analysis, of whom 20 had CT measurable disease. After 1 cycle of chemotherapy, 7 patients attained a partial response and 13 had stable disease on CT assessment by modified RECIST (Response Evaluation Criteria in Solid Tumors) criteria. In the 7 patients with radiological partial response, the median TGV on quantitative PET analysis fell to 30% of baseline (range, 11%-71%). After 1 cycle of chemotherapy, Cox regression analysis demonstrated a statistically significant relationship between a fall in TGV and improved patient survival (P = 0.015). Neither a reduction in the maximum standardized uptake value (P = 0.097) nor CT (P = 0.131) demonstrated a statistically significant association with patient survival. CONCLUSION: Semiquantitative (18)F-FDG PET using the volume-based parameter of TGV is feasible in mesothelioma and may predict response to chemotherapy and patient survival after 1 cycle of treatment. Therefore, metabolic imaging has the potential to improve the care of patients receiving chemotherapy for mesothelioma by the early identification of responding patients. This technology may also be useful in the assessment of new systemic treatments for mesothelioma.     

18F-FDG PET/CT in the evaluation of adrenal masses.

Our purpose was to evaluate the performance of (18)F-FDG PET/CT, using data from both the PET and the unenhanced CT portions of the study, in characterizing adrenal masses in oncology patients. METHODS: One hundred seventy-five adrenal masses in 150 patients referred for (18)F-FDG PET/CT were assessed. Final diagnosis was based on histology (n = 6), imaging follow-up (n = 118) of 6-29 mo (mean, 14 mo), or morphologic imaging criteria (n = 51). Each adrenal mass was characterized by its size; its attenuation on CT, expressed by Hounsfield units (HU); and the intensity of (18)F-FDG uptake, expressed as standardized uptake value (SUV). Receiver operating characteristic curves were drawn to determine the optimal cutoff values of HU and SUV that would best discriminate between benign and malignant masses. RESULTS: When malignant lesions were compared with adenomas, PET data alone using an SUV cutoff of 3.1 yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 98.5%, 92%, 89.3%, 98.9%, respectively. For combined PET/CT data, the sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 98%, 97%, 100%, respectively. Specificity was significantly higher for PET/CT (P < 0.01). Fifty-one of the 175 masses were 1.5 cm or less in diameter. When a cutoff SUV of 3.1 was used for this group, (18)F-FDG PET/CT correctly classified all lesions. CONCLUSION: (18)F-FDG PET/CT improves the performance of (18)F-FDG PET alone in discriminating benign from malignant adrenal lesions in oncology patients.     

~（18）F-FDG符合探测正电子显像在恶性淋巴瘤诊治评估中的应用

目的探讨18F-FDG符合探测正电子显像（SPECT/PET）在恶性淋巴瘤诊治中的应用。方法回顾性分析2006年1月~2010年9月在本院经病理确诊为恶性淋巴瘤67例患者共102次18F-FDGSPECT/PET显像结果。霍奇金淋巴瘤患者9例,1例治疗前行SPECT/PET显像,8例为治疗中、后行检查。非霍奇金淋巴瘤患者58例,16例治疗前SPECT/PCT显像,9例治疗前、后均进行SPECT/PET检查,33例治疗后显像。结果 9例霍奇金淋巴瘤患者中治疗前阳性显像1例,化疗中和（或）放疗后SPECT/PET显像共8例,其中5例完全缓解,1例未见明显缓解,1例部分缓解,1例进展。58例非霍奇金淋巴瘤患者中25例治疗前患者中的SPECT/PET显像24例为阳性（96.0%）。42例接受治疗的非霍奇金淋巴瘤患者（包括9例治疗前后均行检查患者）,其中16例SPECT/PET显像为完全缓解（38.09%）,10例部分缓解（23.81%）,9例病灶有进展（21.43%）,7例缓解后又复发（16.67%）。结论 18F-FDGSPECT/PET在淋巴瘤的临床诊断分期与疗效评估中具有重要的临床价值。     

Imaging proliferation in brain tumors with 18F-FLT PET: comparison with 18F-FDG.

3'-Deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) is a recently developed PET tracer to image tumor cell proliferation. We characterized (18)F-FLT PET of brain gliomas and compared (18)F-FLT with (18)F-FDG PET in side-by-side studies of the same patients. METHODS: Twenty-five patients with newly diagnosed or previously treated glioma underwent PET with (18)F-FLT and (18)F-FDG on consecutive days. Three stable patients in long-term remission were included as negative control subjects. Tracer kinetics in normal brain and tumor were measured. Uptake of (18)F-FLT and (18)F-FDG was quantified by the standardized uptake value (SUV) and the tumor-to-normal tissue (T/N) ratio. The accuracy of (18)F-FLT and (18)F-FDG PET in evaluating newly diagnosed and recurrent gliomas was compared. More than half of the patients underwent resection after the PET study and correlations between PET uptake and the Ki-67 proliferation index were examined. Patients were monitored for a mean of 15.4 mo (range, 12-20 mo). The predictive power of PET for tumor progression and survival was analyzed using Kaplan-Meier statistics. RESULTS: (18)F-FLT uptake in tumors was rapid, peaking at 5-10 min after injection and remaining stable up to 75 min. Hence, a 30-min scan beginning at 5 min after injection was sufficient for imaging. (18)F-FLT visualized all high-grade (grade III or IV) tumors. Grade II tumor did not show appreciable (18)F-FLT uptake and neither did the stable lesions. The absolute uptake of (18)F-FLT was low (maximum-pixel SUV [SUV(max)], 1.33) but image contrast was better than with (18)F-FDG (T/N ratio, 3.85 vs. 1.49). (18)F-FDG PET studies were negative in 5 patients with recurrent high-grade glioma who subsequently suffered tumor progression within 1-3 mo. (18)F-FLT SUV(max) correlated more strongly with Ki-67 index (r = 0.84; P < 0.0001) than (18)F-FDG SUV(max) (r = 0.51; P = 0.07). (18)F-FLT uptake also had more significant predictive power with respect to tumor progression and survival (P = 0.0005 and P = 0.001, respectively). CONCLUSION: Thirty-minute (18)F-FLT PET 5 min after injection was more sensitive than (18)F-FDG to image recurrent high-grade tumors, correlated better with Ki-67 values, and was a more powerful predictor of tumor progression and survival. Thus, (18)F-FLT appears to be a promising tracer as a surrogate marker of proliferation in high-grade gliomas.     

基线18F-FDG PET/CT在转移性恶性黑色素瘤患者预后评估中的价值

目的 探讨治疗前18F-氟脱氧葡萄糖（FDG）PET/CT代谢参数在转移性恶性黑色素瘤（MM）患者预后评估中的价值。 方法 回顾性分析2011年8月至2018年12月在南京大学医学院附属鼓楼医院确诊为转移性MM的47例患者的临床资料,其中男性20例、女性27例,中位年龄59（23~86）岁。对所有患者行化疗、免疫或靶向治疗。随访时间为0.5~53.6个月。黑色素瘤特异性生存期（MSS）和无进展生存期（PFS）分别定义为从18F-FDG PET成像到患者病死的时间和疾病进展或病死的时间。所有患者在治疗前均行18F-FDG PET/CT检查,测量最大标准化摄取值（SUV_max）,并以SUV>40% SUV_max的体素边界作为临界值,分别测量并计算全身肿瘤代谢体积（MTV）和全身病灶糖酵解总量（TLG）。采用受试者工作特征（ROC）曲线分析得出PET参数的最佳临界值,并以SUV_max、全身MTV和全身TLG临界值为界分别将患者分为2组,共6组。采用Kaplan-Meier法及Log-rank检验预测2组间MSS和PFS的差异。采用单因素分析法评估PET参数和临床变量的预后意义。采用Cox比例风险模型多因素分析PET参数是否为MSS和PFS的独立预后危险因素。 结果 SUV_max、全身MTV和全身TLG的最佳临界值分别为10.86、8.12 cm3和91.45。全身MTV和全身TLG以临界值为界的2组患者PFS的差异均有统计学意义（χ2=5.04、5.02,均P<0.05）;SUV_max和全身TLG以临界值为界的2组患者MSS的差异均有统计学意义（χ2=10.22、4.38,均P<0.05）。单因素分析结果表明,血清乳酸脱氢酶水平≥245 U/L、淋巴结转移、SUV_max>10.86和全身TLG>91.45是MSS的预后危险因素;M1期、全身MTV>8.12 cm3和全身TLG>91.45是PFS的预后危险因素。多因素分析结果表明,SUV_max>10.86是MSS的独立预后危险因素。 结论 18F-FDG PET/CT代谢参数SUV_max是转移性MM患者病死的最佳预测因素,而全身MTV和全身TLG对转移性MM患者的预后具有一定的预测价值。     

The prognostic value of mid- and post-treatment [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) in indolent follicular lymphoma

Background

[¹⁸F]fluorodeoxyglucose positron emission tomography (PET) is a useful staging investigation for follicular lymphoma (FL). Recent studies have shown that positive post-treatment PET is also a strong predictor of inferior overall survival.

Purpose

To evaluate the predictive value of mid- and post-treatment PET in FL patients with respect to progression-free survival (PFS) and overall survival (OS).

Methods

We included 57 patients with indolent FL (grade 1, 2, and 3a) who received induction chemotherapy. Mid- and post-treatment PET results were correlated with PFS and OS retrospectively and analysed using Kaplan–Meier survival analysis and Cox regression.

Results

Post-treatment PET was predictive of OS (mean OS 95.2 vs. 45.0 months for PET-negative vs. PET-positive, p < 0.001) and showed a trend towards significance for PFS (mean PFS 74.4 vs. 38.2 months for PET? vs. PET+, p = 0.083). 3-year PFS for post-treatment PET? and PET+ patients were 72 and 30 %, respectively. 3-year OS were 96 and 60 %, respectively. Mid-treatment PET was not predictive of PFS (mean PFS 78.5 vs. 51.0 months for PET? vs. PET+, p = 0.35) nor OS (mean OS 89.9 vs. 76.6 months for PET? vs. PET+, p = 0.92).

Conclusion

Post-treatment PET is predictive of OS in indolent FL. It identifies patients who might benefit from more intensive follow-up, enrolment in clinical trials or second-line therapy. Mid-treatment PET scan results did not appear to predict long-term treatment outcomes.     

术前^18F-FDG PET/CT显像对非小细胞肺癌患者中远期预后的预测价值

目的 探讨非小细胞肺癌(NSCLC)根治性切除术术前^18F-脱氧葡萄糖(FDG) PET/CT显像对患者中远期预后的预测价值.方法 回顾性分析2010年4月至2016年8月间北京医院收治的70例行根治性手术且术前1个月内行^18F-FDG PET/CT显像的初诊NSCLC患者资料,其中男35例,女35例,中位年龄64岁.分析患者肺癌原发灶及纵隔或肺门淋巴结的PET/CT影像学征象[原发灶大小及最大标准摄取值(SUVmax)、纵隔或肺门高代谢淋巴结(HML) SUVmax及分布类型]并随访.研究终点为总生存(OS)期和无进展生存(PFS)期.采用Kaplan-Meier法、log-rank检验和Cox比例风险回归模型分析探讨患者生存的预后因素.结果 随访0.9~8.2年.70例患者中,31.4% (22/70)进展,24.3%(17/70)死亡.对于OS期,术前NSCLC原发灶SUVmax≥10与<10者(4.6和7.6年)、原发灶大小>3 cm与≤3 cm者(4.8和7.4年)、纵隔或肺门HML分布于肺癌同侧与位于双侧或无HML者(4.4和7.4年)、纵隔或肺门HML SUVmax≥5.0与<5.0者(3.8和7.3年)的差异均有统计学意义(x^2值:10.135~ 15.238,均P<0.01);上述组别患者PFS期(3.9和6.7年、3.8和6.6年、3.8和6.4年、3.3和6.3年)的差异亦有统计学意义(x^2值:8.410~ 14.600,均P<0.01).Cox多因素分析显示,原发灶大小和SUVmax是预测NSCLC术后OS期及PFS期的独立危险因素(均P<0.01),纵隔或肺门HML分布类型对预测NSCLC的OS期有边际意义(P=0.051).结论 NSCLC根治术术前^18F-FDG PET/CT显像中的原发灶大小和SUVmax对NSCLC术后生存期有重要的预测价值;纵隔或肺门HML分布类型对术后NSCLC的预后可能有预测价值.     

18F-FDG PET/CT代谢体积参数对复发性宫颈癌的预后预测及其与外周血NLR、PLR相关性的研究

目的 探讨18F-氟脱氧葡萄糖（FDG） PET/CT代谢体积参数肿瘤代谢体积（MTV）和病灶糖酵解总量（TLG）对复发性宫颈癌患者生存预后预测的价值,以及其与外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）的关系。 方法 回顾性分析2014年1月至2020年12月在蚌埠医学院第一附属医院行18F-FDG PET/CT检查并被纳入研究的50例复发性宫颈癌患者[中位年龄为52（45,66）岁]的临床资料和影像资料,得到最大标准化摄取值（SUV_max）和阈值为40% SUV_max、50% SUV_max时的体积参数:全身MTV40% （wbMTV40%）、wbMTV50%和全身TLG40% （wbTLG40%）、wbTLG50%。评价这些18F-FDG PET/CT代谢体积参数与无进展生存率（PFS）和总生存率（OS）的关系,以及其与外周血NLR、PLR的相关性。根据有无再次复发和死亡危险将患者分为无再次复发、再次复发和死亡3组。对患者的FIGO分期（Ⅰ+Ⅱ对Ⅲ+Ⅳ）、病理类型（鳞癌对腺癌）、复发部位（盆腔复发对远处复发）、初始治疗时的放射治疗（是对否）、复发后治疗（手术对非手术）和复发时的年龄（≥60.0岁对<60.0岁）进行危险分组;而患者的连续变量（NLR、PLR和18F-FDG PET/CT代谢体积参数）则根据最佳临界值分为高、低组。采用Chi-square检验分析分类变量在各组间的差异。采用受试者工作特征曲线评估18F-FDG PET/CT代谢体积参数对PFS及OS的预测效能并确定最佳临界值;再用Youden指数分析判定最佳临界值,进而确定最佳18F-FDG PET/CT代谢体积参数。采用Kaplan-Meier法绘制预测患者PFS及OS的生存曲线,采用Log-rank法对组间生存曲线进行检验。采用Cox回归模型对复发性宫颈癌患者各项可能的预后因素进行单因素和多因素分析。将单因素分析中P<0.05的变量纳入多因素回归分析中,得到PFS和OS的独立预测因素。采用Spearman相关分析法分析18F-FDG PET/CT代谢体积参数与外周血NLR、PLR的相关性。 结果 所有患者初始的治疗方法在有无再次复发和死亡危险分组之间的差异有统计学意义（χ2=26.386,P=0.003）,与无再次复发组的患者相比,再次复发和死亡组患者的PLR升高,且差异有统计学意义（χ2=29.528,P=0.001）。wbMTV50%对PFS和OS的预测效能高于其他代谢参数,其预测PFS的临界值为25.24 cm3,曲线下面积（AUC）=0.753（95%CI:0.611~0.864,P=0.009）;其预测OS的临界值为27.36 cm3,AUC=0.780（95%CI:0.640~0.885,P<0.001）。PLR预测PFS的临界值为188.2,AUC=0.708（95%CI:0.562~0.868,P=0.037）,灵敏度为87.5%,特异度为50.5%;PLR预测OS的临界值为213.5,AUC=0.678（95%CI:0.531~0.803,P=0.021）,灵敏度为62.1%,特异度为76.0%。Cox多因素分析结果显示,wbMTV50%（HR=0.260,P=0.003）、PLR（HR=0.380,P=0.031）和初始治疗时的放射治疗（HR=0.209,P=0.014）是PFS的独立预测因素,同时wbMTV50%（HR=0.103,P<0.001）和PLR（HR=0.240,P=0.012）也是OS的独立预测因素。SUV_max、wbTLG40%、wbTLG50%与NLR和PLR呈中度相关（r=0.475、0.542、0.548、0.532、0.599、0.606,均P<0.001）,而wbMTV40%、wbMTV50%与NLR和PLR呈中度至高度相关（r=0.715、0.629、0.766、0.642,均P<0.001）。在相同阈值下,wbMTV与NLR和PLR的相关系数大于wbTLG。 结论 18F-FDG PET/CT代谢体积参数wbMTV50%是复发性宫颈癌患者PFS和OS的独立预测因素,与外周血NLR、PLR相关,可作为复发性宫颈癌预后的预测指标,为其个体化治疗提供有价值的信息。     

Clinical utility of 18F-FDG PET for patients with salivary gland malignancies.

The clinical utility of 18F-FDG PET in evaluating salivary gland malignancies has not been well defined. We therefore evaluated the utility of 18F-FDG PET in management for patients with salivary gland cancers. METHODS: Thirty-four patients with newly diagnosed salivary gland cancers underwent CT and 18F-FDG PET before surgical resection with radiotherapy. The diagnostic accuracies of CT and 18F-FDG PET for detecting primary tumors and neck metastases were compared with a histopathologic reference. We determined the relationship between the maximum standardized uptake value (SUV) of the tumor and clinicopathologic parameters such as sex, age, local tumor invasion, T and N categories, TNM stage, and histologic grade, as well as their associations with disease-free survival (DFS). RESULTS: 18F-FDG PET was more sensitive than CT for the detection of primary tumors (91.2% vs. 79.4%; P < 0.05), cervical metastases (80.5% vs. 56.1%; P < 0.05), and distant metastases in 2 patients at initial staging. High-grade malignancies had higher mean maximum SUVs than did low- and intermediate-grade malignancies (4.6 vs. 2.8; P = 0.011). T and N categories were independent determinants of DFS (P < 0.05), but the maximum SUV (4.0) was not. During a mean follow-up of 25.1 mo, 18F-FDG PET correctly diagnosed local-regional recurrences in 6 patients and new distant metastases in 9 patients. CONCLUSION: Our findings indicate that, in patients with salivary gland malignancies, 18F-FDG PET is clinically useful in initial staging, histologic grading, and monitoring after treatment but not in predicting patient survival.