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1.
Yun Jung Choi Hee Sung Hwang Hyun Jeong Kim Yong Hyu Jeong Arthur Cho Jae Hoon Lee Mijin Yun Jong Doo Lee Won Jun Kang 《Annals of nuclear medicine》2014,28(4):304-313
Objective
The purpose of this study was to evaluate the diagnostic performance of 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) as a single imaging agent in neuroblastoma in comparison with other imaging modalities.Methods
A total of 30 patients with pathologically proven neuroblastoma who underwent FDG PET for staging were enrolled. Diagnostic performance of FDG PET and abdomen CT was compared in detecting soft tissue lesions. FDG PET and bone scintigraphy (BS) were compared in bone metastases. Maximal standardized uptake value (SUVmax) of primary or recurrent lesions was calculated for quantitative analysis.Results
Tumor FDG uptake was detected in 29 of 30 patients with primary neuroblastoma. On initial FDG PET, SUVmax of primary lesions were lower in early stage (I–II) than in late stage (III–IV) (3.03 vs. 5.45, respectively, p = 0.019). FDG PET was superior to CT scan in detecting distant lymph nodes (23 vs. 18 from 23 lymph nodes). FDG PET showed higher accuracy to identify bone metastases than BS both on patient-based analyses (100 vs. 94.4 % in sensitivity, 100 vs. 77.8 % in specificity), and on lesion-based analyses (FDG PET: 203 lesions, BS: 86 lesions). Sensitivity and specificity of FDG PET to detect recurrence were 87.5 % and 93.8, respectively.Conclusion
FDG PET was superior to CT in detecting distant LN metastasis and to BS in detecting skeletal metastasis in neuroblastoma. BS might be eliminated in the evaluation of neuroblastoma when FDG PET is performed. 相似文献2.
Karsten Beiderwellen Michael Huebner Philipp Heusch Johannes Grueneisen Verena Ruhlmann Felix Nensa Hilmar Kuehl Lale Umutlu Sandra Rosenbaum-Krumme Thomas C. Lauenstein 《European radiology》2014,24(8):2023-2030
Objectives
To compare [18?F]FDG PET/MRI with PET/CT for the assessment of bone lesions in oncologic patients.Methods
This prospective study included 67 patients with solid tumours scheduled for PET/CT with [18?F]FDG who also underwent a whole-body PET/MRI scan. The datasets (PET/CT, PET/MRI) were rated by two readers regarding lesion conspicuity (four-point scale) and diagnostic confidence (five-point scale). Median scores were compared using the Wilcoxon test.Results
Bone metastases were present in ten patients (15 %), and benign bone lesions in 15 patients (22 %). Bone metastases were predominantly localized in the pelvis (18 lesions, 38 %) and the spine (14 lesions, 29 %). Benign bone lesions were exclusively osteosclerotic and smaller than the metastases (mean size 6 mm vs. 23 mm). While PET/CT allowed identification of 45 of 48 bone metastases (94 %), PET/MRI allowed identification of all bone metastases (100 %). Conspicuity of metastases was high for both modalities with significantly better results using PET/MRI (p?<?0.05). Diagnostic confidence in lesion detection was high for both modalities without a significant difference. In benign lesions, conspicuity and diagnostic confidence were significantly higher with PET/CT (p?<?0.05).Conclusions
[18?F]FDG PET/MRI shows high potential for the assessment of bone metastases by offering superior lesion conspicuity when compared to PET/CT. In hypersclerotic, benign bone lesions PET/CT still sets the reference.Key Points
? PET/MRI and PET/CT are of equal value for the identification of disease-positive patients ? PET/MRI offers higher lesion conspicuity as well as diagnostic confidence ? PET/MRI is an attractive new alternative for the assessment of bone metastases 相似文献3.
Chiara Fuccio Paolo Castellucci Riccardo Schiavina Ivan Santi Vincenzo Allegri Vincenzina Pettinato Stefano Boschi Giuseppe Martorana Adil Al-Nahhas Domenico Rubello Stefano Fanti 《Annals of nuclear medicine》2010,24(6):485-492
Aim
To assess the utility of 11C-choline PET/CT in the restaging of prostate cancer (PC) patients who showed a single finding on bone scintigraphy (BS) that was classified as equivocal or suspected for metastatic lesion.Materials and methods
A total of 25 PC patients with biochemical failure (mean PSA value 11.1 ng/mL; median value 6.3 ng/mL; range 0.2–37.7 ng/mL) after primary treatment were included in this retrospective study. All of them showed a single lesion on BS reported as suspected for metastatic lesion or as equivocal finding. Patients underwent 11C-choline PET/CT within 1–4 months from BS. Validation was established by follow-up for at least 6 months.Results
On the basis of biopsy confirmation and/or 6-month follow-up, 22 of 25 patients were classified as positive for the presence of metastatic bone lesions: 13 with a single lesion and 9 with multiple lesions. 11C-choline PET/CT was positive in 19/25 patients and, on a lesion basis, it showed 50 positive findings. BS results were confirmed in 8/25 (32%) patients. 11C-choline PET/CT detected multiple sites of relapse in 11/25 (44%) patients: in 2/11, a single bone lesion associated with other extraosseous sites of relapse; in 6/11, multiple bone lesions; in 3/11, multiple bone lesions and other extraosseous localizations. Finally, 6/25 patients were negative on 11C-choline PET/CT. In 3/6 patients, an osteoblastic lesion was seen on CT attenuation correction images (PET false negative; BS true positive), while in 3/6 patients only findings suggestive of the presence of degenerative disease were found (PET true negative; BS false positive). On a patient basis, 11C-choline PET/CT showed a diagnostic sensitivity of 86% (19/22) and a specificity of 100% (19/19).Conclusions
In our study, 11C-choline PET/CT detected unknown lesions in 11/25 patients. Patients with a single equivocal finding on BS could have important additional information from 11C-choline PET/CT study, especially in the detection of additional metastases, to choose an appropriate treatment. 相似文献4.
Daniel C. Bortot Bárbara J. Amorim Glaucia C. Oki Sérgio B. Gapski Allan O. Santos Mariana C. L. Lima Elba C. S. C. Etchebehere Marycel F. Barboza Jair Mengatti Celso Dario Ramos 《European journal of nuclear medicine and molecular imaging》2012,39(11):1730-1736
Purpose
Bone scintigraphy (BS) has been used extensively for many years for the diagnosis of bone metastases despite its low specificity and significant rate of equivocal lesions. 18F-Fluoride PET/CT has been proven to have a high sensitivity and specificity in the detection of malignant bone lesions, but its effectiveness in patients with inconclusive lesions on BS is not well documented. This study evaluated the ability of 18F-fluoride PET/CT to exclude bone metastases in patients with various malignant primary tumours and nonspecific findings on BS.Methods
We prospectively studied 42 patients (34–88?years of age, 26 women) with different types of tumour. All patients had BS performed for staging or restaging purposes but with inconclusive findings. All patients underwent 18F-fluoride PET/CT. All abnormalities identified on BS images were visually compared with their appearance on the PET/CT images.Results
All the 96 inconclusive lesions found on BS images of the 42 patients were identified on PET/CT images. 18F-Fluoride PET/CT correctly excluded bone metastases in 23 patients (68 lesions). Of 19 patients (28 lesions) classified by PET/CT as having metastases, 3 (5 lesions) were finally classified as free of bone metastases on follow-up. The sensitivity, specificity, and positive and negative predictive values of 18F-fluoride PET/CT were, respectively, 100?%, 88?%, 84?% and 100?% for the identification of patients with metastases (patient analysis) and 100?%, 82?% and 100?% for the identification of metastatic lesions (lesion analysis).Conclusion
The factors that make BS inconclusive do not affect 18F-fluoride PET/CT which shows a high sensitivity and negative predictive value for excluding bone metastases even in patients with inconclusive conventional BS. 相似文献5.
Thomas Pyka Shozo Okamoto Marielena Dahlbender Robert Tauber Margitta Retz Matthias Heck Nagara Tamaki Markus Schwaiger Tobias Maurer Matthias Eiber 《European journal of nuclear medicine and molecular imaging》2016,43(12):2114-2121
Purpose
The aim of our study was to compare the diagnostic performance of 68Ga-PSMA PET and 99mTc bone scintigraphy (BS) for the detection of bone metastases in prostate cancer (PC) patients.Methods
One hundred twenty-six patients who received planar BS and PSMA PET within three months and without change of therapy were extracted from our database. Bone lesions were categorized into benign, metastatic, or equivocal by two experienced observers. A best valuable comparator (BVC) was defined based on BS, PET, additional imaging, and follow-up data. The cohort was further divided into clinical subgroups (primary staging, biochemical recurrence, and metastatic castration-resistant prostate cancer [mCRPC]). Additionally, subgroups of patients with less than 30 days delay between the two imaging procedures and with additional single-photon emission computed tomography (SPECT) were analyzed.Results
A total of 75 of 126 patients were diagnosed with bone metastases. Sensitivities and specificities regarding overall bone involvement were 98.7–100 % and 88.2–100 % for PET, and 86.7–89.3 % and 60.8–96.1 % (p?<?0.001) for BS, with ranges representing results for ‘optimistic’ or ‘pessimistic’ classification of equivocal lesions. Out of 1115 examined bone regions, 410 showed metastases. Region-based analysis revealed a sensitivity and specificity of 98.8–99.0 % and 98.9–100 % for PET, and 82.4–86.6 % and 91.6–97.9 % (p?<?0.001) for BS, respectively. PSMA PET also performed better in all subgroups, except patient-based analysis in mCRPC.Conclusion
Ga-PSMA PET outperforms planar BS for the detection of affected bone regions as well as determination of overall bone involvement in PC patients. Our results indicate that BS in patients who have received PSMA PET for staging only rarely offers additional information; however, prospective studies, including a standardized integrated x-ray computed tomography (SPECT/CT) protocol, should be performed in order to confirm the presented results.6.
Nishikant Avinash Damle Chandrasekhar Bal G. P. Bandopadhyaya Lalit Kumar Praveen Kumar Arun Malhotra Sneh Lata 《Japanese journal of radiology》2013,31(4):262-269
Objectives
We aimed to compare the role of 18F-fluoride PET/CT, FDG PET/CT and 99mTc-MDP bone scans in the detection of bone metastases in patients with lung, breast and prostate carcinoma.Methods
This was a prospective study including patients for staging (S) and restaging (R). Seventy-two patients (23S, 49R) with infiltrating ductal breast carcinoma, 49 patients (25S, 24R) with prostate adenocarcinoma and 30 patients (17S, 13R) with non-small-cell lung carcinoma (NSCLC), without known bone metastases but with high risk/clinical suspicion for the same, underwent a 99mTc-MDP bone scan, FDG PET/CT and 18F-fluoride PET/CT within 2 weeks. All scans were reviewed by two experienced nuclear medicine physicians, and the findings were correlated with MRI/thin-slice CT/skeletal survey. Histological verification was done wherever feasible.Results
Sensitivity and negative predictive value (NPV) of 18F-fluoride PET/CT was 100 % in all three malignancies, while that of FDG PET/CT was 79 % and 73 % in NSCLC, 73 % and 80 % in breast cancer and 72 and 65 % in prostate cancer. Specificity and positive predictive value (PPV) of FDG PET/CT were 100 % in NSCLC and prostate and 97 % and 96 % in breast cancer. As compared to the 99mTc-MDP bone scan, all parameters were superior for 18F-fluoride PET/CT in prostate and breast cancer, but sensitivity and NPV were equal in NSCLC. The MDP bone scan had superior sensitivity and NPV compared to FDG PET/CT but had low specificity and PPV.Conclusion
To rule out bone metastases in cases where there is a high index of suspicion, 18F-fluoride PET/CT is the most reliable investigation. 18F-fluoride PET/CT has the potential to replace the 99mTc-MDP bone scan for the detection of bone metastases. 相似文献7.
A meta-analysis of 18F-Fluoride positron emission tomography for assessment of metastatic bone tumor
Ukihide Tateishi Satoshi Morita Masataka Taguri Kazuya Shizukuishi Ryogo Minamimoto Masashi Kawaguchi Takeshi Murano Takashi Terauchi Tomio Inoue E. Edmund Kim 《Annals of nuclear medicine》2010,24(7):523-531
Purpose
The aim of this study was to assess the diagnostic performance of 18F-Fluoride positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) compared with bone scintigraphy (BS) planar or BS planar and single photon emission computed tomography (SPECT) in evaluating patients with metastatic bone tumor.Materials and methods
We performed a meta-analysis of all available studies addressing the diagnostic accuracy of 18F-Fluoride PET, 18F-Fluoride PET/CT, BS planar, and BS planar and SPECT for detecting the metastatic bone tumor. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios, and drew summary receiver operating characteristic curves using hierarchical regression models. We also compared the effective dose and cost-effectiveness estimated by data from the enrolled studies between 18F-Fluoride PET or PET/CT and BS planar or BS planar and SPECT.Results
When comparing all studies with data on 18F-Fluoride PET or PET/CT, sensitivity and specificity were 96.2% [95% confidence interval (CI) 93.5–98.9%] and 98.5% (95% CI 97.0–100%), respectively, on a patient basis and 96.9% (95% CI 95.9–98.0%) and 98.0% (95% CI 97.1–98.9%), respectively, on a lesion basis. The Az values of 18F-Fluoride PET or PET/CT were 0.986 for the patient basis and 0.905 for the lesion basis, whereas those of BS or BS and SPECT were 0.866 for the patient basis and 0.854 for the lesion basis. However, the estimated effective dose and average cost-effective ratio were poorer for 18F-Fluoride PET or PET/CT than those of BS planar or BS planar and SPECT.Conclusion
18F-Fluoride PET or PET/CT has excellent diagnostic performance for the detection of metastatic bone tumor, but the estimated effective dose and average cost-effective ratio are at a disadvantage compared with BS planar or BS planar and SPECT. 相似文献8.
Punit Sharma Krishan Kant Agarwal Sourav Kumar Harmandeep Singh Chandrasekhar Bal Arun Malhotra Rakesh Kumar 《Japanese journal of radiology》2013,31(2):81-88
Purpose
To evaluate single photon emission tomography–computed tomography (SPECT-CT) for diagnosis of skull base osteomyelitis (SBO) and to compare this technique with planar bone scintigraphy (BS), SPECT, and CT.Methods
Data from 13 patients with known/suspected SBO were retrospectively analysed. Planar BS and SPECT images were evaluated by an experienced nuclear medicine physician, CT by and experienced radiologist, and SPECT-CT by the nuclear medicine physician and radiologist in consensus. On the basis of diagnostic confidence a score of 1–5 was given, with 1 being definitely osteomyelitis, 2 being probably osteomyelitis, 3 being equivocal, 4 being probably normal, and 5 being definitely normal. ROC analysis areas under the curves (AUC) were calculated. For diagnostic values a score of ≤2 was taken as positive. Clinical/imaging follow-up/microbiology was taken as reference standard.Results
AUC was largest for SPECT-CT (0.977) followed by SPECT (0.909), CT (0.886), and planar BS (0.614). However, no significant difference was found between the techniques except for borderline significance between planar BS with SPECT-CT (P = 0.071) and CT (P = 0.072). Accuracy was 46 % for planar BS, 85 % for SPECT, 77 % for CT and 92 % for SPECT-CT.Conclusion
SPECT-CT seems to be useful, but not superior to planar BS, SPECT, or CT, for diagnosis of SBO. 相似文献9.
Published data on the diagnosis of bone metastases of prostate cancer are conflicting and heterogeneous. We performed a comprehensive meta-analysis to compare the diagnostic performance of choline-PET/CT, MRI, bone SPECT, and bone scintigraphy (BS) in detecting bone metastases in parents with prostate cancer. Pooled sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated both on a per-patient basis and on a per-lesion basis. Summary receiver operating characteristic (SROC) curves were also drawn to obtain the area under curve (AUC) and Q* value. Sixteen articles consisting of 27 studies were included in the analysis. On a per-patient basis, the pooled sensitivities by using choline PET/CT, MRI, and BS were 0.91 [95 % confidence interval (CI): 0.83–0.96], 0.97 (95 % CI: 0.91–0.99), 0.79 (95 % CI: 0.73–0.83), respectively. The pooled specificities for detection of bone metastases using choline PET/CT, MRI, and BS, were 0.99 (95 % CI: 0.93–1.00), 0.95 (95 % CI: 0.90–0.97), and 0.82 (95 % CI: 0.78–0.85), respectively. On a per-lesion basis, the pooled sensitivities of choline PET/CT, bone SPECT, and BS were 0.84 (95 % CI: 0.81–0.87), 0.90 (95 % CI: 0.86–0.93), 0.59 (95 % CI: 0.55–0.63), respectively. The pooled specificities were 0.93 (95 % CI: 0.89–0.96) for choline PET/CT, 0.85 (95 % CI: 0.80–0.90) for bone SPECT, and 0.75 (95 % CI: 0.71–0.79) for BS. This meta-analysis indicated that MRI was better than choline PET/CT and BS on a per-patient basis. On a per-lesion analysis, choline PET/CT with the highest DOR and Q* was better than bone SPECT and BS for detecting bone metastases from prostate cancer. 相似文献
10.
Yuji Nishiyama Ukihide Tateishi Kazuya Shizukuishi Ayako Shishikura Etsuko Yamazaki Hiroto Shibata Tomohiro Yoneyama Yoshiaki Ishigatsubo Tomio Inoue 《Annals of nuclear medicine》2013,27(1):78-83
Purpose
The aim of this study was to report our early experience with 18F-fluoride PET/CT for detecting lesions and evaluate the usefulness of this modality in the assessment of multiple myeloma (MM).Materials and methods
18F-fluoride PET/CT and 99mTc-MDP bone scintigraphy (BS) studies from 7 myeloma patients (4 male and 3 female, mean age 55 years) diagnosed according to standard criteria were reviewed retrospectively. Two reviewers visually and quantitatively analyzed the images and recorded their findings after reaching a consensus. Diagnostic certainty regarding the presence or absence of myeloma lesions was evaluated according to the reference standard consisting of whole-body magnetic resonance imaging and whole-body X-ray.Results
A total of 93 affected areas were definite according to the reference standard. Of these, 83 affected areas (89 %) were identified on 18F-fluoride PET/CT, whereas 54 affected areas (58 %) were found on BS. Mean SUVmax in the affected areas was 9.8 ± 3.2 (standard deviation) ranging from 5.0 to 21.2. A total of s17 lesions with bone fracture were also detected by 18F-fluoride PET/CT and 2 lesions (12 %) were negative on BS.Conclusion
Our result showed that 18F-fluoride PET was a possible modality to detect areas of lesions in patients with MM. 相似文献11.
Hugo J. A. Adams Thomas C. Kwee Bart de Keizer Rob Fijnheer John M. H. de Klerk Rutger A. J. Nievelstein 《European journal of nuclear medicine and molecular imaging》2014,41(3):565-574
Purpose
To systematically review and meta-analyse published data on the diagnostic performance of 18F-FDG PET/CT in detecting bone marrow involvement in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).Methods
PubMed/MEDLINE and Embase were systematically searched for relevant studies. The methodological quality of each study was assessed. Sensitivities and specificities of FDG PET/CT in individual studies were calculated and meta-analysed with a random effects model. A summary receiver operating characteristic curve (sROC) was constructed with the Moses-Shapiro-Littenberg method. Weighted summary proportions of discrepancies between the FDG PET/CT and (blind) bone marrow biopsy (BMB) results among all patients were calculated.Results
Seven studies, with a total of 654 patients with newly diagnosed DLBCL, were included. Overall, the quality of the included studies was moderate. The sensitivity and specificity of FDG PET/CT for detecting bone marrow involvement ranged from 70.8 % to 95.8 % and from 99.0 % to 100 %, with pooled estimates of 88.7 % (95 % confidence interval, CI, 82.5 – 93.3 %) and 99.8 % (95 % CI 98.8 – 100 %), respectively. The area under the sROC curve was 0.9983. The weighted summary proportion of FDG PET/CT-negative patients with positive BMB findings among all patients was 3.1 % (95 % CI 1.8 – 5.0 %) and the weighted summary proportion of FDG PET/CT-positive patients with negative BMB findings among all patients was 12.5 % (95 % CI 8.4 – 17.3 %).Conclusion
FDG PET/CT is accurate and complementary to BMB for detecting bone marrow involvement in patients with newly diagnosed DLBCL. A negative FDG PET/CT scan cannot rule out the presence of bone marrow involvement, but positive FDG PET/CT findings obviate the need for BMB for the detection of bone marrow involvement in these patients. 相似文献12.
Seok-Ho Yoon Ku Sang Kim Seok Yun Kang Hee-Sung Song Kyung Sook Jo Bong-Hoi Choi Su Jin Lee Joon-Kee Yoon Young-Sil An 《Nuclear Medicine and Molecular Imaging》2013,47(1):27-35
Purpose
Bone metastasis is an important factor for the treatment and prognosis of breast cancer patients. Whole-body bone scintigraphy (WBBS) can evaluate skeletal metastases, and 18F-FDG PET/CT seems to exhibit high specificity and accuracy in detecting bone metastases. However, there is a limitation of 18F-FDG PET in assessing sclerotic bone metastases because some lesions may be undetectable. Recent studies showed that 18F-fluoride PET/CT is more sensitive than WBBS in detecting bone metastases. This study aims to evaluate the usefulness of 18F-fluoride PET/CT by comparing it with WBBS and 18F-FDG PET/CT in breast cancer patients with osteosclerotic skeletal metastases.Materials and Methods
Nine breast cancer patients with suspected bone metastases (9 females; mean age ± SD, 55.6 ± 10.0 years) underwent 99mTc-MDP WBBS, 18F-FDG PET/CT and 18F-fluoride PET/CT. Lesion-based analysis of five regions of the skeletons (skull, vertebral column, thoracic cage, pelvic bones and long bones of extremities) and patient-based analysis were performed.Results
18F-fluoride PET/CT, 18F-FDG PET/CT and WBBS detected 49, 20 and 25 true metastases, respectively. Sensitivity, specificity, positive predictive value and negative predictive value of 18F-fluoride PET/CT were 94.2 %, 46.3 %, 57.7 % and 91.2 %, respectively. Most true metastatic lesions on 18F-fluoride PET/CT had osteosclerotic change (45/49, 91.8 %), and only four lesions showed osteolytic change. Most lesions on 18F-FDG PET/CT also demonstrated osteosclerotic change (17/20, 85.0 %) with three osteolytic lesions. All true metastatic lesions detected on WBBS and 18F-FDG PET/CT were identified on 18F-fluoride PET/CT.Conclusion
18F-fluoride PET/CT is superior to WBBS or 18F-FDG PET/CT in detecting osteosclerotic metastatic lesions. 18F-fluoride PET/CT might be useful in evaluating osteosclerotic metastases in breast cancer patients. 相似文献13.
Fuglø HM Jørgensen SM Loft A Hovgaard D Petersen MM 《European journal of nuclear medicine and molecular imaging》2012,39(9):1416-1424
Purpose
To evaluate the feasibility of 18F-FDG PET/CT for initial assessment in high-grade bone sarcomas (BS) and soft tissue sarcomas (STS).Methods
During the years 2001–2010, 89 patients (30 BS, 59 STS) referred for further evaluation and surgical treatment of a high-grade BS or STS also had a PET/CT scan performed for staging preoperatively (n?=?68) or within 1?month of surgery (n?=?21). Metastatic lesions suggested on the PET/CT scan were confirmed or rejected by histological evaluation, by additional imaging or by follow-up. In 68 patients (28 BS, 40 STS) the relationship between the maximal standardized uptake value (SUVmax) of the primary tumour and survival was examined.Results
The PET/CT scan suggested the presence of 13 metastatic lesions in BS patients (5 lymph node, 8 distant) and 21 metastatic lesions (6 lymph node, 15 distant) in STS patients. The calculated sensitivity (SE) and specificity (SP) were 95?% and 96?% for detection of distant metastases, and the predictive value (PV) of a positive or a negative test was 87?% and 98?%, respectively. SE and SP were 100?% and 90?% for detection of lymph node metastases, and the PV of a positive or a negative test was 27?% and 100?%, respectively. The 5-year survival was 81?% among patients with SUVmax below the median value (≤10), but was 33?% among those with SUVmax >10.Conclusion
FDG PET/CT for the initial assessment of patients with high-grade BS or STS was feasible with high SE and SP, but in those with lymph node metastases the PV of a positive test was low. The SUVmax of the primary tumour was a strong prognostic factor for survival. 相似文献14.
Purpose
Whole-body integrated 11C-choline PET/MR might provide advantages compared to 11C-choline PET/CT for restaging of prostate cancer (PC) due to the high soft-tissue contrast and the use of multiparametric MRI, especially for detection of local recurrence and bone metastases.Materials and methods
Ninety-four patients with recurrent PC underwent a single-injection/dual-imaging protocol with contrast-enhanced PET/CT followed by fully diagnostic PET/MR. Imaging datasets were read separately by two reader teams (team 1 and 2) assessing the presence of local recurrence, lymph node and bone metastases in predefined regions using a five-point scale. Detection rates were calculated. The diagnostic performance of PET/CT vs. PET/MR was compared using ROC analysis. Inter-observer and inter-modality variability, radiation exposure, and mean imaging time were evaluated. Clinical follow-up, imaging, and/or histopathology served as standard of reference (SOR).Results
Seventy-five patients qualified for the final image analysis. A total of 188 regions were regarded as positive: local recurrence in 37 patients, 87 regions with lymph node metastases, and 64 regions with bone metastases. Mean detection rate between both readers teams for PET/MR was 84.7% compared to 77.3% for PET/CT (p > 0.05). Local recurrence was identified significantly more often in PET/MR compared to PET/CT by team 1. Lymph node and bone metastases were identified significantly more often in PET/CT compared to PET/MR by both teams. However, this difference was not present in the subgroup of patients with PSA values ≤2 ng/ml.Inter-modality and inter-observer agreement (K > 0.6) was moderate to substantial for nearly all categories. Mean reduction of radiation exposure for PET/MR compared to PET/CT was 79.7% (range, 72.6–86.2%). Mean imaging time for PET/CT was substantially lower (18.4 ± 0.7 min) compared to PET/MR (50.4 ± 7.9 min).Conclusions
11C-choline PET/MR is a robust imaging modality for restaging biochemical recurrent PC and interpretations between different readers are consistent. It provides a higher diagnostic value for detecting local recurrence compared to PET/CT with the advantage of substantial dose reduction. Drawbacks of PET/MR are a substantially longer imaging time and a slight inferiority in detecting bone and lymph node metastases in patients with PSA values >2 ng/ml. Thus, we suggest the use of 11C-choline PET/MR especially for patients with low (≤2 ng/ml) PSA values, whereas PET/CT is preferable in the subgroup with higher PSA values.15.
Kazuhiro Kitajima Yuko Suenaga Yoshiko Ueno Tomonori Kanda Tetsuo Maeda Natsuko Makihara Yasuhiko Ebina Hideto Yamada Satoru Takahashi Kazuro Sugimura 《Annals of nuclear medicine》2014,28(1):25-32
Background
To evaluate the diagnostic value of retrospective image fusion from pelvic magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (PET) in detecting intra-pelvic recurrence of gynecological tumor.Methods
Thirty patients with a suspicion of recurrence of gynecological malignancy underwent inline contrast-enhanced PET/computed tomography (CT) and pelvic contrast-enhanced MRI for restaging. Diagnostic performance about the local recurrence, pelvic lymph node and bone metastasis and peritoneal lesion of PET/low-dose non-enhanced CT (PET/ldCT), PET/full-dose contrast-enhanced CT (PET/ceCT), contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) were evaluated by two experienced readers. Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. McNemar test was employed for statistical analysis.Results
Documented positive locally recurrent disease, pelvic lymph node and bone metastases, and peritoneal dissemination were present in 53.3, 26.7, 10.0, and 16.7 %, respectively. Patient-based sensitivity for detecting local recurrence, pelvic lymph node and bone metastasis and peritoneal lesion were 87.5, 87.5, 100 and 80.0 %, respectively, for fused PET/MRI, 87.5, 62.5, 66.7 and 60.0 %, respectively, for contrast-enhanced MRI, 62.5, 87.5, 66.7 and 80.0 %, respectively, for PET/ceCT, and 50.0, 87.5, 66.7 and 60.0 %, respectively, for PET/ldCT. The sensitivity of diagnosing local recurrence by fused PET/MRI was significantly better than that of PET/ldCT (p = 0.041). The patient-based sensitivity, specificity and accuracy for the detection of intra-pelvic recurrence/metastasis were 91.3, 100 and 93.3 % for fused PET/MRI, 82.6, 100 and 86.7 % for contrast-enhanced MRI, 82.6, 100 and 86.7 % for PET/ceCT and 78.3, 85.7 and 80.0 % for PET/ldCT.Conclusion
Fused PET/MRI combines the individual advantages of MRI and PET, and is a valuable technique for assessment of intra-pelvic recurrence of gynecological cancers. 相似文献16.
Riccardo Del Vescovo Giulia Frauenfelder Francesco Giurazza Claudia Lucia Piccolo Roberto Luigi Cazzato Rosario Francesco Grasso Emiliano Schena Bruno Beomonte Zobel 《La Radiologia medica》2014,119(10):758-766
Purpose
The aim of this study was to compare the results of whole-body diffusion-weighted magnetic resonance (DW-MR) imaging with staging based on computed tomography (CT) and nuclear scintigraphy using Tc99m results as the standard of reference.Methods and materials
Seventeen patients with known malignant tumours were included in the study. The thorax and the abdomen were imaged using breath-hold diffusion-weighted imaging and T1-weighted imaging sequences in the coronal plane. Location and size of osseous metastases were documented by two experienced radiologists. Whole-body DW-MR imaging findings were compared with results obtained at skeletal scintigraphy and CT bone survey.Results
The mean examination time for whole-body DW-MR imaging was 25.5 min. All bone metastases regardless of the size were identified with whole-body DW-MR imaging; MR imaging depicted more bone metastases than CT. Skeletal scintigraphy depicted osseous metastases in 13 patients (with greater sensitivity to the lower limb), whereas whole-body DW-MR imaging revealed osseous metastases in 13 patients (with greater sensitivity to the spine). DW-MR did not show good results for detection of rib cage metastases. The additional osseous metastases seen with MR imaging were confirmed at follow-up examinations and some had a change in therapy. MR identified 22 % more metastatic lesions when compared to bone scintigraphy and 119 % when compared to CT. Bone scintigraphy identified 80 % more metastatic lesions when compared to CT. On a per-patient basis, whole-body DW-MR imaging revealed sensitivity and specificity values of 100 %.Conclusion
Whole-body DW-MR imaging was more sensitive in the detection of osseous metastases than were skeletal scintigraphy and CT bone survey. 相似文献17.
Caecilia S. Reiner Paul Stolzmann Lars Husmann Irene A. Burger Martin W. Hüllner Niklaus G. Schaefer Paul M. Schneider Gustav K. von Schulthess Patrick Veit-Haibach 《European journal of nuclear medicine and molecular imaging》2014,41(4):649-658
Purpose
To compare the accuracy of PET/MR imaging with that of FDG PET/CT and to determine the MR sequences necessary for the detection of liver metastasis using a trimodality PET/CT/MR set-up.Methods
Included in this single-centre IRB-approved study were 55 patients (22 women, age 61?±?11 years) with suspected liver metastases from gastrointestinal cancer. Imaging using a trimodality PET/CT/MR set-up (time-of-flight PET/CT and 3-T whole-body MR imager) comprised PET, low-dose CT, contrast-enhanced (CE) CT of the abdomen, and MR with T1-W/T2-W, diffusion-weighted (DWI), and dynamic CE imaging. Two readers evaluated the following image sets for liver metastasis: PET/CT (set A), PET/CECT (B), PET/MR including T1-W/T2-W (C), T1-W/T2-W with either DWI (D) or CE imaging (E), and a combination (F). The accuracy of each image set was determined by receiver-operating characteristic analysis using image set B as the standard of reference.Results
Of 120 liver lesions in 21/55 patients (38 %), 79 (66 %) were considered malignant, and 63/79 (80 %) showed abnormal FDG uptake. Accuracies were 0.937 (95 % CI 89.5 – 97.9 %) for image set A, 1.00 (95 % CI 99.9 – 100.0 %) for set C, 0.998 (95 % CI 99.4 – 100.0 %) for set D, 0.997 (95 % CI 99.3 – 100.0 %) for set E, and 0.995 (95 % CI 99.0 – 100.0 %) for set F. Differences were significant for image sets D – F (P?<?0.05) when including lesions without abnormal FDG uptake. As shown by follow-up imaging after 50 – 177 days, the use of image sets D and both sets E and F led to the detection of metastases in one and three patients, respectively, and further metastases in the contralateral lobe in two patients negative on PET/CECT (P?=?0.06).Conclusion
PET/MR imaging with T1-W/T2-W sequences results in similar diagnostic accuracy for the detection of liver metastases to PET/CECT. To significantly improve the characterization of liver lesions, we recommend the use of dynamic CE imaging sequences. PET/MR imaging has a diagnostic impact on clinical decision making. 相似文献18.
Tsutomu Sugihara Mitsuru Koizumi Masamichi Koyama Takashi Terauchi Naoya Gomi Yoshinori Ito Kiyohiko Hatake Naohiro Sata 《Annals of nuclear medicine》2017,31(10):719-725
Background
This study aimed to compare the detection of bone metastases from breast cancer on F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and bone scintigraphy (BS). An explorative search for factors influencing the sensitivity or uptake of BS and FDG-PET was also performed.Methods
Eighty-eight patients with bone metastases from breast cancer were eligible for this study. Histological confirmation of bone metastases was obtained in 31 patients. The bone metastases were visually classified into four types based on their computed tomography (CT) appearance: osteoblastic, osteolytic, mixed, and negative. The sensitivity of BS and FDG-PET were obtained regarding CT type, adjuvant therapy, and the primary tumor characteristics. The FDG maximum standardized uptake value (SUVmax) was analyzed.Results
The sensitivities of the three modalities (CT, BS, and FDG-PET) were 77, 89, and 94%, respectively. The sensitivity of FDG-PET for the osteoblastic type (69%) was significantly lower than that for the other types (P < 0.001), and the sensitivity of BS for the negative type (70%) was significantly lower than that for the others. Regarding tumor characteristics, the sensitivity of FDG-PET significantly differed between nuclear grade (NG)1 and NG2–3 (P = 0.032). The SUVmax of the osteoblastic type was significantly lower than that of the other types (P = 0.009). The SUVmax of NG1 was also significantly lower than that of NG2–3 (P = 0.011). No significant difference in FDG uptake (SUVmax) was detected between different histological types.Conclusion
Although FDG-PET is superior to BS for the detection of bone metastases from breast cancer, this technique has limitations in depicting osteoblastic bone metastases and NG1.19.
Teik Hin Tan Boon Nang Lee Siti Zarina Amir Hassan 《Nuclear Medicine and Molecular Imaging》2014,48(3):212-215
Purpose
In neuroendocrine liver metastases of unknown primary, a multimodality approach is usually adopted and consists of transabdominal ultrasound, endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine techniques, endoscopy and exploratory surgery. The purpose of the study is to evaluate the diagnostic value of 68Ga-DOTATATE positron emission tomography (PET)/CT as part of a multimodality approach in neuroendocrine liver metastases of unknown primary.Materials and Methods
Six patients (M:F?=?5:1, age range 28–56 years) with immunohistochemically proven neuroendocrine liver metastases but inconclusive initial CT work-up were retrospectively analysed. Clinical finding, histopathology, comparative imaging and follow-up were used to validate the results when ethically justified.Results
68Ga-DOTATATE PET/CT identified the primary tumour in five out of six (83.3 %) patients: pancreas (n?=?4) and stomach (n?=?1). Out of three patients with indeterminate primary on initial CT, two patients were confirmed by 68Ga-DOTATATE PET/CT. Absence of uptake in indeterminate primary of one patient was later confirmed negative by histopathology. In another three patients with undetected primary on initial CT, primary site was demonstrated in all patients with unsuspected metastases in two patients on 68Ga-DOTATATE PET/ CT. No further work-up was done to confirm the primary in patients with distant metastases. Change of management was observed in three out of six (50 %) patients.Conclusion
Our small study indicates that 68Ga-DOTATATE PET/CT is a promising diagnostic option in the multimodality approach to neuroendocrine liver metastases of unknown primary origin. 相似文献20.