Disseminated osteomyelitis or bone metastases of breast cancer: 18F-FDG-PET/CT helps unravel an unusual presentation

We present a case wherein striking ¹⁸F-FDG-PET/CT findings initially considered consistent with recurrent disseminated skeletal metastases of breast cancer were later identified as an unusual presentation of disseminated chronic pyogenic osteomyelitis with Staphylococcus aureus and warneri identified on microbiological culture. A 76-year-old female with previous history of breast cancer presented with a 6-month history of pyrexia, myalgia and weight loss. Besides neutrophilia and elevated C-reactive protein, other blood indices, cultures and conventional imaging failed to identify the cause of pyrexia of unknown origin (PUO). ¹⁸F-FDG-PET/CT demonstrated multiple widespread foci of intense FDG uptake in lytic lesions throughout the skeleton. Coupled with previous history of malignancy, findings were strongly suggestive of disseminated metastases of breast cancer. Through targeting an FDG avid lesion, ¹⁸F-FDG-PET/CT aided CT-guided biopsy, which instead identified the lesions as chronic pyogenic osteomyelitis. Following prolonged antibiotic therapy, repeat ¹⁸F-FDG-PET/CT demonstrated significant resolution of lesions. This case demonstrated an unusual presentation of disseminated osteomyelitis on ¹⁸F-FDG-PET/CT and highlighted the use of ¹⁸F-FDG-PET/CT as a trouble shooter in PUO but demonstrated that unusual presentations of benign or malignant pathologies cannot always reliably be differentiated on imaging alone without aid of tissue sampling. Furthermore, this case highlights the potential role ¹⁸F-FDG-PET/CT could provide in assessing response to antibiotic therapy.     

Evolving role of F-FDG-PET/CT for the body tumor and metastases in pediatrics

¹⁸F-FDG-positron emission tomography-computerized tomography (¹⁸F-FDG-PET/CT) scan is an important imaging tool which may provide both functional and anatomical information in a single diagnostic test. It has the potential to be a valuable tool in the noninvasive evaluation and monitoring of pediatric tumors including the metastases because ¹⁸fluorodeoxyglucose (¹⁸F-FDG) is a glucose analogue that concentrates in areas of active metabolic activity. This review provides an update on functional and metabolic imaging approaches for assessment and management of the body tumor and metastases in pediatrics using a combined whole body ¹⁸F-FDG-PET/CT scanners. We discuss the benefits include improved pediatric patients’ outcome facilitated by staging and monitoring of disease and better treatment planning. It is worth to concern the preparation of children undergoing PET studies and radiation dosimetry and its implications for family and caregivers. It is important to consider the normal distribution of ¹⁸FDG in children, common variations of the normal distribution. We show some of our cases that most tumors in children accumulate and retain FDG, allowing high-quality images of their distribution and pathophysiology either at the primary site as well as in the areas of metastatic disease.     

<Superscript>18</Superscript>F-FDG-PET/CT for systemic staging of newly diagnosed triple-negative breast cancer

Purpose

National Comprehensive Cancer Network guidelines recommend ¹⁸F-FDG-PET/CT, in addition to standard staging procedures, for systemic staging of newly diagnosed stage III breast cancer patients. However, factors in addition to stage may influence PET/CT utility. As breast cancers that are negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor (triple-negative breast cancer, or TNBC) are more aggressive and metastasize earlier than other breast cancers, we hypothesized that receptor expression may be one such factor. This study assesses ¹⁸F-FDG-PET/CT for systemic staging of newly diagnosed TNBC.

Methods

In this Institutional Review Board-approved retrospective study, our Healthcare Information System was screened for patients with TNBC who underwent ¹⁸F-FDG-PET/CT in 2007–2013 prior to systemic or radiation therapy. Initial stage was determined from mammography, ultrasound, magnetic resonance imaging, and/or surgery, if performed prior to ¹⁸F-FDG-PET/CT. ¹⁸F-FDG-PET/CT was evaluated to identify unsuspected extra-axillary regional nodal and distant metastases, as well as unsuspected synchronous malignancies. Kaplan Meier survival estimates were calculated for initial stage IIB patients stratified by whether or not stage 4 disease was detected by ¹⁸F-FDG-PET/CT.

Results

A total of 232 patients with TNBC met inclusion criteria. ¹⁸F-FDG-PET/CT revealed unsuspected distant metastases in 30 (13 %): 0/23 initial stage I, 4/82 (5 %) stage IIA, 13/87 (15 %) stage IIB, 4/23 (17 %) stage IIIA, 8/14 (57 %) stage IIIB, and 1/3 (33 %) stage IIIC. Twenty-six of 30 patients upstaged to IV by ¹⁸F-FDG-PET/CT were confirmed by pathology, with the remaining four patients confirmed by follow-up imaging. In addition, seven unsuspected synchronous malignancies were identified in six patients. Initial stage 2B patients who were upstaged to 4 by ¹⁸F-FDG-PET/CT had significantly shorter survival compared to initial stage 2B patients who were not (3-year Kaplan Meier estimate 0.33, 95 % CI 0.13-0.55 versus 0.97, CI 0.76-0.93, p?<?.0001).

Conclusion

F-FDG-PET/CT revealed distant metastases in 15 % of patients with stage IIB TNBC. Stage IIB patients upstaged to 4 by ¹⁸F-FDG-PET/CT had significantly shorter survival than those who were not, consistent with ¹⁸F-FDG-PET/CT detecting an increased burden of disease. This study provides further evidence that populations of patients with stage IIB breast cancer, such as TNBC, should be considered for systemic staging with ¹⁸F-FDG-PET/CT at the time of initial diagnosis.

     

F-FDG-PET/CT in staging,restaging, and treatment response assessment of male breast cancer

Purpose

Male breast cancer (BC) is a rare disease, with patterns different from those found in women. Most tumors are detected at more advanced stages than in women. The aim of this study was to analyze the performance of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) in staging, restaging, and therapy response assessment.

Methods

We performed a systematic analysis in the database of Saint-Louis Hospital to identify male patients with BC referred for PET/CT. ¹⁸F-FDG-PET/CT findings considered suspicious for malignancy were compared to biopsy results, further work-up and/or patient follow-up of at least 6 months. Performances of ¹⁸F-FDG-PET/CT were compared to that of conventional imaging (CI) using the McNemar test. The impact of PET/CT on management was evaluated.

Results

During 6 consecutive years, among 12,692 ¹⁸F-FDG-PET/CT oncology studies, 30 were performed in 15 men with BC: 7 examinations for initial staging, 11 for restaging, and 12 for response assessment. Tumors profile was ER+ and one had HER2 overexpression. PET/CT sensitivity, specificity, positive predictive value, negative predictive value and accuracy to detect distant metastases were 100%, 67%, 86%, 100% and 89%, respectively. PET/CT was more informative than CI in 40% of studies (p = 0.03; 95% confidence interval: 3.26 – 40%). Findings from ¹⁸F-FDG-PET/CT led to modification in the planned treatment in 13/30 cases (43%).

Conclusion

Although all the tumors were ER+, primary lesions and metastases were diagnosed with high sensitivity. ¹⁸F-FDG-PET/CT seems to be a powerful imaging method to perform staging, restaging and treatment response assessment in male patients with BC.     

Skin Manifestation of Unsuspecting Prostate Cancer Detected by 18F-FDG PET/CT Performed To Assess Underlying Multiple Myeloma

Background: Skin metastases from either prostate adenocarcinoma or multiple myeloma rarely occur. We report the case of a 73-year-old man with multiple myeloma who presented with multiple subcutaneous nodules 3 years after his initial diagnosis. Methods: Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging was suggestive of a concomitant second primary from the prostate. Results: This case highlights not only a rare initial manifestation of prostate cancer, but also the role of 18F-FDG-PET/CT in detecting a clinically unsuspected second malignancy. Conclusion: It potentially corroborates the possible association of both diseases, as has been reported before.     

Comparison between skeletal muscle and adipose tissue measurements with high-dose CT and low-dose attenuation correction CT of 18F-FDG PET/CT in elderly Hodgkin lymphoma patients: a two-centre validation

Objectives:High-dose CT (HDCT) is considered the gold-standard imaging for the measurements of skeletal muscle area (SMA), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and intramuscular adipose tissue (IMAT) areas in the abdomen. These parameters may reflect sarcopenia, which can have a prognostic impact in several oncological diseases. The aim of this study was to compare the agreement of measurements of SMA, VAT, SAT and IMAT areas between HDCT and low-dose CT (LDCT) of 18-fludeoxyglucose positron emission tomography (¹⁸F-FDG PET)/CT in elderly patients affected by Hodgkin lymphoma (HL).Methods:We retrospectively included 90 patients affected by HL who underwent baseline ¹⁸F-FDG-PET/CT and HDCT within a mean interval of 7 days. HDCT and LDCT images were analysed by two blinded observers using segmentation software (Slice-O-Matic, Tomovision) to quantify the areas. HDCT and LDCT measurements were compared using Bland–Altman plots and Passing-Bablock regression analyses. Pearson correlation coefficient (r) was used to correlate measurements from the two imaging modalities.Results:Comparison of HDCT and LDCT data demonstrated a strong correlation for measurement of VAT(r = 0.942, p < 0.0001), SAT (r = 0.894, p < 0.0001) and SMA (r = 0.934, p < 0.0001). Instead considering IMAT, correlation was good but less significant (r = 0.742). The mean difference between the two methods was found to be very small, with a difference of 1% for SAT,+6.1% for VAT,+2.5% for SMA and −1.9% for IMAT.Conclusion:LDCT of PET/CT is a safe, accurate and precise method for the measurements of skeletal muscle area, visceral and subcutaneous adipose tissue. Their measurements are reproducible and correlate closely with HDCT.Advances in knowledge:LLDCT of PET/CT is a safe and accurate method for the measurements of SMA, VAT and SAT; their measurements are closely correlated with HDCT. LDCT can be considered an accurate alternative tool for measuring abdominal fat and muscles in the clinical practice.     

18F-Fluorodeoxyglucose positron emission tomography/computed tomography findings in a patient with human immunodeficiency virus-associated Castleman’s disease and Kaposi sarcoma, disorders associated with human herpes virus 8 infection

We report a case of a 38-year-old man affected by the human immunodeficiency virus (HIV) with a diagnosis of Castleman’s disease, plasmablastic type human herpes virus 8 infection, and Kaposi sarcoma based on a histological examination of one cervical lymph node biopsy. The patient underwent ¹⁸F-2-fl uoro-2-deoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT). ¹⁸F-FDG-PET/ CT seems to be a valuable tool in patients with HIV-associated Castleman’s disease and Kaposi sarcoma. It allows accurate staging and identifies more sites of disease than conventional CT.     

The impact of <Superscript>18</Superscript>F-FDG PET/CT in patients with liver metastases

Purpose The aim of this study was to assess the performance of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) versus dedicated contrast-enhanced CT (CECT) in the detection of metastatic liver disease. Methods All patients that presented to our Institution with suspected metastatic liver disease who underwent ¹⁸F-FDG PET/CT and CECT within 6 weeks of each other, were retrospectively analyzed, covering a 5-year period. One hundred and thirty-one patients (67 men, 64 women; mean age 62) were identified. Seventy-five had colorectal carcinoma and 56 had other malignancies. The performance of CECT and that of ¹⁸F-FDG-PET/CT in detecting liver metastases were compared. The ability of each to detect local recurrence, extrahepatic metastases and to alter patient management was recorded. The final diagnosis was based on histology, clinical and radiological follow-up (mean 23 months). Results In detecting hepatic metastases, ¹⁸F-FDG-PET/CT yielded 96% sensitivity and 75% specificity, whilst CECT showed 88% sensitivity and 25% specificity. ¹⁸F-FDG-PET/CT and CECT were concordant in 102 out of 131 patients (78%). In the colorectal group ¹⁸F-FDG-PET/CT showed 94% sensitivity and 75% specificity, whilst CECT had 91% sensitivity and 25% specificity. In the noncolorectal group ¹⁸F-FDG-PET/CT showed 98% sensitivity and 75% specificity whilst CECT had 85% sensitivity and 25% specificity. Overall, ¹⁸F-FDG-PET/CT altered patient management over CECT in 25% of patients. CECT did not alter patient management over ¹⁸F-FDG-PET/CT alone in any patients. Conclusion ¹⁸F-FDG-PET/CT performed better in detecting metastatic liver disease than CECT in both colorectal and noncolorectal malignancies, and frequently altered patient management. The future role of CECT in these patients may need to be re-evaluated to avoid potentially unnecessary duplication of investigation where ¹⁸F-PET/CT is readily available. Authors stated no financial relationship to disclose     

18F-FDG-PET in patients with malignant lymphoma having long-term follow-up: staging and restaging, and evaluation of treatment response and recurrence

Objective  The aim of this study was to evaluate the diagnostic accuracy of positron emission tomography (PET) with 2-[¹⁸F]fluoro-2-deoxy-d-glucose (¹⁸F-FDG) for staging/restaging, evaluating the treatment response, and screening of recurrence in patients with malignant lymphoma (ML) during long-term follow-up, and to compare that with computer tomography (CT)/magnetic resonance imaging (MRI). Methods  The study was conducted in 59 ML patients who underwent whole-body ¹⁸F-FDG-PET examinations three times or more from October 1998 to August 2006. The location of the lesions in the patients with positive findings on ¹⁸F-FDG-PET and/or the corresponding CT/MRI was classified into supradiaphragmatic (n = 10), infradiaphragmatic (n = 7), and extranodal sites (n = 20), and the findings were compared on a site basis according to the gold standard, which consisted of all clinical information available, including follow-up results. Results  A total of 156 ¹⁸F-FDG-PET examinations for which the corresponding CT/MRI images were also available were evaluated, and a total of 305 sites showed positive findings on ¹⁸F-FDG-PET and/or CT/MRI. Concordant positive findings were obtained in 76% for staging/restaging, 34% for evaluation of the treatment response, and 50% for screening of recurrence. The accuracy of ¹⁸F-FDG-PET versus CT/MRI was 92% versus 84% (P = 0.06) for staging/restaging, 84% versus 50% (P < 0.05) for the evaluation of the treatment response, and 83% versus 72% (P = 0.21) for the screening of recurrence. At pathologic sites with discrepant findings between ¹⁸F-FDG-PET and CT/MRI (n = 122), the frequency of accurate diagnosis by ¹⁸F-FDG-PET (76%) was higher than that by CT/MRI (24%), especially for the evaluation of the treatment response. Conclusions   ¹⁸F-FDG-PET is expected to play a significant role in the management of ML patients even after effective treatment is initiated.     

Whole-body-MR imaging including DWIBS in the work-up of patients with head and neck squamous cell carcinoma: A feasibility study

Objectives

To assess the feasibility of whole-body magnetic resonance imaging (WB-MRI) including diffusion-weighted whole-body imaging with background-body-signal-suppression (DWIBS) for the evaluation of distant malignancies in head and neck squamous cell carcinoma (HNSCC); and to compare WB-MRI findings with ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) and chest-CT.

Methods

Thirty-three patients with high risk for metastatic spread (26 males; range 48–79 years, mean age 63 ± 7.9 years (mean ± standard deviation) years) were prospectively included with a follow-up of six months. WB-MRI protocol included short-TI inversion recovery and T1-weighted sequences in the coronal plane and half-fourier acquisition single-shot turbo spin-echo T2 and contrast-enhanced-T1-weighted sequences in the axial plane. Axial DWIBS was reformatted in the coronal plane. Interobserver variability was assessed using weighted kappa and the proportion specific agreement (PA).

Results

Two second primary tumors and one metastasis were detected on WB-MRI. WB-MRI yielded seven clinically indeterminate lesions which did not progress at follow-up. The metastasis and one second primary tumor were found when combining ¹⁸F-FDG-PET/CT and chest-CT findings. Interobserver variability for WB-MRI was κ = 0.91 with PA ranging from 0.82 to 1.00. For ¹⁸F-FDG-PET/CT κ could not be calculated due to a constant variable in the table and PA ranged from 0.40 to 0.99.

Conclusions

Our WB-MRI protocol with DWIBS is feasible in the work-up of HNSCC patients for detection and characterization of distant pathology. WB-MRI can be complementary to ¹⁸F-FDG-PET/CT, especially in the detection of non ¹⁸F-FDG avid second primary tumors.     

18F-FDG-PET/CT in patients with breast cancer and rising Ca 15-3 with negative conventional imaging: A multicentre study

ObjectivesBreast cancer is the second cause of death in women in Europe and North America. The mortality of this disease can be reduced with effective therapy and regular follow up to detect early recurrence. Tumor markers are sensitive in detecting recurrent or residual disease but imaging is required to customize the therapeutic option. Rising tumor markers and negative conventional imaging (US, X-mammography, CT and MR) poses a management problem. Our aim is to assess the role of ¹⁸F-FDG-PET/CT in the management of post-therapy patients with rising markers but negative conventional imaging.Materials and methodsIn the period from January 2008 to September 2009, 89 female patients with breast cancer who developed post-therapy rising markers (serum Ca 15-3 levels = 64.8 ± 16.3 U/mL) but negative clinical examination and conventional imaging were investigated with ¹⁸F-FDG-PET/CT.ResultsTumor deposits were detected in 40/89 patients in chest wall, internal mammary nodes, lungs, liver and skeleton. The mean SUVmax value calculated in these lesions was 6.6 ± 1.7 (range 3.1–12.8). In 23/40 patients solitary small lesion were amenable to radical therapy. In 7 out of these 23 patients a complete disease remission lasting more than 1 year was observed.Conclusions¹⁸F-FDG-PET/CT may have a potential role in asymptomatic patients with rising markers and negative conventional imaging. Our findings agree with other studies in promoting regular investigations such as tumor markers and ¹⁸F-FDG-PET/CT rather than awaiting the developments of physical symptoms as suggested by current guidelines since the timely detection of early recurrence may have a major impact on therapy and survival.     

Tumor thrombus in the inferior vena cava from colon cancer detected by <Superscript>18</Superscript>F-FDG-PET

We present a case of inferior vena cava (IVC) tumor thrombus detected by fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET). A man underwent operations for the treatment of sigmoid colon cancer at the age of 63. Because tumor markers [carcinoembryonic antigen (CEA) and CA19-9] were increased at the age of 67, abdominal contrast-enhanced computed tomography (CT) was performed. CT revealed IVC dilatation, including a low-attenuation area. ¹⁸F-FDG-PET was performed to make the differential diagnosis between tumor thrombus and clot. ¹⁸F-FDG-PET showed that ¹⁸F-FDG had accumulated in the IVC region. We considered the IVC tumor thrombus because of the ¹⁸F-FDG uptake in the IVC region and the patient's clinical course. To our knowledge, there are a few reports concerning ¹⁸F-FDG-PET and IVC tumor thrombus. ¹⁸F-FDG-PET may be useful in diagnosing tumor thrombus.     

Subcutaneous panniculitis-like T-cell lymphoma with breast involvement: functional and morphological imaging findings

Panniculitis-like T-cell lymphoma is a very uncommon subtype of cutaneous T-cell lymphomas. In this case report, we describe the morphological (CT and MRI) and functional (¹⁸F-FDG-PET and bone scan) imaging findings in a 35-year-old patient who suffered from slowly progressing multiple subcutaneous lesions caused by this rare disease.According to the World Health Organization–European Organization for Research and Treatment of Cancer (WHO–EORTC) classification, subcutaneous panniculitis-like T-cell lymphomas (SPTCLs) belong to the group of cutaneous T-cell and natural killer (NK)-cell lymphomas [1]. Less than 1% of all non-Hodgkin lymphomas (NHLs) are SPTCLs. Recent studies differentiate distinct subtypes of SPTCL each with a different prognosis [2]. Only a few reports describe the imaging of primary cutaneous T-cell lymphomas [3–8], even fewer with the imaging of subcutaneous involvement in SPTCLs [4, 9–11]. In this case report, we describe panniculitis-like T-cell lymphoma as a very rare cause of unclear subcutaneous soft-tissue indurations. We detail the morphological and functional CT, MRI, ¹⁸F-FDG-PET and bone scan findings relating to multiple panniculitic lesions in a 35-year-old female patient suffering from this uncommon subgroup of lymphoma.     

Multimodal imaging with <Superscript>18</Superscript>F-FDG-PET/CT and <Superscript>111</Superscript>In-Octreotide SPECT in patients with metastatic medullary thyroid carcinoma

Objective

The aim of our study was to determine the role of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) and indium-111 Octreotide single photon emission tomography (¹¹¹In-Octreotide SPECT) in the evaluation of metastatic medullary thyroid carcinoma (MMTC).

Methods

Twenty-five MMTC patients were retrospectively evaluated. All patients had undergone whole-body ¹⁸F-FDG-PET/CT including 20 who had also undergone ¹¹¹In-Octreotide SPECT within a maximum interval of 6 weeks. Diagnostic contrast-enhanced computed tomography (CT) alone or as part of ¹⁸F-FDG-PET/CT examination was performed in all patients.

Results

Contrast-enhanced CT detected a total of 131 lesions including 79 enlarged lymph nodes and 14 bone lesions. ¹⁸F-FDG-PET/CT visualized a total of 92 true positive lesions (SUV_max range 1.1–10.0, mean 4.0 ± 1.7) including 66 lymph nodes, 7 of which were not enlarged on CT, and 8 bone metastases. In the 20 patients studied with both techniques, a total of 64 and 46 true positive lesions were detected by ¹⁸F-FDG-PET/CT and ¹¹¹In-Octreotide SPECT, respectively. In particular, ¹⁸F-FDG uptake was found in 43 lymph nodes and in 7 bone metastases whereas ¹¹¹In-Octreotide uptake was detected in 27 lymph nodes and in 10 bone metastases.

Conclusions

In MMTC patients, ¹⁸F-FDG-PET/CT provides a useful contribution mainly in evaluating lymph node involvement whereas ¹¹¹In-Octreotide SPECT can contribute to the detection and somatostatin receptor characterization especially of bone lesions.

     

The role of <Superscript>18</Superscript>F-FDG PET/CT in the detection of osteosarcoma recurrence

Aim

The aim of this study was to investigate the diagnostic accuracy of ¹⁸F-FDG-PET/CT in osteosarcoma patients suspicious for disease recurrence after adequate surgical therapy.

Methods

Inclusion criteria were: a) adequate surgical treatment for proven osteosarcoma and documented complete remission after therapy; b) ¹⁸F-FDG-PET/CT performed during follow-up for clinical/diagnostic suspicion of relapse; c) new surgical treatment with excision of the suspected lesions; d) histological validation of ¹⁸F-FDG-PET/CT findings. Thirty-seven patients matching all inclusion criteria were retrospectively enrolled (20 men and 17 female). Primary surgical treatment consists of resection (31 cases) or amputation (six cases). ¹⁸F-FDG-PET/CT performance was assessed with a per-patient and per-site evaluation of sensitivity, specificity, accuracy, positive predicting value (PPV), and negative predicting value (NPV). The sites of relapse were classified as local, lung, lymphnodes (LNs), and distant (other skeletal segments and/or distant soft tissue). The disease-free survival (DFS) and the overall survival (OS) after 18F-FDG PET/CT were evaluated.

Results

¹⁸F-FDG-PET/CT was positive in 89.2% (33/37) of patients. Local uptake only was observed in 35.1% patients (13/37); lung uptake only in 18.9% (7/37); distant uptake only in 2.7% (1/37) case; multiple sites of uptake in 32.4% (12/37). Histology resulted positive in 92% (34/37) of patients. A total of 51 pathologic lesions were evaluated (22 local relapse, 11 lung metastasis, 10 metastatic LNs, eight distant metastatic lesions). On a per-patient analysis ¹⁸F-FDG-PET/CT showed a sensitivity, specificity, accuracy, PPV, and NPV of 91%, 75%, 89%, 97%, 50%. On a per-site analysis the performance for local relapse was 96%, 100%, 97%, 100%, 93%, while for lung relapse detection was 80%, 100%, 92%, 100%, 88%. The mean follow-up after ¹⁸F-FDG-PET/CT was 21.5 months. At the last follow-up, 19% (7/37) of patients were death with disease, 38% (14/37) were alive with disease, and 43% (16/37) had no evidence of disease. Overall survival was 90% and 75% at 24 and 60 months, respectively.

Conclusion

¹⁸F-FDG-PET/CT showed valuable results for detecting recurrence(s) in osteosarcoma patients with suspicious of relapse after treatment, particularly in the detection of local relapse and lung metastasis.

     

Adrenocortical oncocytoma displaying intense activity on <Superscript>18</Superscript>F-FDG-PET: a case report and a literature review

We report on the ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) findings in a case of adrenocortical oncocytoma, a rare tumor of the adrenal gland with the literature review of other imaging findings including ultrasonography, computed tomography, and magnetic resonance imaging. To our knowledge, there have been no reports published in the English literature about ¹⁸F-FDG-PET findings in adrenocortical oncocytoma.     

Adherence to pretreatment and intratreatment imaging of head and neck squamous cell carcinoma patients undergoing (chemo) radiotherapy in a research setting

PurposeThe emerge of improved personalized treatment adaptations and outcome prediction is accompanied with increasing non-invasive assessments in early treatment phase, leading to increased patient burden. This study assessed the adherence of patients with head and neck squamous cell carcinoma (HNSCC) to undergo pretreatment and research-related intratreatment imaging, and assessed which factors caused drop-out.MethodBetween 2013 and 2019, advanced-staged HNSCC patients were prospectively included, underwent (chemo) radiotherapy with curative intent and planned for both pre-treatment and intratreatment sequential 18F-FDG-PET/CT, 18F-FDG-PET/MRI and thereafter MRI (including DWI/DCE). Drop-out-factors were described as healthcare-related (logistics and imaging-system defects) and patient-related (psychological, physical, not-specified). Common Toxicity Criteria (CTC) were routinely scored by radiation/medical oncologists throughout the first 3 weeks, and compared between patient drop-outs and who complete imaging.ResultsNinety-seven patients (mean age 61 ± 6.8 years) were included; 95 patients (97.9%) underwent pretreatment imaging and 63 (64.9%) intratreatment imaging. For 18F-FDG-PET/CT, 18F-FDG-PET/MRI and MRI pretreatment drop-outs were 2, 10 and 3 patients and for intratreatment drop-outs were 34, 39 and 35 patients, respectively. Patient-related drop-out-factors were physical (n = 16, e.g. dysphagia), psychological (n = 6, e.g. claustrophobia) and non-specified (n = 12). Healthcare-related drop-out-factors were logistics (n = 6) and 18F-FDG-PET/CT-/MRI-system defects (n = 2). The CTC mucosal toxicity was significantly higher (p = 0.023) at week 2 of (chemo)radiotherapy in patient drop-outs than with complete imaging.ConclusionsThe drop-out frequency of advanced-staged HNSCC patients for imaging during (chemo)radiotherapy in a research-setting was high and mainly patient-related. Treatment of patient-related inconveniences, communication of rationale and healthcare-related imaging protocol efficiency improvements may contribute to improved adherence.     

Drug-induced pneumonitis detected earlier by 18F-FDG-PET than by high-resolution CT: a case report with non-Hodgkin’s lymphoma

Drug-induced pneumonitis is a serious and an unpredictable side effect of chemotherapy in patients with malignant lymphoma. We present the case of a 51-year-old man who developed drug-induced pneumonitis during chemotherapy for non-Hodgkin’s lymphoma in which pneumonitis was detected earlier by ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) than by high-resolution computed tomography (HRCT). After five courses of chemotherapy, ¹⁸F-FDG-PET was performed for assessing residual lesions, and diffuse lung uptake was incidentally observed. No symptoms were present, and HRCT performed immediately following PET revealed no abnormalities. Mild dyspnea appeared 3 days after PET, and additional HRCT revealed patchy ground-glass opacities disseminated with the appearance of interlobular septum thickening. Drug-induced pneumonitis was finally diagnosed, and treatment was initiated. ¹⁸F-FDG-PET can be an imaging modality for detecting drug-induced pneumonitis at an extremely early stage in which HRCT is incapable of revealing any abnormal changes.     

The clinical efficacy of <Superscript>18</Superscript>F-FDG-PET/CT in benign and malignant musculoskeletal tumors

Objective  Most of the current clinical data on the role of 2-[¹⁸F]fluoro-2-deoxy-d-glucose positron emission tomography (¹⁸F-FDG-PET) in musculoskeletal tumors come from patients studied with PET and less frequently with hardware fusion PET/computed tomography (CT). And the number of cases in each report is too small to clarify the exact clinical efficacy of PET or PET/CT. This prompted us to analyze our experience with ¹⁸F-FDG-PET/CT in a relatively large group of patients with musculoskeletal tumors. Methods   ¹⁸F-FDG-PET/CT was performed on 91 patients from May 2004 to June 2007. The final diagnosis was obtained from surgical biopsy in 83 patients (91%) and clinical follow-up in 8 (9%). We analyzed the characteristics and amount of ¹⁸F-FDG uptake in soft tissue and bone tumors, and investigated the ability of ¹⁸F-FDG-PET/CT to differentiate malignant from benign tumors. The cutoff maximum standardized uptake value (SUV_max) was calculated using the receiver-operation characteristic curve method. Sensitivity, specificity, and diagnostic accuracy were calculated with cutoff SUV_max and the final diagnosis. Unpaired t test was used for the statistical analysis. Results  Final diagnosis revealed 19 benign soft tissue tumors (mean SUV_max 4.7), 27 benign bone tumors (5.1), 25 malignant soft tissue tumors (8.8), and 20 malignant bone tumors (10.8). There was a significant difference in SUV_max between benign and malignant musculoskeletal tumors in total (P < 0.002), soft tissue tumors (P < 0.05), and bone tumors (P < 0.02). Sensitivity, specificity, and diagnostic accuracy were 80%, 65.2%, and 73% in total with cutoff SUV_max 3.8, 80%, 68.4%, and 75% in the soft tissue tumors with cutoff SUV_max 3.8, and 80%, 63%, and 70% in the bone tumors with cutoff SUV_max 3.7. Conclusions   ¹⁸F-FDG-PET/CT reliably differentiated malignant soft tissue and bone tumors from benign ones, although there were many false-positive and falsenegative lesions. Further studies with all kinds of musculoskeletal tumors in large numbers are needed to improve the diagnostic accuracy of ¹⁸F-FDG-PET/CT.     

Role of <Superscript>18</Superscript>F-fluorodeoxyglucose positron emission tomography/computed tomography in patients affected by differentiated thyroid carcinoma,high thyroglobulin level,and negative <Superscript>131</Superscript>I scan: review of the literature

Differentiated thyroid carcinoma (DTC) is a slow-growing tumor that represents 1% of all malignant tumors and is the most frequent endocrine cancer. ¹⁸F-Fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) imaging is an increasingly important imaging tool in oncology and is still under investigation in numerous studies looking into its efficacy and cost-effectiveness. Despite the fact that ¹⁸F-FDG-PET/CT has been shown to be a powerful and accurate diagnostic tool in patients affected by DTC with high serum thyroglobulin (Tg) levels and negative radioiodine (¹³¹I) total body scan, its definitive role is not completely clear, in particular regarding the role of thyroid stimulating hormone (TSH) and Tg value “cutoff” over which is better to perform the study. In this review, these issues are analyzed to clarify controversial aspects and identify established cornerstones. In particular, the literature analysis suggests that levothyroxine withdrawal is preferable in cases of relatively low Tg levels (<10 ng/ml) and good clinical compliance to hypothyroidism. Moreover, recombinant thyrotropin stimulating hor mone (rTSH) could be a preferable alternative in patients clinically unable to tolerate therapy withdrawal. A Tg cutoff level over which to perform the study seems to be 10 ng/ml, a reasonable value maintaining high accuracy in terms of a good compromise between sensitivity and specificity.