Association between diffuse renal uptake of 18F-FDG and acute kidney injury

Annals of Nuclear Medicine - The aim of this study was to investigate the clinical characteristics of patients with diffuse renal uptake (DRU) of 2-deoxy-2-[F-18]fluoro-d-glucose (FDG), with...     

18F-FDG uptake in breast cancer correlates with immunohistochemically defined subtypes

Objectives

To determine whether a correlation exists between maximum standardized uptake value (SUV_max) on ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) and the subtypes of breast cancer.

Methods

This retrospective study involved 548 patients (mean age 51.6 years, range 21–81 years) with 552 index breast cancers (mean size 2.57 cm, range 1.0–14.5 cm). The correlation between ¹⁸F-FDG uptake in PET/CT, expressed as SUV_max, and immunohistochemically defined subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) positive and triple negative) was analyzed.

Results

The mean SUV_max value of the 552 tumours was 6.07?±?4.63 (range 0.9–32.8). The subtypes of the 552 tumours were 334 (60 %) luminal A, 66 (12 %) luminal B, 60 (11 %) HER2 positive and 92 (17 %) triple negative, for which the mean SUV_max values were 4.69?±?3.45, 6.51?±?4.18, 7.44?±?4.73 and 9.83?±?6.03, respectively. In a multivariate regression analysis, triple-negative and HER2-positive tumours had 1.67-fold (P?<?0.001) and 1.27-fold (P?=?0.009) higher SUV_max values, respectively, than luminal A tumours after adjustment for invasive tumour size, lymph node involvement status and histologic grade.

Conclusion

FDG uptake was independently associated with subtypes of invasive breast cancer. Triple-negative and HER2-positive breast cancers showed higher SUV_max values than luminal A tumours.

Key Points

? ¹⁸ F-FDG PET demonstrates increased tissue glucose metabolism, a hallmark of cancers. ? Immunohistochemically defined subtypes appear significantly associated with FDG uptake (expressed as SUV _max ). ? Triple-negative tumours had 1.67-fold higher SUV _max values than luminal A tumours. ? HER2-positive tumours had 1.27-fold higher SUV _max values than luminal A tumours.     

Relationship between 18F-FDG uptake and breast density in women with normal breast tissue.

Breast density affects the mammographic detectability of breast cancer. The study aimed to evaluate the impact of breast density on the (18)F-FDG uptake of normal breast tissue. METHODS: The study population consisted of 45 women (median age, 54 y; age range, 42-77 y). All underwent whole-body (18)F-FDG PET for various indications other than breast cancer, and all underwent mammography within a mean of 6.6 +/- 4.9 mo of PET. On the basis of mammographic findings, breasts were categorized as extremely dense, heterogeneously dense, primarily fatty, or entirely fatty. Regions of interest were drawn on every PET image in which breast tissue was visualized. Average and peak standardized uptake values (SUVs) were calculated for the left and right breasts. RESULTS: Mammography showed that 20 of the 45 women had heterogeneously dense breasts, 1 had extremely dense breasts, 20 had primarily fatty breasts, and 4 had entirely fatty breasts. In dense breasts, the average SUV was 0.39 +/- 0.05 (right breast) and 0.36 +/- 0.07 (left breast) and the peak SUV was 0.93 +/- 0.16 and 0.89 +/- 0.18, respectively. The average and peak SUVs were significantly lower for primarily fatty breasts than for dense breasts (P < 0.01). Peak and average SUVs of entirely fatty breasts also differed significantly from peak and average SUVs of dense and primarily fatty breasts (P < 0.01). The impact of hormonal status on SUV was significant but less than the impact of breast density. No significant relationship between average SUV or peak SUV and age or serum glucose level was observed. CONCLUSION: Breast density and hormonal status affect the uptake of (18)F-FDG. Dense breasts exhibit, on average, significantly higher (18)F-FDG uptake than do nondense breasts. However, the highest peak SUV observed in dense breasts was 1.39, which is well below the SUV of 2.5 commonly used as a cutoff between benign and malignant tissue. Therefore, breast density is unlikely to affect the ability of (18)F-FDG PET to discriminate between benign and malignant breast lesions.     

晚期乳腺癌18F-FDG PET-CT显像标准摄取值与预后的相关性

目的 探讨晚期乳腺癌18 F-FDG PET-CT显像标准摄取值与预后的相关性.方法 选择68例晚期乳腺癌患者,记录诊断时PET-CT的SUV值,均给予全身静脉化疗,以SUV值8为分界点,将本组患者分为两组,随访5年,观察SUV值与5年生存率的关系.结果 本组观察的68例患者,SUV值越小,生存期相对越长,反之,生存期则相对较短.结论 18F-FDG PET-CT显像标准摄取值(SUV值)对乳腺癌的预后有一定价值,值得临床进一步研究.     

Association of vascular 18F-FDG uptake with vascular calcification.

Both calcification and FDG uptake have been advocated as indicators of atheroma. Atheromas calcify as cells in the lesion undergo apoptosis and necrosis during evolution of the lesion and at the end stage of the lesion. FDG concentrates in lesions due to the relatively dense cellularity in regions of inflammation of active atheromas. This investigation examines the geographic relationship of focal vascular (18)F-FDG uptake, as a marker of atherosclerotic inflammation, to arterial calcification detected by contemporaneous CT. METHODS: We reviewed PET/CT images from 78 patients who were referred for tumor staging for the presence of vascular (18)F-FDG uptake and vascular calcification. Arterial wall (18)F-FDG accumulation greater than adjacent blood-pool activity was considered inflammation. Arterial attenuation of >130 Hounsfield units was considered calcification. Sites in the ascending and descending aorta, the carotid and iliac arteries, and the coronary territories were examined on the emission, CT, and fusion images on a point-by-point basis. When lesions were seen, we evaluated whether they were overlapping or discrete. RESULTS: The (18)F-FDG arterial distribution was consistent with established atherosclerotic topography, with increased uptake in the thoracic aorta, at the carotid bifurcation, and in the proximal coronary vessels. Arteries typically displayed a patchwork of normal vessel, focal inflammation, or calcification; inflammation and calcification overlapped in <2% of cases. Arterial inflammation preceded calcification, in terms of mean patient age. Coronary inflammation was more prevalent in patients with more cardiovascular risk factors. CONCLUSION: Vascular calcification and vascular metabolic activity rarely overlap, suggesting these findings represent different stages in the evolution of atheroma.     

Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer

Purpose

The aim of this study was to determine the impact of the main clinicopathological and biological prognostic factors of breast cancer on ¹⁸F-fluorodeoxyglucose (FDG) uptake. Only women with tumours larger than 20?mm (T2?CT4) were included in order to minimize bias of partial volume effect.

Methods

In this prospective study, 132 consecutive women received FDG PET/CT imaging before starting neoadjuvant chemotherapy. Maximum standardized uptake values (SUV_max) were compared to tumour characteristics as assessed on core biopsy.

Results

There was no influence of T and N stage on SUV. Invasive ductal carcinoma showed higher SUV than lobular carcinoma. However, the highest uptake was found for metaplastic tumours, representing 5% of patients in this series. Several biological features usually considered as bad prognostic factors were associated with an increase in FDG uptake: the median of SUV_max was 9.7 for grade 3 tumours vs 4.8 for the lower grades (p?p?=?0.003); triple-negative tumours (oestrogen and progesterone receptor negative, no overexpression of c-erbB-2) had an SUV of 9.2 vs 5.8 for all others (p = 0005); p53 mutated tumours also had significantly higher SUV (7.8 vs 5.0; p?Conclusion Knowledge of the factors influencing uptake is important when interpreting FDG PET/CT scans. Also, findings that FDG uptake is highest in those patients with poor prognostic features (high grade, hormone receptor negativity, triple negativity, metaplastic tumours) is helpful to determine who are the best candidates for baseline staging.     

18F-FDG PET显像在乳腺癌中的应用

^18F-FDG(^18F-氟脱氧葡萄糖)PET(正电子发射型计算断层显像)是反映恶性肿瘤代谢特征的一种无创性的功能显像方法。在绝大多数肿瘤中均得到广泛应用。本文通过对国内外乳腺癌^18F-FDG PET。显像的文章进行全面综合分析，旨在探讨^18F-FDG PET显像在乳腺癌中的应用原理及其临床应用价值。与传统影像学相比，^18F-FDG PET。显像能够更为准确地发现原发性乳腺癌远处转移和局部复发，可以在治疗早期及时评价化疗疗效以指导临床治疗。对于原发性乳腺癌的诊断。PET显像不作为首选检查。但对于临床检查或常规影像检查难以进行或无明确结论的病人。PET显像可以作为其乳腺肿块定性诊断的最佳选择。     

Performance of preoperative breast MRI based on breast cancer molecular subtype

PurposeTo assess the performance of preoperative breast MRI biopsy recommendations based on breast cancer molecular subtype.MethodsAll preoperative breast MRIs at a single academic medical center from May 2010 to March 2014 were identified. Reports were reviewed for biopsy recommendations. All pathology reports were reviewed to determine biopsy recommendation outcomes. Molecular subtypes were defined as Luminal A (ER/PR+ and HER2-), Luminal B (ER/PR+ and HER2+), HER2 (ER-, PR- and HER2+), and Basal (ER-, PR-, and HER2-). Logistic regression assessed the probability of true positive versus false positive biopsy and mastectomy versus lumpectomy.ResultsThere were 383 patients included with a molecular subtype distribution of 253 Luminal A, 44 Luminal B, 20 HER2, and 66 Basal. Two hundred and thirteen (56%) patients and 319 sites were recommended for biopsy. Molecular subtype did not influence the recommendation for biopsy (p = 0.69) or the number of biopsy site recommendations (p = 0.30). The positive predictive value for a biopsy recommendation was 42% overall and 46% for Luminal A, 43% for Luminal B, 36% for HER2, and 29% for Basal subtype cancers. The multivariate logistic regression model showed no difference in true positive biopsy rate based on molecular subtype (p = 0.78). Fifty-one percent of patients underwent mastectomy and the multivariate model demonstrated that only a true positive biopsy (odds ratio: 5.3) was associated with higher mastectomy rates.ConclusionBreast cancer molecular subtype did not influence biopsy recommendations, positive predictive values, or surgical approaches. Only true positive biopsies increased the mastectomy rate.     

Association between serial dynamic contrast-enhanced MRI and dynamic 18F-FDG PET measures in patients undergoing neoadjuvant chemotherapy for locally advanced breast cancer

Purpose:

To investigate the contrast of three‐dimensional balanced steady state free precession (3D bSSFP) in the two component T2 model and to apply the results to optimize 3D bSSFP for prostate imaging at 1.5 Tesla.

Materials and Methods:

In each of seven healthy volunteers, six 3D bSSFP acquisitions were performed with flip angles (α) equally spaced between 10° and 110°. Predictions of signal and contrast were obtained from synthetic bSSFP images calculated from relaxation parameters obtained from a multi‐spin‐echo acquisition. One biexponential and two monoexponential models were applied. Measured and predicted signals were compared by simple linear regression.

Results:

The measured contrast to signal ratio increased continuously with α. Mean R² for the biexponential model was almost constant for α in the range 50–110°. The biexponential model was a better predictor of the measured signal than the monoexponential model. A monoexponential model restricted to the echoes TE = 50–125 ms performed similar to the biexponential model. The predicted contrast peaked at α between 50° and 90°.

Conclusion:

Prostate imaging with bSSFP benefited from high flip angles. The biexponential model provided good signal prediction while predictions from the monoexponential models are dependent on the range of TE used for T2 determination. J. Magn. Reson. Imaging 2010;31:1124–1131. © 2010 Wiley‐Liss, Inc.     

Pattern of uptake and excretion of (18)F-FDG in the lactating breast.

Excretion of radiopharmaceuticals into breast milk poses a potential risk to infants and clear recommendations regarding interruption times are required. There are few data available regarding the impact of (18)F-FDG on this issue. With increasing use of PET for oncologic imaging and its potential advantages to nursing mothers because of its short physical half-life compared with other commonly used tumor imaging agents such as (67)Ga and (201)Tl, evaluation of the excretion pattern of this agent in breast milk is important. METHODS: We have evaluated the uptake of FDG in the breasts in 7 women, 6 of whom were lactating and 1 of whom was in early postpartum but had not commenced breast-feeding. Milk samples were obtained from 4 of the lactating women, including serial samples from 1. RESULTS: Significantly increased breast uptake was identified in all lactating breasts but not in 1 breast consistently refused by the nursing infant or in the woman who had not begun breast-feeding after delivery of her child. No qualitative change or semiquantitative estimate of radiotracer uptake in the breast was seen after expression of breast milk. Decay-corrected activity measurable in breast milk ranged from 5.54 to 19.3 Bq/mL/MBq injected. Using a standard model of breast-feeding, the calculated maximum cumulative dose to the infant, 0.085 mSv with no interruption of breast-feeding, is well below the recommended limit of 1 mSv. CONCLUSION: High uptake of FDG in the lactating breast appears to be related to suckling. There is, however, little secretion of activity into breast milk. Accordingly, a higher radiation dose is received by the infant from close contact with the breast than from ingestion of radioactive milk.     

18F-FDG uptake in diffuse peritoneal lymphomatosis

A 38-year-old man presented with declining appetite and progressive abdominal distention. Abdominal ultrasonography revealed omental and bowel wall thickening. Histopathologic examination showed a high-grade lymphoblastic Burkitt-like B-cell lymphoma. 18F fluorodeoxyglucose positron emission tomography/computed tomography images showed diffusely increased metabolic activity in the thickened omentum, intestines, mesentery, and peritoneum (omental caking). Diffuse peritoneal and omental seeding are well-known forms of dissemination of metastatic carcinoma. However, omental and peritoneal lymphomatosis are rare manifestations of high-grade lymphomas. This uncommon case demonstrates usefulness of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in omental and peritoneal involvement in lymphoma.     

脑脓肿高度摄取18F-FDG

患者男 ,５１岁 ,因“书写、语文、计算能力下降１０天伴头痛３天”于２００１年３月２１日入院。患者入院前２０天患上颌窦炎 ,服红霉素、甲硝唑等药后 ,症状有所好转 ,１０天前开会作记录时 ,突感手指僵硬、书写能力下降、继之语言迟钝 ,３天前出现头痛。入院时神清 ,但口齿不清 ,答不切题 ,计算、书写能力差。入院后查ＭＲＩ示左颞叶大片长Ｔ１、长Ｔ２ 信号 ,信号不均 ,边界尚清 ,中间可见一环状等Ｔ１、等Ｔ２ 信号影 ,增强扫描呈不规则环状强化 ,大小３ｃｍ×３ｃｍ×３．８ｃｍ ,左颞叶脑沟消失 ,左侧脑室变小 ,中线结构右移。两侧上…     

Evaluation of 18F-FDG uptake and arterial wall calcifications using 18F-FDG PET/CT.

Glucose metabolic activity expressed as (18)F-FDG uptake may be increased in active atherosclerotic plaque. Calcium depositions are often increased in mature atherosclerotic plaque. The purpose of the present study was to assess the patterns of vascular-wall (18)F-FDG uptake and CT calcifications using combined PET/CT. METHODS: One hundred twenty-two consecutive patients over the age of 50 (47 women and 75 men; mean age, 66 +/- 9 y) undergoing whole-body (18)F-FDG PET/CT for tumor assessment were retrospectively evaluated. PET, CT, and PET/CT slices were generated for review. Abnormal vascular findings in major arteries in the chest and abdomen were categorized as PET positive (PET+), PET negative (PET-), CT positive (CT+), or CT negative (CT-). The topographic relationship between increased vascular-wall (18)F-FDG uptake on PET and the presence of calcifications on CT was assessed on PET/CT fused images, with abnormal sites further classified as PET+/CT+, PET+/CT-, or PET-/CT+. The presence of CT calcifications and increased vascular-wall (18)F-FDG uptake was correlated with age, sex, presence of cardiovascular risk factors, and cardiovascular disease. RESULTS: Abnormal findings were identified at 349 sites. CT calcifications (CT+) were observed at 320 sites (92%) of 100 patients (82%), more commonly in men (P < 0.03), in older patients (P < 0.0001), in patients with hypertension (P < 0.003) or hyperlipidemia (P < 0.04), and in smokers (P < 0.008). Increased vascular-wall (18)F-FDG uptake (PET+) was observed at 52 sites (15%) of 38 patients (31%), more commonly in men (P < 0.02), in older patients (P < 0.0001), and in patients with hypertension (P < 0.02), and was borderline in patients with cardiovascular disease (P = 0.057). PET+ and CT+ findings correlated in 12 patients, a PET+/CT- pattern was found in 18 patients, and 8 patients had increased vascular-wall (18)F-FDG uptake in sites with and without calcifications (PET+/CT+, CT-). Twenty-two patients (18%) had a PET-/CT- pattern. CONCLUSION: Hybrid PET/CT can be used to identify and to correctly localize vascular-wall (18)F-FDG activity. Increased vascular-wall (18)F-FDG activity was found in 15% of sites and CT calcifications were noted in 92% of sites, with congruent findings in 7%. The clinical significance of the relationship between vascular-wall (18)F-FDG uptake and CT calcifications needs to be assessed by further prospective studies with long-term follow up.     

F-18 fluoride uptake in primary breast cancer

Objective

Bone-specific radiotracers are known to accumulate in breast lesions. Tc-99m diphosphonates have been widely studied in differentiating breast lesions. In this retrospective study, we aimed to assess the uptake of the bone-specific PET radiotracer, F-18 fluoride (NaF), in primary breast cancers to determine its sensitivity and to identify any differences in NaF uptake between calcified and non-calcified tumors, histological subtypes, and patients with or without axillary lymphadenopathy.

Methods

NaF positron emission tomography/computed tomography (PET/CT) images of 69 newly diagnosed breast cancer patients were reviewed. F-18 fluoride uptake as maximum standardized uptake value (NaF SUVmax) was measured in the primary tumor, enlarged axillary lymph nodes and contralateral normal/non-tumoral breast tissue. Low-dose CT images were reviewed to locate the primary tumor and grossly assess its calcification and check for ipsilateral axillary lymphadenopathy. Whole body NaF PET/CT images were reviewed to search for bone metastases. Eighteen patients also underwent F-18 fluorodeoxyglucose (FDG) PET/CT study.

Results

The primary breast tumor was clearly seen as focal or diffuse uptake on NaF PET images in 27 of 69 patients (39%) (mean NaF SUVmax: 2.0?±?1.0). In the rest, there was only mild bilateral diffuse breast uptake. When analyzing images per histological subtype (42 patients, 43 tumors), 14 of 31 invasive ductal carcinomas (IDC) (45%) and 3 of 4 ductal carcinoma in situ (DCIS) were visible on PET. Five invasive lobular carcinomas, 2 invasive mammary carcinomas, and 1 mucinous carcinoma were not visible on PET. Mean NaF SUVmax of contralateral normal/non-tumoral breast tissue was 1.0?±?0.4. There was no significant difference in mean NaF SUVmax of primary tumor in cases with and without calcification or with and without axillary lymphadenopathy (p 0.892 and 0.957). There was no correlation between NaF SUVmax and FDG SUVmax values of the primary tumors (r 0.072, p 0.797, Pearson correlation).

Conclusion

NaF PET has relatively low sensitivity in detecting breast cancer. However, abnormal breast uptake on NaF PET requires further evaluation. F-18 fluoride uptake in the primary breast tumor does not seem to be correlated with axillary lymphadenopathy (metastasis potential), gross tumor calcification or metabolic activity of the tumor.

     

T1期肺癌原发灶18F-FDG摄取与转移的关系

目的 探讨T1期肺癌原发灶18F-脱氧葡萄糖(FDG)摄取与病灶大小、淋巴结转移、远处转移、病理类型的关系.方法 对61例治疗前行全身18F-FDG PET/CT扫描的T1期肺癌患者,确定其临床分期以及原发灶大小(最大径)和18F-FDG摄取值[以最大标准摄取值(SUVmax)表示],并分为无转移组、仅淋巴结转移组和有远处转移组.分析各组的18F-FDG摄取与原发灶大小、淋巴结转移、远处转移、病理类型的关系.结果 原发灶大小与SUVmax呈正相关(r=0.466,P＜0.05),各组间大小差异无统计学意义.SUVmax在无转移组(5.05±1.97)与仅淋巴结转移组(7.96±2.98)、远处转移组(8.25±2.93)之间差异均有统计学意义(P值分别为0.003,0.002).而仅淋巴结转移组与远处转移组之间SUVmax差异无统计学意义(P=0.718).肺腺癌、鳞癌的大小(t=1.566,P=0.111)和SUVmax(t:0.478,P=0.623)差异均无统计学意义.结论 T1期肺癌原发灶18F-FDG摄取可能对预测转移有一定的价值.