Follicular thyroid carcinoma metastasis to the esophagus detected by 18FDG PET/CT.

We report an unusual case of an esophageal metastasis demonstrated on integrated 18F-fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography (PET/CT) scanning. A 55-year-old male with treated well-differentiated follicular thyroid carcinoma (FTC) had persistently raised thyroglobulin levels despite both negative whole-body CT scan and 131I scans. An initial 18FDG PET/CT scan showed moderate focal uptake in the esophagus, which was initially thought to be physiological. A subsequent comparative 18FDG PET/CT scan showed more intense uptake. A diagnostic endoscopy revealed a pedunculated esophageal polyp, which histological examination confirmed to be metastatic FTC. Such a case has not previously been reported.     

临床隐匿性胃癌的FDG PET/CT征象

目的:总结临床隐匿性胃癌的氟脱氧葡萄糖(fluorodeoxyglucose,FDG)PET/CT影像表现特点.方法:回顾分析26例临床隐匿性胃癌的临床及PET/CT影像资料.男18例,女8例,年龄41-83岁,平均年龄60.8岁,皆以转移瘤症状为首发症状,经胃镜活检证实24例,经开腹手术证实2例.以目测法分别分析FDG PET和CT影像,依据其异常表现的强度分为强阳性、弱阳性和阴性;再综合PET和CT表现,根据诊断的难易程度分为3型:易诊型、疑诊型和难诊型.结果:PET表现为强阳性者57.7%(15/26),弱阳性者23.1%(6/26),阴性者19.2%(5/26).同机CT表现强阳性者76.9%(20/26),弱阳性者11.5%(3/26),阴性者11.5%(3/26).易诊型为53.8%(14/26),疑诊型为34.6%(9/26),难诊型为11.5%(3/26).结论:临床隐匿性胃癌大约88.4%的患者可通过FDG PET/CT检查发现或提示胃癌.     

Characterization of adrenal metastatic cancer using FDG PET/CT

The adrenal gland is a common location for metastasis from a primary tumor in another organ. This study evaluated the properties of adrenal lesions in cancer and non-cancer patients and investigated what variables may help predict adrenal metastasis. This retrospective study used 18fluorodeoxyglucose PET/CT on 371 patients with adrenal lesions (N = 260 with a primary tumor and N= 111 with an unknown primary tumor). Parameters such as the presence of a tumor, nodule, enlarged adrenal, maximum standardized uptake (SUVmax ratio) were evaluated. Univariate and multivariate analysis were used to identify variables that may predict risk of adrenal metastasis. Subjects with adrenal metastasis versus those without had a higher frequency of primary lung tumors (53.7% versus 28.6%, respectively; P≤ 0.001) but a lower frequency of gastrointestinal cancer (9.3% versus 20.4%, respectively; P = 0.014). The frequency of other abnormalities including nodules and enlarged adrenals were similar between cancer and non-cancer subjects. A higher proportion of subjects with adrenal metastasis regardless whether the primary tumor site in the lung, gastrointestinal track, or liver had SUVmax ratio > 2.5 versus those with no adrenal metastasis. In this cohort of subjects, the greatest proportion of subjects with adrenal metastasis was those with primary lung cancer. Univariate and multivariate analysis indicated that age, SUVmax ratio, and the presence of metastasis in multiple organs were independent variables for having adrenal metastasis. In this study, FDG PET/CT was useful in characterizing adrenal lesions including determining whether they were benign or malignant. This technology allowed us to identify characteristics that may useful in predicting adrenal metastasis and cancer severity.     

Transanorectal ultrasonography in the staging of anal epidermoid carcinoma

Fifty consecutive patients with anal canal epidermoid carcinoma were evaluated by transanorectal ultrasonography (TRUS) at diagnosis. Forty-six patients were treated with primary radiotherapy plus bleomycin. Twenty-eight of the last 30 patients underwent, in addition, planimetric volume determination. The ultrasound findings were compared with clinical stage as assessed by digital palpation. Tumours in clinical stages T_1–2 showed evidence of penetration through the anorectal muscular wall at ultrasound (UT_3–4) in two-thirds of the cases. This was the case in all tumours in clinical stages T_3–4. A clear correlation between tumour size, depth of invasion, and tumour volume, respectively, and residual tumour after a pre-operative dose of 40 Gy plus bleomycin was found. When combining clinical stage with TRUS, all tumours classified as T_1–2/UT_1–2 and had a complete response (CR) after the first radiotherapy period, whereas the corresponding figures for those with deep invasion ultrasonographically (T_1–2/UT_3–4 and T_3–4/UT_3–4) were 64 percent and 0 percent, respectively. It thus appears that TRUS could complement digital palpation in staging anal canal carcinoma.

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Résumé 50 patients consécutifs présentant un cancer épidermoïde du canal anal ont eu une évaluation diagnostique par ultrasonographie transanorectale. 46 malades ont été traités par radiothérapie première plus bléomycine. 28 des 30 derniers malades eurent en supplément une détermination planimétrique du volume. Les résultats de l'ultrasonographie ont été comparés avec le stade clinique évalué par la palpation digitale. Les stades cliniques T₁-T₂ montraient une évidence de pénétration dans le muscle ano-rectal à l'ultrasonographie (UT_3–4) dans 2/3 des cas. Ce fait était le cas de toutes les tumeurs des stades T₃-T₄. Une corrélation évidente entre le volume de la tumeur, la profondeur de l'invasion, la dimension de la tumeur respectivement et la tumeur résiduelle après une dose pré-opératoire de 40 grays plus bléomycine a été trouvée. En combinant l'évaluation clinique avec l'échographie endo-rectale, toutes les tumeurs classifiées comme T₁-T₂-(UT_1–2) eurent une réponse totale après la première période de radiothérapie, tandis que des résultats semblables pour les tumeurs avec une invasion profonde à l'ultrasonographie (T_1–2/UT_3–4) furent de 64% et de 0% respectivement. Il est ainsi évident que l'échographie endo-rectale complète la palpation digitale pour évaluer le stade du canal anal.

     

Utility of ~(18)F-FDG PET/CT for the diagnosis and staging of gallbladder carcinoma

正Objective To investigate the vaue of18F-FDG PET/CT combined with clinical data in the diagnosis of gallbladder carcinoma and to assess the role of ~(18)F-FDG PET/CT in tumor staging.Methods18F-FDG PET/CT and clinical data of 54 patients(28 males,26 females,age range 18-82 years)with suspected gallbladder carci-     

Technical limits of PET/CT with 18FDG in prostate cancer

There is increasing evidence that (18)FDG-PET is not useful for the imaging of primary prostate cancer. The aim of this examination was to prove whether or not these poor results are due to technical deficiencies of the examination method like older image reconstruction techniques, extensive (18)FDG-tracer activity in the bladder or improper contrast staining of the rectum. We examined three patients with primary prostate cancer using a modern combined PET/CT system, continuous irrigation of the bladder and an air-inflated rectal balloon catheter. PET/CT images show an exact depiction of both the prostate and all surrounding anatomic structures but no enhanced uptake of radiotracer in the tumour. Therefore, the mentioned poor results of (18)FDG-PET seem not to be due to technical deficiencies.     

Use of integrated FDG PET/CT imaging in pulmonary carcinoid tumours

BACKGROUND: Integrated positron emission tomography (PET)/computed tomography (CT) scanners have been recently introduced in the diagnostic work-up of suspected pulmonary malignancy and demonstrate encouraging results in the staging of nonsmall-cell lung cancer. OBJECTIVE: To evaluate the usefulness of integrated FDG PET/CT in pulmonary carcinoid tumours. SETTING: University hospital. METHODS: We studied 13 patients (mean age +/- 1 SD, 57 +/- 11 years) with pulmonary carcinoid tumours. All patients demonstrated a single pulmonary lesion. Integrated PET/CT scan and surgical resection were performed in all patients. RESULTS: The pulmonary lesion size ranged from 1.1 to 5.0 cm. Final histological diagnosis confirmed 12 typical and one atypical pulmonary carcinoid. Mean proliferation rate of the typical carcinoids was 1.7 +/- 1.4%. None of the patients had recurrent carcinoid disease or died during follow-up (864 +/- 218 days). Mean standardized uptake value (SUV) of (18)F-fluorodeoxyglucose (FDG) in typical carcinoids was 3.0 +/- 1.5 (range 1.2 - 6.6); SUV in the atypical carcinoid was remarkably high with a value of 8.5. The SUV was lower than 2.5 in 6 of 12 patients (50%). Mediastinal lymph node metastases or extrathoracic metastases were not detected in any patient. CONCLUSIONS: (18)F-fluorodeoxyglucose PET/CT imaging improves accurate localization of metabolic activity and thus the interpretation of pulmonary lesions on CT. FDG uptake in pulmonary carcinoid tumours is often lower than expected for malignant tumours. Therefore, surgical resection or biopsy of lesions suspected to be carcinoids should be mandatory, even if they show no hypermetabolism on FDG PET images.     

FDG PET与增强CT异机融合图像在胰腺病变良恶性鉴别诊断及胰腺癌分期中的价值

目的 探讨FDG PET与增强CT（CECT）异机融合技术在胰腺病变良恶性鉴别诊断及胰腺癌分期中的价值.方法 回顾性分析2010年9月至2013年10月在上海长海医院行CECT和常规PET/CT检查的70例胰腺病患者的资料,其中男性45例,女性25例,中位年龄57岁;恶性50例,良性20例.使用西门子Multimodality Workplace TureD软件获得PET/CECT异机融合图像.以病理及临床影像随访结果作为标准,比较CECT、PET/CT、PET/CECT异机融合图像对胰腺病变鉴别诊断以及胰腺癌分期的效能.结果 CECT、PET/CT、PET/CECT异机融合在胰腺病灶良恶性诊断方面的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、准确率和Kppa值分别为82.0％、65.0％、85.4％、59.1％、77.1％及0.465; 92.0％、65.0％、86.8％、76.5％、84.2％及0.597; 96.0％、90.0％、96.0％、90.0％、94.3％及0.860,其中CECT与PET/CECT诊断良恶性病变的敏感性、NPV及准确率的差异有统计学意义（P值均＜0.05）.31例胰腺癌经手术证实,其中15例发现伴胰周血管侵犯,3种检查方法诊断的敏感性、特异性、PPV、NPV和准确率分别为93.3％、93.7％、93.3％、93.8％及93.5％;26.7％、75.0％、50.0％、52.2％及51.6％;93.3％、93.7％、93.3％、93.8％及93.5％,其中PET/CT与CECT、PET/CECT诊断胰周血管侵犯的敏感性、PPV、NPV及准确性的差异有统计学意义（P值均＜0.05）.19例病理证实有区域淋巴结转移,3种方法诊断的敏感性、特异性、PPV、NPV和准确率分别为63.2％、91.7％、92.3％、61.1％及74.2％; 78.9％、83.3％、88.2％、71.4％及80.6％; 89.5％、91.7％、94.4％、84.6％及90.3％,差异均无统计学意义.50例恶性病变中17例经组织学或临床随访证实有远处转移,3种方法诊断的敏感性、特异性、PPV、NPV和准确率分别为58.8％、100％、100％、82.5％及86％;82.4％、91.0％、82.4％、90.9％及88％;94.1％、97.0％、94.1％、97.0％及96.0％,     

FDG PET/CT findings in acute adult mononucleosis mimicking malignant lymphoma

We report a case of acute Epstein–Barr virus (EBV) infection in which the clinical syndrome and pattern of F-18-2-fluoro-2-deoxy- d -glucose (FDG) uptake mimicked malignant lymphoma. A 53-yr-old man presented with 2 wk of high fevers, night sweats, sinus congestion and severe fatigue. The patient was treated for 1 wk with broad-spectrum antibiotics for acute sinusitis without any improvement. Persistence of fevers and presence of abnormal lymphadenopathy seen on the abdominal computed tomography (CT) were concerning lymphoma with B symptoms. FDG positron emission tomography (PET) showed avid FDG uptake in numerous abdominal/pelvic nodes, liver, spleen and bone marrow. These findings were highly suspicious for lymphoma. Patient underwent a pelvic lymph node biopsy which showed large granular lymphocytes that were predominantly T cells. Bone marrow biopsy showed diffuse infiltration with plasmocytoid cells that were not kappa lambda restricted. Additional diagnostic workup became available showing positive EBV IgM titers and negative IgG levels indicating acute infectious mononucleosis. Lymph node biopsy stained positively with EBV-encoded RNA. We concluded that patient's abnormal FDG PET was most likely secondary to acute EBV infection. After 2 months, follow-up FDG PET/CT showed marked improvement in lymphadenopathy and decreased hypermetabolic activity in the liver and spleen. Other than EBV, there are many other FDG-avid non-malignant conditions that may lead to false-positive PET scans. FDG accumulates in inflamed and infected lesions with increased glucose metabolism. This case underscores the importance of maintaining a broad differential and restricting use of PET scans for staging.     

Roles of F-18 FDG PET or PET/CT for the evaluation of gastrointestinal malignancies]

18F-FDG PET scan is an useful functional whole body imaging modality that images various types of malignancies with relative high sensitivity and specificity in a reasonably rapid time. It depicts a lesion based on abnormal glucose metabolism whereas CT detects malignant process mostly based on altered anatomy. In patients with gastric cancers, PET scan detects only less than 50% of early cancers and 62-98% of advanced cancers. For initial T staging, anatomical imaging with a high spatial resolution is essential. There are a few studies on the prognostic significance of FDG uptake with inconsistent results. In spite of low sensitivity for lymph node staging, the specificity of CT and PET scan are very high, and the specificity of PET scan tends to be higher than that of CT. Detection of distant metastases on PET scan is dependent on tumor histology, degree of FDG uptake in primary tumors, sites of distant metastases, etc. There are only a few data available for the evaluation of recurrence detection and treatment responses using FDG PET scan. FDG PET scan has been used in the preoperative staging of colorectal cancer with some promising results. It seems to be the most useful in restaging recurrent tumors and selecting those patients who would benefit from surgery. PET scan has a potential value in assessing treatment responses after various combination of treatments in patients with colorectal cancer.     

The role of 18FDG PET/CT in the management of colorectal liver metastases

Introduction

Surgical resection remains the only potentially curative treatment for colorectal liver metastases (CLM). However, involvement of both the hepatic lobes or extrahepatic disease (EHD) can be a contra-indication for resection. The aim of the present study was to examine the addition of combined positron emission and computed tomography (PET/CT) to CLM staging to assess the effects upon staging and management.

Methods

All CLM patients referred to a single centre between January 2005 and January 2009 were prospectively included. All underwent routine staging (clinical examination and computed tomography), followed by a whole body ¹⁸fluoro-deoxy-glucose (¹⁸FDG)-PET/CT scan and Fong clinical risk score calculation.

Results

Sixty-four patients were included [63% male with a median age of 63 years (age range 32–79 years)]. The addition of PET/CT led to disease upstaging in 20 patients (31%) and downstaging in two patients (3%). EHD was found in 24% of low-risk patients (Fong score 0–2) as compared with 44% of high-risk patients (Fong score 3–5) (P = 0.133). There was a trend towards a greater influence upon management in patients with a low score (44% vs. 17%; P = 0.080).

Conclusion

The addition of PET/CT led to management changes in over one-third of patients but there was no correlation between alterations in staging or management and the Fong clinical risk score; suggesting that PET/CT should be utilized, where available, in the pre-operative staging of CLM patients.     

Constant high adrenal FDG uptake in PET/CT associated with mitochondrial disease

We describe a patient with the m.3243A>G mitochondrial DNA mutation who developed sepsis caused by Streptococcus constellatus. In the acute phase of illness, abnormally high uptake of ¹⁸F-FDG was observed in both adrenal glands that appeared anatomically normal. In repeated imaging six months later the adrenal uptake had diminished but remained clearly elevated. We did not observe high adrenal FDG uptake as in the patient described here among 30 patients with Staphylococcus aureus sepsis that were investigated with identical imaging protocol. In sepsis, oxygen consumption and metabolic rate are increased compared to normal metabolism. The observed high adrenal FDG uptake during sepsis in this patient probably reflects the acute metabolic stress induced by the infection. Interestingly, in repeated imaging six months later, the adrenal SUVs had diminished but were still abnormally high: this suggests constant high levels of metabolic stress associated with the mitochondrial disorder.     

Diagnosis of Paget's disease of the pelvis using F-18 FDG PET/CT

Sclerotic lesions of the right iliac bone were discovered incidentally in a 52-year-old Korean woman. In this case, imaging of the right iliac bone showed intense osteoblastic activity on the bone scan and very mild F-18-fluoro-2-deoxyglucose (FDG) uptake on positron emission tomography (PET). Since Paget's disease is rare in Koreans, we aimed to rule out other bone diseases such as osteoblastic metastasis or osteomyelitis. These results allowed us to exclude chronic osteomyelitis or malignancy and clarify the diagnosis of Paget's disease of the iliac bone. This case illustrates how F-18 FDG PET/CT can be a useful tool in the differential diagnosis of various bone diseases.     

18FDG PET/CT在非小细胞肺癌疗效评估及预后的价值

PET/CT实现了CT解剖结构与PET代谢信息的融合,提高了肺癌诊断的敏感性及特异性,已经广泛用于肺癌的TNM分期.越来越多研究显示它在评估肺癌化放疗疗效及判断预后也有应用前景.目前研究示18FDG PET/CT可以早期准确评估肺癌患者化放疗后疗效,但PET机型,疗效评估最佳时间及评价标准尚未统一.回顾性研究提示原发肿瘤的标准摄取值(standard uptake value,SUV)可能是肿瘤生物侵袭性的预后因子,但需大样本的前瞻性研究证实,并探讨其潜在细胞机制及确定其作为预后的18FDG摄取阈值.     

F-18FDGPET／CT在肺癌诊断中的应用价值

据世界卫生组织（World Health Organization．WHO）统计,每年肺癌的新增病例及死亡病例数在26种常见恶性肿瘤中居首位,且5年生存率低于15％。在我国,原发性肺部恶性肿瘤主要是原发性支气管肺癌,居肿瘤死亡率之首,即使早期非小细胞肺癌在手术后进行化疗,其5年生存率也仅为40％左右。     

The Emerging Role of FDG PET/CT in Diagnosing Endocarditis and Cardiac Device Infection

Infective endocarditis and cardiac implantable electronic device infection (CIEDI) have witnessed an increasing incidence in clinical practice and associated with increasing health care expenditure. Expanding indications of CIED in various cardiovascular conditions have also contributed to the surge of these infections. Early diagnosis of these infections is associated with a favorable prognosis. Given the lack of a single definitive diagnostic method and the limitations of echocardiography, which is considered a central diagnostic imaging modality, additional imaging modalities are required. Recent studies have highlighted the diagnostic utility of FDG PET and CT. In this review article, we discuss the existing limitations of echocardiography, acquisition protocols of PET/CT, and indications of these advanced imaging modalities in infective endocarditis and CIEDI diagnosis.