|
1
|
Dudoignon D, Pattison DA, Legallois D, Hicks RJ, Aide N. The utility of pharmacological and radiological interventions to optimize diagnostic information from PET/CT. Cancer Imaging 2020; 20:68. [PMID: 32962752 PMCID: PMC7510123 DOI: 10.1186/s40644-020-00344-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/14/2020] [Indexed: 01/26/2023] Open
Abstract
Background Positron Emission Tomography with Computed Tomography (PET/CT) is widely used in the assessment of many diseases, particularly including cancer. However, many factors can affect image quality and diagnostic performance of PET scans using FDG or other PET probes. Main body The aim of this pictorial essay is to review PET/CT protocols that can be useful to overcome these confounding factors in routine clinical situations, with a particular focus on pharmacological interventions and problem-oriented CT acquisition protocols. Conclusion Imaging protocols and representative cases will be discussed, in addition to potential contraindications and precautions to be taken.
Collapse
Affiliation(s)
- David Dudoignon
- The Department of Nuclear Medicine, University Hospital, Caen, France
| | - David A Pattison
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | | | - Rodney J Hicks
- The Department of Molecular Imaging and Therapeutic Nuclear Medicine, the Peter MacCallum Cancer Institute, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Parkville, Australia
| | - Nicolas Aide
- The Department of Nuclear Medicine, University Hospital, Caen, France. .,INSERM ANTICIPE, Normandie University, Caen, France.
| |
Collapse
|
|
2
|
Kwon HR, Pahk K, Park S, Kwon HW, Kim S. Prognostic Value of Metabolic Information in Advanced Gastric Cancer Using Preoperative 18F-FDG PET/CT. Nucl Med Mol Imaging 2019; 53:386-395. [PMID: 31867074 DOI: 10.1007/s13139-019-00622-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose This study evaluated the usefulness of semiquantitative and volumetric PET parameters for predicting prognosis in patients with advanced gastric cancer (AGC). Methods We enrolled 213 patients who underwent 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) prior to curative surgery for AGC. Maximum standardized uptake value (SUVmax) and tumor-to-liver uptake ratio (TLR) were measured in all patients. Metabolic tumor volume (MTV) and total lesion glycolysis were measured in volume-measurable patients. For further quantification of FDG uptake, we developed PET prognostic scores by combining SUVmax and MTV (1: low SUVmax/low MTV; 2: high SUVmax/low MTV; 3: high SUVmax/high MTV). Comparison of PET parameters between recurrence and non-recurrence groups was performed. Univariate and multivariate analyses for recurrence-free survival (RFS) and overall survival (OS) were subsequently performed. Results The recurrence rate was 32.4% (69/213 patients). Mean SUVmax and mean MTV of the recurrence group were significantly higher than those of the non-recurrence group (p = 0.026 and p = 0.025). TLR showed marginal significance (p = 0.051). In multivariate analysis for RFS including all patients, SUVmax (p = 0.022), TLR (p = 0.010), and PET score (p = 0.003) were independent prognostic factors. In post hoc analysis of PET score, significant differences in RFS were observed between PET scores 2 and 3 as well as scores 1 and 3. No significant difference in RFS was observed between scores 1 and 2. Only PET score was statistically significant for OS in univariate analysis. None of the PET parameters were statistically significant for OS in multivariate analysis. Conclusion High SUVmax and high MTV of the primary tumor suggest a high risk of recurrence for AGC patients. Even if SUVmax is similar, the prognosis may vary depending on MTV. Combining PET parameters results in a better prediction for prognosis.
Collapse
Affiliation(s)
- Hye Ryeong Kwon
- 1Department of Nuclear Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Kisoo Pahk
- 1Department of Nuclear Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Sungsoo Park
- 2Department of Gastrointestinal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Hyun Woo Kwon
- 1Department of Nuclear Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Sungeun Kim
- 1Department of Nuclear Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| |
Collapse
|
|
3
|
Dębiec K, Wydmański J, Gorczewska I, Leszczyńska P, Gorczewski K, Leszczyński W, d’Amico A, Kalemba M. 18-Fluorodeoxy-Glucose Positron Emission Tomography- Computed Tomography (18-FDG-PET/CT) for Gross Tumor Volume (GTV) Delineation in Gastric Cancer Radiotherapy. Asian Pac J Cancer Prev 2017; 18:2989-2998. [PMID: 29172270 PMCID: PMC5773782 DOI: 10.22034/apjcp.2017.18.11.2989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: Evaluation of the 18-fluorodeoxy-glucose positron emission tomography-computed tomography (18-FDG-PET/CT) for gross tumor volume (GTV) delineation in gastric cancer patients undergoing radiotherapy. Methods: In this study, 29 gastric cancer patients (17 unresectable and 7 inoperable) were initially enrolled for radical chemoradiotherapy (45Gy/25 fractions + chemotherapy based on 5 fluorouracil) or radiotherapy alone (45Gy/25 fractions) with planning based on the 18-FDG-PET/CT images. Five patients were excluded due to excess blood glucose levels (1), false-negative positron emission tomography (1) and distant metastases revealed by 18-FDG-PET/CT (3). The analysis involved measurement of metabolic tumor volumes (MTVs) performed on PET/CT workstations. Different threshold levels of the standardized uptake value (SUV) and liver uptake were set to obtain MTVs. Secondly, GTVPET values were derived manually using the positron emission tomography (PET) dataset blinded to the computed tomography (CT) data. Subsequently, GTVCT values were delineated using a radiotherapy planning system based on the CT scans blinded to the PET data. The referenced GTVCT values were correlated with the GTVPET and were compared with a conformality index (CI). Results: The mean CI was 0.52 (range, 0.12-0.85). In 13/24 patients (54%), the GTVPET was larger than GTVCT, and in the remainder, GTVPET was smaller. Moreover, the cranio-caudal diameter of GTVPET in 16 cases (64%) was larger than that of GTVCT, smaller in 7 cases (29%), and unchanged in one case. Manual PET delineation (GTVPET) achieved the best correlation with GTVCT (Pearson correlation = 0.76, p <0.0001). Among the analyzed MTVs, a statistically significant correlation with GTVCT was revealed for MTV10%SUVmax (r = 0.63; p = 0.0014), MTVliv (r = 0.60; p = 0.0021), MTVSUV2.5 (r = 0.54; p = 0.0063); MTV20%SUVmax (r = 0.44; p = 0.0344); MTV30%SUVmax (r = 0.44; p = 0.0373). Conclusion: 18-FDG-PET/CT in gastric cancer radiotherapy planning may affect the GTV delineation.
Collapse
Affiliation(s)
- Kinga Dębiec
- Radiotherapy and Chemotherapy I Clinic, Maria Skłodowska-Curie Memorial Institute of Oncology, Gliwice Branch. Poland.
| | | | | | | | | | | | | | | |
Collapse
|
|
4
|
Incremental diagnostic utility of gastric distension FDG PET/CT. Eur J Nucl Med Mol Imaging 2015; 43:644-53. [PMID: 26487512 DOI: 10.1007/s00259-015-3211-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/28/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the diagnostic utility of gastric distension (GD) FDG PET/CT in both patients with known gastric malignancy and those not known to have gastric malignancy but with incidental focal FDG uptake in the stomach. METHODS This retrospective analysis included 88 patients who underwent FDG PET/CT following GD with hyoscine N-butylbromide (Buscopan®) and water ingestion as part of routine clinical evaluation between 2004 and 2014. FDG PET/CT scans before and after GD were reported blinded to the patient clinical details in 49 patients undergoing pretreatment staging of gastric malignancy and 39 patients who underwent GD following incidental suspicious gastric uptake. The PET findings were validated by a composite clinical standard. RESULTS In the 49 patients undergoing pretreatment staging of gastric malignancy, GD improved PET detection of the primary tumour (from 80 % to 90 %). PET evaluation of tumour extent was concordant with endoscopic/surgical reports in 31 % (interpreter 1) and 45 % (interpreter 2) using pre-GD images and 73 % and 76 % using GD images. Interobserver agreement also improved with GD (κ = 0.29 to 0.69). Metabolic and morphological quantitative analysis demonstrated a major impact of GD in normal gastric wall but no significant effect in tumour, except a minor increase in SUV related to a delayed acquisition time. The tumour to normal stomach SUVmax ratio increased from 3.8 ± 2.9 to 9.2 ± 8.6 (mean ± SD) with GD (p < 0.0001), facilitating detection and improved assessment of the primary tumour. In 25 (64 %) of the 39 patients with incidental suspicious gastric uptake, acquisition after GD correctly excluded a malignant process. In 10 (71 %) of the remaining 14 patients with persistent suspicious FDG uptake despite GD, malignancy was confirmed and in 3 (21 %) an active but benign pathology was diagnosed. CONCLUSION GD is a simple way to improve local staging with FDG PET in patients with gastric malignancy. In the setting of incidental suspicious gastric uptake, GD is also an effective tool for ruling out malignancy and leads to the avoidance of unnecessary endoscopy.
Collapse
|
|
5
|
|
|
6
|
Grabinska K, Pelak M, Wydmanski J, Tukiendorf A, d’Amico A. Prognostic value and clinical correlations of 18-fluorodeoxyglucose metabolism quantifiers in gastric cancer. World J Gastroenterol 2015; 21:5901-5909. [PMID: 26019454 PMCID: PMC4438024 DOI: 10.3748/wjg.v21.i19.5901] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/29/2014] [Accepted: 01/21/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the correlations of pre-treatment positron emission tomography-computer tomography (PET-CT) metabolic quantifiers with clinical data of unstratified gastric cancer (GC) patients.
METHODS: Forty PET-CT scans utilising 18-fluorodeoxyglucose in patients who received no prior treatment were analysed. Analysis involved measurements of maximum and mean standardised uptake volumes (SUV), coefficient of variation (COV), metabolic tumour volumes and total lesion glycolysis of different thresholds above which the tumor volumes were identified. The threshold values were: SUV absolute value of 2.5, 30% of SUVmax, 40% of SUVmax, and liver uptake-based (marked 2.5, 30, 40 and liv, respectively). Clinical variables such as age, sex, clinical stage, performance index, weight loss, tumor histological type and grade, and CEA and CA19.9 levels were included in survival analysis. Patients received various treatment modalities appropriate to their disease stage and the outcome was defined by time to metastasis (TTM) and overall survival (OS). Clinical and metabolic parameters were evaluated by analysis of variance, receiver operating characteristics, univariate Kaplan-Meier, and multivariate Cox models. P < 0.05 was considered statistically significant.
RESULTS: Significant differences were observed between initially disseminated and non-disseminated patients in mean SUV (6.05 vs 4.13, P = 0.008), TLG2.5 (802 cm3vs 226 cm3; P = 0.031), and TLG30 (436 cm3vs 247 cm3, P = 0.018). Higher COV was associated with poor tumour differentiation (0.47 for G3 vs 0.28 for G1 and G2; P = 0.03). MTV2.5 was positively correlated to patient weight loss (< 5%, 5%-10% and > 10%: 40.4 cm3vs 123.6 cm3vs 181.8 cm3, respectively, P = 0.003). In multivariate Cox analysis, TLG30 was prognostic for OS (HR = 1.001, 95%CI: 1.0009-1.0017; P = 0.047) for the whole group of patients. In the same model yet only including patients without initial disease dissemination TLG30 (HR = 1.009, 95%CI: 1.003-1.014; P = 0.004) and MTV2.5 (HR = 1.02, 95%CI: 1.002-1.036; P = 0.025) were prognostic for OS; for TTM TLG30 was the only significant prognostic variable (HR = 1.006, 95%CI: 1.001-1.012; P = 0.02).
CONCLUSION: PET-CT in GC may represent a valuable diagnostic and prognostic tool that requires further evaluation in highly standardised environments such as randomised clinical trials.
Collapse
|
|
7
|
Altini C, Niccoli Asabella A, Di Palo A, Fanelli M, Ferrari C, Moschetta M, Rubini G. 18F-FDG PET/CT role in staging of gastric carcinomas: comparison with conventional contrast enhancement computed tomography. Medicine (Baltimore) 2015; 94:e864. [PMID: 25997066 PMCID: PMC4602890 DOI: 10.1097/md.0000000000000864] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The purpose of the report was to evaluate the role of fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F-FDG PET/CT) in staging gastric cancer comparing it with contrast enhancement computed tomography (CECT).This retrospective study included 45 patients who underwent performed whole body CECT and F-FDG PET/CT before any treatment. We calculated CECT and F-FDG PET/CT sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) for gastric, lymphnode, and distant localizations; furthermore, we compared the 2 techniques by McNemar test. The role of F-FDG PET/CT semiquantitative parameters in relation to histotype, grading, and site of gastric lesions were evaluated by ANOVA test.Sensitivity, specificity, accuracy, PPV and NPV of CECT, and F-FDG PET/CT for gastric lesion were, respectively, 92.11%, 57.14%, 86.66%, 92.11%, 57.14% and 81.58%, 85.71%, 82.22%, 96.88%, 46.15%. No differences were identified between the 2 techniques about sensitivity and specificity. No statistical differences were observed between PET parameters and histotype, grading, and site of gastric lesion. The results of CECT and F-FDG PET/CT about lymphnode involvement were 70.83%, 61.90%, 66.66%, 68%, 65% and 58.33%, 95.24%, 75.55%, 93.33%, 66.67%. The results of CECT and F-FDG PET/CT about distant metastases were 80%, 62.86%, 66.66%, 38.10%, 91.67% and 60%, 88.57%, 82.22%, 60%, 88.57%. FDG PET/CT specificity was significantly higher both for lymphnode and distant metastases.The F-FDG PET/CT is a useful tool for the evaluation of gastric carcinoma to detect primary lesion, lymphnode, and distant metastases using 1 single image whole-body technique. Integration of CECT with F-FDG PET/CT permits a more valid staging in these patients.
Collapse
Affiliation(s)
- Corinna Altini
- From the Nuclear Medicine Unit (CA, ANA, ADP, MF, CF, GR); Section of Diagnostic Imaging, D.I.M., University of Bari "Aldo Moro", Bari, Italy (MM)
| | | | | | | | | | | | | |
Collapse
|
|
8
|
|
|
9
|
Abstract
Heterotopic pancreas is the presence of pancreatic tissue lying outside of its normal location and lacking anatomic or vascular connections with the pancreas. Heterotopic pancreas can undergo inflammatory changes similar to the normal pancreatic gland. We present 2 rare cases showing increased (18)F-FDG uptake in the heterotopic pancreatitis of the stomachs. To our knowledge, heterotopic pancreatitis with increased tracer accumulation on FDG PET/CT has not been reported before. Heterotopic pancreas should be included in the differential diagnosis of abnormal gastric FDG accumulation along with tumor and infectious processes.
Collapse
|
|
10
|
Wu CX, Zhu ZH. Diagnosis and evaluation of gastric cancer by positron emission tomography. World J Gastroenterol 2014; 20:4574-4585. [PMID: 24782610 PMCID: PMC4000494 DOI: 10.3748/wjg.v20.i16.4574] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/18/2013] [Accepted: 01/14/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is the second leading cause of cancer mortality worldwide. The diagnosis of gastric cancer has been significantly improved with the broad availability of gastrointestinal endoscopy. Effective technologies for accurate staging and quantitative evaluation are still in demand to merit reasonable treatment and better prognosis for the patients presented with advanced disease. Preoperative staging using conventional imaging tools, such as computed tomography (CT) and endoscopic ultrasonography, is inadequate. Positron emission tomography (PET), using (18)F-fluorodeoxyglucose (FDG) as a tracer and integrating CT for anatomic localization, holds a promise to detect unsuspected metastasis and has been extensively used in a variety of malignancies. However, the value of FDG PET/CT in diagnosis and evaluation of gastric cancer is still controversial. This article reviews the current literature in diagnosis, staging, response evaluation, and relapse monitoring of gastric cancer, and discusses the current understanding, improvement, and future prospects in this area.
Collapse
|
|
11
|
Yun M. Imaging of Gastric Cancer Metabolism Using 18 F-FDG PET/CT. J Gastric Cancer 2014; 14:1-6. [PMID: 24765531 PMCID: PMC3996244 DOI: 10.5230/jgc.2014.14.1.1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 12/22/2013] [Accepted: 12/22/2013] [Indexed: 12/19/2022] Open
Abstract
Aerobic glycolysis has been the most important hypothesis in cancer metabolism. It seems to be related to increased bioenergetic and biosynthetic needs in rapidly proliferating cancer cells. To this end, F-18 fluorodeoxyglucose (FDG), a glucose analog, became widely popular for the detection of malignancies combined with positron emission tomography/computed tomography (PET/CT). Although the potential roles of FDG PET/CT in primary tumor detection are not fully established, it seems to have a limited sensitivity in detecting early gastric cancer and mainly signet ring or non-solid types of advanced gastric cancer. In evaluating lymph node metastases, the location of lymph nodes and the degree of FDG uptake in primary tumors appear to be important factors affecting the diagnostic accuracy of PET/CT. In spite of the limited sensitivity, the high specificity of PET/CT for lymph node metastases may play an important role in changing the extent of lymphadenectomy or reducing futile laparotomies. For peritoneal metastases, PET/CT seems to have a poorer sensitivity but a better specificity than CT. The roles of PET/CT in the evaluation of other distant metastases are yet to be known. Studies including primary tumors with low FDG uptake or peritoneal recurrence seem suffer from poorer diagnostic performance for the detection of recurrent gastric cancer. There are only a few reports using FDG PET/CT to predict response to neoadjuvant or adjuvant chemotherapy. A complete metabolic response seems to be predictive of more favorable prognosis.
Collapse
Affiliation(s)
- Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
|
12
|
Pretreatment F-18 FDG PET/CT Parameters to Evaluate Progression-Free Survival in Gastric Cancer. Nucl Med Mol Imaging 2013; 48:33-40. [PMID: 24900136 DOI: 10.1007/s13139-013-0243-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 09/17/2013] [Accepted: 10/07/2013] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We performed this study to evaluate the predictive value of pretreatment F-18 FDG PET/CT for progression-free survival (PFS) in patients with gastric cancer. METHODS Of 321 patients with a diagnosis of gastric cancer, we retrospectively enrolled 97 patients (men:women = 61:36, age 59.8 ± 13.2 years), who underwent pretreatment F-18 fluoro-2-deoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) from January 2009 to December 2009. Maximum standardized uptake value (SUVmax) was measured for each case with detectable primary lesions. In the remaining non-detectable cases, SUVmax was measured from the corresponding site seen on gastroduodenoscopy for analysis. In subgroup analysis, metabolic tumor volume (MTV) was measured in 50 patients with clearly distinguishable primary lesions. SUVmax, stage, depth of tumor invasion and presence of lymph node metastasis were analyzed in terms of PFS. Receiver operating characteristic (ROC) curves were used to find optimal cutoff values of SUVmax and MTV for disease progression. The relationship between SUVmax, MTV and PFS was analyzed using the Kaplan-Meier with log-rank test and Cox's proportional hazard regression methods. RESULTS Of 97 patients, 15 (15.5 %) had disease progression. The mean follow-up duration was 29.6 ± 10.2 months. The mean PFS of low SUVmax group (≤5.74) was significantly longer than that of the high SUVmax group (>5.74) (30.9 ± 8.0 vs 24.3 ± 13.6 months, p = 0.008). In univariate analysis, stage (I vs II, III, IV), depth of tumor invasion (T1 vs T2, T3, T4), presence of lymph node metastasis and SUVmax (>5.74 vs ≤5.74) were significantly associated with recurrence. In multivariate analysis, high SUVmax (>5.74) was the only poor prognostic factor for PFS (p = 0.002, HR 11.03, 95 % CI 2.48-49.05). Subgroup multivariate analysis revealed that high MTV (>16.42) was the only poor prognostic factor for PFS (p = 0.034, HR 3.59, 95 % CI 1.10-11.71). CONCLUSION In gastric cancer, SUVmax measured by pretreatment F-18 FDG PET/CT has a significant predictive value for PFS. In addition, if MTV is measurable, high MTV is an independent factor for disease progression.
Collapse
|
|
13
|
Duman K, Simsek A, Gorgulu S, Yagci G, Peker Y. The role of 2-[f-18] fluoro 2-deoxy d-glucose positron emission tomography in the preoperative staging of gastric cancer. Eurasian J Med 2013; 45:149-54. [PMID: 25610272 DOI: 10.5152/eajm.2013.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/04/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE FDG-PET can contribute significantly to the preoperative period of patients with planned curative resections or with isolated liver or lung metastasis. In this study, we analyze the importance and diagnostic value of FDG-PET in the preoperative evaluation of gastric cancers by correlating its value with computerized tomography (CT). MATERIALS AND METHODS A prospective study was conducted. Abdominal and pelvic CTs were obtained for preoperative staging in each patient. Separate stagings were performed according to the findings of conventional methods and PET scans, and the results were compared with the operative and histological findings. RESULTS When the patients were evaluated according to the pathological stage, eight patients were Stage 1 (26.7%), five were Stage 2 (16.7%), eight were Stage 3 (26.7%), and nine were Stage 4 (30%). FDG-PET and CT down-staged the disease in eight (26.7%) and twelve (40%) patients, respectively. FDG-PET and CT up-staged the disease in two (6.7%) and five patients (16.7%), respectively. FDG-PET accurately staged the disease in eighteen patients (60%) (p= 0.182). CONCLUSION To develop highly sensitive radioactive tests that show invasive local lymph node and peritoneal metastases, more studies in the preoperative staging of gastric cancer are needed. FDG-PET indicates a high specificity in the staging of gastric cancer. In patients who are planned for curative surgery, FDG-PET provides better staging when used with CT.
Collapse
Affiliation(s)
- Kazim Duman
- Gumussuyu Military Hospital Department of General Surgery, Istanbul, Turkey
| | - Abdurrahman Simsek
- Gulhane Military Medical Academy, Department of General Surgery, Ankara, Turkey
| | - Semih Gorgulu
- Gulhane Military Medical Academy, Department of General Surgery, Ankara, Turkey
| | - Gokhan Yagci
- Gulhane Military Medical Academy, Department of General Surgery, Ankara, Turkey
| | - Yusuf Peker
- Gulhane Military Medical Academy, Department of General Surgery, Ankara, Turkey
| |
Collapse
|
|
14
|
Takebayashi R, Izuishi K, Yamamoto Y, Kameyama R, Mori H, Masaki T, Suzuki Y. [18F]Fluorodeoxyglucose accumulation as a biological marker of hypoxic status but not glucose transport ability in gastric cancer. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2013; 32:34. [PMID: 23718763 PMCID: PMC3672048 DOI: 10.1186/1756-9966-32-34] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/22/2013] [Indexed: 12/22/2022]
Abstract
Background The use of [18F] 2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for detection of gastric cancer is often debated because FDG uptake varies for each patient. The purpose of this study was to clarify the molecular mechanisms involved in FDG uptake. Material and methods Fifty patients with gastric cancer who underwent FDG-PET and gastrectomy were studied. Snap-frozen tumor specimens were collected and examined by real-time PCR for relationships between maximum standardized uptake value (SUV) and mRNA expression of the following genes: glucose transporter 1 (GLUT1), hexokinase 2 (HK2), hypoxia-inducible factor 1α (HIF1α), and proliferating cell nuclear antigen (PCNA). Results Tumor size was the only clinicopathological parameter that significantly correlated with SUV. Transcripts for the genes evaluated were about three-fold higher in malignant specimens than in normal mucosa, although only HIF1α was significantly correlated with SUV. When divided into intestinal and non-intestinal tumors, there was a significant correlation between SUV and tumor size in intestinal tumors. Interestingly, the weak association between SUV and HIF1α expression in intestinal tumors was substantially stronger in non-intestinal tumors. No correlation was found between SUV and mRNA expression of other genes in intestinal or non-intestinal tumors. Conclusion SUV was correlated with HIF1α, but not PCNA, HK2, or GLUT1 expression. FDG accumulation could therefore represent tissue hypoxia rather than glucose transport activity for aggressive cancer growth.
Collapse
Affiliation(s)
- Ryusuke Takebayashi
- Department of Gastroenterological Surgery, Kagawa University, Miki, Kita, Kagawa, Japan
| | | | | | | | | | | | | |
Collapse
|
|
15
|
Ma Q, Xin J, Zhao Z, Guo Q, Yu S, Xu W, Liu C, Zhai W. Value of ¹⁸F-FDG PET/CT in the diagnosis of primary gastric cancer via stomach distension. Eur J Radiol 2013; 82:e302-6. [PMID: 23434453 DOI: 10.1016/j.ejrad.2013.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/23/2013] [Accepted: 01/24/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To clarify the usefulness of (18)F-FDG PET/CT for detecting primary gastric cancer via gastric distention using a mixture of milk and Diatrizoate Meglumine. MATERIALS AND METHODS A total of 68 patients (male: 47, female: 21; age: 41-87 years) suspected of gastric carcinoma underwent (18)F-FDG PET/CT imaging. After whole-body PET/CT imaging in a fasting state, the patients drank a measured amount of milk with Diatrizoate Meglumine. Local gastric district PET/CT imaging was performed 30 min later. The imaging was analyzed by semi-quantitative analysis, standardized uptake value (SUV) of the primary tumor was measured in a region of interest. The diagnosis results were confirmed by gastroscopy, pathology, and follow-up results. RESULTS Of the 68 patients, 56 malignant gastric neoplasm patients (male: 37, female: 19) were conformed. The sensitivity, specificity, positive predictive value and negative predictive value of fasting whole-body PET/CT imaging for a primary malignant tumor were 92.9%, 75.0%, 94.5%, and 69.0%, respectively. The values for distension with a mixture of milk and Diatrizoate Meglumine were 91.1%, 91.7%, 98.1%, and 68.8%, respectively. The area under the curve was 0.919 ± 0.033 and 0.883 ± 0.066 for the diagnosis of gastric cancer with SUVmax in a fasting state and after intake of mixture respectively, the differences were not statistically significant (P=0.359). Using gastric distension with a mixture of milk and Diatrizoate Meglumine, the mean ratio of the lesion's SUVmax to the adjacent gastric wall SUVmax increased significantly from 3.30 ± 3.05 to 13.50 ± 15.05, which was statistically significant (P<0.001). CONCLUSIONS (18)F-FDG PET/CT imaging is highly accurate for the diagnosis of primary gastric carcinoma. Gastric distention can display the lesions more clearly, however, it cannot significantly improve diagnostic accuracy.
Collapse
Affiliation(s)
- Quanmei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
| | | | | | | | | | | | | | | |
Collapse
|
|
16
|
Lee SJ, Lee WW, Yoon HJ, Lee HY, Lee KH, Kim YH, Park DJ, Kim HH, So Y, Kim SE. Regional PET/CT after water gastric inflation for evaluating loco-regional disease of gastric cancer. Eur J Radiol 2013; 82:935-42. [PMID: 23410909 DOI: 10.1016/j.ejrad.2013.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to improve diagnostic accuracy of (18)F-fluoro-2-deoxyglucose (FDG) PET/CT for gastric cancer with water gastric inflation. MATERIALS AND METHODS 44 gastric cancer patients (M:F=30:14, age ± std=62.1 ± 14.5 y) were enrolled before surgery. Fifty minutes after injection of FDG (0.14 mCi/kg body weight), whole body PET/CT was performed first and then regional PET/CT over gastric area was obtained 80 min post FDG injection after water gastric inflation. Diagnostic accuracies for loco-regional lesions were compared between whole body and regional PET/CT. RESULTS 48 primary tumors (23 EGC and 25 AGC) and 348 LN stations (61 metastatic and 287 benign) in 44 patients were investigated. Primary tumor sensitivity of whole body PET/CT (50%=24/48) was significantly improved by regional PET/CT (75%=36/48, p<0.005). Sensitivity of whole body PET/CT (24.6%=15/61) for LN metastasis was also significantly improved by regional PET/CT (36.1%=22/61, p<0.01), whereas specificity of whole body PET/CT (99.3%=285/287) was not compromised by regional PET/CT (98.3%=282/287, p>0.05). Higher primary tumor FDG uptake in regional PET/CT indicated shorter progress-free survival (p=0.0003). CONCLUSION Diagnostic accuracy of whole body PET/CT for loco-regional disease of gastric cancer could be significantly improved by regional PET/CT after water gastric inflation and prognosis could be effectively predicted by primary tumor FDG uptake in regional PET/CT.
Collapse
Affiliation(s)
- Soo Jin Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Atay-Rosenthal S, Wahl RL, Fishman EK. PET/CT findings in gastric cancer: potential advantages and current limitations. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/iim.12.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
|
18
|
Smyth EC, Shah MA. Role of ( 18F) 2-fluoro-2-deoxyglucose positron emission tomography in upper gastrointestinal malignancies. World J Gastroenterol 2011; 17:5059-74. [PMID: 22171140 PMCID: PMC3235589 DOI: 10.3748/wjg.v17.i46.5059] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 06/09/2011] [Accepted: 06/16/2011] [Indexed: 02/06/2023] Open
Abstract
The role of whole-body FDG [(18F) 2-fluoro-2-deoxyglucose] positron emission tomography (PET) scanning as an imaging modality in the management of patients with malignancy has evolved enormously over the past two decades. FDG-PET has demonstrated significant efficacy in the staging, prognostication and detection of occult metastatic disease in malignancies of the gastrointestinal tract, in addition to assessment of the response to cytotoxic chemotherapy in a more timely manner than has traditionally been possible by more conventional imaging tools. The sensitivity and specificity of FDG-PET for the detection and staging of malignancy depend not only on the site and size of the primary tumor and metastases, but also on histological cell type, reflecting underlying disparities in glucose metabolism. The metabolic response to neo-adjuvant chemotherapy or to chemo-radiotherapy in cancers of the gastro-esophageal junction or stomach has been demonstrated in several prospective studies to correlate significantly with both the histological tumor response to treatment and with consequent improvements in overall survival. This may offer a future paradigm of personalized treatment based on the PET response to chemotherapy. FDG-PET has been less successful in efforts to screen for and detect recurrent upper gastrointestinal malignancies, and in the detection of low volume metastatic peritoneal disease. Efforts to improve the accuracy of PET include the use of novel radiotracers such as (18F) FLT (3-deoxy-3-fluorothymidine) or 11C-choline, or fusion PET-CT with concurrent high-resolution computed tomography. This review focuses on the role of FDG-PET scanning in staging and response assessment in malignancies of the upper gastrointestinal tract, specifically gastric, esophageal and pancreas carcinoma.
Collapse
|
|
19
|
Early Gastric Cancer Detected by 2-Hour Delayed FDG PET With the Water Gastric Distention Method. Clin Nucl Med 2011; 36:e192-3. [DOI: 10.1097/rlu.0b013e3182291f57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
20
|
Yamada T, Inoue Y, Asano Y, Nippashi Y, Woodhams R, Matsunaga K, Tago M. Use of an oral effervescent agent in the evaluation of gastric 67Ga uptake. Ann Nucl Med 2011; 26:192-6. [PMID: 22081275 DOI: 10.1007/s12149-011-0554-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 10/20/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Gastric uptake of (67)Ga may be observed in patients with no obvious gastric lesions, as well as those with gastric malignancy. The aim of this study was to investigate whether the use of an effervescent agent aids in evaluating gastric (67)Ga uptake. METHODS Twenty patients having or suspected of having gastric uptake on whole-body (67)Ga scintigrams were studied. Anterior abdominal images were obtained at baseline and after the oral intake of the effervescent agent (gas contrast image). The presence or absence of malignant gastric uptake was judged visually using the baseline image or gas contrast image. The judgment was compared with the clinical diagnosis, and the clinical usefulness of the gas contrast technique was assessed. RESULTS In all patients, successful distension of the stomach was indicated in the gas contrast image. Clinical assessment showed gastric lesions in six patients (gastric involvement of lymphoma in 3, primary gastric lymphoma in 2, and adenocarcinoma in 1). The gas contrast image yielded accurate judgments of malignant gastric uptake in all patients except one with adenocarcinoma. Imaging after gastric distension induced by the oral effervescent agent contributed to excluding malignant gastric uptake in eight patients and demonstrating malignant gastric uptake in four patients. CONCLUSIONS Benign gastric uptake may complicate the assessment of gastric lesions in (67)Ga scintigraphy. Additional spot imaging after oral intake of an effervescent agent can aid in evaluating malignant gastric lesions through gastric distension.
Collapse
Affiliation(s)
- Takeshi Yamada
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan
| | | | | | | | | | | | | |
Collapse
|
|
21
|
Shimada H, Okazumi S, Koyama M, Murakami K. Japanese Gastric Cancer Association Task Force for Research Promotion: clinical utility of ¹⁸F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature. Gastric Cancer 2011; 14:13-21. [PMID: 21331531 DOI: 10.1007/s10120-011-0017-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 11/29/2010] [Indexed: 02/07/2023]
Abstract
Since April 2010, the Japanese Public Health Insurance System has covered the costs incurred for performing ¹⁸F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) imaging for patients with advanced gastric cancer. The aim of this review was to evaluate the clinical impact of PET for patients with gastric cancer. A systematic literature search was performed in PubMed/MEDLINE using the keywords "gastric cancer" and "PET" to search for relevant articles published from January 2000 to September 2010. The clinical impact of selected articles was assessed by the authors to evaluate the following: (a) tumor staging, (b) diagnosis for recurrent disease, (c) evaluation of treatment response, and (d) screening for gastric cancer. FDG uptake increases in papillary adenocarcinoma, tubular adenocarcinoma, and solid-type poorly differentiated adenocarcinoma. This uptake is also associated with glucose transporter 1 expression. The sensitivity and specificity of FDG-PET for metastatic lymph node detection were 21-40% and 89-100%, respectively. The sensitivity and specificity for distant metastasis detection were 35-74% and 74-99%, respectively. Treatment response can be detectable at an earlier stage by PET than by computed tomography (CT), because FDG uptake by cancer cells decreases according to the treatment response. In summary, although PET has limitations such as frequent false-negative cases in signet-ring cell carcinoma and non-solid type poorly differentiated carcinoma, it can contribute to the selection of a more appropriate treatment modality by detecting distant metastases and treatment response.
Collapse
Affiliation(s)
- Hideaki Shimada
- Department of Surgery, Toho University School of Medicine, Omori Medical Center, Ota-ku, Tokyo, 143-8541, Japan.
| | | | | | | |
Collapse
|