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Katiyi A, Zorea J, Halstuch A, Elkabets M, Karabchevsky A. Surface roughness-induced absorption acts as an ovarian cancer cells growth sensor-monitor. Biosens Bioelectron 2020; 161:112240. [PMID: 32365013 DOI: 10.1016/j.bios.2020.112240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
Abstract
Uncontrolled growth of ovarian cancer cells is the fifth leading cause of female cancer deaths since most ovarian cancer patients are diagnosed at an advanced stage of metastatic disease. Here, we report on the sensor for monitoring the cancer treatment efficiency in real-time. We measure the optical interaction between the evanescent fields of microfiber and ovarian cancer inter-cellular medium at different treatment stages. Spectral absorption signatures are correlated with optical micrographs and western blot tests. We found that the treatment of tumor cells with induces both cells growth arrest and alter the spectral lines in a dose-dependent manner. These observations are mediated by surface roughness out of silica glass material, form an essential step toward the development of early detection of response to cancer therapy.
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Affiliation(s)
- Aviad Katiyi
- School of Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel; Ilse Katz Institute for Nanoscale Science & Technology, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Jonathan Zorea
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
| | - Aviran Halstuch
- School of Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel; Ilse Katz Institute for Nanoscale Science & Technology, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
| | - Alina Karabchevsky
- School of Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel; Ilse Katz Institute for Nanoscale Science & Technology, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
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Bae MR, Roh JL, Kim JS, Lee JH, Cho KJ, Choi SH, Nam SY, Kim SY. 18F-FDG PET/CT versus CT/MR imaging for detection of neck lymph node metastasis in palpably node-negative oral cavity cancer. J Cancer Res Clin Oncol 2020; 146:237-244. [PMID: 31606761 DOI: 10.1007/s00432-019-03054-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Subclinical lymph node (LN) metastasis is associated with poor survival outcome in oral cavity squamous cell carcinoma (OCC), which alleges elective neck LN dissection. Preoperative detection of metastatic LNs may improve prognosis and proper management of OCC. We examined the clinical usefulness of fluorine 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for the detection of occult neck LN metastasis in OCC patients in comparison with conventional CT/magnetic resonance (MR) imaging. METHODS A total of 178 OCC patients with negative neck palpation findings were assessed prospectively with 18F-FDG PET/CT and CT/MR imaging. Histopathological analyses of neck dissection samples served as reference. Diagnostic values of 18F-FDG PET/CT versus CT/MR imaging were compared with the McNemar test and logistic regression with generalized estimating equations. RESULTS Forty-two patients (23.6%) had metastasis in 44 sides and 58 levels of the neck. The sensitivity for detection of occult metastasis was higher for 18F-FDG PET/CT than that for CT/MR imaging on a per-patient (69.1% vs 35.7%), per-side (70.5% vs 36.4%), and per-level (62.1% vs 29.3%) basis (all P ≤ 0.001). However, the specificity for metastatic detection was higher for CT/MR imaging than that for 18F-FDG PET/CT (all P < 0.005). 18F-FDG PET/CT improved detection of occult metastasis up to 33.4% in these patients compared to CT/MR imaging. CONCLUSIONS 18F-FDG PET/CT can better detect occult neck metastasis than CT/MR imaging, which may potentially impact the clinical management of OCC patients.
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Affiliation(s)
- Mi Rye Bae
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Ha SC, Roh JL, Kim JS, Lee JH, Choi SH, Nam SY, Kim SY. Clinical utility of 18F-FDG PET/CT for patients with recurrent head and neck squamous cell carcinoma. Acta Otolaryngol 2019; 139:810-815. [PMID: 31274365 DOI: 10.1080/00016489.2019.1632483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: The accurate detection of distant metastases can facilitate appropriate treatment planning for patients with recurrent head and neck squamous cell carcinoma (HNSCC). Objectives: We evaluated the role of 18F-FDG PET/CT for distant metastasis diagnosis and survival prediction in patients with recurrent HNSCC. Materials and methods: This study included 95 consecutive patients with recurrent HNSCC and salvage treatments. McNemar's test was used to compare the detection of distant metastasis at recurrence using 18F-FDG PET/CT and contrast-enhanced chest and neck CT, and bone scintigraphy. Results: Thirty-two patients (34%) had distant metastases at recurrence. The sensitivity, specificity, accuracy, and positive and negative predictive values of 18F-FDG PET/CT for detecting chest and bone metastases were comparable to those of conventional imaging (p > .1). However, 18F-FDG PET/CT detected two additional distant metastatic lesions. After controlling for clinicopathological factors, a recurrent lesion with maximum standardized uptake value (SUVmax) >8.7 was identified as an independent predictor of poor overall survival (p = .001). Conclusions and significance: 18F-FDG PET/CT or conventional imaging is comparable with regard to detecting distant metastases of recurrent HNSCC. However, 18F-FDG PET/CT may detect additional metastatic lesions in unusual distant sites and the recurrent lesion SUVmax may predict patient survival after salvage treatments.
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Affiliation(s)
- Seung Cheol Ha
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Pelosi E, Deandreis D, Cassalia L, Penna D. Diagnostic Applications of Nuclear Medicine: Colorectal Cancer. NUCLEAR ONCOLOGY 2017:777-797. [DOI: 10.1007/978-3-319-26236-9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Liu Y. The Place of FDG PET/CT in Renal Cell Carcinoma: Value and Limitations. Front Oncol 2016; 6:201. [PMID: 27656421 PMCID: PMC5012103 DOI: 10.3389/fonc.2016.00201] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/26/2016] [Indexed: 12/22/2022] Open
Abstract
Unlike for most other malignancies, application of FDG PET/CT is limited for renal cell carcinoma (RCC), mainly due to physiological excretion of 18F-fluoro-2-deoxy-2-d-glucose (FDG) from the kidneys, which decreases contrast between renal lesions and normal tissue, and may obscure or mask the lesions of the kidneys. Published clinical observations were discordant regarding the role of FDG PET/CT in diagnosing and staging RCC, and FDG PET/CT is not recommended for this purpose based on current national and international guidelines. However, quantitative FDG PET/CT imaging may facilitate the prediction of the degree of tumor differentiation and allows for prognosis of the disease. FDG PET/CT has potency as an imaging biomarker to provide useful information about patient’s survival. FDG PET/CT can be effectively used for postoperative surveillance and restaging with high sensitivity, specificity, and accuracy, as early diagnosis of recurrent/metastatic disease can drastically affect therapeutic decision and alter outcome of patients. FDG uptake is helpful for differentiating benign or bland emboli from tumor thrombosis in RCC patients. FDG PET/CT also has higher sensitivity and accuracy when compared with bone scan to detect RCC metastasis to the bone. FDG PET/CT can play a strong clinical role in the management of recurrent and metastatic RCC. In monitoring the efficacy of new target therapy such as tyrosine kinase inhibitors (TKIs) treatment for advanced RCC, FDG PET/CT has been increasingly used to assess the therapeutic efficacy, and change in FDG uptake is a strong indicator of biological response to TKI.
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Affiliation(s)
- Yiyan Liu
- Nuclear Medicine Service, Department of Radiology, New Jersey Medical School, Rutgers University , Newark, NJ , USA
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YAYLALI O, KIRAÇ FS, YÜKSEL D. The role of 18F-FDG PET-CT in the detection of unknown primary malignancy: a retrospective study. Turk J Med Sci 2016; 46:474-82. [DOI: 10.3906/sag-1502-99] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/01/2015] [Indexed: 11/03/2022] Open
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Ardito A, Massaglia C, Pelosi E, Zaggia B, Basile V, Brambilla R, Vigna-Taglianti F, Duregon E, Arena V, Perotti P, Penna D, Terzolo M. 18F-FDG PET/CT in the post-operative monitoring of patients with adrenocortical carcinoma. Eur J Endocrinol 2015; 173:749-56. [PMID: 26346137 DOI: 10.1530/eje-15-0707] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/07/2015] [Indexed: 12/21/2022]
Abstract
CONTEXT The role of (18)F-labeled 2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the post-operative monitoring of patients with adrenocortical carcinoma (ACC) is still unclear. OBJECTIVE To assess the accuracy of FDG PET/CT to diagnose ACC recurrence in a real world setting. DESIGN AND METHODS Retrospective evaluation of data of 57 patients with presumed ACC recurrence at CT scan who underwent FDG PET/CT within a median time of 20 days. We compared the results of either FDG PET/CT or CT with a gold standard confirmation of recurrence (positive histopathology report of removed/biopsied lesions or radiological progression of target lesions at follow-up) to assess their diagnostic performance at different body sites to correctly categorize target lesions. We also assessed whether FDG PET/CT findings may be useful to inform the management strategy. RESULTS In 48 patients with confirmed ACC recurrence, we found that FDG PET/CT had lower sensitivity than CT in diagnosing liver and lung recurrences of ACC. FDG PET/CT had higher specificity than CT in categorizing liver lesions. FDG PET/CT had a greater positive likelihood ratio than CT to identify liver and abdominal ACC recurrences. The management strategy was changed based on FDG PET/CT findings in 12 patients (21.1%). CONCLUSIONS The greater sensitivity of CT may be partly expected due the specific inclusion criteria of the study; however, the greater specificity of FDG PET/CT was particularly useful in ruling out suspected ACC recurrences found by CT. Thus, use of FDG PET/CT as a second-line test in the post-operative surveillance of ACC patients following CT finding of a potential recurrence may have a significant impact on patient management.
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Affiliation(s)
| | | | - E Pelosi
- Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy
| | | | | | - R Brambilla
- Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy
| | - F Vigna-Taglianti
- Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy
| | - E Duregon
- Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy
| | - V Arena
- Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy
| | | | - D Penna
- Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy
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The added value of PET/Ce-CT/DW-MRI fusion in assessment of hepatic focal lesions: PET/Ce-CT/DW-MRI fusion in hepatic focal lesion. Nucl Med Biol 2015; 42:637-42. [PMID: 25907467 DOI: 10.1016/j.nucmedbio.2015.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/16/2015] [Accepted: 03/31/2015] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The liver hosts a variety of benign and malignant tumors. Accurate diagnosis can be challenging in certain cases, especially in patients with a history of malignancy or in those with underlying liver pathology, such as cirrhosis. OBJECTIVES To evaluate the added clinical value of multi-modality liver imaging utilizing PET/Ce-CT/DW-MRI for characterization of hepatic focal lesions (HFL) and compare it with each diagnostic modality when interpreted alone. METHODS The study included 35 patients with HFL. They were 7 females & 28 males; their age ranged from 41 to 78years, all patients underwent PET/Ce-CT and DW-MRI scans. Ce-CT, PET and DW-MR images were reviewed independently, and then combined PET/Ce-CT, PET/DW-MRI and PET/Ce-CT/DW-MRI scans were analyzed. The results were correlated with histopathology or clinical/imaging follow-up. RESULTS The 35 patients had 98 focal lesions. Fifty-three lesions were finally diagnosed as primary hepatocellular carcinoma, 18 lesions were metastases, 7 lesions were lymphoma and 20 lesions were benign. On a patient based analysis; the sensitivity, specificity, PPV, NPV and accuracy were 100%, 67%, 94%, 100% and 94% for PET/Ce-CT compared to 97%, 83%, 97%, 83% and 94 % for DW-MRI, respectively. Combined PET/Ce-CT/DW-MR scans raise those parameters up to 100%. On a lesion based analysis; the sensitivity, specificity, PPV, NPV and accuracy were 94%, 75%, 94%, 75%, 90% for PET/Ce-CT compared to 94%, 95%, 99%, 97% and 94 % for DW-MRI, respectively. All these parameters were 100 % with PET/Ce-CT/DW-MRI. CONCLUSIONS The addition of DW-MRI to PET/Ce-CT is valuable in the characterization of hepatic focal lesions.
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López E, Lazo A, Gutiérrez A, Arregui G, Núñez I, Sacchetti A. Influence of (11)C-choline PET/CT on radiotherapy planning in prostate cancer. Rep Pract Oncol Radiother 2014; 20:104-12. [PMID: 25859399 DOI: 10.1016/j.rpor.2014.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 10/19/2014] [Accepted: 11/20/2014] [Indexed: 12/13/2022] Open
Abstract
AIM To evaluate the influence of (11)C-choline PET/CT on radiotherapy planning in prostate cancer patients. BACKGROUND Precise information on the extension of prostate cancer is crucial for the choice of an appropriate therapeutic strategy. (11)C-choline positron emission tomography ((11)C-choline PET/CT) has two roles in radiation oncology (RT): (1) patient selection for treatment and (2) target volume selection and delineation. In conjunction with high-accuracy techniques, it might offer an opportunity of dose escalation and better tumour control while sparing healthy tissues. MATERIALS AND METHODS We carried out a retrospective study in order to analyse RT planning modification based on (11)C-choline PET/CT in 16 prostate cancer patients. Patients were treated with hypofractionated step-and-shoot Intensity Modulated Radiotherapy (IMRT), or Volumetric Modulated Arc Therapy (VMAT), and a daily cone-beam CT for Image Guided Radiation Therapy (IGRT). All patients underwent a (11)C-choline-PET/CT scan prior to radiotherapy. RESULTS In 37.5% of cases, a re-delineation and new dose prescription occurred. Data show good preliminary clinical results in terms of biochemical control and toxicity. No gastrointestinal (GI)/genitourinary (GU) grade III toxicities were observed after a median follow-up of 9.5 months. CONCLUSIONS In our experience, concerning the treatment of prostate cancer (PCa), (11)C-choline PET/CT may be helpful in radiotherapy planning, either for dose escalation or exclusion of selected sites.
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Affiliation(s)
- Escarlata López
- Radiotherapy and Oncology Department, ONCOSUR, Granada, Spain
| | - Antonio Lazo
- Radiotherapy and Oncology Department, ONCOSUR, Granada, Spain
| | | | | | - Isabel Núñez
- Radiology and Physical Medicine Department, Granada University, Spain
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Krämer JA, Gübitz R, Beck L, Heindel W, Vieth V. [Imaging diagnostics of bone sarcomas]. Unfallchirurg 2014; 117:491-500. [PMID: 24903499 DOI: 10.1007/s00113-013-2470-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Bone tumors and especially bone sarcomas are rare lesions of the skeletal system in comparison to the much more frequently occurring bone metastases. Despite the relative rarity they are important differential diagnoses of bone lesions. OBJECTIVE The aim of this article is to give the reader an insight into the fundamentals of the primary imaging of bone sarcomas and to illustrate this with the help of two examples (e.g. osteosarcoma and chondrosarcoma). RESULTS The foundation of the imaging of bone sarcomas is the radiograph in two planes. This method delivers important information on bone tumors. This information should be analyzed with the help of the Lodwick classification, the configuration of periosteal reactions and a possible reaction of the cortex. A possible tumor matrix and the localization within the skeleton or within long bones also provide important information for differential diagnostic delimitation. Magnetic resonance imaging (MRI) with specific adapted bone tumor sequences allows an exact local staging of a bone sarcoma. In addition to local imaging a compartmental MRI which illustrates the entire extent of tumor-bearing bone and the adjacent joints should be performed to rule out possible skip lesions. The most common distant metastases of osteosarcoma and chondrosarcoma occur in the lungs; therefore, a computed tomography (CT) of the chest is part of staging. Other imaging methods, such as CT of the tumor, positron emission tomography CT (PET-CT), bone scan and whole body MRI supplement the imaging depending on tumor type.
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Affiliation(s)
- J A Krämer
- Institut für Klinische Radiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
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Current status of imaging and emerging techniques to evaluate liver metastases from colorectal carcinoma. Ann Surg 2014; 259:861-72. [PMID: 24509207 DOI: 10.1097/sla.0000000000000525] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. Liver is a common site of tumor spread and in approximately 30% of the cases; synchronous liver disease is present at the time of diagnosis. Early detection of liver metastases is crucial to appropriately select patients who may benefit from hepatic resection among those needing chemotherapy, to improve 5-year survival. Advances in imaging techniques have contributed greatly to the management of these patients. Multidetector computed tomography is the most useful test for initial staging and in posttreatment surveillance settings. Magnetic resonance imaging is considered superior to multidetector computed tomography and positron emission tomography for the detection and characterization of small lesions and for liver evaluation in the presence of background fatty liver changes. Positron emission tomography-computed tomography has a problem-solving role in the detection of distant metastasis and in posttreatment evaluation. The advanced imaging methods also serve a role in selecting appropriate patients for radiologically targeted therapies and in monitoring response to conventional and novel therapies.
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Liu Y. Fluorodeoxyglucose uptake in absence of CT abnormality on PET-CT: What is it? World J Radiol 2013; 5:460-467. [PMID: 24379932 PMCID: PMC3874502 DOI: 10.4329/wjr.v5.i12.460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/29/2013] [Accepted: 11/19/2013] [Indexed: 02/06/2023] Open
Abstract
The purpose of this article is to provide a pictorial review of the findings and interpretative pitfalls about focal fluorodeoxyglucose (FDG) uptake in the absence of corresponding computer tomography (CT) lesion or abnormality on an integrated positron emission tomography (PET)-CT. The integrated CT images in the PET-CT scanner allow correct co-registration and fused imaging of anatomical and functional data. On FDG PET-CT imaging, a real pathologic process often demonstrates abnormal uptake associated with a visible corresponding CT lesion or abnormality. When focal uptake is seen on PET imaging but no corresponding anatomic abnormality is visualized on the integrated CT, one should always be aware of possible mis-registration or mismatch of the PET and CT images due to the patient’s respiratory or body motion. While most of the hot spots in the absence of corresponding anatomic abnormalities are artefactual or secondary to benign etiologies, some may represent small sized or early staged neoplasm or metastases, especially in the gastrointestinal tract and skeletons. Caution should be exercised to simply diagnose a pathology based on the presence of the uptake only, or exclude the disease based on the absence of anatomic abnormality.
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Smaldone MC, Chen DY, Yu JQ, Plimack ER. Potential role of (124)I-girentuximab in the presurgical diagnosis of clear-cell renal cell cancer. Biologics 2012. [PMID: 23204838 PMCID: PMC3508606 DOI: 10.2147/btt.s30413] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Renal cell carcinoma (RCC) is a biologically heterogeneous disease, with many small renal masses (SRMs) exhibiting an indolent natural history, while others progress more rapidly to become life-threatening. Existing multiphase contrast-enhanced imaging methods, such as computed tomography or magnetic resonance imaging, cannot definitively distinguish between benign and malignant solid tumors or identify histologic subtype, and early results of molecular imaging studies (positron emission tomography [PET]) in the evaluation of SRMs have not improved on these established modalities. Alternative molecular markers/agents recognizing aberrant cellular pathways of cellular oxidative metabolism, DNA synthesis, and tumor hypoxia tracers are currently under development and investigation for RCC assessment, but to date none are yet clinically applicable or available. In contrast, immuno-PET offers highly selective binding to cancer-specific antigens, and might identify radiographically recognizable and distinct molecular targets. A phase I proof-of-concept study first demonstrated the ability of immuno-PET to discriminate between clear-cell RCC (ccRCC) and non-ccRCC, utilizing a chimeric monoclonal antibody to carbonic anhydrase IX (cG250, girentuximab) labeled with 124I (124I-girentuximab PET); the study examined patients with renal masses who subsequently underwent standard surgical resection. A follow-up phase III multicenter trial confirmed that 124I-cG250-PET can accurately and noninvasively identify ccRCC with high sensitivity (86%), specificity (87%), and positive predictive value (95%). In the challenge to appropriately match treatment of an incidentally identified SRM to its biological potential, this highly accurate and histologically specific molecular imaging modality demonstrates the ability of imaging to provide clinically important preoperative diagnostic information, which can result in optimal and personalized therapy.
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Affiliation(s)
- Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Schmidt GP. Whole-body MR or PET-CT? Eur J Radiol 2012; 81 Suppl 1:S142-3. [DOI: 10.1016/s0720-048x(12)70059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
PURPOSE Although initial studies have shown the utility of fluorine-18 fluorodeoxyglucose (F-18 FDG) PET in the detection and restaging of recurrent breast carcinoma, scarce literature exists on F-18 FDG PET/computed tomography (CT). This retrospective study was carried out to evaluate the role of F-18-FDG PET/CT in recurrent breast carcinoma and its impact on management. MATERIALS AND METHODS Retrospective analysis of data of 111 patients who underwent F-18 FDG PET/CT and were suspected of having recurrent breast carcinoma was carried out. PET/CT imaging was carried out for distant metastases in histologically proven locoregional recurrence in 23 patients, clinically suspicious locoregional recurrence in nine patients, increasing tumour markers in two patients, suspicion of distant metastatic disease in 61 patients or as a part of surveillance in 16 patients. The final diagnosis of recurrence and stage of disease was made after histopathological analysis, correlative imaging and clinical or imaging follow-up of at least 6 months. RESULTS The final diagnosis of recurrent breast carcinoma was made in 76 patients and no evidence of recurrence was found in the remaining 35 patients. Locoregional disease requiring local radiotherapy or surgery was diagnosed in 14 patients and distant metastatic disease was diagnosed in 62 patients. FDG PET/CT was true positive in 75 patients, false positive in six patients, true negative in 35 patients and false negative in one patient, with a sensitivity, specificity, positive predictive value and a negative predictive value of 98.7, 85.3, 92.5 and 97.2%, respectively. FDG PET/CT also accurately restaged 22/23 patients with proven locoregional recurrence with an accuracy of 95.45%. Of 53 patients suspected of having distant metastatic disease on other imaging modalities, true distant metastatic disease was diagnosed in 36 patients and FDG PET/CT identified true metastatic disease in 35/36 patients, accurately ruling out metastases in the remaining 17 patients, and was false negative in one patient. In addition to confirming distant metastatic disease, it revealed more metastatic sites in 22 patients. Overall, F-18 FDG PET/CT had a major impact on management in 41% of the 103 patients being analysed for a major change in treatment. CONCLUSION F-18 FDG PET/CT is a very sensitive and specific imaging tool in detecting and restaging recurrent breast carcinoma. It can be a very useful imaging tool for restaging locoregional recurrences, and as a one-stop shop imaging technique to confirm suspicious metastatic disease on conventional imaging and to define the total burden of disease.
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Skanjeti A, Pelosi E. Lymph Node Staging with Choline PET/CT in Patients with Prostate Cancer: A Review. ISRN ONCOLOGY 2011; 2011:219064. [PMID: 22220283 PMCID: PMC3246789 DOI: 10.5402/2011/219064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/13/2011] [Indexed: 11/23/2022]
Abstract
Due to its prevalence, prostate cancer represents a serious health problem. The treatment, when required, may be local in case of limited disease, locoregional if lymph nodes are involved, and systemic when distant metastases are present. In order to choose the best treatment regimen, an accurate disease staging is mandatory. However, the accuracy of conventional imaging modalities in detecting lymph node and bone metastases is low. In the last decade, molecular imaging, particularly, choline PET-CT has been evaluated in this setting. Choline PET represents the more accurate exam to stage high-risk prostate cancer, and it is useful in staging patients with biochemical relapse, in particular when PSA kinetics is high and/or PSA levels are more than 2 pg/ml. The present paper reports results of available papers on these issues, with particular attention to lymph node staging.
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Affiliation(s)
- Andrea Skanjeti
- SCDU Medicina Nucleare 2, ASO S. Giovanni Battista, Corso Bramante, 88, 10126 Torino, Italy
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Reiner CS, Fischer MA, Hany T, Stolzmann P, Nanz D, Donati OF, Weishaupt D, von Schulthess GK, Scheffel H. Molecular imaging of malignant tumor metabolism: whole-body image fusion of DWI/CT vs. PET/CT. Acad Radiol 2011; 18:940-6. [PMID: 21718953 DOI: 10.1016/j.acra.2011.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/27/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To prospectively investigate the technical feasibility and performance of image fusion for whole-body diffusion-weighted imaging (wbDWI) and computed tomography (CT) to detect metastases using hybrid positron emission tomography/computed tomography (PET/CT) as reference standard. MATERIAL AND METHODS Fifty-two patients (60 ± 14 years; 18 women) with different malignant tumor disease examined by PET/CT for clinical reasons consented to undergo additional wbDWI at 1.5 Tesla. WbDWI was performed using a diffusion-weighted single-shot echo-planar imaging during free breathing. Images at b = 0 s/mm(2) and b = 700 s/mm(2) were acquired and apparent diffusion coefficient (ADC) maps were generated. Image fusion of wbDWI and CT (from PET/CT scan) was performed yielding for wbDWI/CT fused image data. One radiologist rated the success of image fusion and diagnostic image quality. The presence or absence of metastases on wbDWI/CT fused images was evaluated together with the separate wbDWI and CT images by two different, independent radiologists blinded to results from PET/CT. Detection rate and positive predictive values for diagnosing metastases was calculated. PET/CT examinations were used as reference standard. RESULTS PET/CT identified 305 malignant lesions in 39 of 52 (75%) patients. WbDWI/CT image fusion was technically successful and yielded diagnostic image quality in 73% and 92% of patients, respectively. Interobserver agreement for the evaluation of wbDWI/CT images was κ = 0.78. WbDWI/CT identified 270 metastases in 43 of 52 (83%) patients. Overall detection rate and positive predictive value of wbDWI/CT was 89% (95% CI, 0.85-0.92) and 94% (95% CI, 0.92-0.97), respectively. CONCLUSION WbDWI/CT image fusion is technically feasible in a clinical setting and allows the diagnostic assessment of metastatic tumor disease detecting nine of 10 lesions as compared with PET/CT.
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Schmidt GP, Paprottka P, Jakobs TF, Hoffmann RT, Baur-Melnyk A, Haug A, Notohamiprodjo M, Baur-Melnyk A, Nikolaou K, Reiser MF, Rist C. FDG-PET-CT and whole-body MRI for triage in patients planned for radioembolisation therapy. Eur J Radiol 2011; 81:e269-76. [PMID: 21398060 DOI: 10.1016/j.ejrad.2011.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/01/2011] [Accepted: 02/04/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose was to evaluate the potential of FDG-PET-CT and whole-body MRI (WB-MRI) as diagnostic triage methods for patients planned for radioembolisation of metastatic liver disease. MATERIALS AND METHODS 135 patients with multifocal liver metastases were evaluated for potential palliative therapy with radioembolisation using 90-Yttrium microspheres. All patients were examined consecutively with FDG-PET-CT and WB-MRI for exclusion of relevant extra-hepatic tumor manifestations. All patients underwent 99mTc-albumine angiography followed by scintigraphy to exclude significant hepato-pulmonary shunting. RESULTS Out of the 135 patients included into the pre-therapeutic diagnostic algorithm, 56% were eligible and received radioembolisation, while 44% could not be treated. In 91% the exclusion criteria was diagnosis of significant extra-hepatic metastatic disease. In 85% exclusion diagnosis was made concordantly by both FDG-PET-CT and WB-MRI, in 9% diagnosis was provided by PET-CT, in 6% by WB-MRI alone. Patient-based sensitivity for detection of extra-hepatic disease was 94% for PET-CT and 91% for WB-MRI. False-positive diagnosis of extrahepatic disease leading to exclusion for radioembolisation therapy was made in 2% of patients, in one patient by PET-CT and in one patient by WB-MRI alone. Overall, specificity for inclusion of radioembolisation therapy by combining both modalities was 99%. In 9% of patients angiographic diagnosis made radioembolisation impossible, in 7% solely the angiographic findings were decisive. CONCLUSION Both FDG-PET-CT and WB-MRI are efficient diagnostic triage methods for patients planned for radioembolisation of liver metastases. Overall, FDG-PET-CT shows a trend to higher diagnostic accuracy compared to WB-MRI and may be used as imaging method of choice as a standalone examination. In combination, both modalities exhibited high sensitivity for the diagnosis of extra-hepatic tumor manifestations and result in high specificity.
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Affiliation(s)
- G P Schmidt
- Department of Clinical Radiology, University Hospitals Munich-Grosshadern, LMU, Marchioninistr. 15, 81377 München, Germany.
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Abstract
The field of convergence technology may be defined as an area of technologic innovation in which multiple devices or functionalities are combined within a single platform in a way that adds functional, operational or economic synergies. Within the field of medical devices, this concept embodies many different types of novel combinations representing syntheses of therapeutic, diagnostic and digital information technologies. In the current era of healthcare reform, such combinatorial technologies will be pressed to demonstrate improvements in comparative effectiveness compared with the use of separate independent components. Moreover, the new more stringent regulatory environment will require much greater levels of pre- and post-market safety reviews conducted under the auspices and authority of the US FDA Office of Combination Products. This branch of the FDA scrutinizes submissions and divides them into drugs, devices and biological products and includes many submissions previously regulated by disparate centers, such as the Center for Devices and Radiologic Health and the Center for Drug Evaluation and Research. The field of convergence technologies already amounts to a worldwide market extending to tens of billions of dollars and this article will attempt to summarize some of the key elements of this continued push for added value and more personalized medicine.
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Affiliation(s)
- Roger M Macklis
- Department of Radiation Oncology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Schmidt GP, Haug A, Reiser MF, Rist C. [Whole-body MRI and FDG-PET/CT imaging diagnostics in oncology]. Radiologe 2010; 50:329-38. [PMID: 20229091 DOI: 10.1007/s00117-009-1971-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The advent of whole-body MRI (WB-MRI) has introduced a systemic approach to oncologic imaging compared to established sequential, multi-modal diagnostic algorithms. Hardware innovations, such as whole-body scanners at 1.5 Tesla and also recently 3 Tesla, combined with acquisition acceleration techniques, have made WB-MRI clinically feasible. With this method dedicated assessment of individual organs with various soft tissue contrast, high spatial resolution and contrast media dynamics can be combined with whole-body anatomic coverage.PET/CT has established itself as a powerful modality in the staging of patients suffering from malignant tumors. In addition to the morphologic information provided by the CT component of this hybrid modality, the PET component contributes invaluable metabolic information, which greatly enhances accuracy in the assessment of lymphatic spread and viability of tumor tissue. Whole-body MR diffusion imaging is a novel and promising technique which may contribute to superior sensitivity in the detection of tumor manifestations. In the assessment of distant metastatic spread WB-MRI is highly sensitive and has advantages over PET/CT, especially in those tumors frequently spreading to the liver, bone or brain. WB-MRI is also very attractive as a radiation-free alternative for imaging of pediatric tumor patients in whom multiple follow-up examinations may be required.WB-MRI allows for precise assessment of the bone marrow and has been proven to be highly accurate for the staging of hematologic diseases, such as multiple myeloma. In this article recent developments and applications of WB-MRI in oncologic imaging are addressed and compared to the results of PET/CT.
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Affiliation(s)
- G P Schmidt
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
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Affiliation(s)
- Susan L Deutscher
- Biochemistry Department, 117 Schweitzer Hall, University of Missouri, Columbia, Missouri 65211, USA.
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Aukema TS, Valdés Olmos RA, Wouters MWJM, Klop WMC, Kroon BBR, Vogel WV, Nieweg OE. Utility of Preoperative 18F-FDG PET/CT and Brain MRI in Melanoma Patients with Palpable Lymph Node Metastases. Ann Surg Oncol 2010; 17:2773-8. [DOI: 10.1245/s10434-010-1088-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Indexed: 11/18/2022]
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Straver ME, Aukema TS, Olmos RAV, Rutgers EJT, Gilhuijs KGA, Schot ME, Vogel WV, Peeters MJTFDV. Feasibility of FDG PET/CT to monitor the response of axillary lymph node metastases to neoadjuvant chemotherapy in breast cancer patients. Eur J Nucl Med Mol Imaging 2010; 37:1069-76. [PMID: 20130860 PMCID: PMC2869017 DOI: 10.1007/s00259-009-1343-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 11/17/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to assess the accuracy of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT to visualize lymph node metastases before the start of neoadjuvant chemotherapy and to determine how often the visualization is sufficiently prominent to allow monitoring of the axillary response. METHODS Thirty-eight patients with invasive breast cancer of >3 cm and/or lymph node metastasis underwent FDG PET/CT before neoadjuvant chemotherapy. The results of the FDG PET/CT were compared with those from ultrasonography with fine-needle aspiration (FNA) cytology or sentinel node biopsy. Patients suitable for response monitoring of the axilla were defined as having either a maximum standardized uptake value (SUV(max)) >or= 2.5 or a tumour to background ratio >or=5 in the most intense lymph node. RESULTS The sensitivity and specificity of FDG PET/CT in detecting axillary involvement were 97 and 100%, respectively. No difference existed between the SUV(max) of the primary tumour and that from the related most intense lymph node metastasis. Moreover, the mean tumour to background ratio was 90% higher in the lymph nodes compared to the primary tumour (p = 0.006). Ninety-three per cent of the patients had sufficient uptake in the lymph nodes to qualify for subsequent response monitoring of the axilla. A considerable distinction in metabolic activity was observed between the different subtypes of breast cancer. The mean SUV(max) in lymph node metastases of oestrogen receptor (ER)-positive, triple-negative and human epidermal growth factor receptor 2 (HER2)-positive tumours was 6.6, 11.6 and 6.6, respectively. CONCLUSION The high accuracy in visualizing lymph node metastases and the sufficiently high SUV(max) and tumour to background ratio at baseline suggest that it is feasible to monitor the axillary response with FDG PET/CT, especially in triple-negative tumours.
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Affiliation(s)
- Marieke E. Straver
- Department of Surgical Oncology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Tjeerd S. Aukema
- Department of Nuclear Medicine, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Renato A. Valdes Olmos
- Department of Nuclear Medicine, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Emiel J. T. Rutgers
- Department of Surgical Oncology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Kenneth G. A. Gilhuijs
- Department of Radiology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Margaret E. Schot
- Department of Medical Oncology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Wouter V. Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Aukema TS, Rutgers EJT, Vogel WV, Teertstra HJ, Oldenburg HS, Vrancken Peeters MTFD, Wesseling J, Russell NS, Valdés Olmos RA. The role of FDG PET/CT in patients with locoregional breast cancer recurrence: a comparison to conventional imaging techniques. Eur J Surg Oncol 2009; 36:387-92. [PMID: 19962268 DOI: 10.1016/j.ejso.2009.11.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/16/2009] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the impact of (18)F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) on clinical management in patients with locoregional breast cancer recurrence amenable for locoregional treatment and to compare the PET/CT results with the conventional imaging data. PATIENTS AND METHODS From January 2006 to August 2008, all patients with locoregional breast cancer recurrence underwent whole-body PET/CT. PET/CT findings were compared with results of the conventional imaging techniques and final pathology. The impact of PET/CT results on clinical management was evaluated based on clinical decisions obtained from patient files. RESULTS 56 patients were included. In 32 patients (57%) PET/CT revealed additional tumour localisations. Distant metastases were detected in 11 patients on conventional imaging and in 23 patients on PET/CT images (p < 0.01). In 25 patients (45%), PET/CT detected additional lesions not visible on conventional imaging. PET/CT had an impact on clinical management in 27 patients (48%) by detecting more extensive locoregional disease or distant metastases. In 20 patients (36%) extensive surgery was prevented and treatment was changed to palliative treatment. The sensitivity, specificity, accuracy, positive and negative predictive values of FDG PET/CT were respectively 97%, 92%, 95%, 94% and 96%. CONCLUSIONS PET/CT, in addition to conventional imaging techniques, plays an important role in staging patients with locoregional breast cancer recurrence since its result changed the clinical management in almost half of the patients. PET/CT could potentially replace conventional staging imaging in patients with a locoregional breast cancer recurrence.
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Affiliation(s)
- T S Aukema
- Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Delbeke D, Schöder H, Martin WH, Wahl RL. Hybrid imaging (SPECT/CT and PET/CT): improving therapeutic decisions. Semin Nucl Med 2009; 39:308-40. [PMID: 19646557 DOI: 10.1053/j.semnuclmed.2009.03.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The incremental diagnostic value of integrated positron emission tomography-computed tomography (PET/CT) or single-photon emission computed tomography (SPECT)/CT images compared with PET or SPECT alone, or PET or SPECT correlated with a CT obtained at a different time includes the following: (1) improvement in lesion detection on both CT and PET or SPECT images, (2) improvement in the localization of foci of uptake resulting in better differentiation of physiological from pathologic uptake, (3) precise localization of the malignant foci, for example, in the skeleton vs soft tissue or liver vs adjacent bowel or node (4) characterization of serendipitous lesions, and (5) confirmation of small, subtle, or unusual lesions. The use of these techniques can occur at the time of initial diagnosis, in assessing the early response of disease to treatment, at the conclusion of treatment, and in continuing follow-up of patients. PET/CT and SPECT/CT fusion images affect the clinical management in a significant proportion of patients with a wide range of diseases by (1) guiding further procedures, (2) excluding the need of further procedures, (3) changing both inter- and intramodality therapy, including soon after treatment has been initiated, and (4) by providing prognostic information. PET/CT fusion images have the potential to provide important information to guide the biopsy of a mass to active regions of the tumor and to provide better maps than CT alone to modulate field and dose of radiation therapy. It is expected that the role of PET/CT and SPECT/CT in changing management will continue to evolve in the future and that these tools will be fundamental components of the truly "personalized medicine" we are striving to deliver.
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Affiliation(s)
- Dominique Delbeke
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232-2675, USA.
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Pantvaidya GH, Agarwal JP, Deshpande MS, Rangarajan V, Singh V, Kakade A, D'Cruz AK. PET-CT in recurrent head neck cancers: a study to evaluate impact on patient management. J Surg Oncol 2009; 100:401-3. [PMID: 19235784 DOI: 10.1002/jso.21257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES PET-CT has shown promise in the management of head neck cancers. However, there have been only few studies evaluating its impact on management of patients with recurrent cancers in the presence of available clinicoradiologic methods of assessment. We conducted this study to assess the same in patients with suspected recurrent head and neck cancer. METHODS Case histories were presented to two oncologists, who were blinded to PET-CT reports. Treatment plans were made by these oncologists based on clinical findings and other conventional imaging. These plans were then compared to the actual treatment received by patients after PET-CT. Any change was recorded as "change in management." RESULTS Forty-nine patients with suspected recurrent head and neck cancer were evaluated in the study. Overall, there was a 38.7% change in management because of the addition of PET-CT to conventional methods of assessment. Eight patients (16.3%) had a major change in therapy while in 11 patients (22.4%), diagnostic procedures like endoscopies, biopsies and examination under anesthesia were avoided. CONCLUSION In our study, PET-CT had a significant impact on the management of patients with suspected recurrent head neck cancer.
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Affiliation(s)
- G H Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
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Bae JS, Chae BJ, Park WC, Kim JS, Kim SH, Jung SS, Song BJ. Incidental thyroid lesions detected by FDG-PET/CT: prevalence and risk of thyroid cancer. World J Surg Oncol 2009; 7:63. [PMID: 19664272 PMCID: PMC2732624 DOI: 10.1186/1477-7819-7-63] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 08/10/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incidentally found thyroid lesions are frequently detected in patients undergoing FDG-PET/CT. The aim of this study was to investigate the prevalence of incidentally found thyroid lesions in patients undergoing FDG-PET/CT and determine the risk for thyroid cancer. METHODS FDG-PET/CT was performed on 3,379 patients for evaluation of suspected or known cancer or cancer screening without any history of thyroid cancer between November 2003 and December 2005. Medical records related to the FDG-PET/CT findings including maximum SUV(SUVmax) and pattern of FDG uptake, US findings, FNA, histopathology received by operation were reviewed retrospectively. RESULTS Two hundred eighty five patients (8.4%) were identified to have FDG uptake on FDG-PET/CT. 99 patients with focal or diffuse FDG uptake underwent further evaluation. The cancer risk of incidentally found thyroid lesions on FDG-PET/CT was 23.2% (22/99) and the cancer risks associated with focal and diffuse FDG uptake were 30.9% and 6.4%. There was a significant difference in the SUVmax between the benign and malignant nodules (3.35 +/- 1.69 vs. 6.64 +/- 4.12; P < 0.001). There was a significant correlation between the SUVmax and the size of the cancer. CONCLUSION The results of this study suggest that incidentally found thyroid lesions by FDG-PET/CT, especially a focal FDG uptake and a high SUV, have a high risk of thyroid malignancy. Further diagnostic work-up is needed in these cases.
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Affiliation(s)
- Ja Seong Bae
- Department of Surgery, The Catholic University of Korea, Seoul, Korea.
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Abstract
This review focuses mainly on clinical applications of PET/CT in patients with breast cancer. It discusses the role of 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) PET/CT (and FDG PET) in the diagnosis and initial staging of breast cancer, in monitoring the response of disease to chemotherapy, and in identifying metastatic and recurrent disease. In addition, it discusses the role of MR imaging and potential future hybrid modalities such as PET/MR imaging.
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Affiliation(s)
- Shamim Ahmed Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, E-81, Ansari Nagar (East), AIIMS Campus, New Delhi 110029, India
| | - Drew A Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, E-81, Ansari Nagar (East), AIIMS Campus, New Delhi 110029, India.
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Schmidt GP, Baur-Melnyk A, Haug A, Utzschneider S, Becker CR, Tiling R, Reiser MF, Hermann KA. Whole-body MRI at 1.5 T and 3 T compared with FDG-PET-CT for the detection of tumour recurrence in patients with colorectal cancer. Eur Radiol 2009; 19:1366-78. [PMID: 19190917 DOI: 10.1007/s00330-008-1289-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Accepted: 12/09/2008] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to assess the diagnostic accuracy of whole-body MRI (WB-MRI) at 1.5 T or 3 T compared with FDG-PET-CT in the follow-up of patients suffering from colorectal cancer. In a retrospective study, 24 patients with a history of colorectal cancer and suspected tumour recurrence underwent FDG-PET-CT and WB-MRI with the use of parallel imaging (PAT) for follow-up. High resolution coronal T1w-TSE and STIR sequences at four body levels, HASTE imaging of the lungs, contrast-enhanced T1w- and T2w-TSE sequences of the liver, brain, abdomen and pelvis were performed, using WB-MRI at either 1.5 T (n = 14) or 3 T (n = 10). Presence of local recurrent tumour, lymph node involvement and distant metastatic disease was confirmed using radiological follow-up within at least 5 months as a standard of reference. Seventy seven malignant foci in 17 of 24 patients (71%) were detected with both WB-MRI and PET-CT. Both investigations concordantly revealed two local recurrent tumours. PET-CT detected significantly more lymph node metastases (sensitivity 93%, n = 27/29) than WB-MRI (sensitivity 63%, n = 18/29). PET-CT and WB-MRI achieved a similar sensitivity for the detection of organ metastases with 80% and 78%, respectively (37/46 and 36/46). WB-MRI detected brain metastases in one patient. One false-positive local tumour recurrence was indicated by PET-CT. Overall diagnostic accuracy for PET-CT was 91% (sensitivity 86%, specificity 96%) and 83% for WB-MRI (sensitivity 72%, specificity 93%), respectively. Examination time for WB-MRI at 1.5 T and 3 T was 52 min and 43 min, respectively; examination time for PET-CT was 103 min. Initial results suggest that differences in accuracy for local and distant metastases detection using FDG-PET-CT and WB-MRI for integrated screening of tumour recurrence in colorectal cancer depend on the location of the malignant focus. Our results show that nodal disease is better detected using PET-CT, whereas organ disease is depicted equally well by both investigations.
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Affiliation(s)
- G P Schmidt
- Department of Clinical Radiology, University Hospitals Grosshadern, Ludwig Maximilian University Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Tuncel M, Souvatzoglou M, Herrmann K, Stollfuss J, Schuster T, Weirich G, Wester HJ, Schwaiger M, Krause BJ. [(11)C]Choline positron emission tomography/computed tomography for staging and restaging of patients with advanced prostate cancer. Nucl Med Biol 2008; 35:689-95. [PMID: 18678354 DOI: 10.1016/j.nucmedbio.2008.05.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 05/06/2008] [Accepted: 05/21/2008] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To evaluate [(11)C]Choline positron emission tomography (PET)/computed tomography (CT) for staging and restaging of patients with advanced prostate cancer and to compare the diagnostic performance of PET, CT and PET/CT. METHODS Forty-five consecutive patients with advanced prostate cancer underwent [(11)C]Choline-PET/CT between 5/2004 and 2/2006. RESULTS Overall, 295 lesions were detected: PET alone, 178 lesions; diagnostic CT, 221 lesions; PET/CT (low-dose CT), 272 lesions; PET/CT (diagnostic CT), 295 lesions. Two thirds of the lesions were located in the bone; one third in the prostate, lymph nodes, periprostatic tissue and soft tissue (lung, liver). The use of diagnostic CT did not result in a statistically significant difference with respect to lesion localization certainty and lesion characterization (P=.063, P=.063). PET-negative but PET/CT-positive lesions were mostly localized in the bone (78%, 91/117) as were PET-positive and CT-negative lesions (72%, 53/74). Of the latter, 91% (48/53) represented bone marrow and 9% (5/53) cortical involvement. CONCLUSIONS Staging and restaging with [(11)C]Choline PET/CT in patients with advanced prostate cancer improve the assessment of local and regional recurrent as well as metastatic disease including skeletal manifestations. [(11)C]Choline PET/CT (with a low-dose CT) results in improved localization and lesion characterization. [(11)C]Choline PET/CT provides an added value for skeletal manifestations. [(11)C]Choline PET/CT changed disease management in 11 (24%) of 45 patients with advanced prostate cancer.
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Affiliation(s)
- Murat Tuncel
- Department of Nuclear Medicine, Klinikum rechts der lsar, Technische Universität München, Munich, Germany
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Dual-phase FDG-PET: delayed acquisition improves hepatic detectability of pathological uptake. Radiol Med 2008; 113:875-86. [DOI: 10.1007/s11547-008-0287-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 11/14/2007] [Indexed: 10/21/2022]
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Sung YM, Lee KS, Kim BT, Choi JY, Chung MJ, Shim YM, Yi CA, Kim TS. (18)F-FDG PET versus (18)F-FDG PET/CT for adrenal gland lesion characterization: a comparison of diagnostic efficacy in lung cancer patients. Korean J Radiol 2008; 9:19-28. [PMID: 18253072 PMCID: PMC2627169 DOI: 10.3348/kjr.2008.9.1.19] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone. Materials and Methods Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test. Results Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively). Conclusion The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.
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Affiliation(s)
- Yon Mi Sung
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, Korea
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The role of PET-CT in the management of patients with advanced cancer of the head and neck. Curr Oncol Rep 2008; 10:149-55. [DOI: 10.1007/s11912-008-0023-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Connell CA, Corry J, Milner AD, Hogg A, Hicks RJ, Rischin D, Peters LJ. Clinical impact of, and prognostic stratification by, F-18 FDG PET/CT in head and neck mucosal squamous cell carcinoma. Head Neck 2008; 29:986-95. [PMID: 17563906 DOI: 10.1002/hed.20629] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to determine prospectively the incremental value of positron emission tomography/computed tomography (PET/CT) over conventional assessment (clinical examination and CT/MRI imaging). METHODS All patients undergoing (18)F-fluorodeoxyglucose (FDG)-PET/CT for primary head and neck mucosal squamous cell carcinoma between January 2002 and December 2003 (inclusive) were included in this study provided they had undergone contemporaneous conventional assessment of the head and neck region and had 12 months minimum follow-up. RESULTS Seventy-six patients underwent 100 PET/CT scans. The majority of patients (74%) were treated with definitive (chemo)radiotherapy. Median follow-up time was 28 months. PET/CT led to a TNM classification alteration in 34% (12/35), a change in radiotherapy planning technique and/or dose in 29% (10/35), and altered treatment response assessment in 43% (13/30). A complete metabolic response was predictive of overall survival (p = .037). CONCLUSION Our results support incorporation of PET/CT into the management paradigm of head and neck mucosal squamous cell carcinoma.
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Affiliation(s)
- Caroline A Connell
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Australia.
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Chung HH, Kang WJ, Kim JW, Park NH, Song YS, Chung JK, Kang SB. The clinical impact of [18F]FDG PET/CT for the management of recurrent endometrial cancer: correlation with clinical and histological findings. Eur J Nucl Med Mol Imaging 2008; 35:1081-8. [DOI: 10.1007/s00259-007-0687-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 12/14/2007] [Indexed: 11/28/2022]
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Eubank WB. Defining Advanced Breast Cancer. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Comprehensive imaging of tumor recurrence in breast cancer patients using whole-body MRI at 1.5 and 3T compared to FDG–PET–CT. Eur J Radiol 2008; 65:47-58. [DOI: 10.1016/j.ejrad.2007.10.021] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2007] [Accepted: 10/29/2007] [Indexed: 11/22/2022]
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Picchio M, Messa C, Zangheri B, Landoni C, Gianolli L, Fazio F. PET/CT and Breast Cancer. Breast Cancer 2007. [DOI: 10.1007/978-3-540-36781-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Preoperative prognostic score for predicting survival after hepatic resection for colorectal liver metastases. Ann Surg 2007; 246:806-14. [PMID: 17968173 DOI: 10.1097/sla.0b013e318142d964] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite indications for resection of colorectal liver metastases having expanded, debate continues about identifying patients that may benefit from surgery. METHODS Clinicopathologic data from a total of 700 patients was gathered between January 1993 and January 2006 from a prospectively maintained dataset. Of these, 687 patients underwent resection for colorectal liver metastases. RESULTS The median age of patient was 64 years and 36.8% of patients had synchronous disease. The overall 5-year survival was 45%. The presence of an inflammatory response to tumor (IRT), defined by an elevated C-reactive protein (>10 mg/L) or a neutrophil/lymphocyte ratio of >5:1, was noted in 24.5% of cases. Only the number of metastases and the presence or absence of an IRT influenced both overall and disease-free survival on multivariable analysis. A preoperative prognostic score was derived: 0 = less than 8 metastases and absence of IRT; 1 = 8 or more metastases or IRT, and 2 = 8 or more metastases and IRT-from the results of the multivariable analysis. The 5-year survival of those scoring 0 was 49% compared with 34% for those scoring 1. None of the patients that scored 2 were alive at 5 years. CONCLUSION The preoperative prognostic score is a simple and effective system allowing preoperative stratification.
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Value of PET and PET/CT in the diagnostics of prostate and penile cancer. Recent Results Cancer Res 2007; 170:159-79. [PMID: 18019625 DOI: 10.1007/978-3-540-31203-1_13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Benign nonphysiologic lesions with increased 18F-FDG uptake on PET/CT: characterization and incidence. AJR Am J Roentgenol 2007; 189:1203-10. [PMID: 17954662 DOI: 10.2214/ajr.07.2083] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of our study was to characterize benign lesions showing increased 18F-FDG uptake and to determine their incidence on whole-body FDG PET/CT performed in oncologic patients. In addition, the performance of PET alone and PET/CT in characterizing lesions as benign was compared. MATERIALS AND METHODS A retrospective review of 1,134 consecutive reports of PET/CT studies performed in patients with proven or suspected malignancy over a 6-month period yielded 289 patients with 313 lesions that showed increased FDG uptake but were suspected to be benign (nonphysiologic) or indeterminate. Lesions were subjectively categorized on the basis of the intensity of FDG uptake (mild, moderate, or marked) as compared with background activity. For each lesion, a decision was made as to whether a benign diagnosis could be obtained by the CT part of the study, the PET pattern, or clinical correlation, or whether histologic sampling was necessary. The performance of PET alone and PET/CT for characterizing lesions as benign was compared. Two hundred twenty-nine of the lesions were assessed further: 210 were benign and 19, malignant. The final diagnosis was determined by pathology (n = 67), PET/CT follow-up (n = 58), correlative imaging (n = 59), clinical correlation (n = 32), or typical benign pattern on PET/CT (n = 13). RESULTS The causes for benign uptake of FDG were inflammatory processes (n = 154, 73.3%), benign tumors (n = 23, 11%), hematoma or seroma (n = 17, 8.1%), fracture (n = 7, 3.3%), fat necrosis (n = 3, 1.4%), and others (n = 6, 2.9%). For lesions with moderate or marked uptake of FDG (n = 117, 55.7%), a benign diagnosis could have been suggested on either PET or CT (e.g., a "hot" osteophyte) in 33 lesions (28.2%), on CT alone (e.g., peritoneal fat necrosis) in 38 lesions (32.5%), on PET alone (e.g., sialadenitis) in 10 lesions (8.5%), or by clinical correlation (e.g., dental abscess) in four lesions (3.4%). A benign diagnosis could not be established without histology (e.g., colonic polyp) in 32 lesions (27.4%). The performance of PET/CT was superior to that of PET alone in characterizing lesions as benign (p < 0.001). CONCLUSION Benign lesions with increased FDG uptake are found in more than 25% of the PET/CT studies performed in patients with proven or suspected malignancy, with inflammation being the most common cause. Lesion characterization on the CT portion of the PET/CT study increases the specificity of PET/CT reporting, especially for lesions with moderate or marked FDG uptake.
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Schmidt GP, Kramer H, Reiser MF, Glaser C. Whole-body magnetic resonance imaging and positron emission tomography-computed tomography in oncology. Top Magn Reson Imaging 2007; 18:193-202. [PMID: 17762383 DOI: 10.1097/rmr.0b013e318093e6bo] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The advent of positron emission tomography-computed tomography (PET-CT) and whole-body magnetic resonance imaging (WB-MRI) has introduced tumor imaging with a systemic and functional approach compared with established sequential, multimodal diagnostic algorithms.Whole-body PET with [18F]-fluoro-2-desoxy-glucose is a useful imaging procedure for tumor staging and monitoring that can visualize active tumor tissue by detecting pathological glucose metabolism. The combination of PET with the detailed anatomical information of multislice computed tomography as dual-modality scanners has markedly increased lesion localization and diagnostic accuracy compared with both modalities as standalone applications.Hardware innovations, such as the introduction of multi-receiver channel whole-body MRI scanners at 1.5 and, recently, 3 T, combined with acquisition acceleration techniques, have made high-resolution WB-MRI clinically feasible. Now, a dedicated assessment of individual organs with various soft tissue contrast, spatial resolution, and contrast media dynamics can be combined with whole-body anatomical coverage in a multiplanar imaging approach. More flexible protocols (eg, T1-weighted turbo spin-echo and short inversion recovery imaging, dedicated lung imaging or dynamic contrast-enhanced studies of the abdomen) can be performed within 45 minutes.Whole-body magnetic resonance imaging has recently been proposed for tumor screening of asymptomatic individuals, and potentially life-changing diagnoses, such as formerly unknown malignancy, have been reported. However, larger patient cohort studies will have to show the cost efficiency and the clinical effectiveness of such an approach.For initial tumor staging, PET-CT has proved more accurate for the definition of T-stage and lymph node assessment, mainly because of the missing metabolic information in WB-MRI. However, new applications, such as magnetic resonance whole-body diffusion-weighted imaging or lymphotropic contrast agents, may significantly increase sensitivity in near future. Whole-body magnetic resonance imaging has shown advantages for the detection of distant metastatic disease, especially from tumors frequently spreading to the liver or brain and as a whole-body bone marrow screening application. Within this context, WB-MRI is highly accurate for the detection of skeletal metastases and staging of multiple myeloma. This article summarizes recent developments of CT/PET-CT and WB-MRI and highlights their performance within the scope of systemic oncological imaging.
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Affiliation(s)
- Gerwin P Schmidt
- Department of Clinical Radiology, University Hospitals Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Abstract
Positron emission tomography (PET)/computed tomography (CT) has a growing role in the imaging of many cancers. As our experience has grown over the past number of years so has our understanding for which cancers it is particularly useful. The value of PET/CT at each stage of the cancer journey is different for each cancer. This review attempts to tease out the role of PET/CT in the common cancers with particular emphasis on where it is the imaging investigation of choice.
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Franc BL, Hawkins RA. Positron Emission Tomography, Positron Emission Tomography–Computed Tomography, and Molecular Imaging of the Breast Cancer Patient. Semin Roentgenol 2007; 42:265-79. [DOI: 10.1053/j.ro.2007.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Scattoni V, Picchio M, Suardi N, Messa C, Freschi M, Roscigno M, Da Pozzo L, Bocciardi A, Rigatti P, Fazio F. Detection of Lymph-Node Metastases with Integrated [11C]Choline PET/CT in Patients with PSA Failure after Radical Retropubic Prostatectomy: Results Confirmed by Open Pelvic-Retroperitoneal Lymphadenectomy. Eur Urol 2007; 52:423-9. [PMID: 17397992 DOI: 10.1016/j.eururo.2007.03.032] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 03/09/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To prospectively evaluate the accuracy of integrated [(11)C]choline-PET/CT in the diagnosis of lymph-node recurrence in prostate cancer patients with biochemical failure after surgery. METHODS Since October 2002, 25 patients with biochemical recurrence (median PSA: 1.98 ng/ml), based on evidence of lymph-node metastases on [(11)C]choline-PET/CT scan (21 cases) or conventional imaging (4 cases), were scheduled for either bilateral pelvic (12 cases) or both pelvic and retroperitoneal lymph-node dissection (13 patients). RESULTS Sixty-three nodal sites were evaluated histologically. The mean number of nodes removed and positive nodes were 21.92+/-16.91 (range: 4-74) and 8.84+/-9.65 (range: 1-31), respectively. Of the four patients with negative [(11)C]choline-PET/CT and positive magnetic resonance, none had nodal metastases. Nineteen of the 21 patients (90%) with positive [(11)C]choline-PET/CT had nodal metastases of prostate adenocarcinoma at histologic evaluation. A lesion-based analysis showed that [(11)C]choline-PET/CT sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 64%, 90%, 86%, 72%, and 77%, respectively. The mean maximum diameter of true positive metastases was larger than false-negative ones (15.0 vs. 6.3mm; p=0.0004). CONCLUSIONS [(11)C]Choline-PET/CT is an accurate diagnostic tool for the detection of lymph-node metastases of recurrent prostate cancer. The low negative predictive value seems to depend on the limited capability of [(11)C]choline-PET/CT to detect microscopic lesions. The high positive predictive value, even with low PSA values, provides a basis for further treatment decisions.
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Affiliation(s)
- Vincenzo Scattoni
- Department of Urology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy.
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Eubank WB. Diagnosis of Recurrent and Metastatic Disease Using F-18 Fluorodeoxyglucose-Positron Emission Tomography in Breast Cancer. Radiol Clin North Am 2007; 45:659-67, vi. [PMID: 17706530 DOI: 10.1016/j.rcl.2007.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
One of the major strengths of F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) in breast cancer imaging is in the evaluation of patients who have suspected loco-regional recurrence or distant metastasis. In general, FDG-PET is more sensitive than conventional imaging for the detection of recurrent disease. Because of its ability to more accurately stage patients who have advanced breast cancer, FDG-PET has a significant impact on choice of treatment and management in this patient group.
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Affiliation(s)
- William B Eubank
- Department of Radiology, Puget Sound Veterans Administration Health Care System, 1660 South Columbian Way, Seattle, WA 98108-1597, USA.
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Piperkova E, Raphael B, Altinyay ME, Castellon I, Libes R, Sandella N, Heiba S, Abdel-Dayem H. Impact of PET/CT in Comparison With Same Day Contrast Enhanced CT in Breast Cancer Management. Clin Nucl Med 2007; 32:429-34. [PMID: 17515747 DOI: 10.1097/rlu.0b013e31805375e0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the impact of F-18 fluorodeoxyglucose (FDG) positron emission tomography with fused computerized tomography (PET/CT) in comparison with same day contrast enhanced CT (CE-CT) in breast cancer management. METHOD Seventy studies in 49 breast cancer patients, 17 for initial and 53 for restaging disease were included. All patients underwent PET/CT for diagnostic purposes followed by CE-CT scans of selected body regions. PET/CT was started approximately 90 minutes following IV injection of 10-15 mCi of F-18 FDG on a GE Discovery PET/CT system. Oral contrast was given before F-18 FDG injection. The CE-CT was performed according to departmental protocol. RESULTS Out of a total of 257 lesions, 210 were concordant between PET/CT and CE-CT. There were 47 discordant lesions, which were verified by either biopsy (35) or follow-up (12 PET positive CE-CT negative lesions). PET/CT correctly identified 25 true positive (TP). CE-CT identified 2 TP lesions missed by PET/CT which were false negatives (FNs): one liver metastasis with necrosis, which was nonavid to FDG uptake because of necrosis and a second one missed on abdominal metastatic node, which did not change staging or treatment. PET/CT incorrectly identified 2 false positive lesions while CE-CT incorrectly identified 18 false positive. TP recurrence of the disease was found by PET/CT in 44% (15/34 pts), whereas 56% (19/34 pts) were free of disease. The CE-CT described progression of the disease in 1 true negative PET/CT study and no progression in 2 TP PET/CT studies. The sensitivity, specificity, accuracy, positive productive value, and negative productive value for PET/CT were 97.8%, 93.5%, 97.3%, 99.1%, 85% and for CE-CT were 87.6%, 42%, 82.1%, 91.6%, 31.7%. CONCLUSION In this study, PET/CT played a more important role than CE-CT scans alone and provided an impact on the management of breast cancer patients.
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Affiliation(s)
- Elena Piperkova
- Department of Nuclear Medicine and Cancer Center, St Vincent's Hospital and New York Medical College, New York, NY 10011, USA
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Fencl P, Belohlavek O, Skopalova M, Jaruskova M, Kantorova I, Simonova K. Prognostic and diagnostic accuracy of [18F]FDG-PET/CT in 190 patients with carcinoma of unknown primary. Eur J Nucl Med Mol Imaging 2007; 34:1783-92. [PMID: 17541584 DOI: 10.1007/s00259-007-0456-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Accepted: 03/13/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study was to determine the accuracy of [(18)F]fluorodeoxyglucose (FDG) PET/CT in the search for the primary and the presence of a malignancy. The prognostic value of FDG-PET/CT information was tested. METHODS A total of 190 patients were retrospectively analysed: 82 with histologically proven metastases (HPM) and 108 with clinical suspicion of the presence of a malignancy (CSM). The sensitivity and specificity were determined. Overall survival was calculated to evaluate the prognostic value of the FDG-PET/CT findings. RESULTS In the search for the primary, the sensitivity and specificity were 62.0% and 81.9%, respectively. In the search for the presence of a malignancy, the sensitivity and specificity were 93.6% and 85.7%, respectively. Between the HPM and CSM groups, no significant difference in sensitivity and specificity was found either in the search for the primary or in the search for the presence of a malignancy. No significant difference in the sensitivity and specificity was found between 78 patients who were investigated by contrast-enhanced FDG-PET/CT and the remaining patients. A significantly shorter overall survival was found among patients with positive FDG-PET/CT findings compared with patients with negative findings (p = 0.00001); no significant difference in survival was found between the HPM and the CSM group (p = 0.770). CONCLUSION FDG-PET/CT imaging is very helpful in the search for the presence of a malignancy in patients with carcinoma of unknown primary syndrome. FDG-PET/CT is less accurate in identifying exactly the site of a primary. Discovery of a hypermetabolic lesion was associated with the worst survival rate.
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Affiliation(s)
- Pavel Fencl
- PET Center, Na Homolce Hospital, Roentgenova 2, 150 30 Prague 5, Czech Republic.
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