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Meng B, Ma Y, Wang Y, Zhou M, He C. Dual-Time-Point 18F-FDG PET/CT imaging in the diagnosis of colorectal carcinoma or advanced adenoma in patients with fixed focal colorectal 18F-FDG uptake. BMC Cancer 2025; 25:755. [PMID: 40264039 PMCID: PMC12012953 DOI: 10.1186/s12885-025-14129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 04/09/2025] [Indexed: 04/24/2025] Open
Abstract
BACKGROUND Fixed focal fluorine 18 fluorodeoxyglucose (18F-FDG) uptake in colorectal areas is commonly seen in PET/CT scan and may indicates malignant tumor. This study aims to investigate the diagnostic efficacy of dual-time-point 18F-FDG PET/CT in detecting colorectal carcinoma or advanced adenoma in patients with fixed focal colorectal 18F-FDG uptake. METHODS A retrospective analysis was conducted on patients who underwent dual-time-point 18F-FDG PET/CT scans between January 2019 and December 2023. Patients showing fixed focal colorectal 18F-FDG uptake in both early and delayed scans, and subsequently undergoing colonoscopy within one month, were included in the study. Advanced adenoma was defined as an adenoma larger than 10 mm in diameter and/or with villous histology and/or presenting with high-grade dysplasia. The maximum standardized uptake value (SUV) in the early and delayed scans, as well as the retention index (RI), were compared between colorectal carcinoma/advanced adenomas and non-advanced lesions. Predictive factors for colorectal carcinoma/advanced adenoma were identified by uni- and multivariable analysis. RESULTS A total of 122 patients were enrolled in this study. A total of 141 lesions was studied, 80 (56.7%) of which were diagnosed as colorectal carcinoma or advanced adenoma. When compared with non-advanced lesions, colorectal carcinoma/advanced adenoma had higher SUVmax in delayed scan (25.1 ± 14.2 vs. 14.5 ± 7.5, P<0.001), and higher RI (32.9%±25.4% vs. 7.8%±28.4%, P<0.001) in dual-time-point PET/CT. SUVmax in delayed scan (odds ratio [OR],1.084; 95% confidence interval [CI]: 1.037, 1.134; P<0.001) and RI (OR, 20.120; 95% CI: 4.068, 99.516; P<0.001) were identified as independent predictors for colorectal carcinoma/advanced adenoma by multivariable logistic regression analysis. When combining the SUVmax in the delayed scan with the retention index, the area under the receiver operating characteristic (ROC) curve achieved 0.801, and the sensitivity and specificity for predicting colorectal carcinoma/advanced adenoma were found to be 65.0% and 80.3%, respectively. Based on the threshold values of SUVmax in the delayed scan and RI, we observed prediction rates of 13.9% (5 out of 36), 58.6% (34 out of 58), and 87.2% (41 out of 47) for colorectal carcinoma/advanced adenoma in the low-, moderate-, and high-risk subgroups, respectively. CONCLUSIONS Dual-time-point PET/CT aids in distinguishing between colorectal cancer/advanced adenoma and non-advanced lesions in fixed focal FDG uptake. Higher SUVmax in delayed scan and higher RI are predictive factors for colorectal carcinoma/advanced adenoma.
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Affiliation(s)
- Baosheng Meng
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China
| | - Yuanyuan Ma
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China
| | - Mingge Zhou
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China.
| | - Chen He
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China.
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Lee H, Hwang KH. Focal incidental colorectal fluorodeoxyglucose uptake: Should it be spotlighted? World J Clin Cases 2024; 12:2466-2474. [PMID: 38817235 PMCID: PMC11135452 DOI: 10.12998/wjcc.v12.i15.2466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/17/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a cornerstone in cancer evaluation imaging, with a well-established history spanning several years. This imaging modality, encompassing the examination of the body from the base of the skull to the upper thighs, comprehensively covers the chest and abdominopelvic regions in a singular scan, allowing for a holistic assessment of nearly the entire body, including areas of marginal interest. The inherent advantage of this expansive scan range lies in its potential to unveil unexpected incidental abnormal hypermetabolic areas. The identification of incidental focal FDG uptake within colorectal regions during PET/CT scans is not an uncommon occurrence, albeit fraught with challenges associated with non-specific FDG uptake. The presence of benign colorectal lesions or physiological uptake poses a particular obstacle, as these may manifest with FDG uptake levels that mimic malignancy. Consequently, physicians are confronted with a diagnostic dilemma when encountering abnormal FDG uptake in unexpected colorectal areas. Existing studies have presented divergent results concerning these uptakes. Standardized uptake value and its derivatives have served as pivotal metrics in quantifying FDG uptake in PET images. In this article, we aim to succinctly explore the distinctive characteristics of FDG, delve into imaging findings, and elucidate the clinical significance of incidental focal colorectal uptake. This discussion aims to contribute valuable insights into the nuanced interpretation of such findings, fostering a comprehensive understanding.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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Lee H, Hwang KH. Unexpected focal fluorodeoxyglucose uptake in main organs; pass through or pass by? World J Clin Cases 2024; 12:1885-1899. [PMID: 38660550 PMCID: PMC11036514 DOI: 10.12998/wjcc.v12.i11.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Since the inception of fluorine-18 fluorodeoxyglucose (F-18 FDG), positron emission tomography/computed tomography (PET/CT) utilizing F-18 FDG has become widely accepted as a valuable imaging modality in the field of oncology, with global prevalence in clinical practice. Given that a single Torso PET/CT scan encompasses the anatomical region from the skull base to the upper thigh, the detection of incidental abnormal focal hypermetabolism in areas of limited clinical interest is both feasible and not uncommon. Numerous investigations have been undertaken to delineate the distinctive features of these findings, yet the outcomes have proven inconclusive. The incongruent results of these studies present a challenge for physicians, leaving them uncertain about the appropriate course of action. This article provides a succinct overview of the characteristics of fluorodeoxyglucose, followed by a comprehensive discussion of the imaging findings and clinical significance associated with incidental focal abnormal F-18 FDG activity in several representative organs. In conclusion, while the prevalence of unrecognized malignancy varies across organs, malignancies account for a substantial proportion, ranging from approximately one-third to over half, of incidental focal uptake. In light of these rates, physicians are urged to exercise vigilance in not disregarding unexpected uptake, facilitating more assured clinical decisions, and advocating for further active evaluation.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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Esmer AC, Öksüzoğlu K, Şen F, Yazıcı H, Tazeoğlu D, Ergelen R, Öneş T, Yeğen ŞC. Evaluation of Colonoscopic Results of Patients with Incidental Colonic FDG Uptake in PET/CT Imaging. World J Surg 2023; 47:2532-2541. [PMID: 37516690 DOI: 10.1007/s00268-023-07135-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Colorectal cancer is a significant global health concern, ranking as the second most deadly and third most common cancer worldwide. Early detection and removal of precancerous lesions play a crucial role in preventing cancer development and reducing mortality. Since FDG uptake is not specific for malignancy, incidental increased FDG uptake in the gastrointestinal tract may be challenging to interpret and may require further colonoscopic examination. This study aimed to investigate the features associated with malignant and premalignant pathology in patients with incidental colonic FDG uptake and determine the necessity of colonoscopy for each FDG uptake. METHODS Retrospective analysis was performed on data from patients who underwent colonoscopies between January 2016 and December 2021. Patients with FDG uptake in known colorectal malignancy regions were excluded. The study included 56 patients with incidental colonic FDG uptake. PET/CT images were visually and quantitatively analyzed, and the corresponding colonoscopy and histopathological results were recorded. Statistical analyses were conducted to evaluate the relationship between FDG uptake patterns, SUVmax values, and histopathological diagnoses. Colonoscopic findings were categorized as malignancy, polyps, and non-neoplastic lesions. RESULTS Among the 56 patients with incidental colonic FDG uptake, 36 lesions were identified, and histopathology revealed malignancy in 10 (17.9%) patients and premalignant polyps in the 26 (46.4%) cases. Focal FDG uptake with corresponding wall thickening or soft tissue density on CT was associated with a higher likelihood of premalignant or malignant lesions. The SUVmax values demonstrated a significant difference between negative findings and polyps/malignancies. However, no significant difference was observed between malignant and premalignant lesions. A ROC curve analysis was made and assesed a cut-off value of 11.1 SUVmax (sensitivity: 83.3% and specificity: 90%) to distinguish premalignant or malignant lesions from non-malignant lesions. CONCLUSION Incidental colonic FDG uptake with a focal pattern and corresponding CT findings were more likely to indicate premalignant or malignant lesions. SUVmax values were helpful in predicting the presence of pathological findings, but histopathological verification remains necessary for a definitive diagnosis. These findings contribute to our understanding of the clinical implications of incidental colonic FDG uptake and highlight the importance of follow-up colonoscopy for further evaluation.
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Affiliation(s)
- Ahmet Cem Esmer
- Department of General Surgery, Faculty of Medicine, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak District Muhsin Yazıcıoğlu Caddesi No:10 Pendik, Istanbul, Turkey.
| | - Kevser Öksüzoğlu
- Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Feyza Şen
- Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Hilmi Yazıcı
- Department of General Surgery, Faculty of Medicine, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak District Muhsin Yazıcıoğlu Caddesi No:10 Pendik, Istanbul, Turkey
| | - Deniz Tazeoğlu
- Department of General Surgery, Osmaniye State Hospital, Osmaniye, Turkey
| | - Rabia Ergelen
- Department of Radiology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Tunç Öneş
- Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Şevket Cumhur Yeğen
- Department of General Surgery, Faculty of Medicine, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak District Muhsin Yazıcıoğlu Caddesi No:10 Pendik, Istanbul, Turkey
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Morrison KR, Wang T, Chan KY, Trotter EW, Gillespie A, Michael MZ, Oakhill JS, Hagan IM, Petersen J. Elevated basal AMP-activated protein kinase activity sensitizes colorectal cancer cells to growth inhibition by metformin. Open Biol 2023; 13:230021. [PMID: 37042113 PMCID: PMC10090877 DOI: 10.1098/rsob.230021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/09/2023] [Indexed: 04/13/2023] Open
Abstract
Expression and activity of the AMP-activated protein kinase (AMPK) α1 catalytic subunit of the heterotrimeric kinase significantly correlates with poor outcome for colorectal cancer patients. Hence there is considerable interest in uncovering signalling vulnerabilities arising from this oncogenic elevation of AMPKα1 signalling. We have therefore attenuated mammalian target of rapamycin (mTOR) control of AMPKα1 to generate a mutant colorectal cancer in which AMPKα1 signalling is elevated because AMPKα1 serine 347 cannot be phosphorylated by mTORC1. The elevated AMPKα1 signalling in this HCT116 α1.S347A cell line confers hypersensitivity to growth inhibition by metformin. Complementary chemical approaches confirmed this relationship in both HCT116 and the genetically distinct HT29 colorectal cells, as AMPK activators imposed vulnerability to growth inhibition by metformin in both lines. Growth inhibition by metformin was abolished when AMPKα1 kinase was deleted. We conclude that elevated AMPKα1 activity modifies the signalling architecture in such a way that metformin treatment compromises cell proliferation. Not only does this mutant HCT116 AMPKα1-S347A line offer an invaluable resource for future studies, but our findings suggest that a robust biomarker for chronic AMPKα1 activation for patient stratification could herald a place for the well-tolerated drug metformin in colorectal cancer therapy.
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Affiliation(s)
- Kaitlin R. Morrison
- Flinders Health and Medical Research Institute, Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA 5042, Australia
| | - Tingting Wang
- Flinders Health and Medical Research Institute, Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA 5042, Australia
| | - Kuan Yoow Chan
- Cancer Research UK Manchester Institute, Alderley Park, Macclesfield SK10 4TG, UK
| | - Eleanor W. Trotter
- Cancer Research UK Manchester Institute, Alderley Park, Macclesfield SK10 4TG, UK
| | - Ari Gillespie
- Flinders Health and Medical Research Institute, Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA 5042, Australia
| | - Michael Z. Michael
- Flinders Health and Medical Research Institute, Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA 5042, Australia
- Flinders Centre for Innovation in Cancer, Dept. Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Jonathan S. Oakhill
- Metabolic Signalling Laboratory, St Vincent's Institute of Medical Research, School of Medicine, University of Melbourne, Victoria 3065, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria 3000, Australia
| | - Iain M. Hagan
- Cancer Research UK Manchester Institute, Alderley Park, Macclesfield SK10 4TG, UK
| | - Janni Petersen
- Flinders Health and Medical Research Institute, Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA 5042, Australia
- Nutrition and Metabolism, SouthAustralia Health and Medical Research Institute, Adelaide, SA 5000, Australia
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Zhang X, Ogihara T, Zhu M, Gantumur D, Li Y, Mizoi K, Kamioka H, Tsushima Y. Effect of metformin on 18F-fluorodeoxyglucose uptake and positron emission tomographic imaging. Br J Radiol 2022; 95:20200810. [PMID: 34705528 PMCID: PMC8822544 DOI: 10.1259/bjr.20200810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Metformin is widely used to treat diabetes, but induces changes in glucose uptake in both normal organs and tumors. Here, we review the effects of metformin on the uptake of 18F-fludeoxyglucose (18F-FDG) in tissues and tumors, and its influence on 18F-FDG positron emission tomographic imaging (18F-FDG PET), as well as the mechanisms involved. This is an important issue, because metformin has diverse effects on tissue uptake of 18F-FDG, and this can affect the quality and interpretation of PET images. Metformin increases glucose uptake in the gastrointestinal tract, cerebral white matter, and the kidney, while regions of the cerebrum associated with memory show decreased glucose uptake, and the myocardium shows no change. Hepatocellular carcinoma and breast cancer show increased glucose uptake after metformin administration, while thyroid cancer shows decreased uptake, and colon and pancreatic cancers show no change. A high-energy diet increases 18F-FDG uptake, but this effect is blocked by metformin. Withdrawal of metformin 48 h before PET image acquisition is widely recommended. However, based on our review of the literature, we propose that the differentiation of metformin discontinuation could be reasonable. But future clinical trials are still needed to support our viewpoint.
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Affiliation(s)
| | | | - Min Zhu
- Weifang Community Health Service Center, Pudong New District, Shanghai, China
| | - Dolgormaa Gantumur
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yang Li
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Kenta Mizoi
- Laboratory of Biopharmaceutics, Department of Pharmacology, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
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Marini C, Cossu V, Bauckneht M, Lanfranchi F, Raffa S, Orengo AM, Ravera S, Bruno S, Sambuceti G. Metformin and Cancer Glucose Metabolism: At the Bench or at the Bedside? Biomolecules 2021; 11:biom11081231. [PMID: 34439897 PMCID: PMC8392176 DOI: 10.3390/biom11081231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
Several studies reported that metformin, the most widely used drug for type 2 diabetes, might affect cancer aggressiveness. The biguanide seems to directly impair cancer energy asset, with the consequent phosphorylation of AMP-activated protein kinase (AMPK) inhibiting cell proliferation and tumor growth. This action is most often attributed to a well-documented blockage of oxidative phosphorylation (OXPHOS) caused by a direct interference of metformin on Complex I function. Nevertheless, several other pleiotropic actions seem to contribute to the anticancer potential of this biguanide. In particular, in vitro and in vivo experimental studies recently documented that metformin selectively inhibits the uptake of 2-[18F]-Fluoro-2-Deoxy-D-Glucose (FDG), via an impaired catalytic function of the enzyme hexose-6P-dehydrogenase (H6PD). H6PD triggers a still largely uncharacterized pentose-phosphate pathway (PPP) within the endoplasmic reticulum (ER) that has been found to play a pivotal role in feeding the NADPH reductive power for both cellular proliferation and antioxidant responses. Regardless of its exploitability in the clinical setting, this metformin action might configure the ER metabolism as a potential target for innovative therapeutic strategies in patients with solid cancers and potentially modifies the current interpretative model of FDG uptake, attributing PET/CT capability to predict cancer aggressiveness to the activation of H6PD catalytic function.
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Affiliation(s)
- Cecilia Marini
- CNR Institute of Molecular Bioimaging and Physiology (IBFM), 20054 Milan, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.B.); (A.M.O.)
- Correspondence: ; Tel.: +39-010-555-4812
| | - Vanessa Cossu
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (V.C.); (F.L.); (S.R.)
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.B.); (A.M.O.)
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (V.C.); (F.L.); (S.R.)
| | - Francesco Lanfranchi
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (V.C.); (F.L.); (S.R.)
| | - Stefano Raffa
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (V.C.); (F.L.); (S.R.)
| | - Anna Maria Orengo
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.B.); (A.M.O.)
| | - Silvia Ravera
- Department of Experimental Medicine, Human Anatomy, University of Genoa, 16132 Genoa, Italy; (S.R.); (S.B.)
| | - Silvia Bruno
- Department of Experimental Medicine, Human Anatomy, University of Genoa, 16132 Genoa, Italy; (S.R.); (S.B.)
| | - Gianmario Sambuceti
- CNR Institute of Molecular Bioimaging and Physiology (IBFM), 20054 Milan, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.B.); (A.M.O.)
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Li Y, Behr S. Acute Findings on FDG PET/CT: Key Imaging Features and How to Differentiate Them from Malignancy. CURRENT RADIOLOGY REPORTS 2020; 8:22. [PMID: 32953250 PMCID: PMC7486592 DOI: 10.1007/s40134-020-00367-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To review acute findings commonly encountered during routine clinical FDG PET/CT studies and present key imaging features to differentiate them from malignant counterparts. RECENT FINDINGS FDG PET/CT is extensively used in routine clinical practice for oncology patients. Incidental acute findings in patients undergoing FDG PET/CT are increasingly common, and awareness of these findings and their mimics are important in delivering a clinically relevant and accurate radiological report for directing further management. SUMMARY This article will review examples of common acute findings encountered during routine FDG PET/CT scans, compare them against examples of FDG-avid malignancy that can mimic these findings and emphasize key imaging findings to differentiate acute findings from their malignant mimics.
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Affiliation(s)
- Yan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 USA
| | - Spencer Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 USA
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Beheshti M, Manafi-Farid R, Rezaee A, Langsteger W. PET/CT and PET/MRI, Normal Variations, and Artifacts. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Garrido Durán C, Payeras Capó MA, García Caparrós C, Giménez García M, Daumal Domenech J. Clinical-endoscopic relevance of incidental colorectal lesions detected by PET-CT. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:434-439. [PMID: 29976073 DOI: 10.17235/reed.2018.4719/2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM to determine the proportion of incidental colon lesions detected by PET-CT and their correlation with the endoscopic and histological findings. In addition, to determine the maximum standardized uptake value (SUVmax) that can discriminate between benign and malignant lesions in our series of cases. METHODS this was a retrospective study of 3,000 patients evaluated by PET-CT for staging or response to treatment of primary neoplasms, between 2011 and 2015. Patients with incidental uptake in the colon were included in the study. Exclusion criteria included an incomplete, poorly prepared or abandoned colonoscopy, inflammatory bowel disease and treatment with metformin. RESULTS the study cohort comprised 71 patients evaluated by PET-CT and subsequently analyzed by endoscopy; 69% were male with a mean age of 65.77 ± 11.2. The rate of incidental colon lesions found by PET-CT was 1.73%, with 52 incidental colonic uptakes reported in 50 patients. The location of the uptake was the rectum (19.23%), sigmoid colon (34.62%), descending colon (13.46%), transverse colon (1.9%), ascending colon (19.23%), cecum (9.62%) and ileocolic anastomosis (1.92%). Thirty-five pathological colonoscopies (71.15%) were identified: the findings included five neoplasms (13.51%), two inflammatory lesions (5.4%) and 30 adenomatous polyps (81.1%). Significant differences were found between neoplastic SUVmax (11.7 g/ml; p = 0.03) and polyps (9.26 g/ml; p = 0.04) in relation to inflammatory lesions and normal endoscopies (6.05 g/ml). There were no differences in terms of the size of the polyps, nor the presence or absence of high grade dysplasia (p = 0.12 and 0.33). Both PET-CT and endoscopy proved consistent for locating lesions (k 0.90; CI 95% 0.86-0.93). CONCLUSION there is a good correlation between the findings identified by PET-CT and the endoscopic study. In our study, a SUVmax > 11 g/ml suggests a malignant pathology, which aids the prioritization of an endoscopic study.
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Boursi B, Werner TJ, Gholami S, Houshmand S, Mamtani R, Lewis JD, Wu GD, Alavi A, Yang YX. Functional imaging of the interaction between gut microbiota and the human host: A proof-of-concept clinical study evaluating novel use for 18F-FDG PET-CT. PLoS One 2018; 13:e0192747. [PMID: 29447210 PMCID: PMC5813966 DOI: 10.1371/journal.pone.0192747] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/30/2018] [Indexed: 12/19/2022] Open
Abstract
Recent data comparing germ-free to conventionally-raised mice demonstrated that energy homeostasis of colonocytes is dependent on gut microbiota through regulation of short chain fatty acids (SCFA) production and glucose utilization. We sought to evaluate 18F-FDG PET-CT as a novel technique for functional imaging of alterations in glucose metabolism as a result of the interaction between the gut microbiota and the human host. We conducted a prospective study in healthy humans that underwent 18F-FDG PET-CT and sampling of the gut microbiota before and after orally administered broad-spectrum antibiotics. The primary outcomes were total and regional physiologic colonic 18F-FDG uptake (measured as the mean and max standardized uptake values [SUVmean and SUVmax]). The study demonstrated significant increases in physiologic colonic 18F-FDG uptake in all study participants following antibiotic treatment and a 4-5log reduction of gut bacterial load. The mean increase in SUVmax was 0.63±0.37 SD (p = 0.004) and the median increase was 0.42 with an IQR of 0.40–0.81. The mean increase in SUVmean was 0.31±0.24 SD (p = 0.01) and the median increase was 0.41 with an IQR of 0.06–0.55. A likely explanation for this phenomenon is a shift in colonocyte metabolism to glycolysis due to a shortage of SCFA.
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Affiliation(s)
- Ben Boursi
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Tel-Aviv University, Tel-Aviv, Israel
- Department of Oncology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- * E-mail:
| | - Thomas J. Werner
- Department of Nuclear Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Saeid Gholami
- Department of Nuclear Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sina Houshmand
- Department of Nuclear Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ronac Mamtani
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - James D. Lewis
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gary D. Wu
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Abass Alavi
- Department of Nuclear Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Yu-Xiao Yang
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Servente L, Gigirey V, García Fontes M, Alonso O. Incidental focal colonic uptake in studies 18F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2017; 37:15-19. [PMID: 28750749 DOI: 10.1016/j.remn.2017.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To assess the frequency of focal colonic uptake as an incidental observation in 18F-FDG PET/CT studies, and to correlate this finding with histopathological results. MATERIAL AND METHODS Out of a total of 3,176 PET/CT studies with 18F-FDG systematic analysis was carried out on 30 studies in which colonic focal uptake was observed. Patients with known colorectal neoplasia were excluded. The maximum standardised uptake values (SUVm) and the morphological findings provided by the CT were recorded. The studies were reported by a radiologist and a nuclear medicine doctor. The findings were compared with endoscopy and pathology findings. RESULTS Of the 30 patients with focal hypermetabolic lesions of the colon (0.94%), 15 were men and 15 were women with ages between 27 and 73 (mean 55 years). The reasons for PET/CT were bronchopulmonary cancer (4), breast cancer (4), tumour of unknown origin (4), melanoma (3), renal carcinoma (3), cervical neoplasia (2), adenocarcinoma of ovary (2), and others (8). Of the 23 colonoscopies performed, 10 patients (43.4%) had malignant lesions, 6 (26.1%) had pre-malignant lesions, and in 7 patients (30.4%) no lesion was identified or was benign. No endoscopy was performed on 7 patients for various reasons (patient refusal to perform the study, advanced oncological disease). An analysis was performed with the SUVm, with no statistically significant differences being found between malignant-premalignant lesions and benign lesions. CONCLUSIONS Focal uptake in the colon of 18F-FDG has clinical relevance, and is mainly associated with morphological lesions in CT. It should be evaluated, as it may be a second tumour or a pre-malignant lesion. It is recommended that all focal uptakes of the colon be evaluated with endoscopy.
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Affiliation(s)
- L Servente
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay.
| | - V Gigirey
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - M García Fontes
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - O Alonso
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
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Goh V, Prezzi D, Mallia A, Bashir U, Stirling JJ, John J, Charles-Edwards G, MacKewn J, Cook G. Positron Emission Tomography/Magnetic Resonance Imaging of Gastrointestinal Cancers. Semin Ultrasound CT MR 2016; 37:352-7. [PMID: 27342899 DOI: 10.1053/j.sult.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
As an integrated system, hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) is able to provide simultaneously complementary high-resolution anatomic, molecular, and functional information, allowing comprehensive cancer phenotyping in a single imaging examination. In addition to an improved patient experience by combining 2 separate imaging examinations and streamlining the patient pathway, the superior soft tissue contrast resolution of MRI and the ability to acquire multiparametric MRI data is advantageous over computed tomography. For gastrointestinal cancers, this would improve tumor staging, assessment of neoadjuvant response, and of the likelihood of a complete (R0) resection in comparison with positron emission tomography or computed tomography.
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Affiliation(s)
- Vicky Goh
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Department of Radiology, Guy׳s & St Thomas׳ Hospitals, London, UK.
| | - Davide Prezzi
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Department of Radiology, Guy׳s & St Thomas׳ Hospitals, London, UK
| | - Andrew Mallia
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
| | - Usman Bashir
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Department of Radiology, Guy׳s & St Thomas׳ Hospitals, London, UK
| | - J James Stirling
- Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
| | - Joemon John
- Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
| | - Geoff Charles-Edwards
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Medical Physics, Guy׳s and St Thomas׳ Hospitals, London, UK
| | - Jane MacKewn
- Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
| | - Gary Cook
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
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Capitanio S, Marini C, Sambuceti G, Morbelli S. Metformin and cancer: Technical and clinical implications for FDG-PET imaging. World J Radiol 2015; 7:57-60. [PMID: 25825634 PMCID: PMC4374089 DOI: 10.4329/wjr.v7.i3.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/15/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Metformin is the most widely used hypoglycemic agent. Besides its conventional indications, increasing evidence demonstrate a potential efficacy of this biguanide as an anticancer drug. Possible mechanisms of actions seem to be independent from its hypoglycemic effect and seem to involve the interference with key pathways in cellular proliferation and glycolysis. To date, many clinical trials implying the use of metformin in cancer treatment are on-going. The increasing use of 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in cancer evaluation raises a number of questions about the possible interference of the biguanide on FDG distribution. In particular, the interferences exerted by metformin on AMP-activated protein kinase pathway (the cellular energy sensor), on insulin levels and on Hexokinase could potentially have repercussion on glucose handling and thus on FDG distribution. A better comprehension of the impact of metformin on FDG uptake is needed in order to optimize the use of PET in this setting. This evaluation would be useful to ameliorate scans interpretation in diabetic patients under chronic metformin treatment and to critically interpret images in the context of clinical trials. Furthermore, collecting prospective data in this setting would help to verify whether FDG-PET could be a valid tool to appreciate the anticancer effect of this new therapeutic approach.
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