Ovarian cancer(OC)is the most lethal gynecological malignancy.Diagnosis usually occurs late,and even with the most effective treatment relapses are frequent.Early diagnosis and precise staging are critical for achievi...Ovarian cancer(OC)is the most lethal gynecological malignancy.Diagnosis usually occurs late,and even with the most effective treatment relapses are frequent.Early diagnosis and precise staging are critical for achieving better treatment outcomes and prognoses.Conventional imaging methods such as ultrasound(US),computed tomography(CT),and magnetic resonance imaging(MRI)are the main imaging techniques supporting management decisions.However,advancements in molecular imaging have made positron emission tomography/computed tomography(PET/CT)a promising noninvasive imaging option for better management of OC.The literature provides evidence indicating that fluorine‐18‐fluorodeoxyglucose(^(18)F‐FDG)PET/CT(FDG‐PET/CT)is effective in primary tumor diagnosis,staging,prognosis evaluation,treatment response assessment,and relapse surveillance.Looking ahead,significant attention should be paid to tracers beyond FDG,integrated PET/MRI,dynamic PET,and artificial intelligence(AI)‐based radiomics.This review examines the application of PET/CT in OC management at each disease stage and discusses its future potential.展开更多
Soft tissue sarcomas(STS)are rare malignant tumors originating from mesoder-mal tissues with a poor prognosis,accounting for approximately 1%of all malig-nancies and comprising around 50 distinct subtypes.Conventional...Soft tissue sarcomas(STS)are rare malignant tumors originating from mesoder-mal tissues with a poor prognosis,accounting for approximately 1%of all malig-nancies and comprising around 50 distinct subtypes.Conventional imaging mo-dalities,such as computed tomography(CT)and magnetic resonance imaging(MRI),primarily provide anatomical information,whereas 18F-fluorodeoxyglucose positron emission tomography/CT(18F-FDG PET/CT)integrates functional metabolic and anatomical imaging,serving as a critical complementary tool in the diagnosis and management of STS.This article reviews recent advances in the application of 18F-FDG PET/CT for STS.The advantages of 18F-FDG PET/CT in STS include:(1)Early detection of metabolic activity changes in tumors,partic-ularly when morphological alterations are insignificant;(2)Effective differen-tiation between benign and malignant soft tissue tumors,as well as aiding in distinguishing high-grade from low-grade sarcomas;(3)Identification of occult metastatic lesions,improving staging accuracy,and facilitating restaging in cases of recurrence or metastasis;(4)Utilization of parameters such as maximum stan-dardized uptake value and metabolic tumor volume to assist in tumor grading and prognostic evaluation;and(5)Monitoring treatment response to guide adjust-ments in personalized therapeutic strategies.However,18F-FDG PET/CT has limitations in diagnosis of certain STS subtypes(e.g.,myxoid liposarcoma),detection and biopsy of metastatic lymph nodes,necessitating integration with clinical evaluation and other imaging techniques.18F-FDG PET/CT is poised to play an increasingly vital role in the precision diagnosis and treatment of STS.展开更多
BACKGROUND Malignant pleural mesothelioma(MPM),a rare aggressive malignancy,is primarily caused by asbestos exposure.MPM typically affects older adults(median age,76 years),is uncommon in those under age 50 years and ...BACKGROUND Malignant pleural mesothelioma(MPM),a rare aggressive malignancy,is primarily caused by asbestos exposure.MPM typically affects older adults(median age,76 years),is uncommon in those under age 50 years and shows male predominance.Based on the American Society of Clinical Oncology guidelines,F-18 fluorodeoxyglucose positron emission tomography/computed tomography(F-18 FDG PET/CT)is essential for initial MPM staging.Integrating quantitative FDG metabolic data with computed tomography(CT)anatomy optimizes biopsy accuracy and staging.CASE SUMMARY A 21-year-old female college student presented with fever(peak 38.4°C),cough,and white mucoid sputum after cold exposure.Initial evaluation revealed elevated C-reactive protein[C-reactive protein(CRP);65.52 mg/L]and Mycoplasma pneumoniae IgM.Despite resolution of fever following a 14-day moxifloxacin regimen,persistent cough prompted chest CT,which demonstrated left pleural mass-like thickenings.Levofloxacin therapy for 2 weeks failed to alleviate symptoms,accompanied by 2.5-kg weight loss over 1 month.Re-evaluation showed rising CRP(88.87 mg/L)with stable CT lesions,and negative T-cell spot test for tuberculosis and tumor markers.Contrast-enhanced CT revealed heterogeneously enhancing masses,while PET/CT detected two broad-based pleural lesions with intense FDG avidity.CT-guided biopsy confirmed epithelioid MPM.Thoracoscopy exposed diffuse fragile,hemorrhagic nodules implanting on diaphragmatic and parietal pleura,confirming metastatic MPM with partial resection performed.This presentation challenges conventional imaging paradigms of MPM,underscoring its diagnostic complexity.CONCLUSION MPM should still be considered an important differential diagnosis in young patients presenting with solitary pleural masses and no history of typical asbestos exposure.F-18 FDG PET/CT,while serving as an essential component of initial staging for MPM,has some inherent limitations.展开更多
BACKGROUND Preoperative prognosis assessment of hepatocellular carcinoma(HCC)is crucial,and pathologic grading is a key prognostic determinant that affects patient prognosis.Therefore,accurate determination of patholo...BACKGROUND Preoperative prognosis assessment of hepatocellular carcinoma(HCC)is crucial,and pathologic grading is a key prognostic determinant that affects patient prognosis.Therefore,accurate determination of pathological grading before surgical intervention is crucial for optimizing treatment strategies and improving prognostic outcomes.AIM To investigate the distinguishing capability of fluorine-18-fluorodeoxyglucosepositron emission tomography/computed tomography(^(18)F-FDG PET/CT)-derived metabolic parameters between Edmondson grade Ⅱ and Ⅲ HCC and to assess their correlation with Ki67 expression levels.METHODS We retrospectively assessed the ^(18)F-FDG PET/CT imaging datasets from 32 patients with solitary HCC,all of whom had pathological confirmation of their diagnosis.Patients were categorized into Edmondson grade Ⅱ and Ⅲ groups according to pathological grading criteria.Comparative analyses were conducted on metabolic parameters,including maximum standardized uptake value(SUV_(max)),mean standardized uptake value(SUV_(mean)),metabolic tumor volume(MTV),total lesion glycolysis(TLG),tumor-to-normal background ratio(TNR),and tumor-to-blood pool ratio(TBR),between the groups.Further,correlations between these parameters and Ki67 expression were investigated.RESULTS Significant differences were observed in SUV_(max),SUV_(mean),TLG,TNR,and TBR between Edmondson grade Ⅱ and Ⅲ HCC groups(P<0.05),whereas MTV was not significantly different(P=0.052).The maximum tumor diameter and Ki67 expression percentage significantly varied between the two groups(P<0.05).SUV_(max) yielded the largest area under the receiver operating characteristic curve,measuring 0.853(95%confidence interval:0.709-0.997,P=0.001).Using an optimal SUV_(max) cut-off of 10.95,the sensitivity and specificity for identifying Edmondson grade Ⅲ HCC were 66.7%and 100%,respectively.Notably,significant positive correlations were identified in terms of SUV_(max),SUV_(mean),TNR,TBR,and the percentage of Ki67 expression(P<0.01).Conversely,MTV,TLG,and maximum tumor diameter exhibited no significant association with Ki67 expression(P>0.05).CONCLUSION ^(18)F-FDG PET/CT-derived metabolic parameters,particularly SUV_(max),SUV_(mean),TNR,TBR,and TLG,are valuable in differentiating Edmondson grade Ⅱ and Ⅲ HCC,with SUV_(max) showing the optimal differential diagnostic efficacy.TLG is a three-dimensional volumetric parameter that holds some differential diagnostic potential,but it fails to display a distinct advantage.Moreover,increased ^(18)F-FDG uptake and Ki67 expression in tumor tissue correlate with poorer HCC prognoses,emphasizing their potential role in prognostic assessments.展开更多
AIM: To evaluate the clinical role of 18F-fluorodeo-xyglucose positron emission and computed tomography (18F-FDG PET/CT) in detection of gastric cancer recurrence after initial surgical resection. METHODS: In the peri...AIM: To evaluate the clinical role of 18F-fluorodeo-xyglucose positron emission and computed tomography (18F-FDG PET/CT) in detection of gastric cancer recurrence after initial surgical resection. METHODS: In the period from January 2007 to May 2008, 23 patients who had previous surgical resection of histopathologically diagnosed gastric cancer underwent a total of 25 18F-FDG PET/CT scans as follow-up visits in our center. The standard of reference for tumor recurrence consisted of histopathologic confirmation or clinical follow-up information for at least 5 mo after PET/CT examinations. RESULTS: PET/CT was positive in 14 patients (61%) and negative in 9 (39%). When correlated with final diagnosis, which was confirmed by histopathologic evidence of tumor recurrence in 8 of the 23 patients (35%) and by clinical follow-up in 15 (65%), PET/CT was true positive in 12 patients, false positive in 2, true negative in 8 and false negative in 2. Overall, the accuracy of PET/CT was 82.6%, the negative predictive value (NPV) was 77.7%, and the positive predictive value (PPV) was 85.7%. The 2 false positive PET/CT findings were actually chronic inflammatory tissue lesions. For the two patients with false negativePET/CT, the f inal diagnosis was recurrence of mucinous adenocarcinoma in the anastomosis in one patient and abdominal wall metastasis in the other. Importantly, PET/CT revealed true-positive findings in 11 (47.8%) patients who had negative or no definite findings by CT. PET/CT revealed extra-abdominal metastases in 7 patients and additional esophageal carcinoma in one patient. Clinical treatment decisions were changed in 7 (30.4%) patients after introducing PET/CT into their conventional post-operative follow-up program. CONCLUSION: Whole body 18F-FDG PET/CT was highly effective in discriminating true recurrence in post-operative patients with gastric cancer and had important impacts on clinical decisions in a considerable portion of patients.展开更多
AIM: To evaluated the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan in diagnosis of hepatocellular carcinoma (HCC) and extrahepatic metastases. METHODS: A total...AIM: To evaluated the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan in diagnosis of hepatocellular carcinoma (HCC) and extrahepatic metastases. METHODS: A total of 138 patients with HCC who had both conventional imaging modalities and 18F-FDG PET/CT scan done between November 2006 and March 2011 were enrolled. Diagnostic value of each imaging modality for detection of extrahepatic metastases was evaluated. Clinical factors and tumor characteristics including PET imaging were analyzed as indicative factors for metastases by univariate and multivariate methods. RESULTS: The accuracy of chest CT was significantly superior compared with the accuracy of PET imaging for detecting lung metastases. The detection rate of metastatic pulmonary nodule ≥ 1 cm was 12/13 (92.3%), when < 1 cm was 2/10 (20%) in PET imaging. The accuracy of PET imaging was significantly superior compared with the accuracy of bone scan for detecting bone metastases. In multivariate analy- sis, increased tumor size (≥ 5 cm) (P = 0.042) and increased average standardized uptake value (SUV) uptake (P = 0.028) were predictive factors for extrahepatic metastases. Isometabolic HCC in PET imaging was inversely correlated in multivariate analysis (P = 0.035). According to the receiver operating characteristic curve, the optimal cutoff of average SUV to predict extrahepatic metastases was 3.4. CONCLUSION: 18F-FDG PET/CT scan is invaluable for detection of lung metastases larger than 1 cm and bone metastases. Primary HCC having larger than 5 cm and increased average SUV uptake more than 3.4 should be considered for extrahepatic metastases.展开更多
BACKGROUND Lymph node(LN)metastasis is an important prognostic factor in patients with gastric cancer(GC).However,the evaluation of LN metastasis status in the preoperative setting is not accurate.Therefore,precise pr...BACKGROUND Lymph node(LN)metastasis is an important prognostic factor in patients with gastric cancer(GC).However,the evaluation of LN metastasis status in the preoperative setting is not accurate.Therefore,precise preoperative prediction of LN metastasis status is crucial for optimal treatment in patients with GC.AIM To develop a preoperative nomogram for LN metastasis using F-18 fluorodeoxyglucose(F-18 FDG)positron emission tomography/computed tomography(PET/CT)and preoperative laboratory test findings in GC.METHODS In this study,the data of 566 GC patients who underwent preoperative F-18 FDG PET/CT and subsequent surgical resection were analyzed.The LN metastasis prediction model was developed in the training cohort and validated in the internal validation cohort.Routine preoperative laboratory tests,including albumin and carbohydrate antigen(CA)19-9 were performed in all patients.Univariate and multivariable logistic regression was performed to validate the preoperative predictive indicators for LN metastasis.RESULTS Of the 566 patients,232(41%)had confirmed histopathologic LN metastasis.Univariate logistic regression revealed that the tumor location,blood hemoglobin,serum albumin levels,neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,CA 19-9,maximum standardized uptake value(SUVmax)of the primary tumor(T_SUVmax),and SUVmax of LN(N_SUVmax)were significantly associated with LN metastasis.In multivariate analysis,T_SUVmax(OR=1.08;95%CI:1.02–1.15;P=0.011)and N_SUVmax(OR=1.49;95%CI:1.19–1.97;P=0.002)were found to be significant predictive factors for LNmetastasis.The LN metastasis prediction model using T_SUVmax,N_SUVmax,serum albumin,and CA 19-9 yielded an area under the curve(AUC)of 0.733(95%CI:0.683–0.784,P=0.025)in the training cohort and AUC of 0.756(95%CI:0.678–0.833,P<0.001)in the test cohort.CONCLUSION T_SUVmax and N_SUVmax measured by preoperative F-18 FDG PET/CT are independent predictive factors for LN metastasis in GC.展开更多
The clinical value of whole body positron emission tomography/computed tomography （PET/CT） as an imaging tool in diagnosis of ophthalmic tumors was investigated. The retrospective observational case series were perf...The clinical value of whole body positron emission tomography/computed tomography （PET/CT） as an imaging tool in diagnosis of ophthalmic tumors was investigated. The retrospective observational case series were performed on the patients with suspected ophthalmic tumors who underwent whole body PET/CT. The golden standard of diagnosis was the final pathological diagnosis or the results of long-term follow-up for patients without surgery/ biopsy. PET/CT findings were compared with the golden standard. The sensitivity, specificity, accuracy an^t positive likelihood ratio of PET/CT in the detection of ophthalmic tumors were calculated. The clinical application of PET/CT in different types of ophthalmic tumors was evaluated. The results showed that 30 patients （18 males and 12 females） with a mean age of 43.0 years （range 4-63 years） were collected. The mean sizes of orbital tumors and intraocular tumors were 26.8 mmxl7.8 mm and 11.2 minx6.1 mm, respectively. The overall sensitivity, specificity, accuracy and positive likelihood ratio of whole body PET/CT in ophthalmic tumors were 76.5%, 71.4%, 75.0% and 2.67, and were 62.5%, 100% and 70.0% in intraocular tumors, and those were 100%, 60.0% and 84.6% in orbital tumors, respectively. PET/CT findings were applied to help make appropriate treatment options in 27 out of 30 patients （90.0%）, and 12 （40.0%） patients changed the treatment strategy. False negative results in 4 cases and false positive results in 2 cases were observed in this series. It was suggested that PET/CT was an effective imaging modality in detecting, diagnosing and developing therapeutic schedule for patients with ophthalmic tumors. It was more sensitive and accurate for detecting orbital tumors than for detecting intraocular tumors.展开更多
AIM:To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT)hybrid imaging for diagnosis of various endocrine disorders.METHODS:We performed MEDLINE and Pub Med searches usin...AIM:To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT)hybrid imaging for diagnosis of various endocrine disorders.METHODS:We performed MEDLINE and Pub Med searches using the terms:"SPECT/CT";"functional anatomic mapping";"transmission emission tomography";"parathyroid adenoma";"thyroid cancer";"neuroendocrine tumor";"adrenal";"pheochromocytoma";"paraganglioma";in order to identify relevant articles published in English during the years 2003 to 2015.Reference lists from the articles were reviewed to identify additional pertinent articles.Retrieved manuscripts(case reports,reviews,meta-analyses and abstracts)concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.RESULTS:The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging,with seamless fusion of three-dimensional volume datasets.The usefulness of combining functional information to depict the biodistribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin,with anatomy derived from CT,has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function.The literature describes benefits of SPECT/CT for^(99m)Tc-sestamibi parathyroid scintigraphy and^(99m)Tc-pertechnetate thyroid scintigraphy,^(123)I-or^(131)I-radioiodine for staging of differentiated thyroid carcinoma,^(111)In-and^(99m)Tclabeled somatostatin receptor analogues for detection of neuroendocrine tumors,^(131)I-norcholesterol(NP-59)scans for assessment of adrenal cortical hyperfunction,and^(123)I-or^(131)I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.CONCLUSION:SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT,translating to improved diagnostic accuracy and meaningful impact on patient care.展开更多
AIM To clarify clinicopathological features of ductal carcinoma in situ(DCIS)visualized on[F-18]fluorodeoxyglucosepositron emission tomography/computed tomography(FDG-PET/CT).METHODS This study retrospectively reviewe...AIM To clarify clinicopathological features of ductal carcinoma in situ(DCIS)visualized on[F-18]fluorodeoxyglucosepositron emission tomography/computed tomography(FDG-PET/CT).METHODS This study retrospectively reviewed 52 consecutive tumors in 50 patients with pathologically proven pure DCIS who underwent[F-18]FDG-PET/CT before surgery.[F-18]FDG-PET/CT was performed after biopsy in all patients.The mean interval from biopsy to[F-18]FDGPET/CT was 29.2 d.[F-18]FDG uptake by visual analysis and maximum standardized uptake value(SUVmax)was compared with clinicopathological characteristics.RESULTS[F-18]FDG uptake was visualized in 28 lesions(53.8%)and the mean and standard deviation of SUVmax was 1.63 and 0.90.On univariate analysis,visual analysis and the SUVmax were associated with symptomatic presentation(P=0.012 and 0.002,respectively),palpability(P=0.030 and 0.024,respectively),use of core-needle biopsy(CNB)(P=0.023 and 0.012,respectively),ultrasound-guided biopsy(P=0.040 and 0.006,respectively),enhancing lesion≥20 mm on magnetic resonance imaging(MRI)(P=0.001 and 0.010,respectively),tumor size≥20 mm on histopathology(P=0.002 and 0.008,respectively).However,[F-18]FDG uptake parameters were not significantly associated with age,presence of calcification on mammography,mass formation on MRI,presence of comedo necrosis,hormone status(estrogen receptor,progesterone receptor and human epidermal growth factor receptor-2),and nuclear grade.The factors significantly associated with visual analysis and SUVmax were symptomatic presentation(P=0.019 and 0.001,respectively),use of CNB(P=0.001 and 0.031,respectively),and enhancing lesion≥20 mm on MRI(P=0.001 and 0.049,respectively)on multivariate analysis.CONCLUSION Although DCIS of breast is generally non-avid tumor,symptomatic and large tumors(≥20 mm)tend to be visualized on[F-18]FDG-PET/CT.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has made it more challenging for patients to undergo yttrium-90(Y-90)radioembolization(RE).Same day Y-90 RE provides an opportunity to minimize logistical chal...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has made it more challenging for patients to undergo yttrium-90(Y-90)radioembolization(RE).Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19,thus improving patient access.AIM To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography(SPECT/CT)in order to optimize therapy.METHODS All patients were selected for Y-90 RE through a multidisciplinary tumor board,and were screened and tested for COVID-19 infection per institutional protocol.A same day procedure was developed,consisting of angiography,imaging,and Y-90 resin particle delivery.Routine SPECT/CT after technetium-99m macroaggregated albumin(Tc-99m MAA)administration was performed for assessment of arterial supply,personalized dosimetry,and extrahepatic activity.Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery,by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles.RESULTS A total of 14 patients underwent same day Y-90 RE between March and June 2020.Mean lung shunt fraction was 6.13%(range 3.5%-13.1%).Y-90 RE was performed for a single lesion in 7 patients,while the remaining 7 patients had treatment of multifocal lesions.The largest lesion measured 8.3 cm.All patients tolerated the procedure well and were discharged the same day.CONCLUSION Same day Y-90 RE with resin-based microspheres is feasible,and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond.We recommend consideration of SPECT/CT,especially among patients with complex malignancies,for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.展开更多
BACKGROUND Incidentally found thyroid tumor(thyroid incidentaloma,TI)on F-18 fluorodeoxyglucose(FDG)positron emission tomography-computed tomography(PETCT)is reported in 2.5%-5%of patients being investigated for non-t...BACKGROUND Incidentally found thyroid tumor(thyroid incidentaloma,TI)on F-18 fluorodeoxyglucose(FDG)positron emission tomography-computed tomography(PETCT)is reported in 2.5%-5%of patients being investigated for non-thyroid purposes.Up to 50%of these cases have been diagnosed to be malignant by cytological/histological results.Ultrasonography(US)and fine-needle aspiration cytology are recommended for thyroid nodules with high FDG uptake(hypermetabolism)that are 1 cm or greater in size.It is important to accurately determine whether a suspicious hypermetabolic TI is malignant or benign.AIM To distinguish malignant hypermetabolic TIs from benign disease by analyzing F-18 FDG PET-CT parameters and to identify a cut-off value.METHODS Totally,12761 images of patients who underwent F-18 FDG PET-CT for nonthyroid purposes at our hospital between January 2016 and December 2020 were retrospectively reviewed,and 339 patients[185 men(mean age:68±11.2)and 154 women(mean age:63±15.0)]were found to have abnormal,either focal or diffuse,thyroid FDG uptake.After a thorough review of their medical records,US,and cytological/histological reports,46 eligible patients with focal hypermetabolic TI were included in this study.The TIs were categorized as malignant and benign according to the cytological/histological reports,and four PET parameters[standardized uptake value(SUV)max,SUV_(peak),SUV_(mean),and metabolic tumor volume(MTV)]were measured on FDG PET-CT.Total lesion glycolysis(TLG)was calculated by multiplying the SUV_(mean) by MTV.Both parametric and non-parametric methods were used to compare the five parameters between malignant and benign lesions.Receiver operating characteristic(ROC)curve analysis was performed to identify a cut-off value.RESULTS Each of the 46 patients[12 men(26.1%;mean age:62±13.1 years)and 34 women(73.9%;mean age:60±12.0 years)]with focal hypermetabolic TIs had one focal hypermetabolic TI.Among them,26(56.5%)were malignant and 20(43.5%)were benign.SUV_(max),SUV_(peak),SUV_(mean),and TLG were all higher in malignant lesions than benign ones,but the difference was statistically significant(P=0.012)only for SUV_(max).There was a positive linear correlation(r=0.339)between SUV_(max) and the diagnosis of malignancy.ROC curve analysis for SUV_(max) revealed an area under the curve of 0.702(P<0.05,95%confidence interval:0.550-0.855)and SUV_(max) cut-off of 8.5 with a sensitivity of 0.615 and a specificity of 0.789.CONCLUSION More than half of focal hypermetabolic TIs on F-18 FDG PET-CT were revealed as malignant lesions,and SUV_(max) was the best parameter for discriminating between malignant and benign disease.Unexpected focal hypermetabolic TIs with the SUV_(max) above the cut-off value of 8.5 may have a greater than 70%chance of malignancy;therefore,further active assessment is required.展开更多
AIM To determine the significance and need for investigation of incidental prostatic uptake in men undergoing ^(18)F-labelled fluorodeoxyglucose(^(18)F-FDG) positron emission tomography/computed tomography(PET/CT) for...AIM To determine the significance and need for investigation of incidental prostatic uptake in men undergoing ^(18)F-labelled fluorodeoxyglucose(^(18)F-FDG) positron emission tomography/computed tomography(PET/CT) for other indications.METHODS Hospital databases were searched over a 5-year period for patients undergoing both PET/CT and prostate magnetic resonance imaging(MRI). For the initial analysis, the prostate was divided into six sectors and suspicious or malignant sectors were identified using MRI and histopathology reports respectively. Maximum and mean ^(18)F-FDG standardised uptake values were measured in each sector by an investigator blinded to the MRI and histopathology findings. Two agematched controls were selected per case. Results were analysed using a paired t-test and one-way ANOVA. For the second analysis, PET/CT reports were searched for prostatic uptake reported incidentally and these patients were followed up. RESULTS Over a 5-year period, 15 patients underwent both PET/CT and MRI and had biopsy-proven prostate cancer.Malignant prostatic sectors had a trend to higher ^(18)F-FDG uptake than benign sectors, however this was neither clinically nor statistically significant(3.13 ±0.58 vs 2.86 ± 0.68, P > 0.05). ^(18)F-FDG uptake showed no correlation with the presence or histopathological grade of tumour. ^(18)F-FDG uptake in cases with prostate cancer was comparable to that from age-matched controls. Forty-six(1.6%) of 2846 PET/CTs over a 5-year period reported incidental prostatic uptake. Of these, 18(0.6%) were investigated by PSA, 9(0.3%)were referred to urology, with 3(0.1%) undergoing MRI and/or biopsy. No cases of prostate cancer were diagnosed in patients with incidental ^(18)F-FDG uptake in our institute over a 5-year period.CONCLUSION ^(18)F-FDG uptake overlaps significantly between malignant and benign prostatic conditions. Subsequent patient management was not affected by the reporting of incidental focal prostatic uptake in this cohort.展开更多
BACKGROUND Alveolar soft part sarcoma(ASPS)is an extremely rare malignant sarcoma,accounting for less than 1%of all soft-tissue sarcomas.However,limited information is available on multimodal imaging[computed tomograp...BACKGROUND Alveolar soft part sarcoma(ASPS)is an extremely rare malignant sarcoma,accounting for less than 1%of all soft-tissue sarcomas.However,limited information is available on multimodal imaging[computed tomography(CT),magnetic resonance imaging(MRI),and positron emission computed tomography/computed tomography(PET/CT)]of ASPS.CASE SUMMARY This study reports a case of a 35-year-old female patient with ASPS of the left thigh with lung metastasis.The patient presented with a 1-year history of a palpable mass in the lower extremity,which exhibited rapid growth for 3 wk.CT,MRI,and F-deoxyglucose PET/CT examinations were performed.CT showed a slightly hypodense or isodense mass with patchy calcifications.On MRI examination,the mass manifested hyperintensity on T1-weighted,T2-weighted,and diffusion-weighted images with some signal voids.PET/CT images demonstrated an intensely hypermetabolic mass in the left thigh and hypermetabolic nodules in lungs.CONCLUSION ASPS should be considered as a possible diagnosis when a slow-growing mass is detected in the soft tissue of the extremities,with hyperintensity and numerous signal voids on T1-weighted,T2-weighted,and diffusion-weighted images and intense F-deoxyglucose uptake on PET/CT.ASPS can have calcifications on CT.展开更多
BACKGROUND Gastric duplication cysts(GDCs)are extremely uncommon lesions and the definitive diagnosis of GDCs is challenging for gastrointestinal specialists.It is important that a differential diagnosis is performed ...BACKGROUND Gastric duplication cysts(GDCs)are extremely uncommon lesions and the definitive diagnosis of GDCs is challenging for gastrointestinal specialists.It is important that a differential diagnosis is performed to rule out the possibility of other diseases,mainly malignancies with a cystic component.Despite the use of multiple diagnostic modalities including endoscopy,the preoperative diagnosis of GDCs is challenging.CASE SUMMARY A 53-year-old female patient with a GDC was confirmed by positron emission tomography/computed tomography(PET/CT)instead of more conventional procedures such as endoscopic ultrasonography-guided fine needle aspiration(EUS-FNA).We propose that 18F-FDG-PET/CT has higher accuracy than EUSFNA and may be an effective technique for the characterization of duplication cysts.CONCLUSION Preoperative diagnosis of GDCs in adults is difficult largely due to their rarity and the absence of characteristic findings.In addition,few endoscopists include GDCs in the differential diagnosis when they encounter a lesion with cystic characteristics.18F-FDG-PET/CT with additional imaging data,may complement EUS-FNA in the diagnosis of GDCs.展开更多
Image quality in positron emission tomography(PET)is affected by random and scattered coincidences and reconstruction protocols.In this study,we investigated the effects of scattered and random coincidences from outsi...Image quality in positron emission tomography(PET)is affected by random and scattered coincidences and reconstruction protocols.In this study,we investigated the effects of scattered and random coincidences from outside the field of view(FOV)on PET image quality for different reconstruction protocols.Imaging was performed on the Discovery 690 PET/CT scanner,using experimental configurations including the NEMA phantom(a body phantom,with six spheres of different sizes)with a signal background ratio of 4:1.The NEMA phantom(phantom I)was scanned separately in a one-bed position.To simulate the effect of random and scatter coincidences from outside the FOV,six cylindrical phantoms with various diameters were added to the NEMA phantom(phantom II).The 18 emission datasets with mean intervals of 15 min were acquired(3 min/scan).The emission data were reconstructed using different techniques.The image quality parameters were evaluated by both phantoms.Variations in the signal-to-noise ratio(SNR)in a 28-mm(10-mm)sphere of phantom II were 37.9%(86.5%)for ordered-subset expectation maximization(OSEM-only),36.8%(81.5%)for point spread function(PSF),32.7%(80.7%)for time of flight(TOF),and 31.5%(77.8%)for OSEM+PSF+TOF,respectively,indicating that OSEM+PSF+TOF reconstruction had the lowest noise levels and lowest coefficient of variation(COV)values.Random and scatter coincidences from outside the FOV induced lower SNR,lower contrast,and higher COV values,indicating image deterioration and significantly impacting smaller sphere sizes.Amongst reconstruction protocols,OSEM+PSF+TOF and OSEM+PSF showed higher contrast values for sphere sizes of 22,28,and 37 mm and higher contrast recovery coefficient values for smaller sphere sizes of 10 and 13 mm.展开更多
BACKGROUND Classic “do not touch” and benign osseous lesions are sometimes detected on 18-Ffluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) studies. These lesions are often refe...BACKGROUND Classic “do not touch” and benign osseous lesions are sometimes detected on 18-Ffluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) studies. These lesions are often referred for biopsy because the physician interpreting the PET/CT may not be familiar with the spectrum of 18F-FDG uptake patterns that these lesions display. AIM To show that “do not touch” and benign osseous lesions can have increased 18FFDG uptake above blood-pool on PET/CT;therefore, the CT appearance of these lesions should dictate management rather than the standardized uptake values (SUV). METHODS This retrospective study evaluated 287 independent patients with 287 classic “do not touch”(benign cystic lesions, insufficiency fractures, bone islands, bone infarcts) or benign osseous lesions (hemangiomas, enchondromas, osteochondromas, fibrous dysplasia, Paget’s disease, osteomyelitis) who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) at a tertiary academic healthcare institution between 01/01/2006 and 12/1/2018. The maximum and mean SUV, and the ratio of the maximum SUV to mean blood pool were calculated. Pearson’s correlations between lesion size and maximum SUV were calculated. RESULTS The ranges of the maximum SUV were as follows: For hemangiomas (0.95-2.99), bone infarcts (0.37-3.44), bone islands (0.26-3.29), enchondromas (0.46-2.69), fibrous dysplasia (0.78-18.63), osteochondromas (1.11-2.56), Paget’s disease of bone (0.93-5.65), insufficiency fractures (1.06-12.97) and for osteomyelitis (2.57- 12.64). The range of the maximum SUV was lowest for osteochondromas (maximum SUV 2.56) and was highest for fibrous dysplasia (maximum SUV of 18.63). There was at least one lesion that demonstrated greater 18F-FDG avidity than the blood pool amongst each lesion type, with the highest maximum SUV ranging from 9.34 times blood pool mean (osteomyelitis) to 1.42 times blood pool mean (hemangiomas). There was no correlation between the maximum SUV and the lesion size except for enchondromas. Larger enchondromas had higher maximum SUV (r = 0.36, P = 0.02). CONCLUSION The classic “do not touch” lesions and classic benign lesions can be 18F-FDG avid. The CT appearance of these lesions should dictate clinical management rather than the maximum SUV.展开更多
AIM To investigate rates of distant metastases(DM)detected with[18]fluorodeoxyglucose-positron emissiontomography/computed tomography(^(18)FDG-PET/CT)in early stage invasive breast cancer.METHODS We searched the Engli...AIM To investigate rates of distant metastases(DM)detected with[18]fluorodeoxyglucose-positron emissiontomography/computed tomography(^(18)FDG-PET/CT)in early stage invasive breast cancer.METHODS We searched the English language literature databases of PubM ed,EMBASE,ISI Web of Knowledge,Web of Science and Google Scholar,for publications on DM detected in patients who had^(18)FDG-PET/CT scans as part of the staging for early stages of breast cancer(stageⅠ?andⅡ),prior to or immediately following surgery.Reports published between 2011 and 2017 were considered.The systematic review was conducted according to the PRISMA guidelines.RESULTS Among the 18 total studies included in the analysis,the risk of DM ranged from 0%to 8.3%and 0%to 12.9%for stageⅠ?andⅡinvasive breast cancer,respectively.Among the patients with clinical stageⅡ,the rate of occult metastases diagnosed by^(18)FDG-PET/CT was 7.2%(range,0%-19.6%)for stageⅡA and 15.8%(range,0%-40.8%)for stageⅡB.In young patients(<40-yearold),^(18)FDG-PET/CT demonstrated a higher prevalence of DM at the time of diagnosis for those with aggressive histology(i.e.,triple-negative receptors and poorly differentiated grade).CONCLUSION Young patients with poorly differentiated tumors and stageⅡB triple-negative breast cancer may benefit from^(18)FDG-PET/CT at initial staging to detect occult DM prior to surgery.展开更多
BACKGROUND Peripheral FDG accumulation in a hepatic hemangioma presenting in a patient with prolonged fever is rare.Therefore,clinicians should pay close attention to patients with hepatic mass.CASE SUMMARY A 54-year-...BACKGROUND Peripheral FDG accumulation in a hepatic hemangioma presenting in a patient with prolonged fever is rare.Therefore,clinicians should pay close attention to patients with hepatic mass.CASE SUMMARY A 54-year-old woman with a 4-wk history of daily fevers was admitted to our hospital.A whole body^(18)-Fluordesoxyglucose(PET-FDG)positron emission tomography/computed tomography(PET/CT)was performed to elucidate the source of the fever.However,whole body^(18)-FDG PET/CT raised the suspicion of a malignant lesion because of peripheral FDG accumulation(SUVmax 3.5 g/mL)higher than that of the normal liver parenchyma(SUVmax 1.6 g/mL)surrounding a hypoactive area,and no other abnormalities were showed.Subsequently,the patient underwent liver mass resection.Histopathology showed a hepatic cavernous hemangioma with fatty infiltration around the lesion.The fever disappeared four days after surgery and the patient did not present any complications during follow-up.CONCLUSION Fatty infiltration in the peripheral parts of hepatic cavernous hemangioma may lead to subacute inflammation which further activate the Kupffer cells.This may cause prolonged fever and peripheral rim FDG accumulation on PET/CT.展开更多
BACKGROUND Primary aortoduodenal fistula is a rare cause of gastrointestinal(GI)bleeding consisting of abnormal channels between the aorta and GI tract without previous vascular intervention that results in massive in...BACKGROUND Primary aortoduodenal fistula is a rare cause of gastrointestinal(GI)bleeding consisting of abnormal channels between the aorta and GI tract without previous vascular intervention that results in massive intraluminal hemorrhage.CASE SUMMARY A 67-year-old man was hospitalized for coffee ground vomiting,tarry stools,and colic abdominal pain.He was repeatedly admitted for active GI bleeding and hypovolemic shock.Intermittent and spontaneously stopped bleeders were undetectable on multiple GI endoscopy,angiography,computed tomography angiography(CTA),capsule endoscopy,and ^(99)mTc-labeled red blood cell(RBC)scans.The patient received supportive treatment and was discharged without signs of rebleeding.Thereafter,he was re-admitted for bleeder identification.Repeated CTA after a bleed revealed a small aortic aneurysm at the renal level contacting the fourth portion of the duodenum.A ^(99)mTc-labeled RBC singlephoton emission CT(SPECT)/CT scan performed during bleeding symptoms revealed active bleeding at the duodenal level.According to his clinical symptoms(intermittent massive GI bleeding with hypovolemic shock,dizziness,dark red stool,and bloody vomitus)and the abdominal CTA and ^(99)mTc-labeled RBC SPECT/CT results,we suspected a small aneurysm and an aortoduodenal fistula.Subsequent duodenal excision and duodenojejunal anastomosis were performed.A 7-mm saccular aneurysm arising from the anterior wall of the abdominal aorta near the left renal artery was identified.Percutaneous intravascular stenting of the abdominal aorta was performed and his symptoms improved.CONCLUSION Our findings suggest that ^(99)mTc-labeled RBC SPECT/CT scanning can aid the diagnosis of a rare cause of active GI bleeding.展开更多
基金supported by the National Natural Science Foundation of China(Grant 32027802)Key Research and Development Program of Zhejiang Province(Grant 2022C03071)+1 种基金Medical and Health Research Project of Zhejiang Province(Grant 2024KY1222)Teaching Reform Project of the Education Department of Zhejiang Province(Grant JGBA2024231).
文摘Ovarian cancer(OC)is the most lethal gynecological malignancy.Diagnosis usually occurs late,and even with the most effective treatment relapses are frequent.Early diagnosis and precise staging are critical for achieving better treatment outcomes and prognoses.Conventional imaging methods such as ultrasound(US),computed tomography(CT),and magnetic resonance imaging(MRI)are the main imaging techniques supporting management decisions.However,advancements in molecular imaging have made positron emission tomography/computed tomography(PET/CT)a promising noninvasive imaging option for better management of OC.The literature provides evidence indicating that fluorine‐18‐fluorodeoxyglucose(^(18)F‐FDG)PET/CT(FDG‐PET/CT)is effective in primary tumor diagnosis,staging,prognosis evaluation,treatment response assessment,and relapse surveillance.Looking ahead,significant attention should be paid to tracers beyond FDG,integrated PET/MRI,dynamic PET,and artificial intelligence(AI)‐based radiomics.This review examines the application of PET/CT in OC management at each disease stage and discusses its future potential.
文摘Soft tissue sarcomas(STS)are rare malignant tumors originating from mesoder-mal tissues with a poor prognosis,accounting for approximately 1%of all malig-nancies and comprising around 50 distinct subtypes.Conventional imaging mo-dalities,such as computed tomography(CT)and magnetic resonance imaging(MRI),primarily provide anatomical information,whereas 18F-fluorodeoxyglucose positron emission tomography/CT(18F-FDG PET/CT)integrates functional metabolic and anatomical imaging,serving as a critical complementary tool in the diagnosis and management of STS.This article reviews recent advances in the application of 18F-FDG PET/CT for STS.The advantages of 18F-FDG PET/CT in STS include:(1)Early detection of metabolic activity changes in tumors,partic-ularly when morphological alterations are insignificant;(2)Effective differen-tiation between benign and malignant soft tissue tumors,as well as aiding in distinguishing high-grade from low-grade sarcomas;(3)Identification of occult metastatic lesions,improving staging accuracy,and facilitating restaging in cases of recurrence or metastasis;(4)Utilization of parameters such as maximum stan-dardized uptake value and metabolic tumor volume to assist in tumor grading and prognostic evaluation;and(5)Monitoring treatment response to guide adjust-ments in personalized therapeutic strategies.However,18F-FDG PET/CT has limitations in diagnosis of certain STS subtypes(e.g.,myxoid liposarcoma),detection and biopsy of metastatic lymph nodes,necessitating integration with clinical evaluation and other imaging techniques.18F-FDG PET/CT is poised to play an increasingly vital role in the precision diagnosis and treatment of STS.
基金Supported by the Tianjin Science and Technology Project,No.TJWJ2025RC008。
文摘BACKGROUND Malignant pleural mesothelioma(MPM),a rare aggressive malignancy,is primarily caused by asbestos exposure.MPM typically affects older adults(median age,76 years),is uncommon in those under age 50 years and shows male predominance.Based on the American Society of Clinical Oncology guidelines,F-18 fluorodeoxyglucose positron emission tomography/computed tomography(F-18 FDG PET/CT)is essential for initial MPM staging.Integrating quantitative FDG metabolic data with computed tomography(CT)anatomy optimizes biopsy accuracy and staging.CASE SUMMARY A 21-year-old female college student presented with fever(peak 38.4°C),cough,and white mucoid sputum after cold exposure.Initial evaluation revealed elevated C-reactive protein[C-reactive protein(CRP);65.52 mg/L]and Mycoplasma pneumoniae IgM.Despite resolution of fever following a 14-day moxifloxacin regimen,persistent cough prompted chest CT,which demonstrated left pleural mass-like thickenings.Levofloxacin therapy for 2 weeks failed to alleviate symptoms,accompanied by 2.5-kg weight loss over 1 month.Re-evaluation showed rising CRP(88.87 mg/L)with stable CT lesions,and negative T-cell spot test for tuberculosis and tumor markers.Contrast-enhanced CT revealed heterogeneously enhancing masses,while PET/CT detected two broad-based pleural lesions with intense FDG avidity.CT-guided biopsy confirmed epithelioid MPM.Thoracoscopy exposed diffuse fragile,hemorrhagic nodules implanting on diaphragmatic and parietal pleura,confirming metastatic MPM with partial resection performed.This presentation challenges conventional imaging paradigms of MPM,underscoring its diagnostic complexity.CONCLUSION MPM should still be considered an important differential diagnosis in young patients presenting with solitary pleural masses and no history of typical asbestos exposure.F-18 FDG PET/CT,while serving as an essential component of initial staging for MPM,has some inherent limitations.
基金Supported by National Natural Science Foundation of China,No.82171983Henan Provincial Science and Technology Research Project,No.242102311089.
文摘BACKGROUND Preoperative prognosis assessment of hepatocellular carcinoma(HCC)is crucial,and pathologic grading is a key prognostic determinant that affects patient prognosis.Therefore,accurate determination of pathological grading before surgical intervention is crucial for optimizing treatment strategies and improving prognostic outcomes.AIM To investigate the distinguishing capability of fluorine-18-fluorodeoxyglucosepositron emission tomography/computed tomography(^(18)F-FDG PET/CT)-derived metabolic parameters between Edmondson grade Ⅱ and Ⅲ HCC and to assess their correlation with Ki67 expression levels.METHODS We retrospectively assessed the ^(18)F-FDG PET/CT imaging datasets from 32 patients with solitary HCC,all of whom had pathological confirmation of their diagnosis.Patients were categorized into Edmondson grade Ⅱ and Ⅲ groups according to pathological grading criteria.Comparative analyses were conducted on metabolic parameters,including maximum standardized uptake value(SUV_(max)),mean standardized uptake value(SUV_(mean)),metabolic tumor volume(MTV),total lesion glycolysis(TLG),tumor-to-normal background ratio(TNR),and tumor-to-blood pool ratio(TBR),between the groups.Further,correlations between these parameters and Ki67 expression were investigated.RESULTS Significant differences were observed in SUV_(max),SUV_(mean),TLG,TNR,and TBR between Edmondson grade Ⅱ and Ⅲ HCC groups(P<0.05),whereas MTV was not significantly different(P=0.052).The maximum tumor diameter and Ki67 expression percentage significantly varied between the two groups(P<0.05).SUV_(max) yielded the largest area under the receiver operating characteristic curve,measuring 0.853(95%confidence interval:0.709-0.997,P=0.001).Using an optimal SUV_(max) cut-off of 10.95,the sensitivity and specificity for identifying Edmondson grade Ⅲ HCC were 66.7%and 100%,respectively.Notably,significant positive correlations were identified in terms of SUV_(max),SUV_(mean),TNR,TBR,and the percentage of Ki67 expression(P<0.01).Conversely,MTV,TLG,and maximum tumor diameter exhibited no significant association with Ki67 expression(P>0.05).CONCLUSION ^(18)F-FDG PET/CT-derived metabolic parameters,particularly SUV_(max),SUV_(mean),TNR,TBR,and TLG,are valuable in differentiating Edmondson grade Ⅱ and Ⅲ HCC,with SUV_(max) showing the optimal differential diagnostic efficacy.TLG is a three-dimensional volumetric parameter that holds some differential diagnostic potential,but it fails to display a distinct advantage.Moreover,increased ^(18)F-FDG uptake and Ki67 expression in tumor tissue correlate with poorer HCC prognoses,emphasizing their potential role in prognostic assessments.
文摘AIM: To evaluate the clinical role of 18F-fluorodeo-xyglucose positron emission and computed tomography (18F-FDG PET/CT) in detection of gastric cancer recurrence after initial surgical resection. METHODS: In the period from January 2007 to May 2008, 23 patients who had previous surgical resection of histopathologically diagnosed gastric cancer underwent a total of 25 18F-FDG PET/CT scans as follow-up visits in our center. The standard of reference for tumor recurrence consisted of histopathologic confirmation or clinical follow-up information for at least 5 mo after PET/CT examinations. RESULTS: PET/CT was positive in 14 patients (61%) and negative in 9 (39%). When correlated with final diagnosis, which was confirmed by histopathologic evidence of tumor recurrence in 8 of the 23 patients (35%) and by clinical follow-up in 15 (65%), PET/CT was true positive in 12 patients, false positive in 2, true negative in 8 and false negative in 2. Overall, the accuracy of PET/CT was 82.6%, the negative predictive value (NPV) was 77.7%, and the positive predictive value (PPV) was 85.7%. The 2 false positive PET/CT findings were actually chronic inflammatory tissue lesions. For the two patients with false negativePET/CT, the f inal diagnosis was recurrence of mucinous adenocarcinoma in the anastomosis in one patient and abdominal wall metastasis in the other. Importantly, PET/CT revealed true-positive findings in 11 (47.8%) patients who had negative or no definite findings by CT. PET/CT revealed extra-abdominal metastases in 7 patients and additional esophageal carcinoma in one patient. Clinical treatment decisions were changed in 7 (30.4%) patients after introducing PET/CT into their conventional post-operative follow-up program. CONCLUSION: Whole body 18F-FDG PET/CT was highly effective in discriminating true recurrence in post-operative patients with gastric cancer and had important impacts on clinical decisions in a considerable portion of patients.
文摘AIM: To evaluated the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan in diagnosis of hepatocellular carcinoma (HCC) and extrahepatic metastases. METHODS: A total of 138 patients with HCC who had both conventional imaging modalities and 18F-FDG PET/CT scan done between November 2006 and March 2011 were enrolled. Diagnostic value of each imaging modality for detection of extrahepatic metastases was evaluated. Clinical factors and tumor characteristics including PET imaging were analyzed as indicative factors for metastases by univariate and multivariate methods. RESULTS: The accuracy of chest CT was significantly superior compared with the accuracy of PET imaging for detecting lung metastases. The detection rate of metastatic pulmonary nodule ≥ 1 cm was 12/13 (92.3%), when < 1 cm was 2/10 (20%) in PET imaging. The accuracy of PET imaging was significantly superior compared with the accuracy of bone scan for detecting bone metastases. In multivariate analy- sis, increased tumor size (≥ 5 cm) (P = 0.042) and increased average standardized uptake value (SUV) uptake (P = 0.028) were predictive factors for extrahepatic metastases. Isometabolic HCC in PET imaging was inversely correlated in multivariate analysis (P = 0.035). According to the receiver operating characteristic curve, the optimal cutoff of average SUV to predict extrahepatic metastases was 3.4. CONCLUSION: 18F-FDG PET/CT scan is invaluable for detection of lung metastases larger than 1 cm and bone metastases. Primary HCC having larger than 5 cm and increased average SUV uptake more than 3.4 should be considered for extrahepatic metastases.
基金Supported by National Research Foundation of Korea,No.2017R1C1B5076640.
文摘BACKGROUND Lymph node(LN)metastasis is an important prognostic factor in patients with gastric cancer(GC).However,the evaluation of LN metastasis status in the preoperative setting is not accurate.Therefore,precise preoperative prediction of LN metastasis status is crucial for optimal treatment in patients with GC.AIM To develop a preoperative nomogram for LN metastasis using F-18 fluorodeoxyglucose(F-18 FDG)positron emission tomography/computed tomography(PET/CT)and preoperative laboratory test findings in GC.METHODS In this study,the data of 566 GC patients who underwent preoperative F-18 FDG PET/CT and subsequent surgical resection were analyzed.The LN metastasis prediction model was developed in the training cohort and validated in the internal validation cohort.Routine preoperative laboratory tests,including albumin and carbohydrate antigen(CA)19-9 were performed in all patients.Univariate and multivariable logistic regression was performed to validate the preoperative predictive indicators for LN metastasis.RESULTS Of the 566 patients,232(41%)had confirmed histopathologic LN metastasis.Univariate logistic regression revealed that the tumor location,blood hemoglobin,serum albumin levels,neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,CA 19-9,maximum standardized uptake value(SUVmax)of the primary tumor(T_SUVmax),and SUVmax of LN(N_SUVmax)were significantly associated with LN metastasis.In multivariate analysis,T_SUVmax(OR=1.08;95%CI:1.02–1.15;P=0.011)and N_SUVmax(OR=1.49;95%CI:1.19–1.97;P=0.002)were found to be significant predictive factors for LNmetastasis.The LN metastasis prediction model using T_SUVmax,N_SUVmax,serum albumin,and CA 19-9 yielded an area under the curve(AUC)of 0.733(95%CI:0.683–0.784,P=0.025)in the training cohort and AUC of 0.756(95%CI:0.678–0.833,P<0.001)in the test cohort.CONCLUSION T_SUVmax and N_SUVmax measured by preoperative F-18 FDG PET/CT are independent predictive factors for LN metastasis in GC.
文摘The clinical value of whole body positron emission tomography/computed tomography （PET/CT） as an imaging tool in diagnosis of ophthalmic tumors was investigated. The retrospective observational case series were performed on the patients with suspected ophthalmic tumors who underwent whole body PET/CT. The golden standard of diagnosis was the final pathological diagnosis or the results of long-term follow-up for patients without surgery/ biopsy. PET/CT findings were compared with the golden standard. The sensitivity, specificity, accuracy an^t positive likelihood ratio of PET/CT in the detection of ophthalmic tumors were calculated. The clinical application of PET/CT in different types of ophthalmic tumors was evaluated. The results showed that 30 patients （18 males and 12 females） with a mean age of 43.0 years （range 4-63 years） were collected. The mean sizes of orbital tumors and intraocular tumors were 26.8 mmxl7.8 mm and 11.2 minx6.1 mm, respectively. The overall sensitivity, specificity, accuracy and positive likelihood ratio of whole body PET/CT in ophthalmic tumors were 76.5%, 71.4%, 75.0% and 2.67, and were 62.5%, 100% and 70.0% in intraocular tumors, and those were 100%, 60.0% and 84.6% in orbital tumors, respectively. PET/CT findings were applied to help make appropriate treatment options in 27 out of 30 patients （90.0%）, and 12 （40.0%） patients changed the treatment strategy. False negative results in 4 cases and false positive results in 2 cases were observed in this series. It was suggested that PET/CT was an effective imaging modality in detecting, diagnosing and developing therapeutic schedule for patients with ophthalmic tumors. It was more sensitive and accurate for detecting orbital tumors than for detecting intraocular tumors.
文摘AIM:To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT)hybrid imaging for diagnosis of various endocrine disorders.METHODS:We performed MEDLINE and Pub Med searches using the terms:"SPECT/CT";"functional anatomic mapping";"transmission emission tomography";"parathyroid adenoma";"thyroid cancer";"neuroendocrine tumor";"adrenal";"pheochromocytoma";"paraganglioma";in order to identify relevant articles published in English during the years 2003 to 2015.Reference lists from the articles were reviewed to identify additional pertinent articles.Retrieved manuscripts(case reports,reviews,meta-analyses and abstracts)concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.RESULTS:The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging,with seamless fusion of three-dimensional volume datasets.The usefulness of combining functional information to depict the biodistribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin,with anatomy derived from CT,has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function.The literature describes benefits of SPECT/CT for^(99m)Tc-sestamibi parathyroid scintigraphy and^(99m)Tc-pertechnetate thyroid scintigraphy,^(123)I-or^(131)I-radioiodine for staging of differentiated thyroid carcinoma,^(111)In-and^(99m)Tclabeled somatostatin receptor analogues for detection of neuroendocrine tumors,^(131)I-norcholesterol(NP-59)scans for assessment of adrenal cortical hyperfunction,and^(123)I-or^(131)I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.CONCLUSION:SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT,translating to improved diagnostic accuracy and meaningful impact on patient care.
文摘AIM To clarify clinicopathological features of ductal carcinoma in situ(DCIS)visualized on[F-18]fluorodeoxyglucosepositron emission tomography/computed tomography(FDG-PET/CT).METHODS This study retrospectively reviewed 52 consecutive tumors in 50 patients with pathologically proven pure DCIS who underwent[F-18]FDG-PET/CT before surgery.[F-18]FDG-PET/CT was performed after biopsy in all patients.The mean interval from biopsy to[F-18]FDGPET/CT was 29.2 d.[F-18]FDG uptake by visual analysis and maximum standardized uptake value(SUVmax)was compared with clinicopathological characteristics.RESULTS[F-18]FDG uptake was visualized in 28 lesions(53.8%)and the mean and standard deviation of SUVmax was 1.63 and 0.90.On univariate analysis,visual analysis and the SUVmax were associated with symptomatic presentation(P=0.012 and 0.002,respectively),palpability(P=0.030 and 0.024,respectively),use of core-needle biopsy(CNB)(P=0.023 and 0.012,respectively),ultrasound-guided biopsy(P=0.040 and 0.006,respectively),enhancing lesion≥20 mm on magnetic resonance imaging(MRI)(P=0.001 and 0.010,respectively),tumor size≥20 mm on histopathology(P=0.002 and 0.008,respectively).However,[F-18]FDG uptake parameters were not significantly associated with age,presence of calcification on mammography,mass formation on MRI,presence of comedo necrosis,hormone status(estrogen receptor,progesterone receptor and human epidermal growth factor receptor-2),and nuclear grade.The factors significantly associated with visual analysis and SUVmax were symptomatic presentation(P=0.019 and 0.001,respectively),use of CNB(P=0.001 and 0.031,respectively),and enhancing lesion≥20 mm on MRI(P=0.001 and 0.049,respectively)on multivariate analysis.CONCLUSION Although DCIS of breast is generally non-avid tumor,symptomatic and large tumors(≥20 mm)tend to be visualized on[F-18]FDG-PET/CT.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has made it more challenging for patients to undergo yttrium-90(Y-90)radioembolization(RE).Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19,thus improving patient access.AIM To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography(SPECT/CT)in order to optimize therapy.METHODS All patients were selected for Y-90 RE through a multidisciplinary tumor board,and were screened and tested for COVID-19 infection per institutional protocol.A same day procedure was developed,consisting of angiography,imaging,and Y-90 resin particle delivery.Routine SPECT/CT after technetium-99m macroaggregated albumin(Tc-99m MAA)administration was performed for assessment of arterial supply,personalized dosimetry,and extrahepatic activity.Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery,by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles.RESULTS A total of 14 patients underwent same day Y-90 RE between March and June 2020.Mean lung shunt fraction was 6.13%(range 3.5%-13.1%).Y-90 RE was performed for a single lesion in 7 patients,while the remaining 7 patients had treatment of multifocal lesions.The largest lesion measured 8.3 cm.All patients tolerated the procedure well and were discharged the same day.CONCLUSION Same day Y-90 RE with resin-based microspheres is feasible,and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond.We recommend consideration of SPECT/CT,especially among patients with complex malignancies,for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.
文摘BACKGROUND Incidentally found thyroid tumor(thyroid incidentaloma,TI)on F-18 fluorodeoxyglucose(FDG)positron emission tomography-computed tomography(PETCT)is reported in 2.5%-5%of patients being investigated for non-thyroid purposes.Up to 50%of these cases have been diagnosed to be malignant by cytological/histological results.Ultrasonography(US)and fine-needle aspiration cytology are recommended for thyroid nodules with high FDG uptake(hypermetabolism)that are 1 cm or greater in size.It is important to accurately determine whether a suspicious hypermetabolic TI is malignant or benign.AIM To distinguish malignant hypermetabolic TIs from benign disease by analyzing F-18 FDG PET-CT parameters and to identify a cut-off value.METHODS Totally,12761 images of patients who underwent F-18 FDG PET-CT for nonthyroid purposes at our hospital between January 2016 and December 2020 were retrospectively reviewed,and 339 patients[185 men(mean age:68±11.2)and 154 women(mean age:63±15.0)]were found to have abnormal,either focal or diffuse,thyroid FDG uptake.After a thorough review of their medical records,US,and cytological/histological reports,46 eligible patients with focal hypermetabolic TI were included in this study.The TIs were categorized as malignant and benign according to the cytological/histological reports,and four PET parameters[standardized uptake value(SUV)max,SUV_(peak),SUV_(mean),and metabolic tumor volume(MTV)]were measured on FDG PET-CT.Total lesion glycolysis(TLG)was calculated by multiplying the SUV_(mean) by MTV.Both parametric and non-parametric methods were used to compare the five parameters between malignant and benign lesions.Receiver operating characteristic(ROC)curve analysis was performed to identify a cut-off value.RESULTS Each of the 46 patients[12 men(26.1%;mean age:62±13.1 years)and 34 women(73.9%;mean age:60±12.0 years)]with focal hypermetabolic TIs had one focal hypermetabolic TI.Among them,26(56.5%)were malignant and 20(43.5%)were benign.SUV_(max),SUV_(peak),SUV_(mean),and TLG were all higher in malignant lesions than benign ones,but the difference was statistically significant(P=0.012)only for SUV_(max).There was a positive linear correlation(r=0.339)between SUV_(max) and the diagnosis of malignancy.ROC curve analysis for SUV_(max) revealed an area under the curve of 0.702(P<0.05,95%confidence interval:0.550-0.855)and SUV_(max) cut-off of 8.5 with a sensitivity of 0.615 and a specificity of 0.789.CONCLUSION More than half of focal hypermetabolic TIs on F-18 FDG PET-CT were revealed as malignant lesions,and SUV_(max) was the best parameter for discriminating between malignant and benign disease.Unexpected focal hypermetabolic TIs with the SUV_(max) above the cut-off value of 8.5 may have a greater than 70%chance of malignancy;therefore,further active assessment is required.
文摘AIM To determine the significance and need for investigation of incidental prostatic uptake in men undergoing ^(18)F-labelled fluorodeoxyglucose(^(18)F-FDG) positron emission tomography/computed tomography(PET/CT) for other indications.METHODS Hospital databases were searched over a 5-year period for patients undergoing both PET/CT and prostate magnetic resonance imaging(MRI). For the initial analysis, the prostate was divided into six sectors and suspicious or malignant sectors were identified using MRI and histopathology reports respectively. Maximum and mean ^(18)F-FDG standardised uptake values were measured in each sector by an investigator blinded to the MRI and histopathology findings. Two agematched controls were selected per case. Results were analysed using a paired t-test and one-way ANOVA. For the second analysis, PET/CT reports were searched for prostatic uptake reported incidentally and these patients were followed up. RESULTS Over a 5-year period, 15 patients underwent both PET/CT and MRI and had biopsy-proven prostate cancer.Malignant prostatic sectors had a trend to higher ^(18)F-FDG uptake than benign sectors, however this was neither clinically nor statistically significant(3.13 ±0.58 vs 2.86 ± 0.68, P > 0.05). ^(18)F-FDG uptake showed no correlation with the presence or histopathological grade of tumour. ^(18)F-FDG uptake in cases with prostate cancer was comparable to that from age-matched controls. Forty-six(1.6%) of 2846 PET/CTs over a 5-year period reported incidental prostatic uptake. Of these, 18(0.6%) were investigated by PSA, 9(0.3%)were referred to urology, with 3(0.1%) undergoing MRI and/or biopsy. No cases of prostate cancer were diagnosed in patients with incidental ^(18)F-FDG uptake in our institute over a 5-year period.CONCLUSION ^(18)F-FDG uptake overlaps significantly between malignant and benign prostatic conditions. Subsequent patient management was not affected by the reporting of incidental focal prostatic uptake in this cohort.
文摘BACKGROUND Alveolar soft part sarcoma(ASPS)is an extremely rare malignant sarcoma,accounting for less than 1%of all soft-tissue sarcomas.However,limited information is available on multimodal imaging[computed tomography(CT),magnetic resonance imaging(MRI),and positron emission computed tomography/computed tomography(PET/CT)]of ASPS.CASE SUMMARY This study reports a case of a 35-year-old female patient with ASPS of the left thigh with lung metastasis.The patient presented with a 1-year history of a palpable mass in the lower extremity,which exhibited rapid growth for 3 wk.CT,MRI,and F-deoxyglucose PET/CT examinations were performed.CT showed a slightly hypodense or isodense mass with patchy calcifications.On MRI examination,the mass manifested hyperintensity on T1-weighted,T2-weighted,and diffusion-weighted images with some signal voids.PET/CT images demonstrated an intensely hypermetabolic mass in the left thigh and hypermetabolic nodules in lungs.CONCLUSION ASPS should be considered as a possible diagnosis when a slow-growing mass is detected in the soft tissue of the extremities,with hyperintensity and numerous signal voids on T1-weighted,T2-weighted,and diffusion-weighted images and intense F-deoxyglucose uptake on PET/CT.ASPS can have calcifications on CT.
文摘BACKGROUND Gastric duplication cysts(GDCs)are extremely uncommon lesions and the definitive diagnosis of GDCs is challenging for gastrointestinal specialists.It is important that a differential diagnosis is performed to rule out the possibility of other diseases,mainly malignancies with a cystic component.Despite the use of multiple diagnostic modalities including endoscopy,the preoperative diagnosis of GDCs is challenging.CASE SUMMARY A 53-year-old female patient with a GDC was confirmed by positron emission tomography/computed tomography(PET/CT)instead of more conventional procedures such as endoscopic ultrasonography-guided fine needle aspiration(EUS-FNA).We propose that 18F-FDG-PET/CT has higher accuracy than EUSFNA and may be an effective technique for the characterization of duplication cysts.CONCLUSION Preoperative diagnosis of GDCs in adults is difficult largely due to their rarity and the absence of characteristic findings.In addition,few endoscopists include GDCs in the differential diagnosis when they encounter a lesion with cystic characteristics.18F-FDG-PET/CT with additional imaging data,may complement EUS-FNA in the diagnosis of GDCs.
基金supported by the Tehran University of Medical Sciences under Grant No.36291PET/CT and Cyclotron Center of Masih Daneshvari Hospital at Shahid Beheshti University of Medical Sciences。
文摘Image quality in positron emission tomography(PET)is affected by random and scattered coincidences and reconstruction protocols.In this study,we investigated the effects of scattered and random coincidences from outside the field of view(FOV)on PET image quality for different reconstruction protocols.Imaging was performed on the Discovery 690 PET/CT scanner,using experimental configurations including the NEMA phantom(a body phantom,with six spheres of different sizes)with a signal background ratio of 4:1.The NEMA phantom(phantom I)was scanned separately in a one-bed position.To simulate the effect of random and scatter coincidences from outside the FOV,six cylindrical phantoms with various diameters were added to the NEMA phantom(phantom II).The 18 emission datasets with mean intervals of 15 min were acquired(3 min/scan).The emission data were reconstructed using different techniques.The image quality parameters were evaluated by both phantoms.Variations in the signal-to-noise ratio(SNR)in a 28-mm(10-mm)sphere of phantom II were 37.9%(86.5%)for ordered-subset expectation maximization(OSEM-only),36.8%(81.5%)for point spread function(PSF),32.7%(80.7%)for time of flight(TOF),and 31.5%(77.8%)for OSEM+PSF+TOF,respectively,indicating that OSEM+PSF+TOF reconstruction had the lowest noise levels and lowest coefficient of variation(COV)values.Random and scatter coincidences from outside the FOV induced lower SNR,lower contrast,and higher COV values,indicating image deterioration and significantly impacting smaller sphere sizes.Amongst reconstruction protocols,OSEM+PSF+TOF and OSEM+PSF showed higher contrast values for sphere sizes of 22,28,and 37 mm and higher contrast recovery coefficient values for smaller sphere sizes of 10 and 13 mm.
文摘BACKGROUND Classic “do not touch” and benign osseous lesions are sometimes detected on 18-Ffluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) studies. These lesions are often referred for biopsy because the physician interpreting the PET/CT may not be familiar with the spectrum of 18F-FDG uptake patterns that these lesions display. AIM To show that “do not touch” and benign osseous lesions can have increased 18FFDG uptake above blood-pool on PET/CT;therefore, the CT appearance of these lesions should dictate management rather than the standardized uptake values (SUV). METHODS This retrospective study evaluated 287 independent patients with 287 classic “do not touch”(benign cystic lesions, insufficiency fractures, bone islands, bone infarcts) or benign osseous lesions (hemangiomas, enchondromas, osteochondromas, fibrous dysplasia, Paget’s disease, osteomyelitis) who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) at a tertiary academic healthcare institution between 01/01/2006 and 12/1/2018. The maximum and mean SUV, and the ratio of the maximum SUV to mean blood pool were calculated. Pearson’s correlations between lesion size and maximum SUV were calculated. RESULTS The ranges of the maximum SUV were as follows: For hemangiomas (0.95-2.99), bone infarcts (0.37-3.44), bone islands (0.26-3.29), enchondromas (0.46-2.69), fibrous dysplasia (0.78-18.63), osteochondromas (1.11-2.56), Paget’s disease of bone (0.93-5.65), insufficiency fractures (1.06-12.97) and for osteomyelitis (2.57- 12.64). The range of the maximum SUV was lowest for osteochondromas (maximum SUV 2.56) and was highest for fibrous dysplasia (maximum SUV of 18.63). There was at least one lesion that demonstrated greater 18F-FDG avidity than the blood pool amongst each lesion type, with the highest maximum SUV ranging from 9.34 times blood pool mean (osteomyelitis) to 1.42 times blood pool mean (hemangiomas). There was no correlation between the maximum SUV and the lesion size except for enchondromas. Larger enchondromas had higher maximum SUV (r = 0.36, P = 0.02). CONCLUSION The classic “do not touch” lesions and classic benign lesions can be 18F-FDG avid. The CT appearance of these lesions should dictate clinical management rather than the maximum SUV.
文摘AIM To investigate rates of distant metastases(DM)detected with[18]fluorodeoxyglucose-positron emissiontomography/computed tomography(^(18)FDG-PET/CT)in early stage invasive breast cancer.METHODS We searched the English language literature databases of PubM ed,EMBASE,ISI Web of Knowledge,Web of Science and Google Scholar,for publications on DM detected in patients who had^(18)FDG-PET/CT scans as part of the staging for early stages of breast cancer(stageⅠ?andⅡ),prior to or immediately following surgery.Reports published between 2011 and 2017 were considered.The systematic review was conducted according to the PRISMA guidelines.RESULTS Among the 18 total studies included in the analysis,the risk of DM ranged from 0%to 8.3%and 0%to 12.9%for stageⅠ?andⅡinvasive breast cancer,respectively.Among the patients with clinical stageⅡ,the rate of occult metastases diagnosed by^(18)FDG-PET/CT was 7.2%(range,0%-19.6%)for stageⅡA and 15.8%(range,0%-40.8%)for stageⅡB.In young patients(<40-yearold),^(18)FDG-PET/CT demonstrated a higher prevalence of DM at the time of diagnosis for those with aggressive histology(i.e.,triple-negative receptors and poorly differentiated grade).CONCLUSION Young patients with poorly differentiated tumors and stageⅡB triple-negative breast cancer may benefit from^(18)FDG-PET/CT at initial staging to detect occult DM prior to surgery.
基金Supported by Zhejiang Province Public Welfare Technology Application Research Project,No.LGF21H180007.
文摘BACKGROUND Peripheral FDG accumulation in a hepatic hemangioma presenting in a patient with prolonged fever is rare.Therefore,clinicians should pay close attention to patients with hepatic mass.CASE SUMMARY A 54-year-old woman with a 4-wk history of daily fevers was admitted to our hospital.A whole body^(18)-Fluordesoxyglucose(PET-FDG)positron emission tomography/computed tomography(PET/CT)was performed to elucidate the source of the fever.However,whole body^(18)-FDG PET/CT raised the suspicion of a malignant lesion because of peripheral FDG accumulation(SUVmax 3.5 g/mL)higher than that of the normal liver parenchyma(SUVmax 1.6 g/mL)surrounding a hypoactive area,and no other abnormalities were showed.Subsequently,the patient underwent liver mass resection.Histopathology showed a hepatic cavernous hemangioma with fatty infiltration around the lesion.The fever disappeared four days after surgery and the patient did not present any complications during follow-up.CONCLUSION Fatty infiltration in the peripheral parts of hepatic cavernous hemangioma may lead to subacute inflammation which further activate the Kupffer cells.This may cause prolonged fever and peripheral rim FDG accumulation on PET/CT.
文摘BACKGROUND Primary aortoduodenal fistula is a rare cause of gastrointestinal(GI)bleeding consisting of abnormal channels between the aorta and GI tract without previous vascular intervention that results in massive intraluminal hemorrhage.CASE SUMMARY A 67-year-old man was hospitalized for coffee ground vomiting,tarry stools,and colic abdominal pain.He was repeatedly admitted for active GI bleeding and hypovolemic shock.Intermittent and spontaneously stopped bleeders were undetectable on multiple GI endoscopy,angiography,computed tomography angiography(CTA),capsule endoscopy,and ^(99)mTc-labeled red blood cell(RBC)scans.The patient received supportive treatment and was discharged without signs of rebleeding.Thereafter,he was re-admitted for bleeder identification.Repeated CTA after a bleed revealed a small aortic aneurysm at the renal level contacting the fourth portion of the duodenum.A ^(99)mTc-labeled RBC singlephoton emission CT(SPECT)/CT scan performed during bleeding symptoms revealed active bleeding at the duodenal level.According to his clinical symptoms(intermittent massive GI bleeding with hypovolemic shock,dizziness,dark red stool,and bloody vomitus)and the abdominal CTA and ^(99)mTc-labeled RBC SPECT/CT results,we suspected a small aneurysm and an aortoduodenal fistula.Subsequent duodenal excision and duodenojejunal anastomosis were performed.A 7-mm saccular aneurysm arising from the anterior wall of the abdominal aorta near the left renal artery was identified.Percutaneous intravascular stenting of the abdominal aorta was performed and his symptoms improved.CONCLUSION Our findings suggest that ^(99)mTc-labeled RBC SPECT/CT scanning can aid the diagnosis of a rare cause of active GI bleeding.
