Predictors of pathologic outcome of focal FDG uptake in the parotid gland identified on whole-body FDG PET imaging

AbstractA young gentleman with suspected cardiac sarcoidosis and LV dysfunction whose CMR revealed multifocal subepicardial to mid myocardial linear enhancement in the left ventricular myocardium underwent cardiac 18F-FDG PET imaging. The images revealed patchy regions of increased FDG uptake involving the apical to mid anterolateral, mid to basal anteroseptal/ right ventricular and mildly increased FDG uptake in apical inferior segments of the LV myocardium concordant with CMR findings. Whole body PET CT imaging showed multiple hypermetabolic supra and infra diaphragmatic lymphadenopathy, with no pulmonary lesion identified. Biopsy from the left para aortic lymph node revealed necrotizing granulomatous inflammation consistent with tuberculosis. Based on the histopathological findings of the lymph nodes, diagnosis of cardiac tuberculosis was made, given the similar imaging appearances in both sarcoidosis and TB. This case highlights that cardiac TB although rare, should be included in the differential diagnosis in patients with suspected infiltrative cardiomyopathy, particularly in TB endemic regions.

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Excretion of FDG into saliva and its significance for PET imaging

Nuklearmedizin ◽

10.1055/s-0038-1625289 ◽

2002 ◽

Vol 41 (05) ◽

pp. 214-216 ◽

Cited By ~ 12

Author(s):

B. Dzewas ◽

M. Schwaiger ◽

W. A. Weber ◽

A. Stahl

Keyword(s):

Drinking Water ◽

Parotid Gland ◽

Pet Imaging ◽

Fdg Pet ◽

Renal Excretion ◽

Whole Body ◽

Floor Of The Mouth ◽

Activity Concentrations ◽

Pet Scans ◽

Salivary Concentration

SummaryAim: Assessment of the salivary excretion of FDG and its significance during PET imaging. Methods: Salivary samples from 16 patients were obtained during the first three hours after FDG injection and their activity concentrations were measured. Furthermore, regional FDG accumulations in whole body PET scans (60 min p. i., ROI technique) were determined in the following locations: vestibulum oris, floor of the mouth, hypopharynx, parotid gland, submandibular gland. This ROI analysis was repeated after drinking water (0.2 l) and a second scan (120 min p. i.). Results: The salivary FDG concentrations (SUV) at the first, second and third hour p. i. were 0.2 ± 0.1, 0.4 ± 0.2, and 0.3 ± 0.2, respectively. The FDG uptake in the investigated cranial and cervical sites ranged from SUV 1.2 ± 0.5 in the major salivary glands to 2.1 ± 0.5 in the floor of the mouth. These values remained unchanged after drinking of water. Conclusion: The salivary FDG concentration is higher than expected from the low physiologic content of glucose. This may – similarly to renal excretion – reflect a different behavior of FDG and glucose during reabsorption processes. Nevertheless, the salivary concentration of FDG is so low that no relevant influence on PET imaging is to be expected. Accordingly, the drinking of water prior to the scan is of no benefit for FDG PET imaging of the head and the neck.

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Traumatic myositis ossificans: multifocal lesions suggesting malignancy on FDG-PET/CT—a case report

Skeletal Radiology ◽

10.1007/s00256-020-03521-w ◽

2020 ◽

Vol 50 (1) ◽

pp. 249-254

Author(s):

Miho Sasaki ◽

Yuka Hotokezaka ◽

Reiko Ideguchi ◽

Masataka Uetani ◽

Shuichi Fujita

Keyword(s):

Case Report ◽

Fdg Pet ◽

Myositis Ossificans ◽

Whole Body ◽

Left Cheek ◽

Multiple Fractures ◽

Fdg Uptake ◽

Pet Ct ◽

Multiple Regions ◽

Fdg Pet Ct

AbstractMyositis ossificans (MO) is a benign soft-tissue lesion characterized by the heterotopic formation of the bone in skeletal muscles, usually due to trauma. MO is occasionally difficult to diagnose because of its clinical and radiological similarities with malignancy. We report a case of traumatic MO (TMO) in the masseter and brachial muscles of a 37-year-old man who presented with painless swelling in the left cheek and severe trismus. Due to the absence of a traumatic history at the first consultation and identification of a tumorous lesion in the left masseter muscle by magnetic resonance imaging (MRI), the lesion was suspected to be a malignant tumor. Subsequently, 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) showed multiple regions of high FDG uptake across the whole body, suggestive of multiple metastases or other systemic diseases. However, intramuscular calcifications were also observed in the left masseter and brachial muscles, overlapping the areas with high FDG uptake. Moreover, multiple fractures were seen in the rib and lumbar spine, also overlapping the areas with high FDG uptake. Based on these imaging findings, along with a history of jet-ski trauma, TMO was suspected. The left cheek mass was surgically excised and histologically diagnosed as TMO. In this case report, FDG-PET/CT could detect multiple TMOs across the whole body. To the best of our knowledge, cases of multiple TMOs located far apart in different muscles are rare, and this may be the first report.

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Diffuse Bone Marrow Involvement of Hodgkin Lymphoma Mimics Hematopoietic Cytokine-Mediated FDG uptake on FDG PET Imaging

Clinical Nuclear Medicine ◽

10.1097/01.rlu.0000079394.76990.08 ◽

2003 ◽

Vol 28 (8) ◽

pp. 674-676 ◽

Cited By ~ 15

Author(s):

Stephen B. Chiang ◽

Alan Rebenstock ◽

Liang Guan ◽

Abass Alavi ◽

Hongming Zhuang

Keyword(s):

Bone Marrow ◽

Hodgkin Lymphoma ◽

Pet Imaging ◽

Fdg Pet ◽

Bone Marrow Involvement ◽

Fdg Uptake

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Brain and whole-body FDG-PET in diagnosis, treatment monitoring and long-term follow-up of primary CNS lymphoma

Radiology and Oncology ◽

10.2478/raon-2013-0016 ◽

2013 ◽

Vol 47 (2) ◽

pp. 103-110 ◽

Cited By ~ 27

Author(s):

Sofiane Maza ◽

Ralph Buchert ◽

Winfried Brenner ◽

Dieter Ludwig Munz ◽

Eckhard Thiel ◽

...

Keyword(s):

Fdg Pet ◽

Brain Mri ◽

Prospective Trial ◽

Primary Cns Lymphoma ◽

Treatment Monitoring ◽

Whole Body ◽

Fdg Uptake ◽

Long Term Follow Up

Background. Positron emission tomography (PET) with F-18-labeled fluorodeoxyglucose (FDG) provides remarkable accuracy in detection, treatment monitoring and follow-up of systemic malignant lymphoma. Its value in the management of patients with primary central nervous system lymphoma (PCNSL) is less clear. Patients and methods. In a prospective trial, 42 FDG-PET examinations were performed in ten immunocompetent patients with newly diagnosed or recurrent PCNSL before and repeatedly during and after the treatment. Brain and whole body FDG-PET were compared to brain MRI and extra-cerebral CT, respectively. Results. Before the treatment, 6 of 10 patients had congruent findings on FDG-PET and MRI of the brain. Three patients had lesions on brain MRI, not detected by FDG-PET. One patient had additional FDG-PET positive lesions inconspicuous in MRI. The follow-up suggested FDG-PET to be false positive in these lesions. After the treatment, brain PET was in agreement with MRI in 6 of 8 patients. In the remaining 2 patients there were persistent lesions in brain MRI whereas FDG-uptake was reduced to normal values. In the long-term follow-up of 5 patients (63-169 weeks), 3 patients retained normal in both PET and MRI. In 2 patients a new focal pathologic FDG-uptake was detected 69 and 52 weeks after the end of the treatment. In one of these patients, recurrence was confirmed by MRI not until 9 weeks after PET. Conclusions. Brain FDG-PET may contribute valuable information for the management of PCNSL, particularly in the assessment of the treatment response. Integration of FDG-PET into prospective interventional trials is warranted to investigate prognostic and therapeutic implications.

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FDG-PET Predicts Response to Fractionated Radioimmunotherapy with 90Y-Epratuzumab Anti-CD22 MAB in Patients with NHL.

Blood ◽

10.1182/blood.v106.11.4782.4782 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4782-4782

Author(s):

Caroline Bodet-Milin ◽

Caroline Rousseau ◽

Loic Campion ◽

Catherine Ansquer ◽

Benoit Dupas ◽

...

Keyword(s):

Pet Imaging ◽

Fdg Pet ◽

Residual Disease ◽

Complete Response ◽

Standard Uptake Value ◽

Ct Scans ◽

Fdg Uptake ◽

Focal Uptake ◽

Progression Of Disease ◽

Conventional Ct

Abstract Objective: To evaluate FDG-PET imaging for early prediction of response in patients with NHL treated with fractionated radioimmunotherapy (RIT). Methods: Ten patients from a larger ongoing, multicenter, Phase I/II trial of fractionated RIT (2–3 injections 1-week apart of humanized anti-CD22 antibody, epratuzumab, labeled with 90Y) underwent FDG-PET imaging together with CT scans of the chest, abdomen and pelvis at baseline and 6 weeks post-RIT, and then every 3 months until progression. Tumor responses evaluated from CT images were classified using Cheson lymphoma criteria as complete response (CR), unconfirmed CR (CRu), partial response (PR), stable disease (SD) or progression of disease (PD). PET images were evaluated for abnormal focal uptake visually, using standard uptake value (SUV) quantitation, and were classified as CR when all tumor foci disappeared, incomplete response (IR) when FDG uptake decreased with persistent foci, or PD when FDG uptake increased or new foci developed. Results: A total of 36 paired imaging studies were obtained post RIT (including 3 patients after retreatment) and evaluated as CR (n=7), CRu (n=14), SD (n=5) or PD (n=10) by CT and CR (n= 13), IR (n= 8) or PD (n=15) by PET. Of the 14 studies evaluated as CRu by CT, 7 were definitively evaluated by PET as CR, 3 as IR, and 4 as PD. Of 22 studies not evaluated as CRu by CT, PET identified PD in one case evaluated as CR by CT and was otherwise concordant with CT (10 PD/PD, 6 CR/CR, 5 SD/IR). Among PET images acquired at 6 weeks post-RIT, the mean time-to-progression (TTP) was 9.6 months for negative PET images (CR) compared to 4.1 months for positive PET findings (IR, PD) (P=0.16). Conclusion: In our study, FDG-PET appeared superior to conventional CT in evaluating response to fractionated RIT. For CT scans frequently evaluated as CRu, PET resolved uncertainty regarding residual disease, and PET images acquired 6 weeks after RIT predicted later relapse.

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Diagnostic Value and Limitations of FDG-PET for the Staging of Childhood Lymphomas.

Blood ◽

10.1182/blood.v114.22.3658.3658 ◽

2009 ◽

Vol 114 (22) ◽

pp. 3658-3658 ◽

Cited By ~ 1

Author(s):

Edita Kabickova ◽

Jana Votrubova ◽

David Sumerauer ◽

Ester Mejstrikova ◽

Ondrej Hrusak ◽

...

Keyword(s):

Bone Marrow ◽

Fdg Pet ◽

Hodgkin’S Lymphoma ◽

Conflicts Of Interest ◽

Hodgkin's Lymphoma ◽

Disease Stage ◽

Whole Body ◽

Fatty Tissue ◽

Fdg Uptake ◽

Pet Ct

Abstract Abstract 3658 Poster Board III-594 Introduction Positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) has the potential to detect malignant cells by their increased glycolysis. PET can detect early changes, before they are apparent on anatomic imaging. Whole-body PET can also detect lesions at unexpected sites. However, physiologic FDG uptake in non-malignant conditions limits the specificity of PET. PET is predominantly used in adult lymphoma patients, limited number of studies were published dealing with PET and PET/CT in childhood lymphomas. The aim of our study was to assess the usefulness of PET for initial staging of pediatric lymphomas and to evaluate benign pathologic causes of FDG uptake. Patients and methods Over a period of 5 years 86 children and adolescents with lymphoma (58 with Hodgkin's lymphoma, 28 with non-Hodgkin's lymphoma) had complete staging work-up including FDG-PET or PET/CT and were included into this prospective study. Patients were aged 4-19 years, 57 (66%) were boys. No patient had CNS lymphoma infiltration. PET findings were correlated with conventional staging methods (CSM) including CT, ultrasound, and bone marrow examination. Discordant findings were verified by MRI and follow-up radiographic studies including PET. Results PET revealed 40 additional lymphoma manifestations in 34% (26/86) of studies and correctly upstaged 15% (13/86) of patients. Only 2% (2/86) of children were not accurately staged by PET, when PET failed to visualize diffuse bone marrow infiltration (extent of 15% cells) in 1 patient, and missed small pulmonary metastases (≤6 mm) in 1 child. Compared with CSM, PET had significantly higher sensitivity (97% vs. 83%), specificity (100% vs. 89%), and significantly higher accuracy (98% vs. 84%). Physiologic thymic FDG uptake was observed in 15% (13) of patients; diffuse increased FDG bone marrow activity had 22% (19) of children, and intense FDG activity in fatty tissue occurred only in 8% (7) of patients. Conclusions PET imaging was highly sensitive in detecting all subtypes of pediatric lymphomas and has potential to accurately define the disease stage except the lungs, where CT has excellent sensitivity. Understanding of the physiologic FDG biodistribution and benign pathologic causes of FDG uptake is essential for accurate scan interpretation. Supported by grants: IGA NS/9997-4, NS/10480-3, MSM 0021620813 and MZO FNM 2005 Disclosures: No relevant conflicts of interest to declare.

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Pilot study to enhance FDG-PET imaging of prostate cancers with the metabolic inhibitor ranolazine.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16551 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16551-e16551

Author(s):

Isabel R. Schlaepfer ◽

Elizabeth R Kessler ◽

Jennifer J Kwak ◽

Lauren Liebman ◽

Paul Maroni ◽

...

Keyword(s):

Prostate Cancer ◽

Pilot Study ◽

Pet Imaging ◽

Fdg Pet ◽

Imaging Modality ◽

Small Sample ◽

Metabolic Inhibitor ◽

Acid Oxidation ◽

Absolute Change ◽

Fdg Uptake

e16551 Background: 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) is a widely-used imaging modality for many cancers; however, its utility in prostate cancer is limited. Fatty acid oxidation (FAO) is a primary source of energy for early prostate cancer. We previously demonstrated that FAO inhibition in prostate cancer mouse models resulted in increased glucose metabolism and enhanced tumor FDG uptake, with peak uptake at 24 hours. To validate these preclinical findings, we conducted a pilot study to evaluate whether a partial FAO inhibitor, ranolazine, increases tumor FDG uptake on PET imaging for prostate cancer. Methods: Prostate cancer patients with untreated localized cancer (arm 1) and with metastatic disease on hormonal or other therapy (arm 2) were enrolled and underwent baseline and post-treatment FDG-PET/CT scans (standard dose of 10 mCi FDG). Ranolazine 1000mg PO BID x 2 doses was given within 24-48 hours of the second scan. The primary objective was to evaluate the rate of successful enhancement of FDG uptake on PET imaging, based on one or more of the following criteria: 30% increase in maximum SUV with an absolute change of 2 units; 30% increase in mean SUV with an absolute change of 0.75 units; or 20% increase in mean SUV with an absolute change of 1 unit. Results: Eleven patients (four in arm 1, seven in arm 2) were enrolled. Ranolazine was well tolerated by all participants, with no adverse effects observed. Both increases and decreases in SUV uptake were observed on the post-ranolazine scans. No patient met the predefined criteria for successful enhancement of FDG uptake. There was an incidental finding of thyroid cancer seen in one patient that was discovered on PET imaging. The study was closed early due to the emerging clinical availability of alternative and effective PET imaging modalities such as [11C] choline, [18F] fluciclovine, [68Ga] PSMA, and [18F] sodium fluoride. Conclusions: Given the small sample size, we were not able to make any firm conclusions. In this limited study, ranolazine treatment did not result in enhanced FDG-PET-tumor detection. ClinicalTrials.gov identifier: NCT01992016. Supported by the William Meyn Foundation; NIH/NCI P30CA46934, 5K12CA086913, CA168934; ACS RSG-16-256-01-TBE; Colorado Translational Research Imaging Center Pilot Award; Paul Sandoval Cancer Research Summer Fellowship. Clinical trial information: NCT01992016.

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Iatrogenic Artifacts on Whole-Body F-18 FDG PET Imaging

Clinical Nuclear Medicine ◽

10.1097/01.rlu.0000129124.52554.92 ◽

2004 ◽

Vol 29 (7) ◽

pp. 429-439 ◽

Cited By ~ 33

Author(s):

Peeyush Bhargava ◽

Hongming Zhuang ◽

Rakesh Kumar ◽

Martin Charron ◽

Abass Alavi

Keyword(s):

Pet Imaging ◽

Fdg Pet ◽

Whole Body

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Detection of Inflammatory Lesions by F-18 Fluorodeoxyglucose Positron Emission Tomography in Patients with Polymyositis and Dermatomyositis

The Journal of Rheumatology ◽

10.3899/jrheum.111597 ◽

2012 ◽

Vol 39 (8) ◽

pp. 1659-1665 ◽

Cited By ~ 33

Author(s):

TAKAYOSHI OWADA ◽

REIKA MAEZAWA ◽

KAZUHIRO KURASAWA ◽

HARUTSUGU OKADA ◽

SATOKO ARAI ◽

...

Keyword(s):

Positron Emission Tomography ◽

Pet Imaging ◽

Fdg Pet ◽

Inflammatory Myopathy ◽

Emission Tomography ◽

Fluorodeoxyglucose Positron Emission Tomography ◽

Muscle Diseases ◽

Fdg Uptake ◽

Positron Emission ◽

Fluorodeoxyglucose Positron Emission

Objective.To evaluate the usefulness of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in the management of patients with inflammatory myopathy. We examined whether FDG-PET scanning detects myositis or extramuscular lesions in patients with polymyositis (PM) and dermatomyositis (DM).Methods.FDG-PET imaging was performed in 24 patients with active inflammatory myopathy (PM, 11; DM, 13). The images were read by radiologists in a blinded manner. FDG uptake into muscles was judged positive when the intensity of muscles was higher than or equal to that of the liver. As controls, FDG imaging findings of patients with a lung mass and without muscle diseases were used. To investigate associations between FDG-PET findings and clinical/laboratory findings, the patients’ medical records were reviewed retrospectively.Results.Increased FDG uptake in muscles was found in 8 of 24 (33%) patients. In 67 of 69 (97%) controls without muscle diseases, no muscle FDG uptake was detected. The sensitivity of FDG-PET to detect myositis was lower than that of electromyogram (EMG), magnetic resonance imaging, and muscle biopsy. There were no significant differences in clinical manifestations between patients with and without increased FDG uptake in muscles, although patients with FDG muscle uptake had a tendency to have extended myositis with endomysial cell infiltration. FDG-PET detected neoplasms in patients with associated malignancy. FDG uptake in lungs was found in 7 of 18 patients with interstitial lung disease.Conclusion.FDG-PET imaging has limited usefulness for the evaluation of myositis in patients with PM/DM because of its low sensitivity, although it might be useful for detection of malignancy in these patients.

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