18-FDG PET/ CT Scan in the Diagnosis and Follow-up of Chronic Q fever Aortic Valve Endocarditis

Tuberculosis (TB) can present with various forms and can occasionally be mistaken for malignancy. Hereby, we report a 53-year-old man diagnosed and treated for Burkitt's lymphoma in 2009 who achieved a complete remission confirmed by a computed tomography (CT) scan. During the follow-up 2 years later, he complained of left hip pain that warranted investigation with magnetic resonance imaging and whole-body 18F-fludeoxyglucose-positron emission tomography (FDG-PET)/CT which showed a benign lesion in the left hip associated with multiple lymph nodes in the chest and abdomen not amenable for biopsy. A follow-up PET/CT scan a few months later showed intense tracer uptake in the lymph nodes with size progression and appearance of new lymph nodes suspicious of lymphoma relapse. The patient was asymptomatic, and all investigations including viral and connective tissue disease studies were negative. Also the tuberculin skin test and QuantiFERON were negative. Lymph node biopsy was planned; however, the patient presented a few days earlier with fever, headache and photophobia. Cerebrospinal fluid (CSF) examination confirmed meningitis with lymphocytic pleocytosis and elevated protein. The CSF Gram stain, culture, viral and acid-fast bacilli were negative. CSF flow cytometry and cytopathology confirmed polyclonal lymphocytosis and suggested reactive causes. CSF TB culture grew Mycobacterium tuberculosis. Mediastinal lymph node biopsy also confirmed TB lymphadenitis. Four antituberculosis drugs were started. One year later, a PET/CT scan showed regression of all the involved lymph nodes. This case highlights the importance of excluding TB in patients with suspected malignancy, especially if they belong to endemic regions, and the increasing role of 18F-FDG-PET/CT in the early detection of extrapulmonary TB.

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Challenging case of chronic Q fever endocarditis: usefulness of 18F-FDG PET/CT in the diagnosis and follow-up

BMJ Case Reports ◽

10.1136/bcr-2021-243290 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243290

Author(s):

Anna Hermine Markowich ◽

Lorenza Romani ◽

Lucia Leccisotti ◽

Maia De Luca

Keyword(s):

Fdg Pet ◽

Q Fever ◽

Specific Treatment ◽

Prosthetic Valve Endocarditis ◽

Serological Tests ◽

Prosthetic Valves ◽

Chronic Q Fever ◽

Pet Ct ◽

Fdg Pet Ct

Diagnosis of infective endocarditis can be challenging for clinicians, especially when involving prosthetic valves. Recent data suggest that 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) could be a useful diagnostic tool in this setting. Here, we report a case of a patient with an aortic biological prosthesis who presented with a history of fever and fatigue. Echocardiograms were negative for vegetations. The 18F-FDG PET/CT revealed an infective process of the valve and serological tests were positive for chronic Coxiella burnetii infection. Specific treatment for chronic Q fever endocarditis was, therefore, started and the response was monitored using 18F-FDG PET/CT. This case highlights the challenges and pitfalls clinicians face when confronted with prosthetic valve endocarditis and the use of 18F-FDG PET/CT for diagnosis and follow-up.

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Primary malignant melanoma of the stomach: a rare entity

BMJ Case Reports ◽

10.1136/bcr-2020-234830 ◽

2020 ◽

Vol 13 (9) ◽

pp. e234830

Author(s):

Pradeep Zechariah ◽

Suraj Surendran ◽

Vijay Abraham ◽

Inian Samarasam

Keyword(s):

Malignant Melanoma ◽

Ct Scan ◽

Fdg Pet ◽

Gastric Fundus ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

A 54-year-old man presented with easy fatiguability, dyspnoea on exertion and dyspeptic symptoms. On evaluation, he was found to have an ulcero-proliferative growth in the gastric fundus, the biopsy of which was malignant melanoma of the stomach. Further evaluation with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) scan showed operable disease with no focus of disease elsewhere. He was diagnosed as primary gastric melanoma and underwent radical total gastrectomy with adequate margins. His postoperative period was uneventful. Further adjuvant therapy was refused by the patient. At 6-month follow-up, an 18F-FDG PET-CT scan was done, which showed no evidence of disease. On follow-up at 1-year, he was alive and asymptomatic.

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Clinical and Prognostic Value of 18F-FDG-PET/CT in the Restaging Process of Recurrent Cutaneous Melanoma

Current Radiopharmaceuticals ◽

10.2174/1874471012666191009161826 ◽

2020 ◽

Vol 13 (1) ◽

pp. 42-47 ◽

Cited By ~ 2

Author(s):

Domenico Albano ◽

Demetrio Familiari ◽

Maria C. Fornito ◽

Salvatore Scalisi ◽

Riccardo Laudicella ◽

...

Keyword(s):

Ct Scan ◽

Fdg Pet ◽

Imaging Modality ◽

Metastatic Progression ◽

Pet Ct ◽

Risk Of Disease ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

Background: Several studies on 18F-FDG-PET/CT have investigated the prognostic role of this imaging modality in different tumors after treatment. Nevertheless, its role in restaging patients with recurrent CM still needs to be defined. Objective: The aim of this retrospective multicenter study was to evaluate the clinical and prognostic impact of 18F-FDG-PET/CT on the restaging process of cutaneous melanoma (CM) after surgery in patients with suspected distant recurrent disease or suspected metastatic progression disease. Materials and Methods: 74 patients surgically treated for CM underwent 18F-FDG-PET/CT for suspected distant recurrent disease or suspected metastatic progression disease. The diagnostic accuracy of visually interpreted 18F-FDG-PET/CT was obtained by considering histology (n=21 patients), other diagnostic imaging modalities performed within 2 months of PET/CT (CT in 52/74 patients and Whole-Body MRI in 18/74 patients) and clinical follow-up (n=74 patients) for at least 24 months containing all the clinical and diagnostic information useful for the PET performance assessment and outcome. Progression-free survival (PFS) and overall survival (OS) were assessed by using the Kaplan- Meier method. The risk of progression (Hazard Ratio-HR) was computed by the Cox regression analysis. Results: Suspicion of recurrent CM was confirmed in 24/27 patients with a positive 18F-FDG-PET/CT scan. Overall, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG-PET/CT were 82%, 93%, 88%, 89%, and 89%, respectively, with area under the curve being 0.87 (95%IC 0.78-0.97; p<0.05). 18F-FDG-PET/CT findings significantly influenced the therapeutic management in 18 patients (modifying therapy in 10 patients; guiding surgery in 8 patients). After 2 years of follow-up, PFS was significantly longer in patients with a negative vs. a positive 18F-FDG-PET/CT scan (90% vs 46%, p<0.05; Fig. 1). Moreover, a negative scan was associated with a significantly longer OS than a positive one (76% vs 39% after 2 years, p<0.05; Fig. 2). In addition, a positive 18F-FDG-PET/CT scan was associated with an increased risk of disease progression (HR=8.2; p0,05). Conclusion: 18F-FDG-PET/CT showed a valuable diagnostic performance in patients with suspicion of recurrent CM. This imaging modality might have an important prognostic value in predicting the survival outcomes, assessing the risk of disease progression, and guiding treatment decision making.

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The role of 18F-FDG PET/CT scan compared to CT-scan alone for lymph node staging before radical cystectomy in patients with bladder cancer

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.04.027 ◽

2021 ◽

Author(s):

Mohamad Moussa ◽

Mohamad Abou Chakra ◽

Wajih Saad ◽

Athanasios Dellis ◽

Athanasios Papatsoris

Keyword(s):

Bladder Cancer ◽

Lymph Node ◽

Ct Scan ◽

Fdg Pet ◽

Lymph Node Staging ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

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Total-body 18F-FDG PET/CT scan in oncology patients: how fast could it be?

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-021-05357-5 ◽

2021 ◽

Author(s):

Pengcheng Hu ◽

Yiqiu Zhang ◽

Haojun Yu ◽

Shuguang Chen ◽

Hui Tan ◽

...

Keyword(s):

Ct Scan ◽

Fdg Pet ◽

Oncology Patients ◽

Pet Ct ◽

18F Fdg ◽

Total Body ◽

Fdg Pet Ct ◽

Pet Ct Scan

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Dual-tracer (68Ga-DOTATOC and 18F-FDG-)-PET/CT scan and G1-G2 non-functioning pancreatic neuroendocrine tumors: A single-center retrospective evaluation of 124 non-metastatic resected cases

Neuroendocrinology ◽

10.1159/000514809 ◽

2021 ◽

Author(s):

Salvatore Paiella ◽

Luca Landoni ◽

Sarah Tebaldi ◽

Michele Zuffante ◽

Matteo Salgarello ◽

...

Keyword(s):

Ct Scan ◽

Neuroendocrine Tumors ◽

Fdg Pet ◽

Pancreatic Neuroendocrine Tumors ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Work Up ◽

Pet Ct Scan ◽

Dual Tracer

Introduction:The combined use of 68Gallium [68GA]-DOTA-peptides and 18Fluorine-fluoro-2-deoxyglucose [18F-FDG] PET/TC scans in the work-up of pancreatic neuroendocrine tumors (PanNETs) is controversial. This study aimed at assessing both tracers’ capability to identify tumors and to assess its association with pathological predictors of recurrence. Methods:Prospectively collected, preoperative, dual-tracer PET/CT scan data of G1-G2, non-metastatic, PanNETs that underwent surgery between January 2013 and October 2019 were retrospectively analyzed. Results:The final cohort consisted of 124 cases. There was an approximately equal distribution of males and females(50.8%/49.2%), and G1 and G2 tumors(49.2%/50.8%). The disease was detected in 122(98.4%) and 64(51.6%) cases by 68Ga-DOTATOC and by 18F-FDG PET/CT scans, respectively, with a combined sensitivity of 99.2%. 18F-FDG-positive examinations found G2 tumors more often than G1 (59.4% versus 40.6%;p = 0.036), and 18F-FDG-positive PanNETs were larger than negative ones (median tumor size 32 mm, IQR 21 versus 26 mm, IQR 20;p = 0.019). The median Ki67 for 18F-FDG-positive and -negative examinations was 3(IQR 4) and 2(IQR 4), respectively, (p = 0.029). At least one pathologic predictor of recurrence was present in 74.6% of 18F-FDG-positive cases (versus 56.7%;p = 0.039), whereas this was not found when dichotomizing the PanNETs by their dimensions (≤/> 20 mm). None of the two tracers predicted nodal metastasis. ROC curve analysis showed that 18F-FDG uptake higher than 4.2 had a sensitivity of 49.2%, and specificity of 73.3% for differentiating G1 from G2 (AUC=0.624, p=0.009). Conclusion: The complementary adoption of 68Ga-DOTATOC and 18F-FDG tracers may be valuable in the diagnostic work-up of PanNETs despite not being a game-changer for the management of PanNETs ≤ 20 mm.

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