Impact of whole-body 18F-FDG PET on diagnostic and therapeutic management of Medical Oncology patients

SummaryThe clinical significance of 18F-FDG-PET/CT in the follow-up of patients with differentiated thyroid carcinoma was evaluated and the results were compared with those of 18F-FDGPET, 131I-whole-body scintigraphy including SPECT/CT (WBS) and ultrasound. In addition, it was the aim to investigate the impact of 18F-FDG-PET/CT on the therapeutic management. Patients, methods: 327 patients (209 women, 118 men; mean age 53 ± 18 years) with differentiated thyroid cancer (242 papillary, 75 follicular, 6 mixed, 1 Hürthle cell and 3 poorly differentiated tumours) were analyzed retrospectively at four tertiary referral centres. 289 18F-FDG-PET/CT and 118 18F-FDG-PET studies were performed in these patients between 2007 and 2010. In addition, an overall clinical evaluation was performed, including cytology, histology, thyroglobulin level, ultrasound, WBS, and subsequent clinical course in order to compare the molecular imaging results. Finally, the change in therapeutic management due to findings of 18F-FDG-PET/CT was investigated. Results: The sensitivity of 18F-FDG-PET/CT was 92%, the specificity was 95%. Sensitivity and specificity of 18F-FDG-PET alone were 67% and 93%, respectively. WBS showed a sensitivity of 65% and a specificity of 94%. The corresponding values of ultrasound were 37% and 94%, respectively. The sensitivity of 18F-FDG-PET/CT in the group of patients with a negative WBS (n=194) amounted to 96%. When 18F-FDG-PET/CT and WBS were considered in combination, tumour tissue was missed in only 2 out of 133 patients; when 18F-FDG-PET and WBS were combined, tumour tissue was missed in 1 out of 24 patients. 18F-FDG-PET/CT resulted in management change in 43% (n=57/133) with a decision on surgical approach in 20% (n=27/133). Conclusions: 18F-FDG-PET/CT is superior to 18F-FDG-PET alone in patients with differentiated thyroid cancer and has a direct impact on the therapeutic management of patients with suspected local recurrence or metastases, particularly in those with negative WBS.

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Reducing Radiation Exposure to Paediatric Patients Undergoing [18F]FDG-PET/CT Imaging

Molecular Imaging and Biology ◽

10.1007/s11307-021-01601-4 ◽

2021 ◽

Author(s):

Hunor Kertész ◽

Thomas Beyer ◽

Kevin London ◽

Hamda Saleh ◽

David Chung ◽

...

Keyword(s):

Image Quality ◽

Fdg Pet ◽

Signal To Noise Ratio ◽

Paediatric Oncology ◽

Whole Body ◽

Oncology Patients ◽

Pet Ct ◽

18F Fdg ◽

Noise Ratio ◽

Fdg Pet Ct

Abstract Purpose To investigate the possibility of reducing the injected activity for whole-body [18F]FDG-PET/CT studies of paediatric oncology patients and to assess the usefulness of time-of-flight (TOF) acquisition on PET image quality at reduced count levels. Procedures Twenty-nine paediatric oncology patients (12F/17M, 3–18 years old (median age 13y), weight 45±20 kg, BMI 19±4 kg/m2), who underwent routine whole-body PET/CT examinations on a Siemens Biograph mCT TrueV system with TOF capability (555ps) were included in this study. The mean injected activity was 156 ± 45 MBq (3.8 ± 0.8 kg/MBq) and scaled to patient weight. The raw data was collected in listmode (LM) format and pre-processed to simulate reduced levels of [18F]FDG activity (75, 50, 35, 20 and 10% of the original counts) by randomly removing events from the original LM data. All data were reconstructed using the vendor-specific e7-tools with standard OSEM only, with OSEM plus resolution recovery (PSF). The reconstructions were repeated with added TOF (TOF) and PSF+TOF. The benefit of TOF together with the reduced count levels was evaluated by calculating the gains in signal-to-noise ratio (SNR) in the liver and contrast-to-noise ratio (CNR) in all PET-positive lesions before and after TOF employed at every simulated reduced count level. Finally, the PSF+TOF images at 50, 75 and 100% of counts were evaluated clinically on a 5-point scale by three nuclear medicine physicians. Results The visual inspection of the reconstructed images did not reveal significant differences in image quality between 75 and 100% count levels for PSF+TOF. The improvements in SNR and CNR were the greatest for TOF reconstruction and PSF combined. Both SNR and CNR gains did increase linearly with the patients BMI for both OSEM only and PSF reconstruction. These benefits were observed until reducing the counts to 50 and 35% for SNR and CNR, respectively. Conclusions The benefit of using TOF was noticeable when using 50% or greater of the counts when evaluating the CNR and SNR. For [18F]FDG-PET/CT, whole-body paediatric imaging the injected activity can be reduced to 75% of the original dose without compromising PET image quality.

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The therapeutic impact of 18F-FDG whole body PET

Nuklearmedizin ◽

10.1055/s-0038-1623920 ◽

2005 ◽

Vol 44 (01) ◽

pp. 8-14 ◽

Cited By ~ 7

Author(s):

B. Dietl ◽

J. Marienhagen

Keyword(s):

Fdg Pet ◽

Diagnostic Information ◽

Whole Body ◽

Therapeutic Concept ◽

Therapeutic Impact ◽

Additional Diagnostic Information ◽

Therapeutic Decisions ◽

Target Volumes ◽

18F Fdg ◽

Pet Scans

Summary Aims: An explorative analysis of the diagnostic as well as therapeutic impact of 18F-FDG whole body PET on patients with various tumours in the setting of an university hospital radiation therapy was performed. Patients and methods: 222 FDG PET investigations (148 initial stagings, 74 restagings) in 176 patients with diverse tumour entities (37 lung carcinoma, 15 gastrointestinal tumours, 38 head and neck cancer, 30 lymphoma, 37 breast cancer, 19 sarcoma and 16 other carcinomas) were done. All PET scans were evaluated in an interdisciplinary approach and consecutively confirmed by other imaging modalities or biopsy. Unconfirmed PET findings were ignored. Proportions of verified PET findings, additional diagnostic information (diagnostic impact) and changes of the therapeutic concept intended and documented before PET with special emphasis on radiooncological decisions (therapeutic impact) were analysed. Results: 195/222 (88%) FDG-PET findings were verified, 104/222 (47%) FDG-PET scans yielded additional diagnostic information (38 distant, 30 additional metastasis, 11 local recurrencies, 10 primary tumours and 15 residual tumours after chemoptherapy). The results of 75/222 (34%) scans induced changes in cancer therapy and those of 58/222 (26%) scans induced modifications of radiotherapeutic treatment plan (esp. target volumes). Conclusion: 18F-FDG whole body PET is a valuable diagnostic tool for therapy planning in radiooncology with a high impact on therapeutic decisions in initial staging as well as in restaging. Especially in a curative setting it should be used for definition of target volumes.

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Brain Metabolic Correlates of Persistent Olfactory Dysfunction after SARS-Cov2 Infection

Biomedicines ◽

10.3390/biomedicines9030287 ◽

2021 ◽

Vol 9 (3) ◽

pp. 287

Author(s):

Maria Isabella Donegani ◽

Alberto Miceli ◽

Matteo Pardini ◽

Matteo Bauckneht ◽

Silvia Chiola ◽

...

Keyword(s):

Fdg Pet ◽

Structural Connectivity ◽

Statistical Parametric Mapping ◽

Brain Regions ◽

Olfactory Dysfunction ◽

Whole Body ◽

Mapping Software ◽

18F Fdg ◽

Left Insula

We aimed to evaluate the brain hypometabolic signature of persistent isolated olfactory dysfunction after SARS-CoV-2 infection. Twenty-two patients underwent whole-body [18F]-FDG PET, including a dedicated brain acquisition at our institution between May and December 2020 following their recovery after SARS-Cov2 infection. Fourteen of these patients presented isolated persistent hyposmia (smell diskettes olfaction test was used). A voxel-wise analysis (using Statistical Parametric Mapping software version 8 (SPM8)) was performed to identify brain regions of relative hypometabolism in patients with hyposmia with respect to controls. Structural connectivity of these regions was assessed (BCB toolkit). Relative hypometabolism was demonstrated in bilateral parahippocampal and fusiform gyri and in left insula in patients with respect to controls. Structural connectivity maps highlighted the involvement of bilateral longitudinal fasciculi. This study provides evidence of cortical hypometabolism in patients with isolated persistent hyposmia after SARS-Cov2 infection. [18F]-FDG PET may play a role in the identification of long-term brain functional sequelae of COVID-19.

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Independent attenuation correction of whole body [18F]FDG-PET using a deep learning approach with Generative Adversarial Networks

EJNMMI Research ◽

10.1186/s13550-020-00644-y ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Karim Armanious ◽

Tobias Hepp ◽

Thomas Küstner ◽

Helmut Dittmann ◽

Konstantin Nikolaou ◽

...

Keyword(s):

Deep Learning ◽

Attenuation Correction ◽

Fdg Pet ◽

Whole Body ◽

Generative Adversarial Networks ◽

Learning Approach ◽

Adversarial Networks ◽

18F Fdg

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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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Low positive yield from routine inclusion of the brain in whole-body 18F-FDG PET/CT imaging for noncerebral malignancies

Nuclear Medicine Communications ◽

10.1097/mnm.0b013e32836066c0 ◽

2013 ◽

Vol 34 (6) ◽

pp. 540-543 ◽

Cited By ~ 8

Author(s):

Kuruva Manohar ◽

Anish Bhattacharya ◽

Bhagwant R. Mittal

Keyword(s):

Fdg Pet ◽

Ct Imaging ◽

Whole Body ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

The Brain

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Comparison of the diagnostic performance and impact on management of 18F-FDG PET/CT and whole-body MRI in multiple myeloma

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-020-05182-2 ◽

2021 ◽

Author(s):

Olwen Westerland ◽

◽

Ashik Amlani ◽

Christian Kelly-Morland ◽

Michal Fraczek ◽

...

Keyword(s):

Multiple Myeloma ◽

Clinical Data ◽

Bone Disease ◽

Fdg Pet ◽

Diagnostic Performance ◽

Whole Body ◽

Bone Lesions ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Abstract Purpose Comparative data on the impact of imaging on management is lacking for multiple myeloma. This study compared the diagnostic performance and impact on management of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and whole-body magnetic resonance imaging (WBMRI) in treatment-naive myeloma. Methods Forty-six patients undergoing 18F-FDG PET/CT and WBMRI were reviewed by a nuclear medicine physician and radiologist, respectively, for the presence of myeloma bone disease. Blinded clinical and imaging data were reviewed by two haematologists in consensus and management recorded following clinical data ± 18F-FDG PET/CT or WBMRI. Bone disease was defined using International Myeloma Working Group (IMWG) criteria and a clinical reference standard. Per-patient sensitivity for lesion detection was established. McNemar test compared management based on clinical assessment ± 18F-FDG PET/CT or WBMRI. Results Sensitivity for bone lesions was 69.6% (32/46) for 18F-FDG PET/CT (54.3% (25/46) for PET component alone) and 91.3% (42/46) for WBMRI. 27/46 (58.7%) of cases were concordant. In 19/46 patients (41.3%) WBMRI detected more focal bone lesions than 18F-FDG PET/CT. Based on clinical data alone, 32/46 (69.6%) patients would have been treated. Addition of 18F-FDG PET/CT to clinical data increased this to 40/46 (87.0%) patients (p = 0.02); and WBMRI to clinical data to 43/46 (93.5%) patients (p = 0.002). The difference in treatment decisions was not statistically significant between 18F-FDG PET/CT and WBMRI (p = 0.08). Conclusion Compared to 18F-FDG PET/CT, WBMRI had a higher per patient sensitivity for bone disease. However, treatment decisions were not statistically different and either modality would be appropriate in initial staging, depending on local availability and expertise.

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