Discussion on the alteration of FDG uptake by the breast according to the menstrual cycle in18F-FDG PET/CT

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial inflammation may occur in the context of a multisystem disease such as sarcoidosis, adversely affecting prognosis. A definitive diagnosis of cardiac sarcoidosis (CS) is essential to implementing life-saving treatment but this is complicated by the invasive nature of endomyocardial biopsy (EMB) and its low accuracy. Positron emission tomography (PET) assists in diagnosis, which relies on visual interpretation of myocardial F-18 FDG uptake. The value of quantitative analysis and its application to clinical practice remain uncertain. Purpose To investigate the power of quantitative F-18 FDG PET-CT imaging analysis for detecting CS in patients with suspected disease. Methods All patients underwent F-18 FDG PET-CT after a 24-hour low-carbohydrate diet and 15-hour fasting as part of their diagnostic work-up for suspected cardiac inflammation. Cardiovascular magnetic resonance acted as gatekeeper to PET-CT in 8 of every 10 scans. Myocardial F-18 FDG uptake was assessed qualitatively and quantitatively using both manually drawn regions of interest and automatic polar maps to measure global and segmental standardised F-18 FDG uptake values (SUV). The coefficient of variation (CoV) was calculated to determine uptake heterogeneity. To confirm diagnosis, follow-up data regarding disease progression, further testing and treatment were collected. To allow for sufficient follow-up time, the first 40 consecutive patients from a prospective registry (n= 214; Sep 2017-Jun 2020) were included. Results A comprehensive clinical picture was obtained successfully in 37 patients (median [IQR], 17 [13.5] months) and a final diagnosis of CS reached in 7 (disease prevalence, 19%). EMB was performed in 2 patients only while 3 underwent PPM/ICD implantation. Significant predictors of CS were fulfilment of Japanese Ministry of Health and Welfare criteria (Wald, 6.44; p = 0.01) and left ventricular dysfunction (Wald 6.72; p = 0.01). Qualitative F-18 FDG PET-CT had a high negative (95%) but low positive (45%) predictive value for CS (sensitivity, 83%; specificity, 77%). F-18 FDG SUV CoV was the strongest imaging predictor (Wald, 6.77; p = 0.009) and was significantly higher in CS than non-CS (CoV median [quartiles], 0.26 [0.21, 0.36] and 0.12 [0.11, 0.14] respectively; p = 0.004). As per ROC curve analysis (AUC, 0.84), a CoV threshold of 0.20 was highly specific (93%) and sensitive (86%) for CS. Conclusion In a referring population with a low prevalence of cardiac sarcoidosis, F-18 FDG PET-CT imaging is sensitive for the detection of myocardial inflammation with active disease unlikely in patients with a negative scan. Quantitative evaluation of metabolic heterogeneity within the myocardium provides a strong, independent marker of active disease and should be considered alongside visual assessment.

Download Full-text

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.

Download Full-text

Pulmonary Findings of [18F]FDG PET/CT Images on Asymptomatic COVID-19 Patients

Pathogens ◽

10.3390/pathogens10070839 ◽

2021 ◽

Vol 10 (7) ◽

pp. 839

Author(s):

Tzu-Chuan Ho ◽

Chin-Chuan Chang ◽

Hung-Pin Chan ◽

Ying-Fong Huang ◽

Yi-Ming Arthur Chen ◽

...

Keyword(s):

Systematic Review ◽

Fdg Pet ◽

Standardized Uptake Value ◽

Fdg Uptake ◽

Asymptomatic Patients ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Maximal Standardized Uptake Value ◽

Fdg Pet Ct

During the coronavirus disease 2019 (COVID-19) pandemic, several case studies demonstrated that many asymptomatic patients with COVID-19 underwent fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) examination for various indications. However, there is a lack of literature to characterize the pattern of [18F]FDG PET/CT imaging on asymptomatic COVID-19 patients. Therefore, a systematic review to analyze the pulmonary findings of [18F]FDG PET/CT on asymptomatic COVID-19 patients was conducted. This systematic review was performed under the guidelines of PRISMA. PubMed, Medline, and Web of Science were used to search for articles for this review. Articles with the key words: “asymptomatic”, “COVID-19”, “[18F]FDG PET/CT”, and “nuclear medicine” were searched for from 1 January 2020 to 20 May 2021. Thirty asymptomatic patients with COVID-19 were included in the eighteen articles. These patients had a mean age of 62.25 ± 14.85 years (male: 67.71 ± 12.00; female: 56.79 ± 15.81). [18F]FDG-avid lung lesions were found in 93.33% (28/30) of total patients. The major lesion was [18F]FDG-avid multiple ground-glass opacities (GGOs) in the peripheral or subpleural region in bilateral lungs, followed by the consolidation. The intensity of [18F]FDG uptake in multiple GGOs was 5.605 ± 2.914 (range from 2 to 12) for maximal standardized uptake value (SUVmax). [18F]FDG-avid thoracic lymph nodes (LN) were observed in 40% (12/40) of the patients. They mostly appeared in both mediastinal and hilar regions with an SUVmax of 5.8 ± 2.93 (range from 2.5 to 9.6). The [18F]FDG uptake was observed in multiple GGOs, as well as in the mediastinal and hilar LNs. These are common patterns in PET/CT of asymptomatic patients with COVID-19.

Download Full-text

A Few Cases of Increased FDG Uptake on 18F-FDG PET/CT in Residual Lesions of Tuberculosis at the Time of Treatment Completion

CHEST Journal ◽

10.1378/chest.2279071 ◽

2015 ◽

Vol 148 (4) ◽

pp. 168A

Author(s):

MYUNGSUN LEE ◽

Ina Jung ◽

Youngran Kim ◽

Jiyeon Lee

Keyword(s):

Fdg Pet ◽

Treatment Completion ◽

Fdg Uptake ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Residual Lesions

Download Full-text

FDG uptake in brown adipose tissue—A brief report on brown fat with FDG uptake mechanisms and quantitative analysis using dual-time-point FDG PET/CT

Revista Española de Medicina Nuclear ◽

10.1016/j.remn.2010.05.006 ◽

2011 ◽

Vol 30 (1) ◽

pp. 14-18 ◽

Cited By ~ 10

Author(s):

B. Esen Akkas ◽

D. Gökaslan ◽

L. Güner ◽

N. Ilgin Karabacak

Keyword(s):

Adipose Tissue ◽

Quantitative Analysis ◽

Brown Adipose Tissue ◽

Fdg Pet ◽

Fdg Uptake ◽

Brown Adipose ◽

Pet Ct ◽

Fdg Pet Ct ◽

Uptake Mechanisms ◽

Time Point

Download Full-text

[18F]-Fluorodeoxyglucose Uptake in Lymphoid Tissue Serves as a Predictor of Disease Outcome in the Nonhuman Primate Model of Monkeypox Virus Infection

Journal of Virology ◽

10.1128/jvi.00897-17 ◽

2017 ◽

Vol 91 (21) ◽

Cited By ~ 2

Author(s):

Julie Dyall ◽

Reed F. Johnson ◽

Svetlana Chefer ◽

Christopher Leyson ◽

David Thomasson ◽

...

Keyword(s):

Bone Marrow ◽

Immune Response ◽

Lymph Nodes ◽

Metabolic Activity ◽

Fdg Pet ◽

Ct Imaging ◽

Lymphoid Tissues ◽

Fdg Uptake ◽

Pet Ct ◽

Fdg Pet Ct

ABSTRACT Real-time bioimaging of infectious disease processes may aid countermeasure development and lead to an improved understanding of pathogenesis. However, few studies have identified biomarkers for monitoring infections using in vivo imaging. Previously, we demonstrated that positron emission tomography/computed tomography (PET/CT) imaging with [18F]-fluorodeoxyglucose (FDG) can monitor monkeypox disease progression in vivo in nonhuman primates (NHPs). In this study, we investigated [18F]-FDG-PET/CT imaging of immune processes in lymphoid tissues to identify patterns of inflammation in the monkepox NHP model and to determine the value of [18F]-FDG-PET/CT as a biomarker for disease and treatment outcomes. Quantitative analysis of [18F]-FDG-PET/CT images revealed differences between moribund and surviving animals at two sites vital to the immune response to viral infections, bone marrow and lymph nodes (LNs). Moribund NHPs demonstrated increased [18F]-FDG uptake in bone marrow 4 days postinfection compared to surviving NHPs. In surviving, treated NHPs, increase in LN volume correlated with [18F]-FDG uptake and peaked 10 days postinfection, while minimal lymphadenopathy and higher glycolytic activity were observed in moribund NHPs early in infection. Imaging data were supported by standard virology, pathology, and immunology findings. Even with the limited number of subjects, imaging was able to differentiate the difference between disease outcomes, warranting additional studies to demonstrate whether [18F]-FDG-PET/CT can identify other, subtler effects. Visualizing altered metabolic activity at sites involved in the immune response by [18F]-FDG-PET/CT imaging is a powerful tool for identifying key disease-specific time points and locations that are most relevant for pathogenesis and treatment. IMPORTANCE Positron emission tomography and computed tomography (PET/CT) imaging is a universal tool in oncology and neuroscience. The application of this technology to infectious diseases is far less developed. We used PET/CT imaging with [18F]-labeled fluorodeoxyglucose ([18F]-FDG) in monkeys after monkeypox virus exposure to monitor the immune response in lymphoid tissues. In lymph nodes of surviving monkeys, changes in [18F]-FDG uptake positively correlated with enlargement of the lymph nodes and peaked on day 10 postinfection. In contrast, the bone marrow and lymph nodes of nonsurvivors showed increased [18F]-FDG uptake by day 4 postinfection with minimal lymph node enlargement, indicating that elevated cell metabolic activity early after infection is predictive of disease outcome. [18F]-FDG-PET/CT imaging can provide real-time snapshots of metabolic activity changes in response to viral infections and identify key time points and locations most relevant for monitoring the development of pathogenesis and for potential treatment to be effective.

Download Full-text

Abstract 12920: The Value of 18 FDG PET/CT in the Diagnostic Work-Up of Patients With Possible Infective Endocarditis

Circulation ◽

10.1161/circ.130.suppl_2.12920 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Fabio Chirillo ◽

Franco Boccaletto ◽

Paola Pantano ◽

Alessandro De Leo ◽

Marta Possamai ◽

...

Keyword(s):

Infective Endocarditis ◽

Clinical Judgment ◽

Predictive Value ◽

Fdg Pet ◽

Blood Cultures ◽

Fdg Uptake ◽

Duke Criteria ◽

Pet Ct ◽

Fdg Pet Ct

The diagnosis of infective endocarditis (IE) is sometimes difficult when there are discrepancies between blood cultures, transesophageal echocardiography (TEE) and clinical judgment. The aim of this study was to assess the incremental diagnostic value of 18 F-FDG-PET/CT in 45 consecutive patients (73% male, mean age 61 ± 26 years) with suspected IE and inconclusive tests at admission. In 28 patients (19 with a cardiac valvular (15) or nonvalvular (4) device) with blood cultures positive for germs typically involved in IE the initial TEE was negative or inconclusive. In 10 patients presenting with fever TEE identified cardiac lesion possibly related to IE (ruptured mitral chordae, thickened valve leaflet, thickened prosthetic annulus), but blood cultures were persistently negative. Finally, 7 patients had metastatic or embolic lesions and a predisposing cardiac condition, but TEE was negative. When previous unknown lesions detected by PET/CT were confirmed by succeeding examinations, they were considered true positives. When PET/CT was negative, it was compared with the final diagnosis that was defined according to the modified Duke criteria determined during a 6-month follow-up. Thirty patients had definite IE at the end of the follow-up, 3 had possible IE, and in 12 patients the diagnosis was rejected. Twenty-seven patients (60%) exhibited abnormal FDG uptake around the cardiac valves, and 12 (27%) had extracardiac accumulation. In 5 patients the initial negative TEE became positive a mean 5 ±7 days after PET/CT had been performed The sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT were as follows (95% confidence interval): 87% (68% to 95%), 67% (38% to 87%), 84% (65% to 94%), and 71% (42% to 92%), respectively. Adding abnormal FDG uptake as a new major criterion significantly increased the sensitivity of the modified Duke criteria at admission (68% [53% to 82%] vs. 96% [88% to 99%], p = 0.01). This result was due to a significant reduction (p < 0.001) in the number of possible IE cases. In conclusion PET/CT increases the diagnostic accuracy for IE in the subset of patients with possible IE and may help to manage a challenging situation.

Download Full-text

Discontinuation of metformin to prevent metformin-induced high colonic FDG uptake: is 48 h sufficient?

Annals of Nuclear Medicine ◽

10.1007/s12149-020-01509-z ◽

2020 ◽

Vol 34 (11) ◽

pp. 833-839

Author(s):

Nanno Schreuder ◽

Hedwig Klarenbeek ◽

Brian N. Vendel ◽

Pieter L. Jager ◽

Jos G. W. Kosterink ◽

...

Keyword(s):

Fdg Pet ◽

Control Group ◽

Diabetic Patients ◽

Fdg Uptake ◽

Pet Ct ◽

Group A ◽

Clinically Significant ◽

Fdg Pet Ct ◽

Colon Ascendens

Abstract Objective In this retrospective, single-center observational study, we investigated whether discontinuing metformin for at least 48 h prevents metformin-induced [18F]fluorodeoxyglucose (FDG) uptake in all segments of the colon. Methods Patients with type 2 diabetes who were using metformin before undergoing an FDG PET/CT scan were included. Two groups were created: patients who discontinued metformin for less than 48 h (< 48 h group) and patients who discontinued metformin for between 48 and 72 h (≥ 48 h group). A control group comprised non-diabetic patients who were not using metformin before undergoing an FDG PET/CT. We visually scored the uptake of FDG in four segments of the colon—the ascendens, transversum, descendens, and rectosigmoid—using a four-point scale (1–4) and considered scores of 3 or 4 to be clinically significant. Results Colonic FDG uptake in the ≥ 48 h group (n = 23) was higher than uptake in the control group (n = 96) in the colon descendens [odds ratio (OR) 14.0; 95% confidence interval (CI) 4.8–40.9; p value: 0.001] and rectosigmoid (OR 11.3; 95% CI 4.0–31.9; p value: 0.001), and there was no difference in the colon ascendens and transversum. Colonic FDG uptake in the < 48 h group (n = 25) was higher than uptake in the ≥ 48 h group (n = 23) in the colon transversum (OR 4.8; 95% CI 1.3–18.5; p value: 0.022) and rectosigmoid (p value: 0.023), and there was no difference in the colon ascendens and descendens. Conclusions Discontinuing metformin for 48 h before undergoing an FDG PET/CT still gives a high uptake in the distal parts of the colon when compared with non-diabetic patients who are not using metformin. Discontinuing metformin for 48 h seems to be useful for scanning the more proximal segments of the colon.

Download Full-text

Prevalence of focal incidental breast uptake on FDG-PET/CT and risk of malignancy: a systematic review and meta-analysis

European Journal of Hybrid Imaging ◽

10.1186/s41824-019-0063-5 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Else Marie Aarstad ◽

Petter Nordhaug ◽

Mohammad Naghavi-Behzad ◽

Lisbet Brønsro Larsen ◽

Oke Gerke ◽

...

Keyword(s):

Systematic Review ◽

Fdg Pet ◽

Fixed Effects ◽

Meta Analysis ◽

Previous History ◽

Fdg Uptake ◽

Pooled Prevalence ◽

Pet Ct ◽

Risk Of Malignancy ◽

Fdg Pet Ct

Abstract Background FDG-PET/CT is increasingly used for oncologic and inflammatory diseases. Focal incidental FDG uptake occurs rarely in breast tissue but has often significant consequences. This study aimed to systematically review literature regarding focal incidental breast uptake (FIBU) on FDG-PET/CT in order to yield an update on the prevalence and risk of malignancy for FIBU. Methods A systematic search for relevant articles published between 2012 and 2018 was performed through MEDLINE, Embase, and Cochrane databases. Studies addressing the detection of FIBU in patients without a previous history of breast malignancy were included. The QUADAS-2 was used for quality assessment, and eligible data were pooled using a fixed-effects model. I2 was calculated for the heterogeneity between studies. Results Eight studies containing 180,002 scans were included in the systematic review. The median prevalence of FIBU for both genders was 0.52% (range 0.18–22.5%). Prevalence for women was mentioned separately in five studies and varied from 0.51 to 23.5%. One study reporting a high prevalence was based on patients being staged for known malignancy, and the word “breast” was used in the search, which may have caused selection bias. Data from four studies were eligible for meta-analysis. A high degree of heterogeneity was observed for prevalence data (I2 of 97.5%), while moderate heterogeneity was observed for data on malignancy risk assessment (I2 of 62.8%). The pooled prevalence of FIBU in women was 0.61% (range 0.56–0.66%), and the pooled prevalence of malignancy of FIBUs was 38.7% (range 34.4–43.0%). The most commonly detected malignancy was invasive ductal carcinoma. Conclusion FIBU occurs rarely on FDG-PET/CT for female patients but yields a high risk of malignancy according to the results of published papers. Therefore, it should be considered relevant to further elucidate patients with incidentally detected FDG uptake in breast in clinical practice.

Download Full-text