scholarly journals Value of [18F]-FDG positron emission tomography in patients with recurrent glioblastoma receiving bevacizumab

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Maya S Graham ◽  
Simone Krebs ◽  
Tejus Bale ◽  
Kwaku Domfe ◽  
Stephanie M Lobaugh ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Antiangiogenic Therapy ◽  
Multivariable Analysis ◽  
Standardized Uptake Value ◽  
Recurrent Glioblastoma ◽  
Emission Tomography ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Recurrent Gbm

Abstract Background Treatment of recurrent glioblastoma (GBM) with bevacizumab can induce MRI changes that confound the determination of progression. We sought to determine the value of [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) in GBM patients receiving bevacizumab at the time of suspected progression and, thereby, its utility as a potential prognostic adjunct in progressive disease. Methods This retrospective study included patients who underwent brain FDG PET within 4 weeks of receiving bevacizumab for recurrent GBM with suspected progression. Volumes-of-interest were placed over the reference lesion with measurement of maximum standardized uptake value (SUVmax), peak standardized uptake value (SUVpeak), metabolic tumor volume, total lesion glycolysis (TLG), and tumor-to-normal contralateral white matter ratios (TNR-WM). Tumors were additionally categorized as non-avid or avid based on qualitative FDG uptake. Associations between baseline variables and overall survival (OS) were examined using univariable and multivariable Cox proportional hazards regression, with P < .05 considered significant. Results Thirty-one patients were analyzed. Qualitative FDG uptake was significantly associated with OS (P = .03), with a median OS of 9.0 months in non-avid patients versus 4.5 months in avid patients. SUVmax, SUVpeak, TNR-WM, and TLG were significantly associated with OS (P < .001, TLG: P = .009). FDG avidity and SUVmax remained significantly associated with OS (P = .046 and .048, respectively) in the multivariable analysis including age, KPS, and MGMT status. Dichotomizing patients using an SUVmax cutoff of 15.3 was associated with OS (adjusted P = .048). Conclusion FDG PET is a promising imaging tool to further stratify prognosis in recurrent GBM patients on antiangiogenic therapy.

Early Response Evaluation in Malignant Pleural Mesothelioma by Positron Emission Tomography With [18F]Fluorodeoxyglucose

2006 ◽  
Vol 24 (28) ◽  
pp. 4587-4593 ◽  
Author(s):  
Giovanni L. Ceresoli ◽  
Arturo Chiti ◽  
Paolo A. Zucali ◽  
Marcello Rodari ◽  
Romano F. Lutman ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Malignant Pleural Mesothelioma ◽  
Fdg Pet ◽  
Metabolic Response ◽  
Standardized Uptake Value ◽  
Emission Tomography ◽  
Pleural Mesothelioma ◽  
Response Evaluation ◽  
Fdg Uptake ◽  
Positron Emission

Purpose Response evaluation with conventional criteria based on computed tomography (CT) is particularly challenging in malignant pleural mesothelioma (MPM) due to its diffuse pattern of growth. There is growing evidence that therapy-induced changes in tumor [18F]fluorodeoxyglucose (FDG) uptake as measured by positron emission tomography (PET) may predict response and patient outcome early in the course of treatment. Patients and Methods Patients with histologically proven MPM, not candidates to curative surgery, scheduled to undergo palliative chemotherapy with a pemetrexed-based regimen were eligible for this study. Patients were evaluated by FDG-PET and CT at baseline and after two cycles of therapy. A decrease of 25% or more in tumor FDG uptake as measured by standardized uptake value was defined as a metabolic response (MR). Best overall response from CT scans was determined according to previously published criteria. Results Twenty-two patients were included in the study, and 20 were assessable for early metabolic response with FDG-PET. Of these, eight were classified as responders (40%) and 12 as nonresponders (60%). Early MR was significantly correlated to median time-to-tumor progression (TTP) with a median TTP for metabolic responders of 14 months versus 7 months for nonresponders (P = .02). No correlation was found between TTP and radiologic response evaluated by CT. Patients with a MR had a trend toward longer overall survival. Conclusion The use of MR evaluated by FDG-PET in the assessment of treatment efficacy in MPM appears promising. Our observations need to be validated in a larger prospective series.

Clinical molecular imaging in intestinal graft-versus-host disease: mapping of disease activity, prediction, and monitoring of treatment efficiency by positron emission tomography

Blood ◽  
2008 ◽  
Vol 111 (5) ◽  
pp. 2909-2918 ◽  
Author(s):  
Matthias Stelljes ◽  
Sven Hermann ◽  
Jörn Albring ◽  
Gabriele Köhler ◽  
Markus Löffler ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Graft Versus Host Disease ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Graft Versus Host ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Intestinal Gvhd

Gastrointestinal graft-versus-host disease (GVHD) is a common and potentially life-threatening complication after allogeneic hematopoietic stem-cell transplantation (HSCT). Noninvasive tests for assessment of GVHD activity are desirable but lacking. In the present study, we were able to visualize intestinal GVHD-associated inflammation in an allogeneic murine transplantation model by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in vivo. A predominant localization of intestinal GVHD to the colon was verified by histology and fluorescence reflectance imaging of enhanced green fluorescent protein (EGFP)–expressing donor cells. Colonic infiltration by EGFP+ donor lymphocytes matched increased FDG uptake in PET examinations. These preclinical data were prospectively translated into 30 patients with suspected intestinal GVHD beyond 20 days after transplantation. A total of 14 of 17 patients with a diagnostic histology showed significant FDG uptake of the gut, again predominantly in the colon. No increased FDG uptake was detected in 13 patients without histologic evidence of intestinal GVHD. Our findings indicate that FDG-PET is a sensitive and specific noninvasive imaging technique to assess intestinal GVHD, map its localization, and predict and monitor treatment responsiveness. Novel targeted tracers for PET may provide new insights into the pathophysiology of GVHD and bear the potential to further improve GVHD diagnosis.

The Relevance of Increased Tonsil Uptake When Restaging Lymphoma with Positron Emission Tomography

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3133-3133
Author(s):  
Javier Munoz ◽  
Belisario Arango ◽  
Jessica Schering ◽  
James Morrison ◽  
Ishani Dalal ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Conflicts Of Interest ◽  
Standardized Uptake Value ◽  
Emission Tomography ◽  
Invasive Approach ◽  
Fdg Uptake ◽  
Tonsillar Tissue ◽  
Positron Emission ◽  
Lymphomatous Involvement ◽  
The Mean

Abstract Abstract 3133 Introduction: Significant tonsil uptake is sometimes observed in F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) after treatment. Some patients undergo tonsillectomy or FNA (fine needle aspiration) to rule out malignant involvement particularly when management depends on restaging (Figure 1). Our study describes the incidence and degree of tonsil FDG uptake in a large group of lymphoma patients that underwent PET scanning. Patients and Methods: Single institution, retrospective chart review by ICD code, 617 lymphoma patients that underwent PET at our institution from 2004 to 2009. Results of PET were compared to pathological diagnosis of tonsillectomy (Table 1) or FNA biopsy (Table 2) when available which was performed at physician's discretion. Patients that were diagnosed with lymphoma during restaging studies performed for a different primary malignancy were excluded. Results and Discussion: All 8 tonsillectomies and FNA biopsies performed after a restaging PET that showed increased tonsil uptake were negative for malignancy (Figure 2). All of these 8 patients had an initial previous PET that did not show increased tonsil uptake and also these 8 patients remained in remission from their lymphoma after the procedure was performed. In contrast, 6 out of 7 patients that underwent tonsillectomy or FNA at diagnosis were positive for malignancy (Table 3). Differences among tonsil FDG uptake has been thought to reflect differences in activity of “physiological” inflammation of the palatine tonsils. Increased glucose metabolism during active inflammation in the case of chronic tonsillitis or lymphocyte proliferation in the case of a patient that has received prior chemotherapy (likely experiencing compensatory extra medullar lymphoid hyperplasia) were thought to be causes of high FDG uptake in the tonsils. The significance of such increased tonsil FDG uptake is currently unknown however previous studies suggest that normal pharyngeal palatine tonsil uptake was generally symmetrical and that the difference in maximal standardized uptake value (SUVmax) between right and left tonsils (right-to-left ratio or a surrogate of symmetry) in the same patient might be helpful in detecting malignant tissue. The mean right-to-left ratio of tonsillar SUV was 4.55 in patients with confirmed malignant pathology and 1.53 in patients with documented benign tonsillar tissue (Table 4). The mean tonsillar SUVmax was 15.35 in patients with confirmed malignant pathology and 7.05 in patients with documented benign tonsillar tissue hence SUVmax seems to be useful in differentiating tumor from physiological accumulation. Younger patients with low SUV max symmetric tonsillar uptake and no other abnormal FDG areas seen during restaging PET could probably be watched non-invasively. Conclusions: At the time of initial staging PET, increased tonsil uptake showed true lymphomatous involvement in most cases. At restaging, increased tonsil uptake displayed no cases positive for lymphomatous involvement as all tonsillectomies and FNA biopsies were negative for malignancy. These findings seem to be valid irrespective of the subtype of lymphoma. Our study supports a conservative non-invasive approach because physiologic uptake is the most common cause of increased tonsil uptake when restaging lymphoma patients after treatment has been completed. Disclosures: No relevant conflicts of interest to declare.

Prognostic value of positron emission tomography and preoperative CA19-9 in patients treated on a prospective phase II trial of neoadjuvant therapy and surgery.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15766-e15766
Author(s):  
Chad Barnes ◽  
Mohammed Aldakkak ◽  
Kathleen K. Christians ◽  
Parag Tolat ◽  
Paul S. Ritch ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Neoadjuvant Therapy ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Prognostic Value ◽  
Prospective Trial ◽  
Standardized Uptake Value ◽  
Carbohydrate Antigen ◽  
Emission Tomography ◽  
Positron Emission

e15766 Background: The role of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the staging of pancreatic cancer (PC) has not been well defined. We evaluated the prognostic value of FDG-PET imaging in patients with localized PC enrolled in a prospective trial of personalized molecular-directed neoadjuvant therapy. Methods: Pretreatment FDG-PET was classified as high or low based on a standardized uptake value (SUV) cutpoint of 7.2 (population median). Carbohydrate antigen 19-9 (CA19-9) was measured after the completion of neoadjuvant therapy (preoperative) and classified as normal (≤35 U/mL) or elevated. Results: Pretreatment FDG-PET imaging was performed on 100 consecutive patients; SUV was high in 50 and low in 50. Preoperative CA19-9 values were available in 99 of 100 patients; 54 (55%) were elevated and 45 (45%) were normal. Of the 100 patients, 81 completed neoadjuvant therapy and surgery, and 19 were not resected. Among the 81 resected patients, SUV was high in 37 (46%) and low in 44 (54%); preoperative CA19-9 was elevated in 40 (49%) and normal in 41 (51%). The median overall survival (OS) for all patients was 39 months; 45 months for who completed all intended neoadjuvant therapy and surgery and 9 months for patients who were not resected. The median OS for patients with normal CA19-9/low SUV, normal CA19-9/high SUV, elevated CA19-9/low SUV, and elevated CA19-9/high SUV were not reached, 35, 24, and 18 months, respectively (p = 0.0001). Conclusions: Pretreatment FDG-PET avidity and preoperative CA19-9 are important prognostic markers and may be used to estimate the anticipated benefit of surgery; information of immediate clinical significance for both treatment sequencing and the application of surgery to patients who are frequently of advanced age or high-risk.

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

2012 ◽  
Vol 39 (8) ◽  
pp. 1659-1665 ◽  
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.

scholarly journals Physiological Appearance of Hybrid FDG–Positron Emission Tomography/Computed Tomography Imaging Following Uncomplicated Endovascular Aneurysm Sealing Using the Nellix Endoprosthesis

2020 ◽  
Vol 27 (3) ◽  
pp. 509-515
Author(s):  
Erik Groot Jebbink ◽  
Leo H. van Den Ham ◽  
Beau B. J. van Woudenberg ◽  
Riemer H. J. A. Slart ◽  
Clark J. Zeebregts ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Graft Infection ◽  
Emission Tomography ◽  
Visual Examination ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

Purpose: To investigate the physiological uptake of hybrid fluorine-18-fluorodeoxyglucose (FDG)–positron emission tomography/computed tomography (PET/CT) before and after an uncomplicated endovascular aneurysm sealing (EVAS) procedure as a possible tool to diagnose EVAS graft infection and differentiate from postimplantation syndrome. Materials and Methods: Eight consecutive male patients (median age 78 years) scheduled for elective EVAS were included in the prospective study ( ClinicalTrials.gov identifier NCT02349100). FDG-PET/CT scans were performed in all patients before the procedure and 6 weeks after EVAS. The abdominal aorta was analyzed in 4 regions: suprarenal, infrarenal neck, aneurysm sac, and iliac. The following parameters were obtained for each region: standard uptake value (SUV), tissue to background ratio (TBR), and visual examination of FDG uptake to ascertain its distribution. Demographic data were obtained from medical files and scored based on reporting standards. Results: Visual examination showed no difference between pre- and postprocedure FDG uptake, which was homogenous. In the suprarenal region no significant pre- and postprocedure differences were observed for the SUV and TBR parameters. The infrarenal neck region showed a significant decrease in the SUV and no significant decrease in the TBR. The aneurysm sac and iliac regions both showed a significant decrease in SUV and TBR between the pre- and postprocedure scans. Conclusion: Physiological FDG uptake after EVAS was stable or decreased with regard to the preprocedure measurements. Future research is needed to assess the applicability and cutoff values of FDG-PET/CT scanning to detect endograft infection after EVAS.

scholarly journals Genomic Signature of the Standardized Uptake Value in 18F-Fluorodeoxyglucose Positron Emission Tomography in Breast Cancer

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 497
Author(s):  
Seon-Kyu Kim ◽  
Sung Gwe Ahn ◽  
Jeong-Yeon Mun ◽  
Mi-So Jeong ◽  
Soong June Bae ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Standardized Uptake Value ◽  
Emission Tomography ◽  
Diagnostic Tools ◽  
Fluorodeoxyglucose Positron Emission Tomography ◽  
18F Fluorodeoxyglucose ◽  
Positron Emission ◽  
Fluorodeoxyglucose Positron Emission

The standardized uptake value (SUV), an indicator of the degree of glucose uptake in 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), has been used for predicting the clinical behavior of malignant tumors. However, its characteristics have been insufficiently explored at the genomics level. Here, we aim to identify genomic signatures reflecting prognostic SUV characteristics in breast cancer (BRC). Through integrative genomic profiling of 3710 BRC patients, including 254 patients who underwent preoperative FDG-PET, we identified an SUV signature, which showed independent clinical utility for predicting BRC prognosis (hazard ratio [HR] 1.27, 95% confidence interval [CI] = 1.12 to 1.45, p = 2.23 × 10−4). The risk subgroups classified by the signature exhibited mutually exclusive mutation patterns of TP53 and PIK3CA and showed significantly different responsiveness to immunotherapy. Experimental assays revealed that a signaling axis defined by TP53–FOXM1 and its downstream effectors in glycolysis–gluconeogenesis, including LDHA, might be important mediators in the FDG-PET process. Our molecular characterizations support an understanding of glucose metabolism and poor prognosis in BRC with a high SUV, utilizable in clinical practice to assist other diagnostic tools.

Usefulness of FDG-PET (Positron Emission Tomography) in the Discrimination between Hypoplastic Myelodysplastic Syndromes and Aplastic Anemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4738-4738
Author(s):  
Masaaki Takatoku ◽  
Takahiro Nagashima ◽  
Toshihiko Sato ◽  
Tadashi Nagai ◽  
Norio Komatsu ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Bone Marrow ◽  
Aplastic Anemia ◽  
Myelodysplastic Syndromes ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Fdg Uptake ◽  
Positron Emission ◽  
18F Fdg ◽  
Time Point

Abstract Usefulness of FDG-PET (positron emission tomography) in the discrimination between hypoplastic myelodysplastic syndromes and aplastic anemia Masaaki Takatoku, MD PhD1, Takahiro Nagashima, MD*1, Toshihiko Sato, MD*2, Tadashi Nagai, MD PhD1, Norio Komatsu, MD PhD1, Keiya Ozawa, MD PhD1 1Division of Hematology, Department of Medicine, Jichi Medical School, Minamikawachi, Tochigi, Japan; 2Utsunomiya Central Clinic, Utsunomiya, Tochigi, Japan It is sometimes difficult to distinguish hypoplastic myelodysplastic syndromes (MDS) from aplastic anemia (AA) using current diagnostic methods, such as bone marrow pathology and chromosome analysis. Although magnetic resonance imaging (MRI) is useful for diagnosis of MDS with hypercellular marrow, it is not easy to discriminate between hypoplastic MDS and AA using this method, because the high intensity pattern on T1 enhanced image is similar in these disorders. Recently, quantitative imaging with fluorine-18 fluorodeoxyglucose (FDG) PET has been recognized as a useful method for the discrimination between benign and malignant regions in various conditions. Because the decrease in the FDG-uptake at the late phase is much slower in malignant region than in benign region, dual time point imaging provides more accurate information than single time point scanning. In this study, we investigated the usefulness of dual time protocol FDG-PET in the differential diagnosis of hypoplastic MDS and AA. Six patients [2 with AA, 4 with MDS (including one hypoplastic MDS)] and 30 healthy adults agreed to participate in this study. Bone marrow biopsy, FDG- PET, MRI, and computed tomography (CT) were carried out, and a PET functional image was integrated into a CT anatomical image. The spine, femur and sternum lesions were detected by their increased 18F-FDG uptake at 60 and 120 min after injection of 0.12 mCi/kg of 18F-FDG. The maximum and mean lesional standardized uptake values (SUVmax and SUVmean) after 60 and 120 min were determined. The median SUVmax and SUVmean values of normal lumbar regions at 60 min were 1.94 ± 0.16 and 1.77 ± 0.11, respectively. In the MDS cases, those values at 60 min were 2.39 (range 2.12–2.72) and 2.06 (range 1.91–2.23), respectively. At 120 min, the median SUVmax and SUVmean values of normal cases were 1.33 ± 0.21 and 1.20 ± 0.16, respectively, whereas those of MDS cases were 2.42 (range 2.08–2.78) and 2.14 (range 1.50–2.26), respectively. Thus, the SUVmax and SUVmean values in MDS cases remained at high levels at 120 min in contrast to the decreased levels in normal cases. It is noteworthy that the SUVmax and SUVmean values of a hypoplastic MDS case were also high (2.21 and 2.01 at 60 min, 2.16 and 1.97 at 120 min), suggesting that bone marrow in MDS has a hyper metabolic state of glucose like other malignant disorders. We also observed patchy hot areas, which may be a visualization of ineffective hematopoiesis, throughout the spine image of hypoplastic MDS. In contrast, the SUVmax and SUVmean values of AA cases were 1.82 and 1.66 at 60 min and 1.31 and 1.19 at 120 min (case 1), 1.69 and 1.61 at 60 min and 1.30 and 1.13 at 120 min (case 2), indicating that there is no difference in the SUVmax and SUVmean values at the both time points between AA and normal cases. These results raised the possibility that the discrimination between hypoplastic MDS and AA, in which MRI shows a common observation, can be made using FDG-PET.

18Fluorodeoxyglucose Positron Emission Tomography to Detect Mediastinal or Internal Mammary Metastases in Breast Cancer

2001 ◽  
Vol 19 (15) ◽  
pp. 3516-3523 ◽  
Author(s):  
W. B. Eubank ◽  
D. A. Mankoff ◽  
J. Takasugi ◽  
H. Vesselle ◽  
J. F. Eary ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Positron Emission Tomography ◽  
Metastatic Breast Cancer ◽  
Fdg Pet ◽  
Metastatic Breast ◽  
Emission Tomography ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Internal Mammary ◽  
Conventional Staging

PURPOSE: To determine the prevalence of suspected disease in the mediastinum and internal mammary (IM) node chain by18fluorodeoxyglucose (FDG) positron emission tomography (PET), compared with conventional staging by computed tomography (CT) in patients with recurrent or metastatic breast cancer.PATIENTS AND METHODS: We retrospectively evaluated intrathoracic lymph nodes using FDG PET and CT data in 73 consecutive patients with recurrent or metastatic breast cancer who had both CT and FDG PET within 30 days of each other. In reviews of CT scans, mediastinal nodes measuring 1 cm or greater in the short axis were considered positive. PET was considered positive when there were one or more mediastinal foci of FDG uptake greater than the mediastinal blood pool.RESULTS: Overall, 40% of patients had abnormal mediastinal or IM FDG uptake consistent with metastases, compared with 23% of patients who had suspiciously enlarged mediastinal or IM nodes by CT. Both FDG PET and CT were positive in 22%. In the subset of 33 patients with assessable follow-up by CT or biopsy, the sensitivity, specificity, and accuracy for nodal disease was 85% , 90%, and 88%, respectively, by FDG PET; 54% , 85%, and 73%, respectively, by prospective interpretation of CT; and 50%, 83%, and 70%, respectively, by blinded observer interpretation of CT. Among patients suspected of having only locoregional disease recurrence (n = 33), 10 had unsuspected mediastinal or IM disease by FDG PET.CONCLUSION: FDG PET may uncover disease in these nodal regions not recognized by conventional staging methods. Future prospective studies using histopathology for confirmation are needed to validate the preliminary findings of this retrospective study.

scholarly journals Valor do FDG[18F]-PET/TC como preditor de câncer em nódulo pulmonar solitário

2008 ◽  
Vol 34 (7) ◽  
pp. 473-480 ◽  
Author(s):  
Rafael de Castro Martins ◽  
Sérgio Altino de Almeida ◽  
Antônio Alexandre de Oliveira Siciliano ◽  
Maria Carolina Pinheiro Pessoa Landesmann ◽  
Fabrício Braga da Silva ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Standardized Uptake Value ◽  
Emission Tomography ◽  
Positron Emission

OBJETIVO: Determinar a acurácia diagnóstica da positron emission tomography (tomografia por emissão de pósitrons)/tomografia computadorizada (PET/TC) com deoxiglicose marcada com flúor-18, conhecida como fluorodeoxiglicose (FDG[18F]), na avaliação de nódulo pulmonar solitário (NPS). MÉTODOS: Análise prospectiva de 53 pacientes consecutivos que realizaram PET/TC para avaliação de NPS, entre março de 2005 e maio de 2007. Destes 32 preencheram os critérios de inclusão. As lesões foram avaliadas quanto a sua localização e tamanho, grau de captação do radiofármaco e o standardized uptake value (SUV, valor padronizado de captação) máximo das lesões. Os achados dos estudos de FDG-PET/TC foram correlacionados com outros preditores de malignidade (idade, sexo, tabagismo, tamanho e localização do nódulo). O diagnóstico definitivo foi estabelecido por confirmação histopatológica ou acompanhamento clínico-radiológico por um período mínimo de um ano. RESULTADOS: Encontrados 14 NPS malignos. Após análise da curva ROC, o SUV de 2,5 foi considerado o melhor ponto de corte que identificou corretamente 13 dos 14 NPS malignos. Os resultados abaixo deste ponto de corte mostraram um exame falso positivo para neoplasia num total de 14. O método semiquantitativo apresentou sensibilidade de 92,9%, especificidade de 72,2%, valor preditivo positivo de 72,2%, valor preditivo negativo de 92,9% e acurácia de 81,2%. Na análise multivariada, apenas a localização do nódulo nos lobos superiores (p = 0,048) e o SUV (p = 0,007) demonstraram significância estatística para malignidade no NPS. CONCLUSÕES: Os dados do estudo mostram que o SUV da FDG[18F] é um bom preditor de neoplasia em nódulos pulmonares e com alto valor preditivo negativo, o que oferece grande segurança em afastar presença de malignidade, indicando sua importância na abordagem diagnóstica do nódulo pulmonar.

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