Assessment of therapeutic response of lymphoma patients by PET/CT

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Aya Y Ahmed ◽  
Mona A Nagi ◽  
Radwa H. El Sheikh
Keyword(s):  
Therapeutic Response ◽  
Imaging Modality ◽  
Treatment Plan ◽  
Response Assessment ◽  
Response To Therapy ◽  
University Hospital ◽  
Lymphoid Tissues ◽  
Cross Sectional ◽  
End Of Treatment ◽  
Pet Ct

Abstract Background Lymphoma compromises а histologically heterogeneous group of cancers derived from the cells of the immune system. The hallmark of the disease is the enlargement and proliferation of lymph nodes or secondary lymphoid tissues. Aim of the Work to evaluate the role of Positron emission tomography in the assessment of response to therapy in lymphoma patients: in particular, a five-point scale (Deauville criteria), which can be employed for early- and late-therapeutic response assessment. Patients and Methods This cross sectional study was conducted on 20 Patients with different types of lymphoma recruited and enrolled from Ain Shams university hospital. Results PET/CT and Contrast enhanced computed tomography were concurrent in results in 55% of cases during treatment and 75 % at the end of treatment with CT sensitivity of 61.1%, specificity of 92.2% and accuracy of 76.2% during treatment in comparison to 100 % sensitivity and specificity of PET/CT.While sensitivity of CT at end of treatment is 57.5% with specificity of 86.7% and accuracy of 71.6%. Conclusion PET/СT using 2-deoxy-2[18F]fluoro-D-glucose is considered one of the best oncologic imaging modality at the time being with valuable applications in lymphoma.It is very efficient with least possible pitfalls and false results compared to either of its components alone and to side by side reading of separately acquired PET and СT. It is becoming а standard modality for lymphoma providing а new vision to management and treatment plan.

scholarly journals PET/CT vs CECT in assessment of therapeutic response in lymphoma

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Aya Yassin ◽  
Radwa Hany El Sheikh ◽  
Mona Mohamed Ali
Keyword(s):  
Sensitivity And Specificity ◽  
Therapeutic Response ◽  
Treatment Plan ◽  
Response Assessment ◽  
Response To Therapy ◽  
University Hospital ◽  
Lymphoid Tissues ◽  
End Of Treatment ◽  
Contrast Enhanced ◽  
Pet Ct

Abstract Background Lymphoma incorporates histologically variable cancers derived from the immune system cells. The distinctive feature of lymphoma is the rapid increase in size and number of lymph nodes and/or secondary lymphoid tissues. The aim of the work is to evaluate the accuracy of PET/CT vs CECT in the assessment of response to therapy in lymphoma patients: both early and late therapeutic response assessment. This retrospective study was conducted on 80 patients with different types of lymphoma recruited and enrolled from a university hospital. All 80 patients underwent pre-treatment, during the course of chemotherapy and at the end of planned treatment contrast-enhanced СT (СEСT) and PET-СT. Interpretation of the СEСT and the fusion images PET/СT each was done separately and comparison of the results was achieved. Results PET/CT and contrast-enhanced computed tomography were concurrent in results in 55% of cases during treatment and 75% at the end of treatment with CT sensitivity of 61.1%, specificity of 92.2%, and accuracy of 76.2% during treatment in comparison to 100% sensitivity and specificity of PET/CT. Sensitivity of CT at end of treatment was 57.5%, specificity 86.7%, and accuracy 71.6% as compared to 100% sensitivity and specificity of PET/CT. Conclusion PET/СT using 2-deoxy-2-[18F] fluoro-d-glucose is considered one of the best oncologic imaging modalities at the time being with valuable applications in lymphoma. It is very efficient with least possible pitfalls and false results compared to either of its components alone and to side by side reading of separately acquired PET and СT. PET/CT can detect both anatomical information as well as metabolical information providing more data and thus giving more accurate results than CECT. It is becoming а standard modality for lymphoma providing а new vision to management and treatment plan.

scholarly journals Usefulness of 18f-FDG PET-CT in Staging, Restaging, and Response Assessment in Pediatric Rhabdomyosarcoma

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1112
Author(s):  
Davide Donner ◽  
Paola Feraco ◽  
Linda Meneghello ◽  
Barbara Rombi ◽  
Lorena Picori ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Pediatric Patients ◽  
Response Assessment ◽  
Response To Therapy ◽  
High Morbidity ◽  
European Guidelines ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Clinical Advances

Rhabdomyosarcoma is the most common soft-tissue sarcoma of childhood. Despite clinical advances, subsets of these patients continue to suffer high morbidity and mortality rates associated with their disease. Following the European guidelines for 18F-FDG PET and PET-CT imaging in pediatric oncology, the routine use of 18F-FDG PET-CT may be useful for patients affected by rhabdomyosarcoma, in staging, in the evaluation of response to therapy, and for restaging/detection of relapse. The European Pediatric Protocols are very old, and for staging and restaging, they recommend only radionuclide bone scan. The 18F-FDG PET-CT exam is listed as an optional investigation prescribed according to local availability and local protocols in the investigations panel required at the end of the treatment. We present two cases highlighting the usefulness of 18F-FDG PET-CT in managing pediatric patients affected by rhabdomyosarcoma, providing some bibliographic references.

scholarly journals Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gaetano Paone ◽  
Mariana Raditchkova-Sarnelli ◽  
Teresa Ruberto-Macchi ◽  
Marco Cuzzocrea ◽  
Emanuele Zucca ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Metabolic Response ◽  
Residual Disease ◽  
Response Assessment ◽  
Complete Response ◽  
Moderate Increase ◽  
Comparable Rate ◽  
Contrast Enhanced Ct ◽  
End Of Treatment ◽  
Pet Ct

AbstractDespite follicular lymphoma (FL) is frequently characterized by a moderate increase of glucose metabolism, PET/CT examinations provides valuable information for staging and response assessment of the disease. The aim of the study was to assess and compare the diagnostic performance of PET/ldCT and PET/ceCT, respectively, in evaluating FL patients at the end of treatment. Fifty FL consecutive patients who underwent end-of-therapy PET/CT with both ldCT and ceCT were analyzed. Two blinded observers independently assessed PET/ldCT and PET/ceCT applying the Deauville score (DS) and Lugano classification criteria. PET imaging obtained after the end-of-treatment (EoT) was classified as showing PET and ce-CT matched response (concordant imaging group, CIG) or PET and ce-CT unmatched response (discordant imaging group, DIG). Relapse rate and Event-Free Survival (EFS) were compared between CIG and DIG patients. Overall, no differences in metabolic response classification were observed between PET/ldCT and PET/ceCT. In 13 (26%) patients PET/ceCT identified additional FDG-negative nodal lesions in mesenteric, retroperitoneal and iliac regions. However, in all cases, final DS remained unchanged and the additional results did not modify the following therapeutic decision. Among patients, who obtained complete metabolic response a comparable rate of relapse was registered in DIG 3/13 (23%) and CIG subgroups 5/20 (25%) [p = 0.899]. In all 3 DIG cohort patients who relapsed the recurrent disease involved also, but not exclusively, PET negative lymph nodes detected by ceCT. In overall population metabolic response defined by PET/ldCT predicted EFS [76% (group of patients with metabolic response) vs 35% (group of patients with residual disease), p = 0.0013] significantly better than ceCT-Based response assessment [75% (group of patients with complete response) vs 53% (group of patients with residual disease), p = 0.06]. Our study demonstrates a negligible diagnostic and predictive value of ceCT performed in addition to standard 18FDG PET/ldCT for EoT response evaluation in FLs. PET/ldCT should be performed as first-line imaging procedure, also in patients with prevalent abdominal and pelvic involvement, limiting the acquisition of ceCT in selected cases. This tailored approach would contribute to avoid useless radiation exposure and preserve renal function of patients.

Fluorodeoxyglucose positron emission tomography/computed tomography in the diagnosis, assessment of disease activity and therapeutic response in relapsing polychondritis

Rheumatology ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 99-106 ◽  
Author(s):  
Aman Sharma ◽  
Rajender Kumar ◽  
Adarsh MB ◽  
G S R S N K Naidu ◽  
Vikas Sharma ◽  
...  
Keyword(s):  
Disease Activity ◽  
Fdg Pet ◽  
Therapeutic Response ◽  
Clinical Symptoms ◽  
Relapsing Polychondritis ◽  
Response To Therapy ◽  
Ct Examination ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Assessment Of Disease Activity

Abstract Objective To evaluate 18F-fluorodeoxyglucose (FDG) PET/CT in the assessment of disease activity, extent of the disease and response to therapy in relapsing polychondritis. Methods Twenty-five patients (9 men, 16 women) with a mean age of 38.2 years (s.d. 13.7; range 18–62), diagnosed to have relapsing polychondritis according to Damiani and Levine’s modification of McAdam’s criteria, who underwent PET/CT examination were included. Ten patients underwent a second PET/CT examination after therapy or during follow-up. Clinical symptoms and auxiliary examination findings were recorded. PET/CT findings were reviewed and correlated with the clinical symptoms. Results The major symptoms were aural pain (n = 21), nasal pain (n = 10), stridor (n = 5), cough (n = 9), fever (n = 8) and laryngeal tenderness (n = 8). The initial PET/CT was positive in 23/25 patients. PET/CT revealed involvement of auricular (n = 14), nasal (n = 8), laryngeal (n = 7), tracheobronchial (n = 6) and Eustachian (n = 3) cartilages with a mean maximum standardized uptake value (SUVmax) of 4.1 (s.d. 2.5; range 1.7–12.7). Fair correlation of aural/nasal pain/stridor with FDG avidity of cartilage involvement on PET/CT was noted. The key finding was detection of asymptomatic large airway involvement in seven patients (28%). Re-examination PET in 10 patients revealed complete therapeutic response (n = 5), partial response (n = 1), stable disease (n = 1), progressive disease (n = 1) and disease recurrence (n = 2). Conclusion FDG PET/CT is a useful tool for the assessment of the disease activity and extent. It identified activity in clinically inaccessible sites that are of clinical significance. It is also useful in assessing treatment response and finding relapse.

Application of Deep Learning as a Noninvasive Tool to Determine Pathological Diagnosis of Enlarged Cervical Lymph Nodes with PET/CT

2020 ◽  
Author(s):  
Yuhan Yang ◽  
Bo Zheng ◽  
Yixi Wang ◽  
Xuelei Ma
Keyword(s):  
Deep Learning ◽  
Lymph Nodes ◽  
Diagnostic Performance ◽  
Imaging Modality ◽  
Ct Images ◽  
Pathological Diagnosis ◽  
Therapeutic Interventions ◽  
Cross Sectional ◽  
Cervical Lymph Nodes ◽  
Pet Ct

Abstract Objective: To construct a deep-learning convolution neural network (DL-CNN) system for pathological diagnosis of cervical lymph nodes by using computed tomography (CT), fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), and fused PET/CT images.Materials and methods: A total of 1020 cross-sectional images for each imaging modality was obtained from 211 patients (153 patients with lymphomas and 116 patients with metastases) with enlarged cervical lymph nodes from January 2014 to June 2018. All eligible images were distributed randomly into the training, validation, and testing cohorts with ratios of 70%, 15%, and 15%. We applied eight DL-CNN algorithms with pretrained bases from ImageNet dataset on CT, PET, and fused PET/CT imaging datasets to differentiate lymphomatous nodes from metastatic nodes, respectively. Attention heatmaps of PET and fused PET/CT images generated by class activation mapping (CAM) were used in visualization of class specific regions recognized by the prediction model with best performance. Results: The accuracy of eight deep learning algorithms with pretrained base ranged from 0.650 to 0.981 on PET testing cohort, and from 0.738 to 0.981 on fused PET/CT testing cohort. The VGG16 model on PET images and DenseNet121 model on fused PET/CT images had the best diagnostic performance among all eight algorithms with sensitivity and specificity of 1.000 and 0.963. Class-specific discriminative subregions were highlighted by attention maps for clinical review.Conclusion: A DL-CNN system was developed for classifying metastatic and lymphomatous involvement with favorable diagnostic performance on PET and PET/CT images in patients with enlarged cervical lymph nodes. The further clinical practice of this system may improve quality of the following therapeutic interventions and optimize patients’ outcomes.

Skeletal Survey in Multiple Myeloma: Role of Imaging

2021 ◽  
Vol 17 ◽  
Author(s):  
Paolo Spinnato ◽  
Giacomo Filonzi ◽  
Alberto Conficoni ◽  
Giancarlo Facchini ◽  
Federico Ponti ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Low Dose ◽  
Imaging Modality ◽  
Bone Marrow Involvement ◽  
Conventional Radiography ◽  
Response To Therapy ◽  
Whole Body ◽  
Initial Assessment ◽  
Bone Lesions ◽  
Pet Ct

: Bone disease is the hallmark of multiple myeloma. Skeletal lesions are evaluated to establish the diagnosis, to choose the therapies and also to assess the response to treatments. Due to this, imaging procedures play a key-role in the management of multiple myeloma. For decades, conventional radiography has been the standard imaging modality. Subsequently, advances in the treatment of multiple myeloma have increased the need for accurate evaluation of skeletal disease. The introduction of new high performant imaging tools, such as whole-body low dose computed tomography, different types of magnetic resonance imaging studies, and 18F-fluorodeoxyglucose positron emission tomography, replaced conventional radiography. In this review we analyze the diagnostic potentials, indications of use, and applications of the imaging tools nowadays available. Whole body low-dose CT should be considered as the imaging modality of choice for the initial assessment of multiple myeloma lytic bone lesions. MRI is the gold-standard for detection of bone marrow involvement, while PET/CT is the preferred technique in assessment of response to therapy. Both MRI and PET/CT are able to provide prognostic information.

scholarly journals Imaging in multiple myeloma: How? When?

Blood ◽  
2019 ◽  
Vol 133 (7) ◽  
pp. 644-651 ◽  
Author(s):  
Elena Zamagni ◽  
Paola Tacchetti ◽  
Michele Cavo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Multiple Myeloma ◽  
Magnetic Resonance ◽  
Imaging Modality ◽  
Response To Therapy ◽  
Whole Body ◽  
Bone Lesions ◽  
Resonance Imaging ◽  
Pet Ct

Abstract Bone disease is the most frequent feature of multiple myeloma (MM) and represents a marker of end-organ damage; it is used to establish the diagnosis and to dictate the immediate need for therapy. For this reason, imaging plays a significant role in the management of MM patients. Although conventional radiography has traditionally been the standard imaging modality, its low sensitivity in detecting osteolytic lesions and inability to evaluate response to therapy has called for the use of more sophisticated techniques, such as whole-body low-dose computed tomography (WBLDCT), whole-body magnetic resonance imaging, and 18F-fluorodeoxyglucose–positron emission tomography/computed tomography (PET/CT). In this review, the advantages, indications of use, and applications of the 3 techniques in the management of patients with MM in different settings will be discussed. The European Myeloma Network and the European Society for Medical Oncology guidelines have recommended WBLDCT as the imaging modality of choice for the initial assessment of MM-related lytic bone lesions. Magnetic resonance imaging is the gold-standard imaging modality for detection of bone marrow involvement, whereas PET/CT provides valuable prognostic data and is the preferred technique for assessment of response to therapy. Standardization of most of the techniques is ongoing.

scholarly journals Limited Benefit of Additional Contrast-Enhanced CT To End-of-Treatment PET/CT Evaluation In Patients With Follicular Lymphoma

2021 ◽  
Author(s):  
Gaetano Paone ◽  
Mariana Raditchkova-Sarnelli ◽  
Teresa Ruberto-Macchi ◽  
Marco Cuzzocrea ◽  
Emanuele Zucca ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Metabolic Response ◽  
Response Assessment ◽  
Moderate Increase ◽  
Comparable Rate ◽  
Contrast Enhanced Ct ◽  
End Of Treatment ◽  
Pet Ct ◽  
Ct Evaluation ◽  
Line Imaging

Abstract Purpose: Despite follicular lymphoma (FL) is frequently characterized by a moderate increase of glucose metabolism, PET/CT examinations provides valuable information for staging and response assessment of the disease. The aim of the study was to assess and compare the diagnostic performance of PET/ldCT and PET/ceCT, respectively, in evaluating FL patients at the end of treatment. Methods: Fifty FL consecutive patients who underwent end-of-therapy PET/CT with both ldCT and ceCT were analyzed. Two blinded observers independently assessed PET/ldCT and PET/ceCT applying the Deauville score (DS) and Lugano classification criteria. PET imaging obtained after the end-of-treatment (EoT) was classified as showing PET and ce-CT matched response (concordant imaging group, CIG) or PET and ce-CT unmatched response (discordant imaging group, DIG). Relapse rate and Event-Free Survival (EFS) were compared between CIG and DIG patients. Results: Overall, no differences in metabolic response classification were observed between PET/ldCT and PET/ceCT. In 13 (26%) patients PET/ceCT identified additional FDG-negative nodal lesions in mesenteric, retroperitoneal and iliac regions. However, in all cases, final DS remained unchanged and the additional results did not modify the following therapeutic decision. Among patients, who obtained complete metabolic response a comparable rate of relapse was registered in DIG 3/13 (23%) and CIG subgroups 5/20 (25%) [p = 0.899]. In all 3 DIG cohort patients who relapsed the recurrent disease involved also, but not exclusively, PET negative lymph nodes detected by ceCT. In overall population metabolic response defined by PET/ldCT predicted EFS (76% vs 35%, p = 0.0013) significantly better than ceCT-Based response assessment (75% vs 53%, p = 0.06). Conclusion: Our study demonstrates a negligible diagnostic and predictive value of ceCT performed in addition to standard 18FDG PET/ldCT for EoT response evaluation in FLs. PET/ldCT should be performed as first-line imaging procedure, also in patients with prevalent abdominal and pelvic involvement, limiting the acquisition of ceCT in selected cases. This tailored approach would contribute to avoid useless radiation exposure and preserve renal function of patients.

scholarly journals Brain metastases assessment by FDG-PET/CT: can it eliminate the necessity for dedicated brain imaging?

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mamdouh A. Zidan ◽  
Radwa S. Hassan ◽  
Khaled I. El-Noueam ◽  
Yasser M. Zakaria
Keyword(s):  
Brain Metastases ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Imaging Modality ◽  
False Negative ◽  
Whole Body ◽  
Cross Sectional ◽  
Primary Tumors ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background Brain metastases (BM) are the most common intracranial tumors in adults outnumbering all other intracranial neoplasms. Positron emission tomography combined with computed tomography (PET/CT) is a widely used imaging modality in oncology with a unique combination of cross-sectional anatomic information provided by CT and the metabolic information provided by PET using the [18F]-2-fluoro-2-deoxy-d-glucose (FDG) as a tracer. The aim of the study is to assess the role and diagnostic performance of brain-included whole-body PET/CT in detection and evaluation of BM and when further imaging is considered necessary. The study was conducted over a period of 12 months on 420 patients suffering from extra-cranial malignancies utilizing brain-included whole-body PET/CT. Results Thirty patients with 71 brain lesions were detected, 18 patients (60%) had BM of unknown origin while 12 patients (40%) presented with known primary tumors. After brain-included whole-body FDG-PET/CT examination, the unknown primaries turned out to be bronchogenic carcinoma in 10 patients (33.3%), renal cell carcinoma in 2 patients (6.7%), and lymphoma in 2 patients (6.7%), yet the primary tumors remained unknown in 4 patients (13.3%). In 61 lesions (85.9%), the max SUV ranged from 0.2- < 10, while in 10 lesions (14.1%) the max SUV ranged from 10 to 20. Hypometabolic lesions were reported in 41 (57.7%) lesions, hypermetabolic in 3 lesions (4.2%), whereas 27 lesions (38.0%) showed similar FDG uptake to the corresponding contralateral brain matter. PET/CT overall sensitivity, specificity, positive and negative predictive, and accuracy values were 78.1, 92.6, 83.3, 90, and 88% respectively. Conclusion Brain-included whole-body FDG-PET/CT provides valuable complementary information in the evaluation of patients with suspected BM. However, the diagnostic performance of brain PET-CT carries the possibility of false-negative results with consequent false sense of security. The clinicians should learn about the possible pitfalls of PET/CT interpretation to direct patients with persistent neurological symptoms or high suspicion for BM for further dedicated CNS imaging.

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