scholarly journals SAT0557 RESIDUAL DISEASE ACTIVITY IN ADULT-ONSET STILL’S DISEASE: QUALITATIVE AND QUANTITATIVE ANALYSIS OF A SERIES OF 18F FDG-PET/MR

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1236.2-1237
Author(s):  
S. Bindoli ◽  
P. Galozzi ◽  
F. Magnani ◽  
G. Abruzzino ◽  
D. Cecchin ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Lymph Nodes ◽  
Disease Activity ◽  
Fdg Pet ◽  
Residual Disease ◽  
Clinical Manifestations ◽  
Serum Markers ◽  
Positive Scan ◽  
Negative Scan

Background:Adult-onset Still’s disease (AOSD) is a systemic autoinflammatory disorder characterized by episodes of spiking fever, the presence of an evanescent pink-salmon rash, arthritis/arthralgias, sore throat and increased inflammatory serum markers. The diagnosis is clinical and needs the exclusion of potential mimickers such as infections and lymphoproliferative disorders. Currently, a specific diagnostic test to assess the disease activity is not available.Objectives:To define the residual disease activity in AOSD and establish a possible response to therapy through18F-FDG PET/MR imaging technique.Methods:23 patients affected by AOSD and 24 controls underwent18F-FDG PET/MR between 2014 and 2018. A total of 5418F-FDG PET/MR were analysed. AOSD patients were diagnosed according to the Yamaguchi’s criteria and were in follow-up at the Rheumatology Unit of Padova University Hospital. The controls were chosen among non-AOSD patients with a previous diagnosis of solid tumors (lymphomas excluded). Aqualitative analysisof PET/RM carried out by a Nuclear Medicine Specialist and asemiquantitative analysiscarried out by measuring SUVs-to-liver (Standardized Uptake Value) for spleen, bone marrow (BM), lymph nodes and pharynx were performed. A SUVmax BM/SUVmean liver higher than 2.09 was set up as significant area of uptake for each organ considered. This threshold was calculated by adding the standard deviation multiplied by 2 at the mean ratio between SUVmax BM and SUVmean liver of the control group. The Pouchot score for disease activity was calculated for each subject. The distribution of the variables was investigated by Shapiro-Wilk test. The analysis of the association between the variables was carried out using the Mann-Whitney U test.Results:AOSD patients present areas of focal18F-FDG uptake mainly in BM, lymph nodes, pharynx, spleen and salivary glands. Sites of uptake in spleen were found in 3.3% of PET/MR, in BM in 23.3%, in lymph nodes in 23.3% and in pharynx in 36.6% of PET/RM respectively. Eleven/thirty (47.8%) patients were defined as “positive” since the uptake was higher than liver, and twelve/thirty (52.2%) were defined as “negative” since the uptake was lower than liver, regardless of SUVs and clinical manifestations. A semi-quantitative analysis assessed whether the values of the SUVmax BM/liver were higher than the cut-off of 2.09 in “positive” PET/MR and lower in the “negative” ones and if the clinical manifestations were present or absent in agreement with the evaluation of SUVs for each patient. BM was found to be active (SUVmax ratio > of 2.09) in 7 out of 11 patients when the PET/MR was defined “positive”, while only in 1 case out of 12 BM SUVmax was >2.09 when the exam was “negative”. Clinical manifestations were present in 10 out of 11 AOSD with a “positive” scan and in 7 out of 11 with both a “positive” scan and a SUV max BM/liver >2.09. Clinical manifestations were present in 1 out of 12 patients with a “negative” scan, while in 10 out of 12 cases with both a negative scan and a SUV max BM/liver <2.09 were absent. Six patients repeated PET/MR during follow-up. The values of the SUVmax BM/liver significantly decreased after anti IL-1β treatment with anakinra. In two cases in which anakinra was deferred, the BM SUVmax values exceeded the cut-off of 2.09 despite the patients did not complain any symptom or inflammation markers increase.Conclusion:18F FGD-PET/MR could be able to evaluate the disease activity in AOSD when clinical manifestations and serum markers are not sufficient to establish it. The uptake on BM seems quite sensitive in pointing out the disease severity and in assessing the response to anti IL-1β therapy.18F PET/MR is an accurate and repeatable method, however further studies are required to validate its applicability in routinary clinical practice.Disclosure of Interests:None declared

Prediction of lymph node metastase in NSCLC

2010 ◽  
Vol 01 (05) ◽  
pp. 219-226 ◽  
Author(s):  
F. Beyer ◽  
B. Buerke ◽  
J. Gerss ◽  
K. Scheffe ◽  
M. Puesken ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Fdg Pet ◽  
Automatic Segmentation ◽  
Correlation Coefficients ◽  
Mediastinal Lymph Nodes ◽  
Intra Class Correlation ◽  
Axial Diameter ◽  
Pet Ct ◽  
Fdg Pet Ct

SummaryPurpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT.Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean

scholarly journals The prevalence of cardiac sarcoidosis is underestimated: [18F]FDG-PET is the answer

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
J Borges-Rosa ◽  
M Oliveira-Santos ◽  
R Silva ◽  
J Lopes De Almeida ◽  
L Goncalves ◽  
...  
Keyword(s):  
Heart Failure ◽  
Fdg Pet ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Clinical Manifestations ◽  
European Population ◽  
Response To Therapy ◽  
Histological Diagnosis ◽  
18F Fdg

Abstract Funding Acknowledgements Type of funding sources: None. Background Overt cardiac involvement is reported in 5% of patients with sarcoidosis, although autopsy and imaging studies suggest higher prevalence, worldwide variation. The role of 18F-fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) in non-invasive diagnosis and follow-up has increased in the last decade. Purpose Our goal is to describe the prevalence, clinical manifestations and outcomes of cardiac sarcoidosis (CS), diagnosed through [18F]FDG-PET, in a southern European population. Methods We included all patients with histological diagnosis of extracardiac sarcoidosis screened with [18F]FDG-PET between 2009 and 2020. We collected data on clinical manifestations, cardiac magnetic resonance (CMR) results, and mortality outcomes and compared those with and without cardiac involvement. We applied the criteria for the diagnosis of CS from Heart Rhythm Society. Results Of the 400 patients screened with [18F]FDG-PET, 128 had a histological diagnosis of extracardiac sarcoidosis (54.7% females, mean age 51.0 ± 14.2 years). None underwent endomyocardial biopsy. Ten patients had a pattern of [18F]FDG uptake consistent with CS defined as diffuse (n = 5), focal (n = 3), and focal on diffuse (n = 2). Of the 128 patients, 14 also underwent CMR, which identified 2 subjects with positive findings in both modalities and 3 additional patients: focal (n = 1), multifocal mid-wall (n = 2), focal mid-wall (n = 2), and multifocal subepicardial (n = 1) delayed gadolinium enhancement. Overall, 13 patients (10.2%) fulfilled the criteria for probable CS (53.8% female, mean age 56.2 ± 12.6 years), all with multiorgan involvement, mostly lung and lymph nodes (each 92%), followed by skin and central nervous system (each 15%). Median left ventricle ejection fraction was 62% [55-65] and there were cardiac manifestations of CS in 6 patients (46%): sick sinus syndrome (n = 2), complete heart block (n = 1), frequent premature ventricular complexes (n = 1), ventricular tachycardia plus heart failure (n = 1), and bifascicular block plus heart failure (n = 1). Eleven patients (85%) with probable CS were medicated with immunosuppressant drugs: corticosteroids (n = 9), methotrexate (n = 4), and azathioprine (n = 2). Four patients with previous [18F]FDG screening were revaluated after treatment, each showing no cardiac uptake.  After a mean follow-up of 4.0 ± 1.0 years, mortality was three-fold higher in patients with cardiac involvement, despite the absence of statistical significance (15% vs. 5%, P = 0.151). Conclusions In a southern European population with histological extracardiac sarcoidosis, the prevalence of cardiac involvement was 10.2%, most asymptomatic. [18F]FDG-PET improves the diagnostic yield and plays an important role in monitoring response to therapy. The higher mortality trend in those with CS needs to be ascertained in longer follow-up.

Post-chemotherapy modified template retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumours

2021 ◽  
Author(s):  
Murat Zor ◽  
Sercan Yilmaz ◽  
Bahadir Topuz ◽  
Engin Kaya ◽  
Serdar Yalcin ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Germ Cell ◽  
Residual Disease ◽  
Germ Cell Tumors ◽  
Operation Time ◽  
Long Term Results ◽  
Perioperative Outcomes ◽  
Retroperitoneal Lymph Node Dissection

Abstract Introduction/background: Although a full bilateral template RPLND is thought to be the standard of care for the management of postchemotherapy retroperitoneal residual masses for nonseminomatous germ cell tumors (NSGCT), in the past decade modified templates have become increasingly popular. In this study, we aimed to present our oncological and perioperative outcomes of consecutive seventeen NSGCT patients who underwent a modified template unilateral PC-RPLND for retroperitoneal residual disease. Materials and Methods: We retrospectively evaluated the medical records of 17 consecutive NSGCT patients who underwent modified template unilateral PC-RPLND in our university hospital between 2017 and 2020. All patients had normal serum tumour markers with residual disease in the retroperitoneum. Surgical characteristics including the size of the retroperitoneal residual mass, residual tumor pathology, removed lymph nodes, positive percentage of removed lymph nodes, accompanying operations, complications, mean operation time and hospital stay, and long-term results including survival and antegrade ejaculation were evaluated. Results: Eleven patients underwent left and six right-sided surgery. Median residual lymph node diameter was 41mm. Median hospitalisation time was 3.5 days. Median follow-up time was 10.5 months. Necrosis/fibrosis was seen in 6 patients, and teratoma in 11 patients. No viable tumour was seen. No patients died in the follow-up period. None of the patients relapsed during follow-up. Ten/seventeen patients had antegrade ejaculation. Conclusions: Modified template unilateral PC-RPLND leads to very good oncological outcomes with decreased perioperative morbidity as well as better antegrade ejaculation rates. Low volume retroperitoneal disease seems to fit this procedure best.

FDG-PET in the Serial Assessment of Patients with Lymphoma in Complete Remission.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 216-216 ◽  
Author(s):  
Pier Luigi Zinzani ◽  
Vittorio Stefoni ◽  
Valentina Ambrosini ◽  
Enrico Derenzini ◽  
Gerardo Musuraca ◽  
...  
Keyword(s):  
Complete Remission ◽  
Fdg Pet ◽  
False Negative ◽  
Great Majority ◽  
True Negative ◽  
Non Hodgkin Lymphoma ◽  
Pet Scans ◽  
Negative Scan

Abstract FDG-PET role in the assessment of lymphoma patients is well established but only few papers evaluated the usefulness of FDG-PET during follow up. Aim: to prospectively investigate the value of serial FDG-PET scans in the follow up of lymphoma patients in complete remission. All lymphoma patients who achieved a complete remission were prospectively enrolled in the study and scheduled for serial FDG-PET scans at 6, 12, 18 and 24 months; further scans were then carried out on annual basis (overall 421 pts, 160 pts with Hodgkin’s Disease (HD) and 261 pts with non-Hodgkin Lymphoma (NHL) were studied). All patients had a final assessment using other imaging procedures and/or biopsy and/or clinical evolution. FDG-PET findings were reported as positive, indeterminate or negative for relapse; after comparison with all available data, PET results were categorized as true positive (TP), true negative (TN), false positive (FP), indeterminate turned out to be relapse (I+) and indeterminate turned out to be complete remission (I-). Results: PET documented relapse in 42 cases at 6 mo (14 HD (8.8%) and 28 NHL (10.7%); in 31 cases at 12 mo (14 HD (9.5%) and 17 NHL (7.3%); in 27 cases at 18 mo (6 HD (4.5%) and 21 NHL (3.2%); in 9 cases at 24 mo (3 HD (2.4%) and 6 NHL (3.2%); and in 5 cases at &gt; 36 mo (2 HD (2.8%) and 3 NHL (6.5%). Out of 125 scans reported as positive for relapse, 109 turned out to be TP (PPV of 87%); no false negative scan was recorded, and in the great majority of cases PET detected the presence of relapse before clinical evidence. Our results confirm that FDG-PET is a valid tool for lymphoma patients follow-up. The higher incidence of relapse occurred in both HD and NHL quite early after complete remission (at 6 and 12 months for HD and at 6, 12 and 18 months for NHD), thus confirming the usefulness of performing FDG-PET scans at these times in order to identify recurrence. The role of serial PET at later times (after 18 months for HD and 24 months for NHL) was found less relevant.

How to choose PET-CT or CT in the diagnosis and staging of lung cancer

2010 ◽  
Vol 01 (05) ◽  
pp. 213-218
Author(s):  
X. Tao ◽  
H. Liu ◽  
T. Jiang ◽  
X. Zheng ◽  
S. Liu
Keyword(s):  
Lymph Nodes ◽  
Fdg Pet ◽  
Automatic Segmentation ◽  
Correlation Coefficients ◽  
Mediastinal Lymph Nodes ◽  
Intra Class Correlation ◽  
Axial Diameter ◽  
Pet Ct ◽  
Fdg Pet Ct

SummaryPurpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT. Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean

FRI0150 USEFULNESS OF SALIVARY GLAND ULTRASONOGRAPHY IN THE ASSESSMENT OF SALIVARY GLAND ACTIVITY AND DAMAGE IN PRIMARY SJÖGREN’S SYNDROME: A SINGLE CENTER EXPERIENCE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 659.1-659
Author(s):  
F. Ferro ◽  
G. Governato ◽  
V. Donati ◽  
G. Fulvio ◽  
S. Fonzetti ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Lymph Nodes ◽  
Disease Activity ◽  
Primary Sjögren’S Syndrome ◽  
Newly Diagnosed ◽  
Primary Sjogren’S Syndrome ◽  
Primary Sjögren's Syndrome ◽  
Submandibular Glands ◽  
Salivary Gland Disease

Background:Salivary gland ultrasonography (SGUS) has an emerging role in the diagnosis of primary Sjögren’s syndrome (pSS); however, it is still an open issue whether distinct sonographic abnormalities may indicate reversible glandular activity or irreversible disease-induced damage.Objectives:to assess the association between SGUS abnormalities, salivary gland disease activity and loss of function in pSS patients over a long-term follow-up.Methods:Patients with pSS fulfilling the AECG 2002 criteria were included in this observational study. Both parotid and submandibular glands were examined at the time of the study inclusion and during the follow-up. SGUS findings (i.e gland size, echogenicity, homogeneity, hyperechoic bands, number and location of the hypoechoic/anechoic areas, number of lymph nodes, calcification, posterior border visibility) were defined according to previous studies and monitored over the time. Patients demographics, clinical, histological and laboratory data were routinely collected. ESSDAI and ESSPRI were used to asses disease activity and PROs.Results:We included 419 (402 F:17 M) pSS patients: 206/419 at the diagnosis and 213/419 with a median disease duration of 7 (IQR 4-11) years. SGUS examination was repeated in 81/206 and in 108/213 patients, after a median follow-up of 30 (IQR 12-42) months, respectively. Noteworthy, 18/419 pSS patients were treated with rituximab (RTX) during the study period. The overall SGUS score correlated directly with the minor salivary focus score (r=0.366, p=0.000) and with the ESSDAI (r=0.482, p=0.000); the parotid inhomogeneity score correlated directly with the glandular domain of the ESSDAI (r=0.530, p=0.000). The unstimulated salivary flow rate (USFR) correlated inversely with the overall SGUS score (r=-257, p=0.000) and with the presence of hyperechoic bands in both the parotid (r=-210, p=0.03) and the submandibular glands (r=-316, p=0.000). When compared to patients with an established pSS, newly diagnosed patients presented less frequently a gross inhomogeneity in their parotid glands (30/206, 14.6% vs 53/213, 24.9%, p=0.01) and less hyperechoic bands in both their parotid (33/206, 16% vs 61/213, 29%, p=0.001) and submandibular glands (53/206, 26% vs 110/213, 52%, p=0.001). However, over a median 30 month-follow-up we did not observe any significant change neither in the number of hypo-anechoic areas nor in the inhomogeneity score in both newly diagnosed patients and in those with an established disease. Out of the 18 pSS patients treated with RTX, 14 (78%) presented at the baseline a moderate to gross inhomogeneity in their glands: no changes in the number of hypo-anechoic areas were observed also in these patients with the exception of a variation in the number of intra-parotid lymph nodes.Conclusion:SGUS abnormalities appeared to be associated to both salivary gland disease activity and damage. Namely, the presence of hyperechoic bands significantly correlated with salivary loss function. Diffuse-scattered hypoechoic areas did not change over a median 30-month followed-up indicating that additional studies are required to better elucidate the correlation between SGUS abnormalities and the corresponding histopathologic lesions.Disclosure of Interests:Francesco Ferro: None declared, Gianmaria Governato: None declared, Valentina Donati: None declared, Giovanni Fulvio: None declared, Silvia Fonzetti: None declared, Elena Elefante: None declared, Nicoletta Luciano Speakers bureau: Paid as speaker for Eli Lilly, Sanofi, Marta Mosca: None declared, Antonella Cecchettini: None declared, Chiara Baldini: None declared

Achievement a Negative 18-FDG/PET Status at the End of Procedure by Tailored Treatment According Pre-Transplantation Pet Status in Lymphomas Improve 5 Years-OS and EFS.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2193-2193
Author(s):  
Dominique Bordessoule ◽  
Benoit Marin ◽  
Stéphane Girault ◽  
Fredericka Bompart ◽  
Julie Abraham ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Fdg Pet ◽  
De Novo ◽  
Residual Disease ◽  
Prognostic Score ◽  
Conditioning Regimen ◽  
Metabolic Imaging ◽  
High Dose ◽  
The Impact

Abstract In patients (pts) with non Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) with poor prognosis factors, pre-transplantation (ASCT) 18-fluorodeoxyglucose (FDG)-positron-emission tomography (PET) status is important for evaluation of response and predicting the outcome. A positive pre-ASCT PET (+PET) indicated a high risk (HR) of relapse which was increased by a positive post-ASCT PET. For these patients additional therapy (salvage therapies prior ASCT, targeted radiotherapy, second transplant or new treatment approaches) will be required (Spaepen K 2001, Filmont JE 2003; Svoboda J 2006, Mounier, 2007). In a french regional network, we try to obtain a negative metabolic status with additive « targeted-therapy », before or after the ASCT, in the hope to improve the clinical outcome for these HR NHL/HD. Objective: The study assessed the impact of tailored therapy according to pre-transplantation FDG-PET status on pts outcome after high-dose chemotherapy and ASCT. Patients & Methods: We performed a retrospective analysis of pts included according three criteria: 1) histologically proven malignant lymphoma (NHL/HD) with a metabolic active disease in PET imaging 2) planned to receive an ASCT for HR factors according international recommendations (de novo initial aaIPI III/IV or not in CR after front line chemotherapy or in early and unfavorable relapse; 3) having a PET prospectively performed prior and after ASCT on a CDET replaced in 2005 by a PET/CT (Siemens). The metabolic imaging interpretation had been performed by 2 experienced nuclear physicans first blinded to clinical and CT scan then discussed in multidisciplinary team. + PET defined as any focal or diffuse area of increased activity in a location suspect for residual disease and -PET if any metabolic activity according revised Cheson criteria. Survival analysis were performed using Kaplan-Meier method for event free survival (EFS), overall survival (OS). Results: For 95 consecutive pts treated from 05/1999 to 12/2006 18 HD and 77 NHL, an ASCT has been planned either in initial HR prognostic score (n=39), primary refractory disease (n=31), or in relapse (n=25). First line therapy were mainly ABVD for HD and ACVBP/CHOP +/− Rituximab for NHL. A pre-ASCT -PET was obtained in 52 pts (55%) and 43 pts (45%) remained pre-ASCT +PET. Additional salvage chemotherapy (MINE or DHAP(+/−R) most frequently) obtained a - PET status from pre-ASCT +PET in 9/43 pts (21%) prior the ASCT. ASCT has been performed for all these HR pts with a conditioning regimen mainly BICNU-Etoposide-Aracytine-Melphalan (BEAM). After ASCT, 22/43 pre-ASCT +PET pts were converted in a post-ASCT -PET status. Residual disease of post-ASCT +PET pts was treated by targeted radiation (n=11) or by a second transplant (n=2). One pre-ASCT -PET converted to positive (1/52). At the end of procedure, we obtained a –PET status in 88 pts (92%), persistant + PET in 7 pts (7%) (3 PR/4 PD). With a median follow-up of 4.14 years (range 0.61–9.48) since diagnosis, 15/43pts (35%) pre-ASCT +PET and 14/52pts (26%) pre-HDT/ASCT -PET pts relapsed. Mortality was 23% (22/95pts range -PET : 11/52 (21%) and +/−PET 11/43 (25%) respectively and 4/7 (57%) resistant +/+PET). In –PET and in +/−PET median OS and EFS were not reached, 5yOS was 79% and 73% (p=0.7) and 5 y-EFS 62% and 54% respectively (p=0.2). In residual post-ASCT+PET, median OS was 4,5 months. Conclusion: PET-guided consolidative therapy prior or post ASCT in patients with HR lymphoma is routinely feasible and could obtain a negative status in 92% of pts at the end of procedure and reduce relapses with encouraging results in terms of OS and EFS with a 5-y median follow-up. Next step is now on-going: including pts in multicentric PETdesigned trials to confirm prospectively the crucial role of the metabolic imaging to determine which is the best tailoring therapy.

scholarly journals Tubercular Meningitis and Lymphadenitis Mimicking a Relapse of Burkitt's Lymphoma on 18F-FDG-PET/CT: A Case Report

2015 ◽  
Vol 8 (2) ◽  
pp. 226-232 ◽  
Author(s):  
Halima El Omri ◽  
Zsolt Hascsi ◽  
Ruba Taha ◽  
Lajos Szabados ◽  
Hesham El Sabah ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Ct Scan ◽  
Fdg Pet ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

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.

scholarly journals Longitudinal 18f-FDG-PET-CT Analysis in Newly Diagnosed Multiple Myeloma (NDMM) Patients Following Carfilzomib, Lenalidomide, Dexamethasone Induction and Lenalidomide Maintenance (CRd-R)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3274-3274
Author(s):  
Neha S Korde ◽  
Dickran Kazandjian ◽  
Mark Roschewski ◽  
Sham Mailankody ◽  
Malin Hultcrantz ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Fdg Pet ◽  
Research Funding ◽  
Residual Disease ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Over Time

Abstract Introduction: Multiple myeloma (MM) is a patchy bone marrow based malignancy of plasma cells, resulting in painful bone lytic lesions that can be visualized by 18F-FDG-PET-CT. We treated 45 NDMM patients with CRd-R therapy that resulted in high rates of minimal residual disease (MRD) negativity (62%)(Korde et al. JAMA Onc 2015). In this study, we assessed longitudinal FDG response through lenalidomide (Len) maintenance period and aimed to correlate with clinical findings and MRD status. Methods: The details of treatment received, study design and patients' characteristics have already been published. As part of the study design, all patients had serial PET imaging at baseline, after achievement of CR and/or at completion of 8 cycles of CRd, and at year-1 and -2 of Len maintenance, or termination of protocol therapy. Whole body (vertex to toes) static FDG imaging was performed at 1-hour post injection, implemented according to institutional practice. Focal lesions on FGD were defined as: increased uptake (above background reference) within the bone, (excluding articular regions due to high prevalence and likelihood of confounding arthritic disease), maximum standardized uptake value (SUV) >1.5 for lesion size on CT ranging from 0.5-1.0 cm, or maximum SUV >2.5 for lesions >1.0 cm. Results: At baseline, 37/45(82.2%) patients had FDG-positive lesions and 8/45(17.8%) were negative. Median follow-up for longitudinal analysis is 30.1 months. Among initial FDG-negative patients, 7/8 (87.5%) patients remained negative throughout follow-up; 1/8 (12.5%) patients developed a sclerotic FDG-positive lesion deemed not to be progression (rib 5 SUV 1.7). Among the 37 patients with baseline FDG-positive lesions, 12/37(32.4%) patients had complete resolution of FDG-PET-CTs (FDG-responders); 25/37(67.5%) remained FDG-long-term positive at time of last protocol scan. Eight of the 25(32%) FDG-long-term positive patients met IMWG criteria for progression, compared to 0/12 FDG-responders (p value=0.04). For patients with available data, MRD negative status after initial CRd (prior to Len maintenance) was not associated with long-term PET-CT response [19/24(79.2%) vs. 8/11(72.7%), FDG-long-term positive vs. FDG-responders, p=NS]. For the remaining FDG-long-term positive patients not meeting progression criteria, all 17 patients had low-positive persistent FDG with decreased or partial SUV response that decreased over time while on Len maintenance. Conclusions: In patients receiving CRd followed by long-term Len maintenance, 68% of baseline FDG-positive patients have persistent longitudinal FDG-positive myeloma lesions. While there is an increased risk of clinical progression among these patients, the majority showed low-positive FDG lesion uptake that decreased over time with long-term Len maintenance. Long-term resolution of FDG-positive lesions is not associated with MRD status after initial CRd therapy. Further follow-up is needed to examine the significance of persistent FDG-positive lesions in relationship to residual disease and mechanisms of resistance. Figure Figure. Disclosures Korde: Medscape: Honoraria. Hassoun:Takeda: Consultancy, Research Funding; Celgene: Research Funding; Novartis: Consultancy; Binding Site: Research Funding. Landgren:Medscape Myeloma Program: Honoraria; BMS: Honoraria; Merck: Honoraria; Takeda: Honoraria; Amgen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding.

scholarly journals FDG-PET/CT in the Assessment of Treatment Response after Oncologic Treatment of Head and Neck Squamous Cell Carcinoma

2014 ◽  
Vol 7 ◽  
pp. CMENT.S16399 ◽  
Author(s):  
Harri Keski-Säntti ◽  
Timo Mustonen ◽  
Jukka Schildt ◽  
Kauko Saarilahti ◽  
Antti A. Mäkitie
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Treatment Response ◽  
Predictive Value ◽  
Fdg Pet ◽  
Residual Disease ◽  
Pet Ct ◽  
Fdg Pet Ct

Background In many centers, 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG–PET/CT) is used to monitor treatment response after definitive (chemo)radiotherapy [(C)RT] for head and neck squamous cell carcinoma (HNSCC), but its usefulness remains somewhat controversial. We aimed at assessing the accuracy of FDG-PET/CT in detecting residual disease after (C)RT. Method All HNSCC patients with FDG-PET/CT performed to assess treatment response 10–18 weeks after definitive (C)RT at our institution during 2008–2010 were included. The patient charts were reviewed for FDG-PET/CT findings, histopathologic findings, and follow-up data. The median follow-up time for FDG-PET/CT negative patients was 26 months. Results Eighty-eight eligible patients were identified. The stage distribution was as follows: I, n = 1; II, n = 15; III, n = 17; IV, n = 55. The negative predictive value, positive predictive value, specificity, sensitivity, and accuracy of FDG-PET/CT in detecting residual disease were 87%, 81%, 94%, 65%, and 85%, respectively. The corresponding specific figures for the primary tumor site were 91%, 71%, 94%, 59%, and 86% and for the neck 93%, 100%, 100%, 75%, and 94%, respectively. Conclusions In patients who have received definitive (C)RT for HNSCC, post-treatment FDG-PET/CT has good potential to guide clinical decision-making. Patients with negative scan can safely be followed up clinically only, while positive scan necessitates tissue biopsies or a neck dissection to rule out residual disease.

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