POS0822 NEW FACES OF POLYARTERITIS NODOSA: 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY FINDINGS IN A SERIES OF 10 PATIENTS

Background:18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is widely used in patients with large-vessel vasculitis (1). The benefits of FDG-PET/CT in polyarteritis nodosa (PAN) has only been assessed in a few case reports (2-3).Objectives:Our aim was to describe FDG-PET/CT findings in 10 patients with newly diagnosed PAN.Methods:This was a retrospective study of patients with PAN who underwent FDG-PET/CT at the time of diagnosis, between 2017 and 2020. The FDG-PET/CT data were analysed retrospectively and compared with clinical, biological, histological and conventional imaging data.Results:Ten patients were included: 9 men and 1 woman, median age of 67 (43–78) years. PAN was diagnosed according to ACR criteria (6) in 9 patients, and histologically in the remaining patient. The clinical manifestations were: systemic (n=10), muscular (n=6), joint (n=3), skin (n=3), peripheral nervous system (n=3), and gastrointestinal (n=2). All patients had high C-reactive protein levels (median, 223 mg/L). One patient had incomplete FDG-PET exploration. Three patients had begun corticosteroid therapy before their FDG-PET/CT scan. The main FDG-PET/CT abnormality was increased tracer uptake in the muscles, particularly in the connective tissue (perimysium, epimysium) (n=7), in linear (n=5) or focal (n=2) patterns. Increased FDG uptake in large-diameter vessels was observed in 4 patients, in the humeral (n=4), femoral (n=1) and the common interosseous (n=1) arteries. Nine patients had bone-marrow FDG uptake, six had splenic FDG uptake. Three patients had synovitis. Three had lymph-node uptake. One patient had subcutaneous FDG uptake, with a “leopard skin” appearance.Conclusion:FDG-PET/CT seems to be a useful non-invasive imaging technique for diagnosing PAN, particularly in patients with non-specific systemic features. Tracer uptake in muscular connective tissue seems to be a recurrent sign in patients with PAN.References:[1]Prieto-González S, Depetris M, García-Martínez A, Espígol-Frigolé G, Tavera-Bahillo I, Corbera-Bellata M et al. Positron emission tomography assessment of large vessel inflammation in patients with newly diagnosed, biopsy-proven giant cell arteritis: a prospective, case-control study. Ann Rheum Dis. 2014;73(7):1388-92.[2]Mino N, Yamashita H, Takahashi Y, Kaneko H. Polyarteritis Nodosa With Reversible FDG Accumulation in Vessels and Kidneys. Clin Nucl Med. 2019;44(11):889-891.[3]Schollhammer R, Schwartz P, Jullie ML, Pham-Ledard A, Mercie P, Fernandez P et al. 18F-FDG PET/CT Imaging of Popliteal Vasculitis Associated With Polyarteritis Nodosa. Clin Nucl Med. 2017;42(8):e385-e387.[4]Lightfoot RW Jr, Michel BA, Bloch DA, Hunder GG, Zvaifler NJ, McShane DJ et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum. 1990;33(8):1088-93.Disclosure of Interests:None declared

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

Journal of Endovascular Therapy ◽

10.1177/1526602820913888 ◽

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.

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OP0190 USEFULNESS OF 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY IN DIAGNOSING POLYMYALGIA RHEUMATICA AND LARGE-VESSEL VASCULITIS: A CASE-CONTROL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.780 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 114.2-115

Author(s):

A. Desvages ◽

F. Hives ◽

X. Deprez ◽

A. Pierache ◽

R. M. Flipo ◽

...

Keyword(s):

Positron Emission Tomography ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Emission Tomography ◽

Control Groups ◽

Fdg Uptake ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct ◽

And Control

Background:Polymyalgia rheumatica (PMR) is a relatively common disease among the elderly. None of the most common imaging techniques provides diagnostic certainty of PMR. 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) may be a useful candidate as it can be used to visualize articular and periarticular FDG uptake at different locations, as well as associated large-vessel vasculitis (LVV), but its usefulness needs to be evaluated in the absence of large-scale case-control studies.Objectives:The purpose of this study was to determine the usefulness of FDG-PET/CT in diagnosing PMR and LVV.Methods:We analysed FDG-PET/CT scans performed between January 2015 and December 2019 on patients diagnosed with PMR. For comparisons, patients with PMR were matched 1:1 to controls according to age and sex. FDG-PET/CT scans had been performed on controls over the same period for diagnosis of cancer-associated stroke. FDG uptake was scored visually using a semi-quantitative analysis (score 0-3) for 17 articular or periarticular sites, as described by Sondag et al. [1], and for 13 vascular sites, as described by Slart et al. [2]. The case and control groups were compared using generalized linear mixed models (binomial distribution, logit function) for binary outcomes, and linear mixed models for continuous outcomes, with matched sets as a random effect. The optimal threshold for the number of sites with significant hyperfixation (score ≥ 2) was determined by maximizing the Youden index.Results:81 patients with a diagnosis of PMR and 81 controls were included (mean (SD) age 70.7 (9.8) years; 44.4% women). We found significant differences between the PMR and control groups at all articular or periarticular sites for: 1) FDG uptake score (p<0.0001); 2) number of patients per site with significant FDG uptake (score ≥ 2) (p<0.0001); 3) global FDG articular uptake scores (score 0-51) (31 [IQR, 21 to 37] versus 6 [IQR, 3 to 10], p<0.001); and 4) number of sites with significant FDG uptake (score ≥ 2) (score 0-17) (11 [IQR, 7 to 13] versus 1 [IQR, 0 to 2], p<0.001). Using ROC curve analysis (Figure 1), we found that the presence of 6 or more sites with significant FDG uptake (≥ 2) was associated with the diagnosis of PMR with a sensitivity of 84% and a specificity of 96% (AUC 0.96 [95% CI 0.93-0.99]). No significant differences in global FDG vascular uptake scores (score 0-39) or in number of patients with at least 1 significant uptake vascular site (score ≥ 2) were found between the PMR and control groups (1 [IQR, 0 to 4] versus 4 [0 to 6], p=0.06 and 8 (11.3%) versus 10 (14.1%), p=0.62 respectively).Figure 1.ROC curve analyzing performance of FDG-PET/CT for the diagnosis of PMR according to the number of sites with significant FDG uptake (≥ 2)Conclusion:Our results demonstrate that the FDG uptake score and the number of sites with significant FDG uptake could be relevant criteria for the diagnosis of PMR. However, unlike other authors, we found no evidence suggesting that FDG-PET/CT may be useful in diagnosing silent underlying LVV in patients with isolated PMR.References:[1]Sondag M, Guillot X, Verhoeven F, Blagosklonov O, Prati C, Boulahdour H, et al. Utility of 18F-fluoro-dexoxyglucose positron emission tomography for the diagnosis of polymyalgia rheumatica: a controlled study. Rheumatology (Oxford). 2016;55(8):1452-7.[2]Slart RHJA, Writing group, Reviewer group, Members of EANM Cardiovascular, Members of EANM Infection & Inflammation, Members of Committees, SNMMI Cardiovascular, Members of Council, PET Interest Group, et al. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging. 2018;45(7):1250-69.Disclosure of Interests:None declared

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INTRAOSSEOUS SARCOIDOSIS MIMICKING AS BONE METASTASES ON 18F- FDG PET/CT

Journal of Cancer & Allied Specialties ◽

10.37029/jcas.v1i1.16 ◽

2015 ◽

Vol 1 (1) ◽

Author(s):

Saima Muzahir ◽

Scott Perlman ◽

Thomas Warner ◽

Lance T Hall

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Proximal Femur ◽

Fdg Pet ◽

Tracer Uptake ◽

Emission Tomography ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

A 62-year-old male with known prostate cancer underwent 18F- uorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) scan for suspected osseous metastases after a magnetic resonance imaging of the pelvis, done for chronic low back pain and demonstrated a number of suspicious T1 hypointense/T2 hyperintense lesions in the sacrum, iliac bones and right proximal femur.18F-FDG PET/CT showed abnormal foci of increased tracer uptake in the sacrum, iliac bones and right proximal femur. Core biopsies from the sacrum were performed, showing intertrabecular non-caseating granulomata with surrounding small lymphocytes. Acid-fast bacilli and Gomori methenamine silver stains were negative, consistent with intraosseous sarcoidosis. Key words: 18F- uorodeoxyglucose positron emission tomography/computed tomography, non-caseating granulomata, sarcoidosis

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POSITRON EMISSION TOMOGRAPHY WITH 18F -FDG IN THE DIAGNOSIS OF PROSTHETIC HEART VALVE ENDOCARDITIS

Emergency Cardiology and Cardiovascular Risks ◽

10.51922/2616-633x.2021.5.2.1151 ◽

2021 ◽

Vol 5 (1) ◽

pp. 1151-1160

Author(s):

A.S. Lukashevich ◽

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Fdg Pet ◽

Prosthetic Heart Valve ◽

Emission Tomography ◽

Whole Body ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Purpose. The purpose of the article is to evaluate the diagnostic significance of positron emission tomography / computed tomography with 18F -fluorodeoxyglucose (18F -FDG PET/CT) for the diagnosis of prosthetic endocarditis. Methods of research. The study included 82 patients with suspected prosthetic endocarditis in accordance with the criteria proposed by Duke University [1-5]. The patients received hospital treatment at the State Institution RSPC "Cardiology" from January 2016 to March 2021. The study was of a prospective, non-randomized, single-center cohort design. The duration of the monitor period was 12 months from the moment of patients’ inclusion in the study. Whole-body positron emission tomography / computed tomography (PET/CT) examinations were performed in 82 patients. 27 patients were selected for surgical treatment. Conservative treatment group included 16 patients. 27 patients were selected into the observation group, they were suspected to have prosthetic heart valve infection in the primary referral and underwent PET/CT scanning, according to which the diagnosis of prosthetic endocarditis was excluded. The event under the study did not develop in this group during the year of observation. Results and conclusion. The history of infective endocarditis was not statistically significant and did not increase the risk of developing prosthetic endocarditis in the sample presented. The Duke criteria are less reliable in establishing the diagnosis of prosthetic endocarditis. The median number of days from the date of the first prosthesis implantation to the onset of prosthetic endocarditis was about 4 years. This study revealed that the development of the infectious process in the area of the prosthesis was noted in a more distant postoperative period compared to literature data. Histological confirmation of infection was noted in 100% (27 patients) of cases in reoperated patients. The presence of a more formidable complication such as valve ring abscess located mainly in the projection of the aortic valve ring was quite common in both groups. Presepsin and Interleukin-6 have a statistically significant (U = 394,50 p = 0,01 and U = 94,50 p = 0.004) value in the prognosis of prosthetic endocarditis. Considering the data obtained from ROC analysis, it can be said that the cut-off point at which it is possible to diagnose prosthetic endocarditis based on PETCT is 2.85. The presented methods for the interpretation of whole-body FDG-PET/CT images of patients with suspected infectious complications after cardiac surgery, as well as with the presence of prosthetic endocarditis, show high sensitivity and specificity.

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Combined [18F]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) for Detection of Recurrent, 131I-Negative Thyroid Cancer

Yearbook of Otolaryngology-Head and Neck Surgery ◽

10.1016/s1041-892x(09)79354-0 ◽

2009 ◽

Vol 2009 ◽

pp. 15-16

Author(s):

M. Gapany

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Thyroid Cancer ◽

Fdg Pet ◽

Emission Tomography ◽

Fluorodeoxyglucose Positron Emission Tomography ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct ◽

Fluorodeoxyglucose Positron Emission

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Clinical Value of Fluorine-18 2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography in Bladder Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.7052 ◽

2010 ◽

Vol 28 (25) ◽

pp. 3973-3978 ◽

Cited By ~ 93

Author(s):

Andrea B. Apolo ◽

Jamie Riches ◽

Heiko Schöder ◽

Oguz Akin ◽

Alisa Trout ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Bladder Cancer ◽

Sensitivity And Specificity ◽

Fdg Pet ◽

Malignant Disease ◽

Emission Tomography ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct

Purpose Fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been approved for imaging in many malignancies but not for bladder cancer. This study investigated the value of FDG-PET/CT imaging in the management of patients with advanced bladder cancer. Patients and Methods Between May 2006 and February 2008, 57 patients with bladder cancer at our center underwent FDG-PET/CT after CT (n = 52) or magnetic resonance imaging (MRI; n = 5). The accuracy of FDG-PET/CT was assessed using both organ-based and patient-based analyses. FDG-PET/CT findings were validated by either biopsy or serial CT/MRI. Clinician questionnaires performed before and after FDG-PET/CT assessed whether those scan results affected management. Results One hundred thirty-five individual lesions were evaluable in 47 patients for the organ-based analysis. Overall sensitivity and specificity were 87% (95% CI, 76% to 94%) and 88% (95% CI, 78% to 95%), respectively. In the patient-based analysis, malignant disease was correctly diagnosed in 25 of 31 patients, resulting in a sensitivity of 81% (95% CI, 63% to 93%). FDG-PET/CT was negative in 15 of 16 patients without malignant lesions for a specificity of 94% (95% CI, 71% to 100%). Pre- and post-PET surveys revealed that FDG-PET/CT detected more malignant disease than conventional CT/MRI in 40% of patients. Post-PET surveys showed that clinicians changed their planned management in 68% of patients based on the FDG-PET/CT results. Conclusion FDG-PET/CT has excellent sensitivity and specificity in the detection of metastatic bladder cancer and provides additional diagnostic information that enhances clinical management more than CT/MRI alone. FDG-PET/CT scans may provide better accuracy in clinical information for directing therapy.

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Clinical Impact of 18F-FDG PET/CT in the Diagnostic Workup of Pancreatic Ductal Adenocarcinoma: A Systematic Review

Diagnostics ◽

10.3390/diagnostics10121042 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1042

Author(s):

Annachiara Arnone ◽

Riccardo Laudicella ◽

Federico Caobelli ◽

Priscilla Guglielmo ◽

Marianna Spallino ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Pancreatic Ductal Adenocarcinoma ◽

Fdg Pet ◽

Emission Tomography ◽

Ductal Adenocarcinoma ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

In this review, the performance of fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in the diagnostic workup of pancreatic ductal adenocarcinoma (PDAC) is evaluated. A comprehensive literature search up to September 2020 was performed, selecting studies with the presence of: sample size ≥10 patients and index test (i.e., “FDG” or “18F-FDG” AND “pancreatic adenocarcinoma” or “pancreas cancer” AND “PET” or “positron emission tomography”). The methodological quality was evaluated using the revised quality assessment of diagnostic accuracy studies (QUADAS-2) tool and presented according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Basic data (authors, year of publication, country and study design), patients’ characteristics (number of enrolled subjects and age), disease phase, type of treatment and grading were retrieved. Forty-six articles met the adopted research criteria. The articles were divided according to the considered clinical context. Namely, besides conventional anatomical imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), molecular imaging with FDG PET/CT is an important tool in PDAC, for all disease stages. Further prospective studies will be necessary to confirm the cost-effectiveness of such imaging techniques by testing its real potential improvement in the clinical management of PDAC.

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Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography: A Novel Approach for the Diagnosis of Cholecystitis for Equivocal Diagnoses after Ultrasound Imaging

The American Surgeon ◽

10.1177/000313481207801022 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1109-1113

Author(s):

Yosef Nasseri ◽

Ariel J. Ourian ◽

Alan Waxman ◽

Alessandro D'Angolo ◽

Louise E. Thomson ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Fdg Pet ◽

Emission Tomography ◽

Fluorodeoxyglucose Positron Emission Tomography ◽

Hida Scan ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct ◽

Fluorodeoxyglucose Positron Emission

Although hepatobiliary iminodiacetic acid (HIDA) scan is often used when the diagnosis of cholecystitis remains questionable after ultrasound, it carries a high false-positive rate and has other limitations. Fluorodeoxyglucose positron emission tomography–computed tomography (18FDG PET-CT) has recently gained enthusiasm for its ability to detect infection and inflammation. In this study, we evaluate the accuracy of 18FDG PET-CT in diagnosing cholecystitis. Nineteen patients with suspected cholecystitis (Group S) underwent PET-CT and 10 had positive PET-CT findings. Of these 10, nine underwent cholecystectomies, and pathology confirmed cholecystitis in all nine. One patient was managed nonoperatively as a result of multiple comorbidities. Of the nine patients with negative PET-CT, six were managed nonoperatively, safely discharged, and had no readmissions at 3-month follow-up. The other three patients with negative PET-CT underwent cholecystectomies, and two showed no cholecystitis on pathology. The third had mild to moderate cholecystitis with focal mucosal erosion/ulceration without gallbladder wall thickening on pathology. 18FDG PET-CT detected gallbladder inflammation in all but one patient with pathology-proven cholecystitis with a sensitivity and specificity of 0.90 and 1.00, respectively. 18FDG-PET-CT appears to be a promising, rapid, direct, and accurate test in diagnosing cholecystitis and could replace HIDA scan in cases that remain equivocal after ultrasound.

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18F-fluorodeoxyglucose positron emission tomography is useful for the diagnosis of intraocular sarcoidosis in patients with a normal CT scan

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313133 ◽

2019 ◽

Vol 103 (11) ◽

pp. 1650-1655 ◽

Cited By ~ 2

Author(s):

Pierre Chauvelot ◽

Andrea Skanjeti ◽

Yvan Jamilloux ◽

Audrey de Parisot ◽

Christiane Broussolle ◽

...

Keyword(s):

Positron Emission Tomography ◽

Ct Scan ◽

Predictive Factors ◽

Fdg Pet ◽

Emission Tomography ◽

Fluorodeoxyglucose Positron Emission Tomography ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct ◽

Fluorodeoxyglucose Positron Emission

AimTo assess the usefulness of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) and the predictive factors for the diagnosis of sarcoidosis in patients with uveitis who have normal thoracic tomography.MethodsWe retrospectively reviewed 67 consecutive patients with uveitis of unknown aetiology or a suspected sarcoidosis. All patients with normal thoracic tomography underwent an 18F-FDG PET/CT, which was blindly reinterpreted. We then assessed the proportion of positive 18F-FDG PET/CT and the impact on the final aetiology, using Abad’s criteria for the diagnosis of intraocular sarcoidosis.Results19 of the 67 patients (28.4%) had mediastinal hypermetabolic foci on their 18F-FDG PET/CT consistent with sarcoidosis. It identified a biopsy site in two cases, which were consistent with sarcoidosis. At the end of the study, six patients (10%) had a proven sarcoidosis, six patients (9%) were considered as having a presumed sarcoidosis and 18 patients (26.9%) as having indeterminate sarcoidosis. 18F-FDG PET/CT enabled the diagnosis of presumed sarcoidosis in these six patients. An older age at diagnosis (p=0.004) and the presence of synechiae (p=0.02) were significantly related to an abnormal 18F-FDG PET/CT, with a trend for an elevated ACE (p=0.0993). We established a nomogram to estimate the probability of having positive findings on the 18F-FDG PET/CT according to different predictive factors.Conclusion18F-FDG PET/CT enabled the diagnosis of intraocular sarcoidosis even in patients with a normal CT scan. Older age at diagnosis, presence of synechiae and elevated ACE are associated with positive findings on 18F-FDG PET/CT consistent with sarcoidosis.

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