scholarly journals Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-216948
Author(s):  
Fiona J Gilbert ◽  
Scott Harris ◽  
Kenneth A Miles ◽  
Jonathan R Weir-McCall ◽  
Nagmi R Qureshi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Accuracy ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct ◽  
Sensitivity Specificity

IntroductionDynamic contrast-enhanced CT (DCE-CT) and positron emission tomography/CT (PET/CT) have a high reported accuracy for the diagnosis of malignancy in solitary pulmonary nodules (SPNs). The aim of this study was to compare the accuracy and cost-effectiveness of these.MethodsIn this prospective multicentre trial, 380 participants with an SPN (8–30 mm) and no recent history of malignancy underwent DCE-CT and PET/CT. All patients underwent either biopsy with histological diagnosis or completed CT follow-up. Primary outcome measures were sensitivity, specificity and overall diagnostic accuracy for PET/CT and DCE-CT. Costs and cost-effectiveness were estimated from a healthcare provider perspective using a decision-model.Results312 participants (47% female, 68.1±9.0 years) completed the study, with 61% rate of malignancy at 2 years. The sensitivity, specificity, positive predictive value and negative predictive values for DCE-CT were 95.3% (95% CI 91.3 to 97.5), 29.8% (95% CI 22.3 to 38.4), 68.2% (95% CI 62.4% to 73.5%) and 80.0% (95% CI 66.2 to 89.1), respectively, and for PET/CT were 79.1% (95% CI 72.7 to 84.2), 81.8% (95% CI 74.0 to 87.7), 87.3% (95% CI 81.5 to 91.5) and 71.2% (95% CI 63.2 to 78.1). The area under the receiver operator characteristic curve (AUROC) for DCE-CT and PET/CT was 0.62 (95% CI 0.58 to 0.67) and 0.80 (95% CI 0.76 to 0.85), respectively (p<0.001). Combined results significantly increased diagnostic accuracy over PET/CT alone (AUROC=0.90 (95% CI 0.86 to 0.93), p<0.001). DCE-CT was preferred when the willingness to pay per incremental cost per correctly treated malignancy was below £9000. Above £15 500 a combined approach was preferred.ConclusionsPET/CT has a superior diagnostic accuracy to DCE-CT for the diagnosis of SPNs. Combining both techniques improves the diagnostic accuracy over either test alone and could be cost-effective.Trial registration numberNCT02013063

scholarly journals Prospective Study on the Performance of 18F-DOPA Positron Emission Tomography/Computed Tomography in Patients with Medullary Thyroid Carcinoma

2022 ◽  
Author(s):  
Inés Califano ◽  
Fabian Pitoia ◽  
Roxana Chirico ◽  
Alejandra de Salazar ◽  
Maria Bastianello
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Distant Metastases ◽  
Emission Tomography ◽  
Medullary Thyroid ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct

Abstract Purpose 18F-DOPA Positron Emission Tomography/Computed Tomography (18F-DOPA PET/CT) is a sensitive functional imaging method (65-75%) for detecting disease localization in medullary thyroid cancer (MTC). We aimed: i) to assess the clinical usefulness of 18F-DOPA PET/CT in patients with MTC and elevated calcitonin (Ctn) and CEA levels and, ii) to evaluate changes in disease management secondary to the findings encountered with this methodology. Methods thirty-six patients with MTC and Ctn levels ≥150 pg/ml were prospectively included. Neck ultrasound, chest contrast-enhanced CT, liver magnetic resonance imaging/ abdominal 3-phase contrast-enhanced CT and bone scintigraphy were carried out up to 6 months before the 18F DOPA PET/CT. Results 77.7% were female and 27% had hereditary MTC. Median Ctn level was 1450 pg/ml [150-56620], median CEA level 413 ng/ml [2.9-7436]. Median Ctn DT was 37.5 months [5.7-240]; median CEA DT was 31.8 [4.9-180]. 18F-DOPA PET/CT was positive in 33 patients (91.6%); in 18 (56%) uptake was observed in lymph nodes in the neck or mediastinum, in 7 cases (22%) distant metastases were diagnosed, and in 8 additional patients (24%) both locoregional and distant sites of disease were found. Ctn and CEA levels were higher in patients with ≥ 3 foci of distant metastases. In 14 patients (38.8%), findings on 18F-DOPA PET/CT led to changes in management; surgery for locoregional lymph nodes was the most frequent procedure in 8 patients (22%). Conclusion 18F-DOPA PET/CT was useful for the detection of recurrent disease in MTC and provided helpful information for patient management.

scholarly journals Diagnostic Accuracy of PET/CT and Contrast Enhanced CT in Patients With Suspected Infected Aortic Aneurysms

2020 ◽  
Vol 59 (6) ◽  
pp. 972-981 ◽  
Author(s):  
Lars Husmann ◽  
Martin W. Huellner ◽  
Bruno Ledergerber ◽  
Nadia Eberhard ◽  
Marisa B. Kaelin ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Aortic Aneurysms ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct

scholarly journals Latissimus dorsi free flap reconstruction of major abdominal defect in treatment of giant Marjolin’s ulcer: a short report focused on preoperative imaging

2014 ◽  
Vol 3 (1) ◽  
pp. 204798161351661 ◽  
Author(s):  
Signe Muus Steffensen ◽  
Anders Thomassen ◽  
Jesper Poul Naested Jensen ◽  
Jens Ahm Soerensen
Keyword(s):  
Lymph Nodes ◽  
Ct Scan ◽  
Preoperative Imaging ◽  
Short Report ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct ◽  
Pet Ct Scan

We present a case of a 56-year-old man with a giant carcinoma in the abdominal wall. Based on positron emission tomography/computed tomography (PET/CT) scan there were FDG-avid lymph nodes in the ipsilateral axillary and groin, suspicious for metastases. At contrast-enhanced CT the parietal peritoneum seemed free of tumor invasion, which was essential to radical surgery planning. The tumor was completely removed with clear margins of resection and no metastasis in the resected lymph nodes. The PET/CT scan was repeated after 4 months, showing no signs of recurrence.

[18F]Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET)/Computed Tomography (CT) in Suspected Recurrent Breast Cancer: A Prospective Comparative Study of Dual-Time-Point FDG-PET/CT, Contrast-Enhanced CT, and Bone Scintigraphy

2016 ◽  
Vol 34 (16) ◽  
pp. 1889-1897 ◽  
Author(s):  
Malene Grubbe Hildebrandt ◽  
Oke Gerke ◽  
Christina Baun ◽  
Kirsten Falch ◽  
Jeanette Ansholm Hansen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Fdg Pet ◽  
Distant Recurrence ◽  
Receiver Operating Curve ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct ◽  
Fdg Pet Ct

Purpose To prospectively investigate the diagnostic accuracy of [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) with dual-time-point imaging, contrast-enhanced CT (ceCT), and bone scintigraphy (BS) in patients with suspected breast cancer recurrence. Patients and Methods One hundred women with suspected recurrence of breast cancer underwent 1-hour and 3-hour FDG-PET/CT, ceCT, and BS within approximately 10 days. The study was powered to estimate the precision of the individual imaging tests. Images were visually interpreted using a four-point assessment scale, and readers were blinded to other test results. The reference standard was biopsy along with treatment decisions and clinical follow-up (median, 17 months). Results FDG-PET/CT resulted in no false negatives and fewer false positives than the other imaging techniques. Accuracy of results were similar for 1-hour and 3-hour FDG-PET/CT. For distant recurrence, the area under the receiver operating curve was 0.99 (95% CI, 0.97 to 1) for FDG-PET/CT, 0.84 (95% CI, 0.73 to 0.94) for ceCT, and 0.86 (95% CI, 0.77 to 0.94) for the combined ceCT+BS. Of 100 patients, 22 (22%) were verified with distant recurrence, and 18 of these had bone involvement. Nineteen patients (19%) had local recurrence only. In exploratory analyses, diagnostic accuracy of FDG-PET/CT was better than ceCT alone or ceCT combined with BS in diagnosing distant, bone, and local recurrence, shown by a greater area under the receiver operating curve and higher sensitivity, specificity, and superior likelihood ratios. Conclusion FDG-PET/CT was accurate in diagnosing recurrence in breast cancer patients. It allowed for distant recurrence to be correctly ruled out and resulted in only a small number of false-positive cases. Exploratory findings suggest that FDG-PET/CT has greater accuracy than conventional imaging technologies in this patient group.

scholarly journals Solitary pulmonary nodule and 18F-FDG PET/CT. Part 2: accuracy, cost-effectiveness, and current recommendations

2016 ◽  
Vol 49 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Marcos Pretto Mosmann ◽  
Marcelle Alves Borba ◽  
Francisco Pires Negromonte de Macedo ◽  
Adriano de Araujo Lima Liguori ◽  
Arthur Villarim Neto ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pulmonary Nodule ◽  
Solitary Pulmonary Nodule ◽  
Radiographic Finding ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract A solitary pulmonary nodule is a common, often incidental, radiographic finding. The investigation and differential diagnosis of solitary pulmonary nodules remain complex, because there are overlaps between the characteristics of benign and malignant processes. There are currently many strategies for evaluating solitary pulmonary nodules. The main objective is to identify benign lesions, in order to avoid exposing patients to the risks of invasive methods, and to detect cases of lung cancer accurately, in order to avoid delaying potentially curative treatment. The focus of this study was to review the evaluation of solitary pulmonary nodules, to discuss the current role of 18F-fluorodeoxyglucose positron-emission tomography, addressing its accuracy and cost-effectiveness, and to detail the current recommendations for the examination in this scenario.

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