Abstract 5825: Association between Patterns of FDG Uptake and Arterial Wall Calcification on PET/CT and Atherogenic Risk Factors in Healthy Subjects

Background: Augmented metabolic activity of macrophages leads to enough F-18 Fluorodeoxyglucose (FDG) uptake to allow visualization by positron emission tomography (PET). A large body of data, based on computed tomography (CT), has also accumulated concerning the relevance of vascular calcification to the atherosclerotic process. FDG PET/CT can localize both inflammatory changes and vascular calcification. The purpose of this study was to investigate risk factors contributing to these changes in the aorta in healthy subjects. Materials and Methods: A total of 66 consecutive healthy subjects (44 men, 22 women; age range, 30–82 years, mean age, 55.8 years) participating in a health check protocol including FDG PET/CT were evaluated retrospectively. We placed regions of interest on the arterial wall to measure FDG uptake by PET images. To assess arterial calcification, the calcium score of the aorta was measured on CT images. Results: FDG uptake was observed most commonly in proximal, followed by descending, thoracic, and abdominal segments. On the other hand, the most common site of vascular calcification was the descending thoracic aorta, followed by abdominal and, proximal segment. Whole aortic calcification (total calcium score of the whole aorta) was significantly correlated with age (r= 0.353, P= 0.004). On the other hand, FDG uptake (total SUV max of the whole aorta) was significantly correlated with systolic blood pressure (SBP) (r= 0.303, P= 0.013), triglyceride (TG) (r= 0.281, P= 0.022), fasting plasma glucose (FPG) (r= 0.317, P= 0.010), HbA1c (r= 0.433, P< 0.001), visceral abdominal fat area (r= 0.319, P= 0.005), and was negatively correlated with high density lipoprotein (HDL) (r= −0.317, P= 0.010), and adiponectin (r= −0.273, P= 0.029). Conclusions: Aortic calcification was significantly correlated with age. On the other hand, FDG uptake was significantly correlated with the components of metabolic syndrome such as SBP, TG, FPG, HbA1c, visceral adipose fat area and negatively correlated with HDL and adiponectin, but not with age. Our results may suggest that the components of metabolic syndrome and aging affect the progression of atherosclerosis differently.

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Prognostic parameters in recurrent colorectal cancer: A role of control or restaging by FDG-PET/CT

Vojnosanitetski pregled ◽

10.2298/vsp170817065h ◽

2020 ◽

Vol 77 (2) ◽

pp. 201-208

Author(s):

Oguz Hancerliogullari ◽

Kursat Okuyucu ◽

Semra Ince ◽

Subutay Peker ◽

Nuri Arslan

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Fdg Pet ◽

Tumor Differentiation ◽

Fdg Uptake ◽

Pet Ct ◽

Serum Carcinoembryonic Antigen ◽

Malignant Group ◽

Fdg Pet Ct ◽

Benign Group

Background/Aim. Colorectal cancer ranks the third most frequent cancer in the world. Approximately 40% of the disease recurs after surgical resection. Determination of predictive parameters for recurrence may help in stratification of patients and contribute to patient management. There are still very few studies which sought factors to predict the recurrence of colorectal cancer. The aim of this study was to examine the predefined risk factors in metastatic development and evaluate clinical significance of 18Ffluorodeoxyglucose (FDG) uptake. Methods. The study was conducted with 56 patients for whom FDG-PET/CT (FDG-positron emission tomography/computed tomography) was requested for the suspicious recurrence or metastasis by routine conventional screening tests. Thirty three patients in whom recurrence/metastases were established with final histopathologic diagnosis formed the malignant group, and 23 patients with no recurrence/metastases formed the benign group. Risk factors [age, serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (Ca 19-9) levels, the maximum standardized uptake volume (SUVmax), tumor size (TS), CT/magnetic resonance imaging (MRI) findings, sex, primary tumor localization, lymphovascular invasion, perineural invasion (PNI), initial neoadjuvant therapy, lymph node initial metastasis (ILNM) excision, stage, tumor differentiation] were compared between these groups. Results. CEA, Ca 19-9, SUVmax, TS, PNI, ILNM, FDG uptake pattern, pattern of lesions on CT and tumor differentiation were found statistically significant by univariate analysis. After multivariate analysis, SUVmax and ILNM remained as the main risk parameters impacting recurrence/metastases. Mean SUVmax was 7.25 in the benign group, while it was 11.7 in the malignant group (p = 0.019). ILNM was present in 66.5% of patients in the malignant group, and in 30.5% of patients in the benign group (p = 0.015). For an estimated cut-off value of 6.3 and 12.5, respectively on ROC curve, the calculated specificities were 61% and 87%, respectively. Conclusion. ILNM and SUVmax are the main risk factors for recurrence of colorectal cancer and the patients with these factors must be followed up carefully. FDG-PET/CT is very sensitive for the detection of recurrence/metastases of colorectal cancer and SUVmax appears to improve its specificity.

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Effect of Statin Therapy on Arterial Wall Inflammation Based on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis of Interventional Studies

Journal of Clinical Medicine ◽

10.3390/jcm8010118 ◽

2019 ◽

Vol 8 (1) ◽

pp. 118 ◽

Cited By ~ 16

Author(s):

Matteo Pirro ◽

Luis Simental-Mendía ◽

Vanessa Bianconi ◽

Gerald Watts ◽

Maciej Banach ◽

...

Keyword(s):

Statin Therapy ◽

Fdg Pet ◽

Arterial Wall ◽

Meta Analysis ◽

Statin Treatment ◽

Fdg Uptake ◽

Pet Ct ◽

18F Fdg ◽

Anti Inflammatory ◽

Fdg Pet Ct

Aim. To evaluate by meta-analysis of interventional studies the effect of statin therapy on arterial wall inflammation. Background. Arterial exposure to low-density lipoprotein (LDL) cholesterol levels is responsible for initiation and progression of atherosclerosis and arterial wall inflammation. 18F-fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (18F-FDG PET/CT) has been used to detect arterial wall inflammation and monitor the vascular anti-inflammatory effects of lipid-lowering therapy. Despite a number of statin-based interventional studies exploring 18F-FDG uptake, these trials have produced inconsistent results. Methods. Trials with at least one statin treatment arm were searched in PubMed-Medline, SCOPUS, ISI Web of Knowledge, and Google Scholar databases. Target-to-background ratio (TBR), an indicator of blood-corrected 18F-FDG uptake, was used as the target variable of the statin anti-inflammatory activity. Evaluation of studies biases, a random-effects model with generic inverse variance weighting, and sensitivity analysis were performed for qualitative and quantitative data assessment and synthesis. Subgroup and meta-regression analyses were also performed. Results. Meta-analysis of seven eligible studies, comprising 10 treatment arms with 287 subjects showed a significant reduction of TBR following statin treatment (Weighted Mean Difference (WMD): −0.104, p = 0.002), which was consistent both in high-intensity (WMD: −0.132, p = 0.019) and low-to-moderate intensity statin trials (WMD: −0.069, p = 0.037). Statin dose/duration, plasma cholesterol and C-reactive protein level changes, and baseline TBR did not affect the TBR treatment response to statins. Conclusions. Statins were effective in reducing arterial wall inflammation, as assessed by 18F-FDG PET/CT imaging. Larger clinical trials should clarify whether either cholesterol-lowering or other pleiotropic mechanisms were responsible for this effect.

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Crossed cerebellar diaschisis: risk factors and prognostic value in focal cortical dysplasia by 18F-FDG PET/CT

Annals of Nuclear Medicine ◽

10.1007/s12149-021-01613-8 ◽

2021 ◽

Author(s):

Yaqin Hou ◽

Kun Guo ◽

Xiaotong Fan ◽

Kun Shang ◽

Jingjuan Wang ◽

...

Keyword(s):

Risk Factors ◽

Fdg Pet ◽

Prognostic Value ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Crossed Cerebellar Diaschisis ◽

Pet Ct ◽

Cerebellar Diaschisis ◽

18F Fdg ◽

Fdg Pet Ct

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Quantitative analysis of myocardial metabolic heterogeneity is superior to visual assessment for the detection of active cardiac sarcoidosis by F-18 FDG PET-CT imaging

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.345 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

M Malik ◽

M Yazdani ◽

SM Gould ◽

E Reyes

Keyword(s):

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Visual Assessment ◽

Ct Imaging ◽

Myocardial Inflammation ◽

Fdg Uptake ◽

Pet Ct ◽

Metabolic Heterogeneity ◽

Fdg Pet Ct

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial inflammation may occur in the context of a multisystem disease such as sarcoidosis, adversely affecting prognosis. A definitive diagnosis of cardiac sarcoidosis (CS) is essential to implementing life-saving treatment but this is complicated by the invasive nature of endomyocardial biopsy (EMB) and its low accuracy. Positron emission tomography (PET) assists in diagnosis, which relies on visual interpretation of myocardial F-18 FDG uptake. The value of quantitative analysis and its application to clinical practice remain uncertain. Purpose To investigate the power of quantitative F-18 FDG PET-CT imaging analysis for detecting CS in patients with suspected disease. Methods All patients underwent F-18 FDG PET-CT after a 24-hour low-carbohydrate diet and 15-hour fasting as part of their diagnostic work-up for suspected cardiac inflammation. Cardiovascular magnetic resonance acted as gatekeeper to PET-CT in 8 of every 10 scans. Myocardial F-18 FDG uptake was assessed qualitatively and quantitatively using both manually drawn regions of interest and automatic polar maps to measure global and segmental standardised F-18 FDG uptake values (SUV). The coefficient of variation (CoV) was calculated to determine uptake heterogeneity. To confirm diagnosis, follow-up data regarding disease progression, further testing and treatment were collected. To allow for sufficient follow-up time, the first 40 consecutive patients from a prospective registry (n= 214; Sep 2017-Jun 2020) were included. Results A comprehensive clinical picture was obtained successfully in 37 patients (median [IQR], 17 [13.5] months) and a final diagnosis of CS reached in 7 (disease prevalence, 19%). EMB was performed in 2 patients only while 3 underwent PPM/ICD implantation. Significant predictors of CS were fulfilment of Japanese Ministry of Health and Welfare criteria (Wald, 6.44; p = 0.01) and left ventricular dysfunction (Wald 6.72; p = 0.01). Qualitative F-18 FDG PET-CT had a high negative (95%) but low positive (45%) predictive value for CS (sensitivity, 83%; specificity, 77%). F-18 FDG SUV CoV was the strongest imaging predictor (Wald, 6.77; p = 0.009) and was significantly higher in CS than non-CS (CoV median [quartiles], 0.26 [0.21, 0.36] and 0.12 [0.11, 0.14] respectively; p = 0.004). As per ROC curve analysis (AUC, 0.84), a CoV threshold of 0.20 was highly specific (93%) and sensitive (86%) for CS. Conclusion In a referring population with a low prevalence of cardiac sarcoidosis, F-18 FDG PET-CT imaging is sensitive for the detection of myocardial inflammation with active disease unlikely in patients with a negative scan. Quantitative evaluation of metabolic heterogeneity within the myocardium provides a strong, independent marker of active disease and should be considered alongside visual assessment.

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Long-Term Follow-Up of Thyroid Incidentalomas Visualized with 18F-Fluorodeoxyglucose Positron Emission Tomography—Impact of Thyroid Scintigraphy in the Diagnostic Work-Up

Diagnostics ◽

10.3390/diagnostics11030557 ◽

2021 ◽

Vol 11 (3) ◽

pp. 557

Author(s):

Kirsten Korsholm ◽

Michala Reichkendler ◽

Louise Alslev ◽

Åse Krogh Rasmussen ◽

Peter Oturai

Keyword(s):

Emission Tomography ◽

Thyroid Scintigraphy ◽

Fdg Uptake ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Diagnostic Work ◽

Fdg Pet Ct ◽

Work Up ◽

Diagnostic Work Up

Our objective was to evaluate the frequency of malignancy in incidental thyroidal uptake on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in a cohort of Danish patients, and furthermore to evaluate the impact of thyroid scinti-graphy in the diagnostic work-up. All whole-body PET/CT reports from 1 January 2010 to 31 December 2013 were retrospectively reviewed and further analyzed if visually increased thyroidal FDG uptake was reported. Patient electronic files were searched for further thyroid evaluation. Of 13,195 18F-FDG-PET/CT scans in 9114 patients, 312 PET/CT reports mentioned incidental thyroid FDG-uptake, and 279 patients were included in the study (3.1%). The thyroid was further investigated in 137 patients (49%), and 75 patients underwent thyroid scintigraphy. A total of 57 patients had a thyroid biopsy and 21 proceeded to surgery. Surgical specimens displayed malignancy in 10 cases, and one thyroid malignancy was found by autopsy. Hence, 11 patients were diagnosed with thyroid malignancies among 279 patients with incidental thyroid 18F-FDG uptake (3.9%). In 34 patients, a biopsy was avoided due to the results of the thyroid scintigraphy. We conclude that patients with thyroid incidentalomas can benefit from further diagnostic work-up including a thyroid scintigraphy.

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Traumatic myositis ossificans: multifocal lesions suggesting malignancy on FDG-PET/CT—a case report

Skeletal Radiology ◽

10.1007/s00256-020-03521-w ◽

2020 ◽

Vol 50 (1) ◽

pp. 249-254

Author(s):

Miho Sasaki ◽

Yuka Hotokezaka ◽

Reiko Ideguchi ◽

Masataka Uetani ◽

Shuichi Fujita

Keyword(s):

Case Report ◽

Fdg Pet ◽

Myositis Ossificans ◽

Whole Body ◽

Left Cheek ◽

Multiple Fractures ◽

Fdg Uptake ◽

Pet Ct ◽

Multiple Regions ◽

Fdg Pet Ct

AbstractMyositis ossificans (MO) is a benign soft-tissue lesion characterized by the heterotopic formation of the bone in skeletal muscles, usually due to trauma. MO is occasionally difficult to diagnose because of its clinical and radiological similarities with malignancy. We report a case of traumatic MO (TMO) in the masseter and brachial muscles of a 37-year-old man who presented with painless swelling in the left cheek and severe trismus. Due to the absence of a traumatic history at the first consultation and identification of a tumorous lesion in the left masseter muscle by magnetic resonance imaging (MRI), the lesion was suspected to be a malignant tumor. Subsequently, 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) showed multiple regions of high FDG uptake across the whole body, suggestive of multiple metastases or other systemic diseases. However, intramuscular calcifications were also observed in the left masseter and brachial muscles, overlapping the areas with high FDG uptake. Moreover, multiple fractures were seen in the rib and lumbar spine, also overlapping the areas with high FDG uptake. Based on these imaging findings, along with a history of jet-ski trauma, TMO was suspected. The left cheek mass was surgically excised and histologically diagnosed as TMO. In this case report, FDG-PET/CT could detect multiple TMOs across the whole body. To the best of our knowledge, cases of multiple TMOs located far apart in different muscles are rare, and this may be the first report.

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Pulmonary Findings of [18F]FDG PET/CT Images on Asymptomatic COVID-19 Patients

Pathogens ◽

10.3390/pathogens10070839 ◽

2021 ◽

Vol 10 (7) ◽

pp. 839

Author(s):

Tzu-Chuan Ho ◽

Chin-Chuan Chang ◽

Hung-Pin Chan ◽

Ying-Fong Huang ◽

Yi-Ming Arthur Chen ◽

...

Keyword(s):

Systematic Review ◽

Fdg Pet ◽

Standardized Uptake Value ◽

Fdg Uptake ◽

Asymptomatic Patients ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Maximal Standardized Uptake Value ◽

Fdg Pet Ct

During the coronavirus disease 2019 (COVID-19) pandemic, several case studies demonstrated that many asymptomatic patients with COVID-19 underwent fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) examination for various indications. However, there is a lack of literature to characterize the pattern of [18F]FDG PET/CT imaging on asymptomatic COVID-19 patients. Therefore, a systematic review to analyze the pulmonary findings of [18F]FDG PET/CT on asymptomatic COVID-19 patients was conducted. This systematic review was performed under the guidelines of PRISMA. PubMed, Medline, and Web of Science were used to search for articles for this review. Articles with the key words: “asymptomatic”, “COVID-19”, “[18F]FDG PET/CT”, and “nuclear medicine” were searched for from 1 January 2020 to 20 May 2021. Thirty asymptomatic patients with COVID-19 were included in the eighteen articles. These patients had a mean age of 62.25 ± 14.85 years (male: 67.71 ± 12.00; female: 56.79 ± 15.81). [18F]FDG-avid lung lesions were found in 93.33% (28/30) of total patients. The major lesion was [18F]FDG-avid multiple ground-glass opacities (GGOs) in the peripheral or subpleural region in bilateral lungs, followed by the consolidation. The intensity of [18F]FDG uptake in multiple GGOs was 5.605 ± 2.914 (range from 2 to 12) for maximal standardized uptake value (SUVmax). [18F]FDG-avid thoracic lymph nodes (LN) were observed in 40% (12/40) of the patients. They mostly appeared in both mediastinal and hilar regions with an SUVmax of 5.8 ± 2.93 (range from 2.5 to 9.6). The [18F]FDG uptake was observed in multiple GGOs, as well as in the mediastinal and hilar LNs. These are common patterns in PET/CT of asymptomatic patients with COVID-19.

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Abstract 14789: Multimodality Imaging in Mycobacterium Chimaera Cardiovascular Infections

Circulation ◽

10.1161/circ.142.suppl_3.14789 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nicholas Y Tan ◽

Alex D Tarabochia ◽

Omar M Abu Saleh ◽

Courtney Bennett

Keyword(s):

Aortic Valve ◽

Prosthetic Valve ◽

Multimodality Imaging ◽

Fluid Collection ◽

Prosthetic Valve Endocarditis ◽

The Other ◽

Aortic Prosthesis ◽

Fdg Uptake ◽

Valve Conduit ◽

Pet Ct

Introduction: Mycobacterium Chimaera (MC) infections following cardiovascular surgery are challenging to diagnose given their insidious presentation. We therefore reviewed the various imaging modalities used to diagnose these infections at Mayo Clinic. Methods: Cases from 01/01/2010-06/01/2020 were identified using electronic medical records. Demographics and clinical history were collected. Imaging studies, including transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), positron emission tomography / computed tomography (PET/CT), cardiac CT (CCT), and cardiac magnetic resonance (CMR) were reviewed. Results: A total of 7 patients (85.7% male) were found. 6 underwent aortic valve replacement and 1 received an aortic composite valve conduit. Surgical dates ranged from 01/2010-12/2018. Mean age at presentation was 63.3 years. Mean time from surgery to symptom onset was 28.0 months. All patients underwent TTE and TEE; prosthetic valve endocarditis was identified in 6 cases between both, while CMR established the diagnosis in 1 case. TTE showed prosthetic valve obstruction in 2 cases and an anterior pseudoaneurysm in 1 case. TEE findings included thickened prosthesis and/or vegetations (n=5), thickened posterior root (n=4), and root abscess (n=3). Among the 3 patients who underwent PET/CT, 2 demonstrated increased fluorodeoxyglucose (FDG) uptake around the aortic prosthesis; in addition, 1 had elevated FDG uptake in the myocardium suggesting myocarditis. 1 patient did not have aortic prosthesis FDG uptake. In the 2 patients who had CCT, 1 showed a pseudoaneurysm that prompted suspicion for endocarditis, and the other revealed a fluid collection adjacent to the aortic valve conduit. 2 patients underwent CMR; 1 had aortic prosthesis thickening and patchy areas of myocardial delayed enhancement suspicious for myocarditis, whereas the other showed vegetation and an aortic root abscess. Conclusion: TTE plus TEE successfully identified MC prosthetic valve endocarditis in most cases with TEE having higher specificity. Advanced imaging techniques are helpful to support the diagnosis and assess for myocardial and/or aortic involvement. Combining these modalities is therefore crucial in unveiling this elusive organism.

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