scholarly journals Comparison of F18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Dynamic Contrast-Enhanced Magnetic Resonance Imaging as Markers of Graft Viability in Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 47 (1) ◽  
pp. 88-95 ◽  
Author(s):  
Siva Srivastava Garika ◽  
Anshul Sharma ◽  
Abdul Razik ◽  
Akshima Sharma ◽  
Ravindra Mohan Pandey ◽  
...  

Background: F18-fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT) can be used to assess changes in the metabolism of an anterior cruciate ligament (ACL) graft as it is undergoing “ligamentization.” Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the preferred modality for noninvasive assessment of graft structure and graft vascularity. Purpose: To compare the use of F18-FDG PET/CT and DCE-MRI to assess ligamentization within the ACL graft and correlate the results with clinical tests. Study Design: Case series; Level of evidence, 4. Methods: Among 30 recruited patients, 27 patients (3 females and 24 males) completed 2 follow-up assessments at a mean of 125 ± 22 days and 259 ± 38 days after arthroscopic ACL reconstruction. At both assessments, anterior drawer test, Lachman test, and Lysholm scoring (LS) were conducted. Images from F18-FDG PET/CT and MRI were analyzed qualitatively and quantitatively (maximum standardized uptake value [SUVmax], SUVmax ratio to the contralateral side [SUVmax CL], normalized enhancement [NE]) in 3 zones: femoral, intra-articular (IA), and tibial. Of the 27 recruited patients, 1 patient had reinjury due to a fall. Therefore, 26 patients were considered for the final analysis. Results: A significant improvement ( P = .0001) was found in median LS, from 78.5 (range, 62-90) to 94.5 (range, 84-100), at the second follow-up. All grafts were found to be viable on PET/CT and vascularized on MRI. All grafts were seen as continuous on MRI, with exception of 1 graft at the second follow-up. Dynamic MRI identified single-vessel supply to all of the grafts at the first follow-up and multiple-vessel supply in 10 patients at the second follow-up. Reduction in the median SUVmax, SUVmax CL, and NE at second follow-up was seen in all 3 zones. Only SUVmax CL in the IA zone showed a significant reduction ( P = .032); patients with excellent LS at the second follow-up showed significantly higher reduction ( P = .005) than patients with good LS. NE in the IA zone was correlated (0.39; P = .048) with LS only at the first follow-up, whereas SUVmax CL (–0.52; P = .006) and SUVmax (–0.49, P = .010) in the IA zone negatively correlated with LS at the second follow-up only. No correlation was observed between PET/CT and MRI parameters. Conclusion: Glucose metabolism and vascularity in the graft tissue can be used to assess ligamentization of ACL graft. A viable and vascularized graft at first follow-up is associated with good to excellent final outcome, regardless of LS at this stage. Since no correlation was observed between PET/CT and MRI parameters, they may be assessing different domains of the same process. Higher NE in the IA zone at the first follow-up and lower SUVmax CL in the same region at second follow-up are associated with better outcome.

2020 ◽  
Vol 9 (5) ◽  
pp. 1581
Author(s):  
Corinna Altini ◽  
Valentina Lavelli ◽  
Artor Niccoli-Asabella ◽  
Angela Sardaro ◽  
Alessia Branca ◽  
...  

Spondylodiscitis is a spine infection for which a diagnosis by a magnetic resonance imaging (MRI) is considered the most appropriate imaging technique. The aim of this study was to compare the role of an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and an MRI in this field. For 56 patients with suspected spondylodiscitis for whom MRI and 18F-FDG PET/CT were performed, we retrospectively analyzed the results. Cohen’s κ was applied to evaluate the agreement between the two techniques in all patients and in subgroups with a different number of spinal districts analyzed by the MRI. Sensitivity, specificity, and accuracy were also evaluated. The agreements of the 18F-FDG PET/CT and MRI in the evaluation of the entire population, whole-spine MRI, and two-districts MRI were moderate (κ = 0.456, κ = 0.432, and κ = 0.429, respectively). In patients for whom one-district MRI was performed, 18F-FDG PET/CT and MRI were both positive and completely concordant (κ = 1). We also separately evaluated patients with suspected spondylodiscitis caused by Mycobacterium tuberculosis for whom the MRI and 18F-FDG PET/CT were always concordant excepting in 2 of the 18 (11%) patients. Sensitivity, specificity, and accuracy of the MRI and 18F-FDG PET/CT were 100%, 60%, 97%, and 92%, 100%, and 94%, respectively. Our results confirmed the 18F-FDG PET/CT diagnostic value in the diagnosis of spondylodiscitis is comparable to that of MRI for the entire spine evaluation. This could be considered a complementary technique or a valid alternative to MRI.


2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Alberto Zaniboni ◽  
Giordano Savelli ◽  
Claudio Pizzocaro ◽  
Pietro Basile ◽  
Valentina Massetti

The aim of the present paper is to review the scientific literature concerning the usefulness of18F-FDG PET/CT in the evaluation of response to chemotherapy in patients affected by liver metastases from colorectal cancer.Material and Methods. Studies were identified by searching PubMed electronic databases. Both prospective and retrospective studies were included. Information regarding the figure of merit of PET for the evaluation of therapy response was extracted and analyzed.Results. Existing data suggests that18F-FDG PET/CT may have an outstanding role in evaluating the response. The sensitivity of PET in detecting therapy response seems to be greater than conventional imaging (CT and MRI). PET/CT response is strictly related to better overall survival and progression-free survival.Conclusions. PET/CT is more than a promising technique to assess the response to chemotherapy in colorectal and liver metastases. However, to be fully validated, this examination needs further studies by recruiting more patients.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2330-2330 ◽  
Author(s):  
Rebecca L. Elstrom ◽  
Richard K.J. Brown

Abstract Background and Objectives: Positron tomission tomography using 18fluoro-2-deoxyglucose in combination with low dose non-enhanced computed tomography (FDG-PET/CT) is increasingly utilized in the management of patients with lymphoma. Numerous studies have demonstrated improved accuracy for both staging and restaging as compared to standard diagnostic CT. However, there is a paucity of data on the significance of bone uptake in patients with lymphoma. This is one area in which FDG-PET has the potential to dramatically influence care of lymphoma patients. However, false positive FDG-PET has been shown in patients with traumatic or benign bone lesions. The aim of this study was to evaluate the utility and accuracy of FDG-PET/CT in comparison with standard anatomic imaging with CT and MRI in the staging and follow up of patients with Hodgkin lymphoma (HL) or diffuse large B cell lymphoma (DLBCL). Design and Methods: We reviewed a database of 75 lymphoma patients who underwent concurrent FDG-PET/CT and standard diagnostic CT scans or MRI, and identified those with bone involvement by lymphoma. Involvement of bone was demonstrated by either biopsy of a bone lesion or radiologic appearance and clinical follow up highly suggestive of bone involvement. Follow up studies were evaluated for resolution of FDG avid lesions on PET, and anatomic lesions on CT or MRI. Results: Fourteen patients with either HL or DLBCL who underwent both FDG-PET/CT and diagnostic CT were identified to have bone involvement by lymphoma. FDG-PET identified bone involvement in all 14 patients, whereas CT imaging identified bone involvement in seven. One patient in whom CT did not detect bone involvement had evidence of bone lymphoma by MRI. Eight patients had confirmation of bone lymphoma by biopsy, while 6 were confirmed by clinical criteria (radiologic appearance and clinical follow up). Thirteen of the patients had follow up FDG-PET/CT scans, and 12 had follow up CT and/or MRI. All follow up FDG-PET scans showed resolution of FDG avid bone lesions after anti-lymphoma therapy. In contrast, all CT and MRI scans which originally showed evidence of bone involvement had persistent abnormality on follow up, with only 2 showing improvement. At a median follow up of 9 months (range 0–20 months), 11 patients remain in remission, while 2 patients subsequently showed progression by FDG-PET, CT and biopsy in soft tissue sites, but not bone. One patient remains on therapy. No patient in our series was found to have a benign etiology of a lesion initially thought due to lymphoma. Conclusion: FDG-PET/CT is useful in the staging and follow up of patients with lymphoma with bone involvement. The lack of sensitivity of CT combined with the delayed resolution of anatomic abnormalities limit the utility of standard anatomic imaging, making FDG-PET/CT the imaging modality of choice for patients with bone lymphoma.


2015 ◽  
Vol 173 (3) ◽  
pp. R115-R130 ◽  
Author(s):  
Massimo Salvatori ◽  
Bernadette Biondi ◽  
Vittoria Rufini

In recent years, 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) has emerged as an important tool for the postoperative management of patients with differentiated thyroid cancer (DTC) and it is widely used in selected clinical situations. The most valuable role that FDG-PET/CT plays in clinical practice is that it can be used to obtain prognostic information in patients with increasing thyroglobulin (Tg) levels and negative 131I whole-body scan post-thyroidectomy and radioiodine (RAI) ablation. FDG-PET/CT may also have a potential role in the initial staging and follow-up of high-risk patients with aggressive histological subtypes, in the identification of patients who are at the highest risk of disease-specific mortality, in the management of patients with RAI-refractory disease, in clinical trials of novel targeted therapies in patients with advanced metastatic disease, and in the evaluation of thyroid nodules with indeterminate fine-needle aspiration for cytology. However, several controversies remain to be resolved, namely: the cutoff value of Tg in the selection of DTC patients for FDG-PET/CT, whether FDG-PET/CT scanning should be performed under thyrotropin stimulation or suppression, and the clinical significance of thyroid FDG-PET/CT incidentalomas. The aim of the present article is to provide an overview of the data about the molecular basis for, clinical indications of, and controversies related to the use of FDG-PET/CT in patients with DTC.


2015 ◽  
Vol 66 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Silvia A. Riccio ◽  
Angel K.M. Chu ◽  
Harvey R. Rabin ◽  
Reinhard Kloiber

Purpose The objective of the study was to determine if fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) can assess the response of patients with pyogenic spine infection to antibiotic treatment in a clinically useful time frame. Methods Twenty-eight patients with suspected pyogenic spine infection had baseline 18F-FDG PET/CT. Patients with proven or probable infection were divided into good and poor responders to antibiotic therapy based on clinical criteria. These patients had a follow-up 18F-FDG PET/CT 6-8 weeks later. Results Six of 28 patients were deemed negative for infection based on 18F-FDG PET/CT. Two patients were excluded because of discrepancies in interpretation. Of the 20 patients deemed positive for infection, 13 had a pathogen isolated and all showed 18F-FDG uptake in bone and/or soft tissue at baseline. Patients with a poor clinical response to treatment had persistent 18F-FDG uptake in bone and/or soft tissue on follow-up. Patients with good clinical response had uptake confined to the margins of the destroyed disc. None of these patients had recurrent infection, even if antibiotics had already been discontinued at the time of the follow-up scan. Conclusions 18F-FDG uptake confined to the margins of a destroyed disc after antibiotic therapy of pyogenic spine infection must not be considered indicative of persistent infection and likely represents mechanically induced inflammation. 18F-FDG uptake in bone or soft tissue does indicate active infection. Quantification of activity could not reliably differentiate patients with active infection from those without active infection and those who had had a successful response to therapy. The pattern of activity is critical to accurate interpretation.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2329-2329
Author(s):  
Rebecca L. Elstrom ◽  
Richard K.J. Brown

Abstract Background and Significance: Positron emission tomography using 18-fluoro-2-deoxyglucose (FDG-PET) is useful in the staging and follow up of patients with lymphoma, and has been shown in several studies to be more accurate than computed tomography (CT). These studies have, however, demonstrated a continued role for CT in staging and restaging of lymphoma, and the two modalities are complementary. Increasingly, FDG-PET is performed in conjunction with a low radiation dose, non-contrast CT scan for attenuation correction and localization of lesions. Currently, many patients undergo both FDG-PET/CT and standard diagnostic, contrast enhanced CT, at a significant cost both financially and in terms of radiation exposure. In this study, we evaluated the clinical utility of performing both studies in patients with lymphoma. Study Design and Methods: We retrospectively identified patients with lymphoma who had undergone both FDG-PET/CT and diagnostic, contrast-enhanced CT (a scan pair) for either staging or restaging following treatment. Patients were included if the two imaging studies were performed within 6 weeks of each other with no intervening anti-lymphoma therapy. We compared the results of the two studies, identifying findings that were detected in either FDG-PET/CT or diagnostic CT scan but not both. Discrepancies were considered clinically significant if they were determined to be related either to lymphoma or another disease process which potentially required intervention. Results: Eighty-nine scan pairs which met the criteria were identified in 75 patients. Sixty-one scan pairs were performed for staging, and 28 were performed for treatment follow up. FDG-PET/CT detected additional potentially clinically relevant lesions over CT in 30 patients, of which 11 demonstrated increased clinical stage. Lymphoma therapy was changed based on FDG-PET/CT findings in 2 patients, and in one patient an occult rectal cancer was detected. In contrast, diagnostic CT detected 5 potentially clinically relevant findings, including 2 incidental findings (one definite and one possible venous thrombosis), and 3 patients with splenic lesions. Of the patients with splenic lesions, one was found on follow up to be definitely not related to lymphoma, and the nature of the splenic lesions in the other two patients remained indeterminate. No patient had a change of stage or lymphoma therapy based on diagnostic CT scan, and one patient was treated with anticoagulation based on CT findings. In the subgroup of scan pairs performed for follow up, diagnostic CT added clinically relevant information in none of the patients. Conclusion: In our series of patients, diagnostic contrast-enhanced CT scan did not contribute to staging or restaging of lymphoma when performed concurrently with FDG-PET/CT. Two clinically important incidental findings were detected by CT alone, of which one led to intervention.


2007 ◽  
Vol 25 (23) ◽  
pp. 3440-3447 ◽  
Author(s):  
Yong Du ◽  
Ian Cullum ◽  
Tim M. Illidge ◽  
Peter J. Ell

Purpose By monitoring bone metastases with sequential [18F]fluorodeoxyglucose positron-emission tomography/computed tomography ([18F]FDG-PET/CT) imaging, this study investigates the clinical relevance of [18F]FDG uptake features of bone metastases with various radiographic appearances. Patients and Methods Bone metastases were found in 67 of 408 consecutive patients with known/suspected recurrent breast cancer on [18F]FDG-PET/CT, characterized by CT morphology changes and/or bony [18F]FDG uptake. Twenty-five of the patients had sequential [18F]FDG-PET/CT examinations (86 studies) over an average follow-up period of 23 months. The temporal changes in [18F]FDG uptake and corresponding CT morphology features of 146 bone lesions identified in these 25 patients were followed up and correlated with therapeutic outcome retrospectively. Results The 146 lesions were classified as osteolytic (77), osteoblastic (41), mixed-pattern (11), or no change/negative (17) on CT. The majority of the osteolytic (72; 93.5%) and mixed-pattern lesions (nine; 81.8%), but fewer of the osteoblastic lesions (25; 61%), showed increased [18F]FDG uptake. After treatment, 58 osteolytic lesions (80.5%) became [18F]FDG negative and osteoblastic on CT and only 14 relatively large lesions (19.5%) remained [18F]FDG avid. Of the 25 [18F]FDG-avid osteoblastic lesions, 13 (52%) became [18F]FDG negative, but 12 (48%) remained [18F]FDG avid and increased in size on CT. Five of the mixed-pattern lesions remained [18F]FDG avid after treatment. All 17 CT-negative lesions became [18F]FDG negative; however, nine of them became osteoblastic. None of the initially [18F]FDG-negative lesions showed [18F]FDG avidity during follow-up. Conclusion [18F]FDG uptake reflects the immediate tumor activity of bone metastases, whereas the radiographic morphology changes vary greatly with time among patients.


2011 ◽  
Vol 6 (4) ◽  
pp. 260-266 ◽  
Author(s):  
Rose Ghanooni ◽  
Isabelle Delpierre ◽  
Michèle Magremanne ◽  
Catherine Vervaet ◽  
Nicolas Dumarey ◽  
...  

2016 ◽  
Vol 34 (16) ◽  
pp. 1889-1897 ◽  
Author(s):  
Malene Grubbe Hildebrandt ◽  
Oke Gerke ◽  
Christina Baun ◽  
Kirsten Falch ◽  
Jeanette Ansholm Hansen ◽  
...  

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.


Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1597-1597 ◽  
Author(s):  
Herve Ghesquieres ◽  
Céline Ferlay ◽  
Bertrand Richioud ◽  
Vanina Isnardi ◽  
Emmanuelle Nicolas-Virlizier ◽  
...  

Abstract Abstract 1597 Background: Primary central nervous system lymphoma (PCNSL) is a rare brain tumor potentially curable by chemotherapy alone or a combination of chemotherapy and radiation therapy. At staging, gadolinium-enhanced magnetic resonance imaging (MRI) is the standard method to evaluate CNS lesions and computed tomography (CT) is perform at diagnosis to detect the presence of a systemic disease. The initial tumor response to therapy is usually assessed by MRI. At present, there are no established imaging markers of prognosis in patients with PCNSL. Positron emission tomography (PET) using 18F-Fluorodeoxyglucose (FDG) is routinely used for the initial staging and the evaluation of treatment response in systemic Diffuse Large B-cell Lymphoma (DLBCL). In PCNSL, the clinical relevance of positron emission tomography FDG PET/CT is not well known. The aim of our study was to determine the added value of FDG PET/CT in the management of PCNSL performed at diagnosis and during initial treatment to assess whether it could predict the outcome of PCNSL patients. Patients and methods: From august 2008 to may 2011, we enrolled 24 consecutive PCNSL immunocompetent patients with histological proven DLBCL who underwent FDG PET/CT before specific treatment. The mean age of patients was 63.7 years (range, 51.7–78.8). Follow-up FDG PET/CT examinations were performed in 14 of them (58%) after 2 cycles of chemotherapy and in patients who relapsed. All PET images were acquired 1 hour after FDG injection and interpreted qualitatively and semi quantitatively by 2 nuclear medicine physician. The maximum standard uptake value (maxSUV) corrected to body weight and injected FDG activity was measured for each patient into the most hypermetabolic CNS lesion (TmaxSUV). The results were compared to the clinical and conventional imaging data. The correlation between TmaxSUV and respectively the Progression Free Survival (PFS) and Overall Survival (OS) was statistically analysed. We also evaluated for 15 patients, the correlation between the Ki67 index on tumors and TmaxSUV. Results: All the patients presented with brain lesions. The spinal cord was also involved in 1 of them. The sensitivity of FDG PET/CT for the detection of CNS lesions was 91.7 %. Two out of 24 patients were considered as false negative. The mean TmaxSUV was 13.9 +/− 9.3 (range, 4.9–38). FDG PET/CT found systemic spread of lymphoma in 2 patients (8.3%). Follow-up ranged from 3.2 to 33.8 months (mean, 20.6 months). After 2 cycles of chemotherapy, FDG PET/CT was considered as negative in 14/14 patients whereas gadolinium-enhanced MRI showed lesions with residual contrast-enhancement in 7 of them. Four patients who were PET- and MRI + after 2 cycles of chemotherapy relapsed exclusively into the CNS (n=2) and/or outside (n=2). FDG PET/CT showed all the sites of relapse. At last follow-up, 18 patients were alive and six died of progressive disease. No correlation between TmaxSUV at diagnosis and PFS (P =.15), OS (P =.14) and Ki67 index was respectively observed. Conclusions: Although the physiologic glucose metabolism in normal brain tissue is high, FDG PET/CT has a good sensitivity to detect PCNSL. FDG PET/CT could be useful to detect any systemic spread of PCNSL at staging and is able to diagnose disease relapse. Pretreatment Tmax SUV is not correlated with PFS and OS in our study. Moreover, FDG PET/CT seems not to be reliable for the prediction of relapse when it is performed after 2 cycles of chemotherapy. Others type of TEP tracers need to be study in PCNSL for response assessment and the prediction of patient's outcome. Disclosures: No relevant conflicts of interest to declare.


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