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 > 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.

scholarly journals Clinical relevance of 18F-FDG PET/CT in the postoperative follow-up of patients with history of medullary thyroid cancer

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jelena Saponjski ◽  
Djuro Macut ◽  
Dragana Sobic Saranovic ◽  
Branislava Radovic ◽  
Vera Artiko
Keyword(s):  
Predictive Value ◽  
Fdg Pet ◽  
Somatostatin Receptor ◽  
False Negative ◽  
Standardized Uptake Value ◽  
True Negative ◽  
Medullary Thyroid ◽  
Pet Ct ◽  
Fdg Pet Ct

AbstractBackgroundThe aim of the study was evaluation of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET/CT) in the detection of active disease in the patients with suspected recurrence of the medullary thyroid carcinoma (MTC).Patients and methods18F-FDG PET/CT investigation was performed in 67 patients, investigated from 2010 to 2019. _ Follow up was performed from 6 to 116 months after surgery (median 16.5 months, x± SD = 29±28.9 months). Twenty five of 67 patients underwent 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy, 11 underwent somatostatin receptor scintigraphy (SRS) with 99mTc-HYNIC TOC while 11 123I-metaiodobenzylguanidine (MIBG) scintigraphy.ResultsFrom 67 patients, 35 (52.2%) had true positive 18F-FDG PET/CT findings (TP). Average maximal standardized uptake value (SUVmax) for all TP lesions was 5.01+3.6. In 25 (37.3%) patients findings were true negative (TN). Four (6%) patients had false positive (FP) findings while three (4.5%) were false negative (FN). Thus, sensitivity of the 18F-FDG PET/ CT was 92.11%, specificity 86.21%, positive predictive value 89.74%, negative predictive value 89.29% and accuracy 89.55%. In 27 patients (40%) 18F-FDG PET/CT finding influenced further management of the patient.Conclusions18F-FDG PET/CT has high accuracy in the detection of metastases/recurrences of MTC in patients after thyroidectomy as well as in evaluation and the appropriate choice of the therapy.

Prognostic value of FDG-PET in Hodgkin lymphoma for posttreatment evaluation. Long-term follow-up results

2009 ◽  
Vol 150 (47) ◽  
pp. 2133-2138
Author(s):  
Zsuzsa Molnár ◽  
Zsófia Simon ◽  
Zita Borbényi ◽  
Beáta Deák ◽  
LászLÓ Galuska ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
False Positive ◽  
Fdg Pet ◽  
Clinical Stage ◽  
False Negative ◽  
True Negative ◽  
Significant Difference ◽  
The Difference

In the past few decades Hodgkin lymphoma (HL) has become a highly curable malignant disease, as a result of using modern polychemotherapy and irradiation. Differentiation of active tumor from fibrosis or necrosis within residual radiographic masses represents a problem of interpretation. Aims: The aim of this retrospective study is to assess the value of FDG-PET for prediction of remission or relapse in HL. Patients and methods: Data of 128 patients, who had residual masses on CT after completion of their planned treatment, have been analyzed. FDG-PET was performed between January 1995 and February 2005. Results: The median duration of the follow-up from PET was 75.5 months (range: 20–180 months). 89 (70%) patients had negative and 39 (30%) patients had positive FDG-PET results. The numbers of true-positive, true-negative, false-positive and false-negative subjects were 29, 83, 10 and 6, respectively. Sensitivity of post-treatment FDG-PET was 83%, specificity 93%, positive predictive value 74%, negative predictive value 93%, and accuracy 88%. The difference between the event free survival of PET positive and negative cases is highly significant (p = 0.0000), according to the Mantel-Cox test. Conclusion: Our results, in accordance with literature, clearly indicate that patients with negative FDG-PET results are unlikely to progress or relapse during a long follow-up. However, false positive uptake is a problem. We have investigated the effect of age, histological subtype, clinical stage and the type of treatment on the accuracy, but on the basis of these facts we could not find any significant difference. However, the date of the investigation influenced the results: before 2000 the number of false results was significantly higher than after that time, which shows the importance of investigators’ experience.

FDG-Positron Emission Tomography in T-Cell Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1614-1614
Author(s):  
Chiara Rusconi ◽  
Cristina Gabutti ◽  
Vittorio Ruggero Zilioli ◽  
Erika Meli ◽  
Maddalena Mazzucchelli ◽  
...  
Keyword(s):  
T Cell ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
Clinical Stage ◽  
T Cell Lymphoma ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Scans

Abstract Abstract 1614 Background: Few data are available on the role of fluoro-deoxy-glucose positron emission tomography (FDG-PET) in T-cell non Hodgkin Lymphoma (NHL). We compared standard contrast-enhanced computerized tomography (CECT) and FDG-PET for initial staging and restaging after treatment in T-cell NHL. Methods: We reviewed 58 FDG-PET scans performed in 29 patients (pts) affected by T-cell NHL and we focused on the 42 cases for which a simultaneous standard CECT was available for comparison. The specific T-cell histology was Peripheral T-Cell Lymphoma Not Otherwise Specified in 12 pts, Angioimmunoblastic T-Cell Lymphoma in 4 pts, Anaplastic Large Cell Lymphoma in 10 pts, other T-NHL hystologies in 3 pts. Twelve pts were males and median age at diagnosis was 57 years (range: 25–77). Baseline FDG-PET scans were 20, while FDG-PET performed for disease reassessment were 22. Results: FDG-PET performed at baseline was positive in all cases. In 6 cases (30%) FDG-PET identified fewer disease sites than CECT, while in 14 cases (70%) FDG-PET identified additional disease sites. New sites identified by FDG-PET were: other nodal sites (11 pts), spleen (2 pts), nasopharynx (1 pt) and testicles (1 pt). Different disease extent evaluation according to FDG-PET modified clinical stage in 10 pts (50%): one pt was downstaged and 9 pts were upstaged. FDG-PET-based stage was not considered for therapeutic decision. FDG-PET scans performed at restaging were negative in 16 cases (72%) and positive in the remaining 6 cases (28%). In 13/16 (81%) negative cases CECT was concordant and showed a complete remission, while in the remaining 3 cases CECT showed a residual nodal disease. In the 6 FDG-PET positive cases, CECT was as follows: abnormal in the same site of FDG-PET in 1 case, abnormal in fewer sites than FDG-PET in 3 cases and abnormal in more sites than FDG-PET in 2 cases. With a median follow-up of 32 months, the median overall survival (OS) of the 6 positive FDG-PET cases at restaging was 26 months. With a median follow-up of 23 months, the median OS of the 16 negative FDG-PET cases at restaging was not reached. Conclusion: FDG-PET can be useful in the initial staging of T-cell NHL, since it can allow a more accurate disease extension evaluation: in our experience it could identify additional sites, both nodal and extra-nodal, in 70% of pts. A change in clinical stage according to FDG-PET was observed in 50% of cases, with an upstaging in the majority of pts. We could confirm the high sensitivity of baseline FDG-PET in T-cell NHL. A high level of concordance was observed between PET and CECT at restaging. However, independently on CECT result, the worse OS of FDG-PET positive cases confirms the role of FDG-PET as prognostic factor for survival. Larger prospective trials are needed to confirm the utility of FDG-PET in baseline staging, reassessment after chemotherapy and treatment planning. Disclosures: No relevant conflicts of interest to declare.

The role of FDG-PET scans in patients with lymphoma

Blood ◽  
2007 ◽  
Vol 110 (10) ◽  
pp. 3507-3516 ◽  
Author(s):  
Pamela Seam ◽  
Malik E. Juweid ◽  
Bruce D. Cheson
Keyword(s):  
Fdg Pet ◽  
Imaging Modality ◽  
False Negative ◽  
Surrogate Marker ◽  
3 Dimensional ◽  
Positron Emission ◽  
Development Data ◽  
Pretreatment Staging ◽  
Pet Scans

Abstract18-Fluoro-deoxyglucose positron emission tomography (FDG-PET) is a noninvasive, 3-dimensional imaging modality that has become widely used in the management of patients with malignant lymphomas. This technology has been demonstrated to be more sensitive and specific than either 67gallium scintigraphy or computerized tomography, providing a more accurate distinction between scar or fibrosis and active tumor. PET scans have been evaluated in pretreatment staging, restaging, monitoring during therapy, posttherapy surveillance, assessment of transformation, and, more recently, as a surrogate marker in new drug development. Data to support these various roles require prospective validation. Moreover, caution must be exercised in the interpretation of PET scans because of technical limitations, variability of FDG avidity among the different lymphoma histologic subtypes, and in the large number of etiologies of false-negative and false-positive results. Recent attempts to standardize PET in clinical trials and incorporation of this technology into uniformly adopted response criteria will hopefully lead to improved outcome for patients with lymphoma.

Predictive Value of 18F-Fluorodeoxyglucose Positron Emission Tomography (FDG PET) Performed after Two Cycles of Standard Chemotherapy (CT) on Treatment Outcome in Hodgkin Disease.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 310-310
Author(s):  
Andrea Gallamini ◽  
Luigi Rigacci ◽  
Francesco Merli ◽  
Pasquale Errico ◽  
Alessandro Levis ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Predictive Value ◽  
Fdg Pet ◽  
Pet Scan ◽  
Prognostic Role ◽  
Fdg Pet Scan ◽  
The Mean ◽  
Pet Scans

Abstract Objectives: Several prognostic models based on simple clinical variables have been proposed for Hodgkin’s Disease (HD); however, when applied in a prospective way, they showed unsatisfactory predictive value and scarce reproducibility. The prognostic role of early evaluation of treatment response by TC or Gallium scan has been proved in the past. We report here the preliminary results of a clinical trial on the prognostic role of FDG PET scan performed very early during treatment in advanced stage HD patients (pts), treated by conventional, standard-dose, CT. Matherials and methods: Starting from january 2002, 55 new HD pts were consecutively enrolled into the trial; 42 completed the program and are valuable for the analysis. Pts characteristics were: mean age 34.9 years (16-79), advanced disease (stages IIB-IVB) in 24, and stage IIA in 18. Bulky and extra-nodal disease were recorded in in 12 and 11 pts, respectively. Histopathology was: NS in 36, LP in 3, MC in 2 and LD in 1. All pts were staged at baseline with TC scan, bone marrow trephine biopsy and FDG PET scan (PET-0); they were re-staged after 2 CT courses and at the end of the treatment, including radiotherapy, by TC scan and PET scan (TC-2, PET-2 and TC-8, PET-8, respectively). Standardized Uptake Value (SUV) was calculated in all FDG PET scans. PET-0 and PET-8 were considerate positive when the SUV value was ≥ 3 and PET-2 when the SUV ratio PET-2/PET 0 was > 33%. CT was ABVD in 36 pts, escalated BEACOPP in 5 and MOPP/EBV/CAD in 1. In 19/42 additional radiotherapy was given. The mean interval between the end of the 2nd CT course and PET-2 was 11.5 days (6-32); the interval between the end of the therapy (either CT or radiotherapy) and PET-8 was never shorter than 50 days. Results: The mean follow-up from the final restaging was 328.7 days (11-690). Mean SUV value of PET-0 was 12.04. At the end of the program 38 pts were in CR and 4 in progression; one relapsed 13 months after CR entry. TC-2 showed PR in 37 pts and CR in 5. By contrast, PET-2 was positive in only 5 pts: two of them, with a mean SUV-2/SUV-0 ratio of 26.5% (20-33), showed a progressive reduction of SUV in subsequent PET scans, up to a complete negativity: both are in continuous CR. Two out of three pts with a mean SUV reduction to 61% (49-85) of the basal values progressed after the 5th and the 8th CT course, respectively; the third relapsed in CR one year after CT completion. 34/37 (92%) pts with a negative PET-2 showed a PET-8 persistently negative and remained in CR; 2 progressed during CT and one relapsed 12 months after the end of the therapy. Upon assuming that a PET-2 is positive when the ratio of SUV-2/SUV-0 is >33%, the Predictive Positive Value (PPV) of a PET-2 was 100% and the Predictive Negative Value (PNV) was 92%. The sensitivity of PET-2 was 50%, the specificity was 100% and the overall accuracy 93%. Conclusions: The FDG PET scan performed very early during therapy predicts the treatment outcome in most pts. (39/42: 93%), with a PPV value of 100% and a PNV value of 92%. However, since most relapses of HD occur within 24 months from diagnosis, definite conclusions will be drawn after a minimum follow-up of two years.

18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) as a prognostic and predictive biomarker in metastatic colorectal cancer (mCRC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15037-e15037
Author(s):  
P. A. Philip ◽  
S. Gupta ◽  
L. Heilbrun ◽  
D. Smith ◽  
B. El-Rayes ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Standardized Uptake Value ◽  
Predictive Biomarker ◽  
Post Treatment ◽  
Background Information ◽  
Cox Models ◽  
Line Setting ◽  
Pet Scans

e15037 Background: Information on the prognostic and predictive role of FDG-PET in the management of patients (pts) with mCRC is limited. The growing complexity of current therapies and the increasing number of agents to be tested in this disease warrants better understanding of the role of FDG-PET in earlier treatment decisions. Methods: Consecutive pts with 2 or more serial FDG-PET scans at baseline and during the treatment course were studied. Tumor standardized uptake value (SUV) and its percentage change (%ΔSUV) were each studied for their potential association with time to progression (TTP) via univariate Cox models to estimate the hazard ratio (HR) for progression. Results: 27 pts (median age 58.2 yrs) with mCRC were studied. 85% of pts were treated in the first line setting. 44% had received prior adjuvant therapy. 63%, 26% and 11% received oxaliplatin based, irinotecan based and fluropyrimidine only regimens, respectively. 85% received concurrent bevacizumab. Median pretreatment SUV was 9.0 (range 1.7 - 46.0); Median post treatment SUV was 3.4 (0–13.5); median %ΔSUV was -77.2 (range -10% to -100%). Mean interval between scans was 4.1 months. Ten (37%) patients had no tumor uptake on post treatment scans. 56% and 37% of pts had partial response and stable disease (RECIST criteria), respectively. Median TTP was 13.0 months (90% CI: 10.9 - 16.3 mos), with a median follow-up time for progression of 7.8 months. The HRs for baseline SUV and %ΔSUV were 0.972 (90% CI: 0.901 - 1.048, p=0.534) and 1.018 (90% CI: 1.003 - 1.033, p=0.049), respectively. The median TTP of patients whose post-treatment SUV reached zero was 13.8 months vs. 10.9 months (p=0.17) for pts whose post-treatment SUV did not reach zero. Conclusions: Systemic therapy significantly decreased the SUV on follow up PET scans in pts treated for mCRC. However, no significant association was seen between either baseline SUV or %ΔSUV and TTP. There may be a very weak statistical association of decreasing SUV with decreasing risk of progression. Further work is needed to optimize and standardize evaluation of tumor response in mCRC patients with FDG-PET. No significant financial relationships to disclose.

The role of FDG-PET in low-grade non-Hodgkin lymphoma (NHL): Impact of histology

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17534-17534
Author(s):  
M. Kassar ◽  
A. Go ◽  
H. Fung ◽  
P. Venugopal ◽  
A. Ali ◽  
...  
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
False Negative ◽  
Initial Evaluation ◽  
Low Grade ◽  
True Positive ◽  
True Negative ◽  
Non Hodgkin Lymphoma ◽  
Imaging Results ◽  
Fdg Pet Scan

17534 Background: FDG-PET scan was proved important diagnostic and prognostic tool in patients with aggressive (NHL). The objective of this study is to investigate the correlation between the histology subtype in low-grade NHL and the sensitivity of the FDG-PET. Methods: We included all patients who presented to our institution during the period from April 2001 till April 2004 and underwent staging evaluation by FDG-PET during the course of their disease. All patients had histologically confirmed low-grade NHL. Patients with history of active malignancy, other than NHL, within the last five years were excluded. Correlation was made with the CT-scan findings. Results: 53 patients were included. Age (range 30–82, median 54), 57% of them were male. 34 patients had follicular lymphoma (FL), 9 patients had marginal zone lymphoma (MZL), and 10 patients had small lymphocytic lymphoma (SLL). 24/34 patients with FL underwent FDG-PET during the initial evaluation of their disease, and 10/34 patients underwent FDG-PET as part of their restaging assessment. 33 patients had true positive FDG-PET findings when compared to CT-scan results. One patient had negative FDG-PET with CT-scan findings suggestive of pathologic lymphadenopathy (sensitivity 97%). The highest SUV was in the range of 3.5–15 (median = 7). 8/9 patients with MZL had true positive FDG-PET findings and one had false negative FDG-PET result (sensitivity 89%). The highest SUV was in the range of 2–6.30 (median 2.6). Among the ten patients with SLL, 5 had FDG-PET during the initial evaluation and 8 patients during re-staging workup. 13 FDG-PET results were available for analysis. 5 cases were false negative, 1 case was false positive, 5 cases were true positive, and 2 cases were true negative (sensitivity 50%). The highest SUV was in the range of 1.8–6.2 (median of 2.5). Conclusion: Histology in low-grade NHL has a major impact on the sensitivity of the FDG-PET imaging results. Whereas it is a highly sensitive diagnostic method in patients with FL, and to a lesser degree in patients with MZL, it has poor sensitivity in patients with SLL. No significant financial relationships to disclose.

Brain FDG PET for the Etiological Diagnosis of Clinically Uncertain Cognitive Impairment During Delirium in Remission

2020 ◽  
Vol 77 (4) ◽  
pp. 1609-1622
Author(s):  
Franziska Mathies ◽  
Catharina Lange ◽  
Anja Mäurer ◽  
Ivayla Apostolova ◽  
Susanne Klutmann ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Fdg Pet ◽  
False Negative ◽  
Ground Truth ◽  
Etiological Diagnosis ◽  
Geriatric Unit ◽  
Positron Emission ◽  
The Brain ◽  
Hospitalized Geriatric Patients

Background: Positron emission tomography (PET) of the brain with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) is widely used for the etiological diagnosis of clinically uncertain cognitive impairment (CUCI). Acute full-blown delirium can cause reversible alterations of FDG uptake that mimic neurodegenerative disease. Objective: This study tested whether delirium in remission affects the performance of FDG PET for differentiation between neurodegenerative and non-neurodegenerative etiology of CUCI. Methods: The study included 88 patients (82.0±5.7 y) with newly detected CUCI during hospitalization in a geriatric unit. Twenty-seven (31%) of the patients were diagnosed with delirium during their current hospital stay, which, however, at time of enrollment was in remission so that delirium was not considered the primary cause of the CUCI. Cases were categorized as neurodegenerative or non-neurodegenerative etiology based on visual inspection of FDG PET. The diagnosis at clinical follow-up after ≥12 months served as ground truth to evaluate the diagnostic performance of FDG PET. Results: FDG PET was categorized as neurodegenerative in 51 (58%) of the patients. Follow-up after 16±3 months was obtained in 68 (77%) of the patients. The clinical follow-up diagnosis confirmed the FDG PET-based categorization in 60 patients (88%, 4 false negative and 4 false positive cases with respect to detection of neurodegeneration). The fraction of correct PET-based categorization did not differ between patients with delirium in remission and patients without delirium (86% versus 89%, p = 0.666). Conclusion: Brain FDG PET is useful for the etiological diagnosis of CUCI in hospitalized geriatric patients, as well as in patients with delirium in remission.

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