Limited Benefit of Additional Contrast-Enhanced CT to End-of- Treatment PET-CT Evaluation in Patients with Follicular Lymphoma

Abstract BACKGROUND: Follicular lymphoma (FL) is generally characterized by a moderate metabolic activity (FDG-avidity) in nodal and extra-nodal sites and by the frequent detection of residual disease in post-treatment PET scans. Since median age at diagnosis is over 60 years, in many FL patients several conditions that affect the elderly often occur in combination with the tumor, thus complicating and limiting the use of conventional imaging for lymphoma staging and response assessment. For this reason, the choice of the imaging technique should take into account clinical needs (preservation of renal function, reduction of diagnostic radiation exposure) as well as the necessity to constrain health care costs. OBJECTIVE: The aim of the study was to investigate if there is any advantage in the use of contrast-enhanced CT (ceCT) vs. unenhanced low-dose CT (ldCT) in routine protocols for end-of-therapy PET/CT evaluation of patients with FL. METHODS: Thirty FL patients who underwent end-of-therapy PET/CT protocol with ldCT and ceCT were analyzed retrospectively. Two different observers evaluated PET/ldCT and PET/ceCT in a blinded manner. Number and sites of nodal or extra-nodal disease were compared, using PET/ceCT as gold standard in order to evaluate if the type of CT could result in changes of the DS and therapeutic strategy. RESULTS: In 26 of 30 patients (87%; 95% confidence interval, 73%-98%), PET/ldCT showed the same number and sites of lesions highlighted by PET/ceCT. The inter-observer concordance and overall concordance between imaging procedures were excellent with a very high Cohen's kappa (respectively 0.82 and 0.83). 97% of lesions (103/107) were found by PET/ldCT and in 4 of 30 patients (13%) PET/ceCT provided additional nodal lesions in the mesenteric and iliac regions (3 mesenteric nodes and 1 iliac node; <1%). In these 4 patients, DS and consequently the therapeutic strategy were not changed after additional ceCT findings. PET/ldCT accuracy, sensibility, specificity, positive predictive value and negative predictive value and NPV were respectively 87%, 83%, 100%,100% and 60%. CONCLUSION: Our results indicate that the clinical impact of PET/ceCT in assessing end-therapy evaluation in FL is limited. The PET/ldCT could be suggested as primary imaging modality of choice, thus limiting the acquisition of PET/ceCT images only for doubtful cases of residual disease in mesenteric area (represented solely by 13 % in our series). This diagnostic approach would be less expensive, minimize diagnostic radiation exposure, and preserve renal function. Disclosures No relevant conflicts of interest to declare.

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Preoperative Contrast-Enhanced CT Versus 18F-FDG PET/CT Evaluation and the Prognostic Value of Extranodal Extension for Surgical Patients with Head and Neck Squamous Cell Carcinoma

Annals of Surgical Oncology ◽

10.1245/s10434-015-4689-7 ◽

2015 ◽

Vol 22 (S3) ◽

pp. 1020-1027 ◽

Cited By ~ 6

Author(s):

Jae Ryung Lee ◽

Young Jun Choi ◽

Jong-Lyel Roh ◽

Jae Seung Kim ◽

Jeong Hyun Lee ◽

...

Keyword(s):

Prognostic Value ◽

Surgical Patients ◽

Extranodal Extension ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct ◽

Ct Evaluation ◽

18F Fdg ◽

Fdg Pet Ct

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EXTH-30. EXPANDING THE UTILITY OF PRE-CLINICAL CONTRAST ENHANCED CT (CE-CT) FOR TUMOR DETECTION IN ORTHOTOPIC GBM MODELS USING RADIOMICS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.384 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii93-ii93

Author(s):

Kate Connor ◽

Emer Conroy ◽

Kieron White ◽

Liam Shiels ◽

William Gallagher ◽

...

Keyword(s):

Imaging Modality ◽

Texture Features ◽

Tumor Detection ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct ◽

Magnetic Resonance Imaging Mri ◽

Work Supports ◽

Selection Of

Abstract Despite magnetic resonance imaging (MRI) being the gold-standard imaging modality in the glioblastoma (GBM) setting, the availability of rodent MRI scanners is relatively limited. CT is a clinically relevant alternative which is more widely available in the pre-clinic. To study the utility of contrast-enhanced (CE)-CT in GBM xenograft modelling, we optimized CT protocols on two instruments (IVIS-SPECTRUM-CT;TRIUMPH-PET/CT) with/without delivery of contrast. As radiomics analysis may facilitate earlier detection of tumors by CT alone, allowing for deeper analyses of tumor characteristics, we established a radiomic pipeline for extraction and selection of tumor specific CT-derived radiomic features (inc. first order statistics/texture features). U87R-Luc2 GBM cells were implanted orthotopically into NOD/SCID mice (n=25) and tumor growth monitored via weekly BLI. Concurrently mice underwent four rounds of CE-CT (IV iomeprol/iopamidol; 50kV-scan). N=45 CE-CT images were semi-automatically delineated and radiomic features were extracted (Pyradiomics 2.2.0) at each imaging timepoint. Differences between normal and tumor tissue were analyzed using recursive selection. Using either CT instrument/contrast, tumors > 0.4cm3 were not detectable until week-9 post-implantation. Radiomic analysis identified three features (waveletHHH_firstorder_Median, original_glcm_Correlation and waveletLHL_firstorder_Median) at week-3 and -6 which may be early indicators of tumor presence. These features are now being assessed in CE-CT scans collected pre- and post-temozolomide treatment in a syngeneic model of mesenchymal GBM. Nevertheless, BLI is significantly more sensitive than CE-CT (either visually or using radiomic-enhanced CT feature extraction) with luciferase-positive tumors detectable at week-1. In conclusion, U87R-Luc2 tumors > 0.4cm3 are only detectable by Week-8 using CE-CT and either CT instrument studied. Nevertheless, radiomic analysis has defined features which may allow for earlier tumor detection at Week-3, thus expanding the utility of CT in the preclinical setting. Overall, this work supports the discovery of putative prognostic pre-clinical CT-derived radiomic signatures which may ultimately be assessed as early disease markers in patient datasets.

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18F-FDG PET/CT versus Diagnostic Contrast-Enhanced CT for Follow-Up of Stage IV Melanoma Patients Treated by Immune Checkpoint Inhibitors: Frequency and Management of Discordances over a 3-Year Period in a University Hospital

Diagnostics ◽

10.3390/diagnostics11071198 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1198

Author(s):

Jean-Baptiste Le Goubey ◽

Charline Lasnon ◽

Ines Nakouri ◽

Laure Césaire ◽

Michel de Pontville ◽

...

Keyword(s):

Fdg Pet ◽

Stage Iv ◽

Anatomical Site ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Induced Changes

Aim: To perform a comprehensive analysis of discordances between contrast-enhanced CT (ceCT) and 18F-FDG PET/CT in the evaluation of the extra-cerebral treatment monitoring in patients with stage IV melanoma. Materials and methods: We conducted a retrospective monocentric observational study over a 3-year period in patients referred for 18F-FDG PET/CT and ceCT in the framework of therapy monitoring of immune checkpoint (ICIs) as of January 2017. Imaging reports were analyzed by two physicians in consensus. The anatomical site responsible for discordances, as well as induced changes in treatment were noted. Results: Eighty patients were included and 195 pairs of scans analyzed. Overall, discordances occurred in 65 cases (33%). Eighty percent of the discordances (52/65) were due to 18F-FDG PET/CT scans upstaging the patient. Amongst these discordances, 17/52 (33%) led to change in patient’s management, the most frequent being radiotherapy of a progressing site. ceCT represented 13/65 (20%) of discordances and induced changes in patients’ management in 2/13 cases (15%). The most frequent anatomical site involved was subcutaneous for 18F-FDG PET/CT findings and lung or liver for ceCT. Conclusions: Treatment monitoring with 18F-FDG PET/CT is more efficient than ceCT and has a greater impact in patient’s management.

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Comparison of liver SUV using unenhanced CT versus contrast-enhanced CT for attenuation correction in 18F-FDG PET/CT

Nuclear Medicine Communications ◽

10.1097/mnm.0000000000000086 ◽

2014 ◽

Vol 35 (5) ◽

pp. 472-477 ◽

Cited By ~ 3

Author(s):

Edwin E.G.W. ter Voert ◽

Hanneke W.M. van Laarhoven ◽

Peter J.M. Kok ◽

Wim J.G. Oyen ◽

Eric P. Visser ◽

...

Keyword(s):

Attenuation Correction ◽

Fdg Pet ◽

Unenhanced Ct ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Detection of Occult Primary Tumors in Patients with Cervical Metastases of Unknown Primary Tumors: Comparison of18F FDG PET/CT with Contrast-enhanced CT or CT/MR Imaging—Prospective Study

Radiology ◽

10.1148/radiol.14141073 ◽

2015 ◽

Vol 274 (3) ◽

pp. 764-771 ◽

Cited By ~ 53

Author(s):

Jae Ryung Lee ◽

Jae Seung Kim ◽

Jong-Lyel Roh ◽

Jeong Hyun Lee ◽

Jung Hwan Baek ◽

...

Keyword(s):

Mr Imaging ◽

Prospective Study ◽

Unknown Primary ◽

Primary Tumors ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct ◽

Fdg Pet Ct ◽

Unknown Primary Tumors

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Cross-modality PET/CT and contrast-enhanced CT imaging for pancreatic cancer

World Journal of Gastroenterology ◽

10.3748/wjg.v21.i10.2988 ◽

2015 ◽

Vol 21 (10) ◽

pp. 2988 ◽

Cited By ~ 17

Author(s):

Jian Zhang

Keyword(s):

Pancreatic Cancer ◽

Ct Imaging ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct

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

10.21203/rs.3.rs-1251733/v1 ◽

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.

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