scholarly journals Assessment of early metabolic progression in melanoma patients under immunotherapy: an 18F-FDG PET/CT study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christos Sachpekidis ◽  
Annette Kopp-Schneider ◽  
Jessica C. Hassel ◽  
Antonia Dimitrakopoulou-Strauss
Keyword(s):  
Fdg Pet ◽  
Checkpoint Inhibitors ◽  
Evaluation Criteria ◽  
Prognostic Information ◽  
European Organization ◽  
Positron Emission ◽  
Pet Ct ◽  
Melanoma Patients ◽  
Fdg Pet Ct

Abstract Background The usage of immune checkpoint inhibitors (ICIs) is the standard practice for the treatment of metastatic melanoma. However, a significant amount of patients show no response to immunotherapy, while issues on its reliable response interpretation exist. Aim of this study was to investigate the phenomenon of early disease progression in 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in melanoma patients treated with ICIs. Methods Thirty-one patients under ICIs serially monitored with 18F-FDG PET/CT were enrolled. All patients exhibited progressive metabolic disease (PMD) after two ICIs’ cycles according to the European Organization for Research and Treatment of Cancer (EORTC) criteria, and were characterized as unconfirmed PMD (uPMD). They were further followed with at least one PET/CT for either confirmation of PMD (cPMD) or demonstration of pseudoprogression remission. Patients were also evaluated with the PET Response Evaluation Criteria for Immunotherapy (PERCIMT). Moreover, in an attempt to investigate immune activation, the spleen to liver ratios (SLRmean, SLRmax) of 18F-FDG uptake were measured. Results Median follow up was 69.7 months [64.6–NA]. According to EORTC, 26/31 patients with uPMD eventually showed cPMD (83.9%) and 5/31 patients showed pseudoprogression (16.1%). Patients with cPMD (n = 26) had a median OS of 10.9 months [8.5–NA], while those with pseudoprogression (n = 5) did not reach a median OS [40.9–NA]. Respectively, after application of PERCIMT, 2/5 patients of the pseudoprogression group were correctly classified as non-PMD, reducing the uPMD cohort to 29 patients; eventually, 26/29 patients demonstrated cPMD (89.7%) and 3/29 pseudoprogression (10.3%). One further patient with pseudoprogression exhibited transient, sarcoid-like, mediastinal/hilar lymphadenopathy, a known immune-related adverse event (irAE). Finally, patients eventually showing cPMD exhibited a significantly higher SLRmean than those showing pseudoprogression after two ICIs’ cycles (p = 0.038). Conclusion PET/CT, performed already after administration of two ICIs’ cycles, can identify the majority of non-responders in melanoma immunotherapy. In order to tackle however, the non-negligible phenomenon of pseudoprogression, another follow-up PET/CT, the usage of novel response criteria and vigilance over emergence of radiological irAEs are recommended. Moreover, the investigation of spleen glucose metabolism may offer further prognostic information in melanoma patients under ICIs.

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 ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Cruciate Ligament ◽  
Acl Graft ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Anterior Cruciate ◽  
Fdg Pet Ct ◽  
Ct And Mri

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.

scholarly journals IMAGING IN ENDOCRINOLOGY: 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in differentiated thyroid carcinoma: clinical indications and controversies in diagnosis and follow-up

2015 ◽  
Vol 173 (3) ◽  
pp. R115-R130 ◽  
Author(s):  
Massimo Salvatori ◽  
Bernadette Biondi ◽  
Vittoria Rufini
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Whole Body ◽  
Clinical Indications ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

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.

Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Interpretation Criteria for Assessment of Antibiotic Treatment Response in Pyogenic Spine Infection

2015 ◽  
Vol 66 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Silvia A. Riccio ◽  
Angel K.M. Chu ◽  
Harvey R. Rabin ◽  
Reinhard Kloiber
Keyword(s):  
Soft Tissue ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Active Infection ◽  
Spine Infection ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

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.

Fusion of Metabolic Function and Morphology: Sequential [18F]Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography Studies Yield New Insights Into the Natural History of Bone Metastases in Breast Cancer

2007 ◽  
Vol 25 (23) ◽  
pp. 3440-3447 ◽  
Author(s):  
Yong Du ◽  
Ian Cullum ◽  
Tim M. Illidge ◽  
Peter J. Ell
Keyword(s):  
Bone Metastases ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Mixed Pattern ◽  
Fdg Pet Ct ◽  
Morphology Changes

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.

scholarly journals Early Evaluation of Immunotherapy Response in Lymphoma Patients by 18F-FDG PET/CT: A Literature Overview

2021 ◽  
Vol 11 (3) ◽  
pp. 217
Author(s):  
Cristina Ferrari ◽  
Nicola Maggialetti ◽  
Tamara Masi ◽  
Anna Giulia Nappi ◽  
Giulia Santo ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Checkpoint Inhibitors ◽  
Imaging Method ◽  
Early Evaluation ◽  
Non Hodgkin Lymphoma ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Immunotherapy is a promising therapeutic strategy both for solid and hematologic tumors, such as in Hodgkin (HL) and non-Hodgkin lymphoma (NHL). In particular, immune-checkpoint inhibitors, such as nivolumab and pembrolizumab, are increasingly used for the treatment of refractory/relapsed HL. At the same time, evidence of chimeric antigen receptor (CAR)-T-cell immunotherapy efficacy mostly in NHL is growing. In this setting, the challenge is to identify an appropriate imaging method to evaluate immunotherapy response. The role of 18F-Fluorodeoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT), especially in early evaluation, is under investigation in order to guide therapeutic strategies, taking into account the possible atypical responses (hyperprogression and pseudoprogression) and immune-related adverse events that could appear on PET images. Herein, we aimed to present a critical overview about the role of 18F-FDG PET/CT in evaluating treatment response to immunotherapy in lymphoma patients.

Utility of FDG PET/CT and Brain MRI in Melanoma Patients with Increased Serum S-100B Level During Follow-up

2010 ◽  
Vol 17 (6) ◽  
pp. 1657-1661 ◽  
Author(s):  
Tjeerd S. Aukema ◽  
Renato A. Valdés Olmos ◽  
Catharina M. Korse ◽  
Bin B. R. Kroon ◽  
Michel W. J. M. Wouters ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Brain Mri ◽  
Pet Ct ◽  
Melanoma Patients ◽  
Fdg Pet Ct

Usefulness of Positron Emission Tomography Using 18F-FDG Performed At Diagnosis and During Initial Chemotherapy for Imaging Primary Central Nervous System Lymphoma: A 24 Immunocompetent patient's Study.

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1597-1597 ◽  
Author(s):  
Herve Ghesquieres ◽  
Céline Ferlay ◽  
Bertrand Richioud ◽  
Vanina Isnardi ◽  
Emmanuelle Nicolas-Virlizier ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Central Nervous System Lymphoma ◽  
Emission Tomography ◽  
Positron Emission ◽  
Systemic Spread ◽  
Pet Ct ◽  
The Mean ◽  
Fdg Pet Ct

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.

Primary malignant melanoma of the stomach: a rare entity

2020 ◽  
Vol 13 (9) ◽  
pp. e234830
Author(s):  
Pradeep Zechariah ◽  
Suraj Surendran ◽  
Vijay Abraham ◽  
Inian Samarasam
Keyword(s):  
Malignant Melanoma ◽  
Ct Scan ◽  
Fdg Pet ◽  
Gastric Fundus ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

A 54-year-old man presented with easy fatiguability, dyspnoea on exertion and dyspeptic symptoms. On evaluation, he was found to have an ulcero-proliferative growth in the gastric fundus, the biopsy of which was malignant melanoma of the stomach. Further evaluation with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) scan showed operable disease with no focus of disease elsewhere. He was diagnosed as primary gastric melanoma and underwent radical total gastrectomy with adequate margins. His postoperative period was uneventful. Further adjuvant therapy was refused by the patient. At 6-month follow-up, an 18F-FDG PET-CT scan was done, which showed no evidence of disease. On follow-up at 1-year, he was alive and asymptomatic.

Role of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT) in malignant ovarian germ cell tumors: a single-center experience with long term follow-up

2019 ◽  
Vol 29 (8) ◽  
pp. 1298-1303
Author(s):  
Carlotta Dolci ◽  
Lorenzo Ceppi ◽  
Luca Guerra ◽  
Cinzia Crivellaro ◽  
Maria Lamanna ◽  
...  
Keyword(s):  
Germ Cell ◽  
Predictive Value ◽  
Fdg Pet ◽  
Germ Cell Tumors ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Staging Surgery ◽  
Fdg Pet Ct

Introduction18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a diagnostic tool widely used in oncology, but to date there are no established recommendations for its use in malignant ovarian germ cell tumors. The aim of this study was to evaluate the role of 18F-FDG PET/CT in the clinical management of patients with malignant ovarian germ cell tumors.MethodsThis was a retrospective review of 18F-FDG PET/CT scans performed in patients diagnosed with malignant ovarian germ cell tumors treated at the gynecology department of San Gerardo Hospital (Monza, Italy) from June 2006 to December 2016. Data collected included clinical history, radiological, biochemical and pathological evaluation, treatment, follow-up, outcome, and clinical indication for the PET/CT scan. PET/CT findings were categorized as negative/normal (no abnormal FDG uptake or physiological uptake), positive/abnormal (FDG uptake considered to indicate active germ cell malignancy), or equivocal (FDG uptake of uncertain significance, not clearly correlated to neoplastic disease).ResultsA total of 69 PET/CT scans in 37 patients were evaluated. The mean age at diagnosis was 25 years (range 20–48). The majority of patients had International Federation of Gynecology and Obstetrics (FIGO) stage I (22/37) disease and had a diagnosis of dysgerminomas (18/37). Imaging indications were initial staging before treatment (4/69, 6%), staging after inadequate staging surgery (24/69, 35%), restaging after adjuvant chemotherapy (17/69, 25%), relapse suspect (9/69, 13%), and follow-up (15/69, 21%). Pathology confirmation of PET/CT results was available in 28/69 (40.5%) studies. All negative PET/CT (15/28) cases were confirmed with laparoscopy as true negative; among 13/28 positive PET cases, histopathology confirmed 7 (54%) as true positive and 6 (46%) as false positive (5 inflammatory and 1 mature teratoma implants). Patient-based analysis showed 100% sensitivity, 71% specificity, 54% positive predictive value, 100% negative predictive value, and 79% accuracy. Clinical follow-up was available in 41 (59.4%) of 69 PET/CT images: 28/41 studies were negative and 13/41 positive. A mean follow-up of 28 months (median 15, range 5–102) confirmed negative PET/CT studies. A total of 13 positive PET/CT patients underwent chemotherapy with subsequent evidence of disease response.DiscussionPET/CT in malignant ovarian germ cell tumors was mainly performed for staging after inadequate staging surgery or for restaging after adjuvant chemotherapy. PET/CT was associated with high sensitivity and negative predictive value.

scholarly journals Role of integrated F-18 fluoro-deoxy-glucose positron emission tomography and computed tomography in evaluation of lung cancer

2012 ◽  
Vol 20 (3-4) ◽  
pp. 107-111
Author(s):  
Dragana Sobic-Saranovic
Keyword(s):  
Lung Cancer ◽  
Fdg Pet ◽  
Small Cell ◽  
Emission Tomography ◽  
Small Cell Lung ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

Lung cancer is one of the leading causes of death in the world. It is generally divided in two groups: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Positron emission tomography (PET)/CT using the glucose analogue labeled with 18-fluor (F-18): fluoro-deoxy-glucose (F-18-FDG), is unique integrated imaging modality that offers simultaneous anatomic and metabolic information valuable in the diagnosis, staging and follow-up of both types of lung cancer and in particular in NSCLC. FDG accumulation in tissue is proportional to the amount of glucose utilization. Increased consumption of glucose is a characteristic of almost all types of lung cancer except in bronchoalveolar carcinoma and well differentiated neuroendocrine tumors. The objective of this brief review is to highlight the clinical role of F-18-FDG PET/CT in detection, staging, re-staging, and assessment of therapy response and follow up in lung cancer. The performance of F-18-FDG PET/CT in specific clinical situations is of special interest: in the differentiation of indeterminate lung lesions, the staging of NSCLC for lymph node and extra thoracic metastases, for therapy planning, the detection of recurrent lung cancer and the use in SCLC. In conclusion, F-18-FDG PET/CT helps in characterization of suspicious lesions, provides more precise staging of NSCLC than other imaging techniques, allows better patients? selection for new modalities of treatment, helps in restaging after induction therapy, allows better delineation for radiotherapy planning and helps in follow up evaluation by differentiating residual or recurrent tumor from post treatment scar.

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