scholarly journals Quantitative implications of the updated EARL 2019 PET–CT performance standards

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Andres Kaalep ◽  
Coreline N. Burggraaff ◽  
Simone Pieplenbosch ◽  
Eline E. Verwer ◽  
Terez Sera ◽  
...  
Keyword(s):  
Performance Standards ◽  
Blood Pool ◽  
Volume Of Interest ◽  
Quantitative Metrics ◽  
Pet Ct ◽  
Significant Difference ◽  
Cancer Types ◽  
Malignant Lesions ◽  
The Impact ◽  
Ct Studies

Abstract Purpose Recently, updated EARL specifications (EARL2) have been developed and announced. This study aims at investigating the impact of the EARL2 specifications on the quantitative reads of clinical PET–CT studies and testing a method to enable the use of the EARL2 standards whilst still generating quantitative reads compliant with current EARL standards (EARL1). Methods Thirteen non-small cell lung cancer (NSCLC) and seventeen lymphoma PET–CT studies were used to derive four image datasets—the first dataset complying with EARL1 specifications and the second reconstructed using parameters as described in EARL2. For the third (EARL2F6) and fourth (EARL2F7) dataset in EARL2, respectively, 6 mm and 7 mm Gaussian post-filtering was applied. We compared the results of quantitative metrics (MATV, SUVmax, SUVpeak, SUVmean, TLG, and tumor-to-liver and tumor-to-blood pool ratios) obtained with these 4 datasets in 55 suspected malignant lesions using three commonly used segmentation/volume of interest (VOI) methods (MAX41, A50P, SUV4). Results We found that with EARL2 MAX41 VOI method, MATV decreases by 22%, TLG remains unchanged and SUV values increase by 23–30% depending on the specific metric used. The EARL2F7 dataset produced quantitative metrics best aligning with EARL1, with no significant differences between most of the datasets (p>0.05). Different VOI methods performed similarly with regard to SUV metrics but differences in MATV as well as TLG were observed. No significant difference between NSCLC and lymphoma cancer types was observed. Conclusions Application of EARL2 standards can result in higher SUVs, reduced MATV and slightly changed TLG values relative to EARL1. Applying a Gaussian filter to PET images reconstructed using EARL2 parameters successfully yielded EARL1 compliant data.

scholarly journals ARE OBESITY AND ADENOMA DEVELOPMENT ASSOCIATED AS COLORECTAL CANCER PRECURSORS?

2020 ◽  
Vol 33 (1) ◽  
Author(s):  
Bianca Astrogildo de FREITAS ◽  
Carlos Alberto Tomatis LOTH ◽  
Gustavo Lazaroto SWAROWSKY ◽  
Graziela Morais LOURENÇO ◽  
Lucio Sarubbi FILLMANN ◽  
...  
Keyword(s):  
Colorectal Carcinoma ◽  
Public Health Problem ◽  
Clinical History ◽  
Normal Weight ◽  
Colorectal Adenomas ◽  
Anthropometric Data ◽  
Significant Difference ◽  
Malignant Lesions ◽  
Cancer Precursors ◽  
The Impact

ABSTRACT Background: One of the most important concerns on health is the increased rates of obesity in population and the speed in which this number is increasing. This number translates a serious public health problem, since it also increases the risk of several other diseases associated with obesity resulting in significant morbidity and mortality. Among them, it seems to be connected to several neoplasms, such as colorectal carcinoma. Aim: To evaluate the impact of obesity as a risk factor for colorectal carcinoma through the detection of adenoma, and to discuss the mechanisms that could establish a link between obesity and neoplasm. Methods: Patients who underwent colonoscopy were included. Personal and anthropometric data, clinical history, and results of the tests were analyzed in order to verify the correlation of BMI and the presence of adenomatous polyps. Results: A total of 142 patients were studied, which a mean age of 62 years. Of the patients, 74 (52.1%) were men and 68 (47.9%) were. Obesity was identified in 16.2% of the patients. Polyps were found in 61 (42.9%), mostly smaller than 1 cm. Obese individuals were 1.56 times more likely to present colorectal adenoma than patients with normal weight. Conclusion: This study, although showing the greater presence of colorectal adenomas in obese individuals, did not show a significant difference in the occurrence of pre-malignant lesions.

scholarly journals Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT: the SPUTNIK trial

2020 ◽  
Author(s):  
J. R. Weir-McCall ◽  
◽  
S. Harris ◽  
K. A. Miles ◽  
N. R. Qureshi ◽  
...  
Keyword(s):  
Multicentre Trial ◽  
Pulmonary Nodules ◽  
Blood Pool ◽  
Qualitative Assessment ◽  
Solitary Pulmonary Nodules ◽  
Nodule Size ◽  
Diagnostic Threshold ◽  
Pet Ct ◽  
The Impact

Abstract Purpose To compare qualitative and semi-quantitative PET/CT criteria, and the impact of nodule size on the diagnosis of solitary pulmonary nodules in a prospective multicentre trial. Methods Patients with an SPN on CT ≥ 8 and ≤ 30 mm were recruited to the SPUTNIK trial at 16 sites accredited by the UK PET Core Lab. Qualitative assessment used a five-point ordinal PET-grade compared to the mediastinal blood pool, and a combined PET/CT grade using the CT features. Semi-quantitative measures included SUVmax of the nodule, and as an uptake ratio to the mediastinal blood pool (SURBLOOD) or liver (SURLIVER). The endpoints were diagnosis of lung cancer via biopsy/histology or completion of 2-year follow-up. Impact of nodule size was analysed by comparison between nodule size tertiles. Results Three hundred fifty-five participants completed PET/CT and 2-year follow-up, with 59% (209/355) malignant nodules. The AUCs of the three techniques were SUVmax 0.87 (95% CI 0.83;0.91); SURBLOOD 0.87 (95% CI 0.83; 0.91, p = 0.30 versus SUVmax); and SURLIVER 0.87 (95% CI 0.83; 0.91, p = 0.09 vs. SUVmax). The AUCs for all techniques remained stable across size tertiles (p > 0.1 for difference), although the optimal diagnostic threshold varied by size. For nodules < 12 mm, an SUVmax of 1.75 or visual uptake equal to the mediastinum yielded the highest accuracy. For nodules > 16 mm, an SUVmax ≥ 3.6 or visual PET uptake greater than the mediastinum was the most accurate. Conclusion In this multicentre trial, SUVmax was the most accurate technique for the diagnosis of solitary pulmonary nodules. Diagnostic thresholds should be altered according to nodule size. Trial registration ISRCTN - ISRCTN30784948. ClinicalTrials.gov - NCT02013063

5965Perimatrial inflammation measured by fluoine-18-fluorodeoxyglucose-positron emission tomography/computed tomography to predict new-onset atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Hada ◽  
S Iwamiya ◽  
S Hijikata ◽  
T Yoshitake ◽  
H Sato ◽  
...  
Keyword(s):  
Blood Pool ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Significant Difference ◽  
Group A ◽  
Arterial Inflammation ◽  
Group B ◽  
Fdg Pet Ct ◽  
New Onset

Abstract Background Fluoine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is a useful modality of inflammatory disease. Epicardial adipose tissue (EAT) contains abundant ganglionated plexi, therefore EAT inflammation may cause atrial arrhythmia, such as atrial premature contraction (APC) and atrial fibrillation (AF). Previous studies have shown that inflammatory activity of EAT has relation to the presence of AF. However, it is unknown whether EAT inflammation contributes to the occurrence of AF. Methods Out of 20720 examinees who underwent FDG-PET/CT for screening of cancer in the years 2012–2018, 151 (aged 65.6±12.0 years old, 62 females) had ambulatory electrocardiographic monitoring (Holter ECG) within a year and non-detection of AF. Standardized uptake value (SUV) was measured in fat adjacent to roof of left atrium (ROOF), atrioventricular groove (AV), left main coronary artery (LMT), and right ventricular blood pool (RV). In order to correct for blood pool activity, SUV of ROOF, AV, and LMT were divided by SUV of RV respectively, yielding target-to-background ratio (TBR). As regards to arterial inflammation, measurements were performed with SUV in ascending aorta (A-Ao) and in superior vena cava (SVC) as blood pool. In the same way, SUV of A-Ao was divided by SUV of SVC, yielding TBR. Results According to Holter ECG, APC≥100 beats per day was seen in 60 patients (Group A), but not in the other 91 (Group B). In Group A, TBR of ROOF, AV, and LMT were all significantly higher than Group B (p<0.001, p=0.004, and p=0.008, respectively). During a median follow-up of 179 days, new-onset AF was diagnosed in 7 patients (4 in Group A (6.7%), 3 in Group B (3.3%), p=0.046). There was significant difference in TBR of ROOF between patients with and without new-onset AF (p<0.001), but not in TBR of AV and LMT. In addition, no significant difference was observed in TBR of A-Ao between these two groups. In the Cox proportional hazard analysis, TBR of ROOF was found to be an independent predictor of new-onset AF (odds ratio 40.1, 95% confidence interval 6.05 to 265.9, p<0.001). Conclusions Although EAT inflammation evaluated by SUV is related to frequent APCs, only in fat adjacent to roof of left atrium is associated with and predicts future occurrence of AF. Arterial inflammation measured by SUV has no relation to atrial arrhythmia.

The impact on diagnostic quality of using contrast media in PET-CT studies

2010 ◽  
Vol 52 (4) ◽  
pp. 327-332
Author(s):  
M. García García-Esquinas ◽  
A. Ortega Candil ◽  
L. Lapeña Gutierrez ◽  
J. Mucientes Rasilla ◽  
J.L. Carreras Delgado ◽  
...  
Keyword(s):  
Contrast Media ◽  
Diagnostic Quality ◽  
Pet Ct ◽  
The Impact ◽  
Ct Studies

scholarly journals The Role of [18F]FDG-PET/CT in Predicting Malignant Transformation of Plexiform Neurofibromas in Neurofibromatosis-1

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
David Tovmassian ◽  
Muzib Abdul Razak ◽  
Kevin London
Keyword(s):  
Systematic Review ◽  
Peripheral Nerve ◽  
Fdg Pet ◽  
Neurofibromatosis 1 ◽  
Noninvasive Test ◽  
Plexiform Neurofibromas ◽  
Pet Ct ◽  
Significant Difference ◽  
Malignant Lesions ◽  
Fdg Pet Ct

Background. Malignant peripheral nerve sheath tumours (MPNSTs) are difficult to diagnose and treat and contribute to significant morbidity and mortality for patients with Neurofibromatosis-1 (NF-1). FDG-PET/CT is being increasingly used as an imaging modality to discriminate between benign and malignant plexiform neurofibromas. Objectives. To assess the value of FDG-PET/CT in differentiating between benign and malignant peripheral nerve lesions for patients with Neurofibromatosis-1. Methods. A systematic review of the literature was performed prior to application of stringent selection criteria. Ultimately 13 articles with 796 tumours were deemed eligible for inclusion into the review. Results. There was a significant difference between mean SUVmax of benign and malignant lesions (1.93 versus 7.48, resp.). Sensitivity ranged from 89 to 100% and specificity from 72 to 94%. ROC analysis was performed to maximise sensitivity and specificity of SUVmax cut-off; however no clear value was identified (range 3.1–6.1). Significant overlap was found between the SUVmax of benign and malignant lesions making differentiation of lesions difficult. Many of the studies suffered from having a small cohort and from not providing histological data on all lesions which underwent FDG-PET/CT. Conclusion. This systematic review is able to demonstrate that FDG-PET/CT is a useful noninvasive test for discriminating between benign and malignant lesions but has limitations and requires further prospective trials.

Combination of Rituximab with Initial Chemotherapy Improves Outcome of Primary Mediastinal B-Cell Lymphoma: A Retrospective Analysis of a Single Institution Cohort

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1283-1283 ◽  
Author(s):  
Abraham Avigdor ◽  
Tsvi Sirotkin ◽  
Noga Shemtov ◽  
Miriam Berkowicz ◽  
Yaron Davidovitz ◽  
...  
Keyword(s):  
B Cell ◽  
Retrospective Analysis ◽  
Predictive Value ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Historical Comparison ◽  
Pet Ct ◽  
Significant Difference ◽  
The Impact

Abstract Primary mediastinal B-cell lymphoma (PMBCL) is a relatively rare clinico-pathologic subtype of diffuse large B-cell lymohoma. The optimal management, the prognostic factors and the role of PET/CT scan in this entity remain a matter of debate. While several retrospective studies suggested that dose-dense regimens are more effective than standard CHOP, the impact of adding rituximab (R) on the outcome of patients (pts) with PMBCL has not been fully evaluated. In this retrospective analysis we reviewed the clinical and radiological records of 81 consecutive pts with PMBCL treated in Sheba Medical Center between August 1985 and October 2006. Chemotherapy in the pre-rituximab era (−R cohort) included VACOPB (n=47) or 6 courses of standard CHOP (n=5). Since October 2002, 6 cycles of R were added concurrent with the treatment in another 29 pts (+R cohort): R-VACOPB (n=21) and R-CHOP (n=8). Radiotherapy was not administered following initial chemotherapy to any of the pts. Median age at diagnosis was 31 years (yrs) (range 17–61). Stage I/II and bulky mediastinum (≥ 10 cm in diameter) were present in 88% and 33%, respectively, and extranodal involvement was evident in 44% of all pts. After a median follow-up of 85 months (range 9–240), the overall (OS) and progression-free (PFS) survival at 5 yrs for the entire cohort were 89% and 66%, respectively, with a plateau 1–2 yrs following treatment. PFS at 5 years was significantly better with +R (81%) than with -R cohort (58%, P=0.03). Five-year PFS in pts treated with R-VACOPB, R-CHOP, VACOP-B and CHOP were 84%, 74%, 62%, 20%, respectively (P=0.025). Yet, there was no significant difference in OS between +R and -R cohorts (96% vs. 88% at 5 yrs, p=0.29). Direct survival comparisons demonstrated that 5-yr OS and PFS were significantly better in VACOPB than in CHOP (P=0.04 and 0.05, respectively) and that R-VACOPB was significantly superior to VACOPB in terms of PFS (p=0.05). In contrast, there was no difference in 5-yr PFS between R-VACOPB and R-CHOP (p=0.44). Univariate analysis revealed that aaIPI was not predictive of OS (p=0.51). Age above 31 yrs (p=0.02) and pericardial effusion (p=0.04) were the only predictors of reduced OS. Furthermore, beginning in 2003, 16 consecutive pts in the +R cohort, who were scanned by PET/CT-FDG before starting and after completion of therapy, were also evaluated in the middle (mid-PET) of treatment. The estimated 3-year PFS rate for mid-PET negative pts (n=8) and for mid-PET positive pts (n=8) was 86% and 75%, respectively (P=0.48). In terms of treatment failure, the negative predictive value of mid-PET was 100%, while the positive predictive value was only 25%. In conclusion, our population-based historical comparison demonstrates that the addition of R to anthracycline-based therapy significantly improved PFS in pts with PMBCL. We observed superior PFS with VACOPB compared with CHOP, but this superiority was abrogated by the introduction of R as part of initial therapy. These findings merit further study in randomized prospective studies.

scholarly journals The Coronavirus Disease Pandemic 2019 [COVID-19]: Impact on NHS England PET-CT Scanning 

2020 ◽  
Author(s):  
Wai Lup Wong ◽  
Peter Ross ◽  
Kevin Peters ◽  
Marion Frenz ◽  
Tong Hai ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Oesophageal Cancer ◽  
Statistical Significance ◽  
Ct Scanning ◽  
Initial Diagnosis ◽  
Cancer Type ◽  
Pet Ct ◽  
Cancer Types ◽  
Rate Of Decline ◽  
The Impact

Abstract Purpose To examine the impact of the COVID-19 pandemic on PET-CT scanning activity across England. Methods Monthly PET-CT scanning activity was collected from 41/48 NHS England provider sites. Data from 31/41sites was stratified by non-oncology/oncology and cancer type. Lung cancer and lymphoma activity was split into specific indications. The data was compiled in Excel and analysed using Stata software to assess distribution and statistical significance of variation in activity comparing levels before and during the COVID-19 pandemic. Results In April and May 2020 a 32% and 31% decrease in activity was observed; a larger decrease for non-cancer compared with cancer PET-CT. In June 2020 PET-CT activity started to recover with 6% fewer scans recorded compared with June 2019. Decrease and recovery varied according to cancer types. Of the six most common indications for PET CT, lung and oesophageal cancer had the largest decrease in activity: lung -29%, -45% and oesophagus -43%, -59% in April and May respectively, and slowest recovery, -23%, -26% respectively in June. By contrast, lymphoma and melanoma showed the smallest decrease: lymphoma -14%, -9%; melanoma -16%, +5% in April and May respectively, and fastest recovery +12% lymphoma +14% respectively. Specifically, lung cancer PET-CTs related to initial diagnosis and staging saw the largest fall and slowest recovery compared with PET-CTs for people with known lung cancer. Conclusions There was considerable variation in the rate of decline and recovery in PET-CT scanning across cancer types and specific indications related to the cancer type. The causes for the variation remain to be explained.

scholarly journals Malignancy Rate of Indeterminate Findings on FDG-PET/CT in Cutaneous Melanoma Patients

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 883
Author(s):  
Ken Kudura ◽  
Florentia Dimitriou ◽  
Daniela Mihic-Probst ◽  
Urs J. Muehlematter ◽  
Tim Kutzker ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Fdg Pet ◽  
Clinical Management ◽  
Clinical Routine ◽  
Malignancy Rate ◽  
Pet Ct ◽  
Malignant Lesions ◽  
Melanoma Patients ◽  
Fdg Pet Ct ◽  
The Impact

Background: The use of 18F-2-Fluor-2-desoxy-D-glucose Positron Emission Tomography/Computed Tomography FDG-PET/CT in clinical routine for staging, treatment response monitoring and post treatment surveillance in metastatic melanoma patients has noticeably increased due to significant improvement of the overall survival rate in melanoma patients. However, determining the dignity of the findings with increased metabolic activity on FDG-PET/CT can be sometimes challenging and may need further investigation. Purpose: We aimed to investigate the malignancy rate of indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients. Methods: This single-center retrospective study included cutaneous melanoma patients who underwent FDG-PET/CT in clinical routine between 2015 and 2017 with findings reported as indeterminate and therefore requiring further evaluation. The dignity of the included findings was determined by subsequent imaging and, if required, additional histopathology. The impact of the outcome on the clinical management was also reported. Results: A total of 842 FDG-PET/CT reports of 244 metastatic cutaneous melanoma patients were reviewed. Sixty indeterminate findings were included. Almost half of all indeterminate findings were lymph nodes, lung nodules and cerebral lesions. In total, 43.3% of all included findings proved to be malignant. 81% of all malignant lesions were metastases of cutaneous melanoma, while 19% of all malignant lesions could be attributed to other primary malignancies, such as lung, breast, thyroid and colorectal cancers. Malignant findings influenced clinical management in 60% of the cases. Conclusion: Indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients should be further investigated. Almost one out of every two indeterminate findings on FDG-PET/CT is malignant. The majority of the findings are melanoma manifestations, however, in a significant percentage, other primary tumors are found. Upon verification, patient management is changed in most cases.

scholarly journals Combination of FDG-PET and FMISO-PET as a treatment strategy for patients undergoing early-stage NSCLC stereotactic radiotherapy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Shiro Watanabe ◽  
Tetsuya Inoue ◽  
Shozo Okamoto ◽  
Keiichi Magota ◽  
Ayumi Takayanagi ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Standardized Uptake Value ◽  
Whole Body ◽  
Study Endpoint ◽  
Tumor Diameter ◽  
Characteristic Analysis ◽  
Cell Lung Carcinoma ◽  
Pet Ct ◽  
Significant Difference ◽  
The Impact

Abstract Background We investigated the prognostic predictive value of the combination of fluorodeoxyglucose (FDG)- and fluoromisonidazole (FMISO)-PET in patients with non-small cell lung carcinoma (NSCLC) treated with stereotactic body radiation therapy (SBRT). Patients and methods We prospectively examined patients with pathologically proven NSCLC; all underwent FDG and FMISO PET/CT scans before SBRT. PET images were acquired using a whole-body time-of-flight PET-CT scanner with respiratory gating. We classified them into recurrent and non-recurrent groups based on their clinical follow-ups and compared the groups' tumor diameters and PET parameters (i.e., maximum of the standardized uptake value (SUVmax), metabolic tumor volume, tumor-to-muscle ratio, and tumor-to-blood ratio). We performed univariate analysis to evaluate the impact of the PET variables on the patients' progression-free survival (PFS). We divided the patients by thresholds of FDG SUVmax and FMISO SUVmax obtained from receiver operating characteristic analysis for assessment of recurrence rate and PFS. Results Thirty-two NSCLC patients (19 male and 13 females; median age, 83 years) were enrolled. All received SBRT. At the study endpoint, 23 patients (71.9%) were non-recurrent and nine patients (28.1%) had recurrent disease. Significant between-group differences were observed in tumor diameter and all the PET parameters, demonstrating that those were significant predictors of the recurrence in all patients. In the 22 patients with tumors > 2 cm, tumor diameter and FDG SUVmax were not significant predictors. Thirty-two patients were divided into three patterns from the thresholds of FDG SUVmax (6.81) and FMISO SUVmax (1.89); A, low FDG and low FMISO (n = 14); B, high FDG and low FMISO (n = 8); C, high FDG and high FMISO (n = 10). No pattern A patient experienced tumor recurrence, whereas two pattern B patients (25%) and seven pattern C patients (70%) exhibited recurrence. A Kaplan-Meier analysis of all patients revealed a significant difference in PFS between patterns A and B (p = 0.013) and between patterns A and C (p < 0.001). In the tumors > 2 cm patients, significant differences in PFS were demonstrated between pattern A and C patients (p = 0.002). Conclusion The combination of FDG- and FMISO-PET can identify patients with a baseline risk of recurrence and indicate whether additional therapy might be performed to improve survival.

scholarly journals Effects of Respiratory Motion on Y-90 PET Dosimetry for SIRT

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 194
Author(s):  
Matthew D. Walker ◽  
Jonathan I. Gear ◽  
Allison J. Craig ◽  
Daniel R. McGowan
Keyword(s):  
Respiratory Motion ◽  
Motion Platform ◽  
Quiescent Period ◽  
Volume Of Interest ◽  
Pet Ct ◽  
Quantification Accuracy ◽  
The Impact ◽  
Pet Scanners ◽  
Phantom Experiments ◽  
Accurate Quantification

Respiratory motion degrades the quantification accuracy of PET imaging by blurring the radioactivity distribution. In the case of post-SIRT PET-CT verification imaging, respiratory motion can lead to inaccuracies in dosimetric measures. Using an anthropomorphic phantom filled with 90Y at a range of clinically relevant activities, together with a respiratory motion platform performing realistic motions (10–15 mm amplitude), we assessed the impact of respiratory motion on PET-derived post-SIRT dosimetry. Two PET scanners at two sites were included in the assessment. The phantom experiments showed that device-driven quiescent period respiratory motion correction improved the accuracy of the quantification with statistically significant increases in both the mean contrast recovery (+5%, p = 0.003) and the threshold activities corresponding to the dose to 80% of the volume of interest (+6%, p < 0.001). Although quiescent period gating also reduces the number of counts and hence increases the noise in the PET image, its use is encouraged where accurate quantification of the above metrics is desired.

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