scholarly journals Brain metastases assessment by FDG-PET/CT: can it eliminate the necessity for dedicated brain imaging?

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mamdouh A. Zidan ◽  
Radwa S. Hassan ◽  
Khaled I. El-Noueam ◽  
Yasser M. Zakaria
Keyword(s):  
Brain Metastases ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Imaging Modality ◽  
False Negative ◽  
Whole Body ◽  
Cross Sectional ◽  
Primary Tumors ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background Brain metastases (BM) are the most common intracranial tumors in adults outnumbering all other intracranial neoplasms. Positron emission tomography combined with computed tomography (PET/CT) is a widely used imaging modality in oncology with a unique combination of cross-sectional anatomic information provided by CT and the metabolic information provided by PET using the [18F]-2-fluoro-2-deoxy-d-glucose (FDG) as a tracer. The aim of the study is to assess the role and diagnostic performance of brain-included whole-body PET/CT in detection and evaluation of BM and when further imaging is considered necessary. The study was conducted over a period of 12 months on 420 patients suffering from extra-cranial malignancies utilizing brain-included whole-body PET/CT. Results Thirty patients with 71 brain lesions were detected, 18 patients (60%) had BM of unknown origin while 12 patients (40%) presented with known primary tumors. After brain-included whole-body FDG-PET/CT examination, the unknown primaries turned out to be bronchogenic carcinoma in 10 patients (33.3%), renal cell carcinoma in 2 patients (6.7%), and lymphoma in 2 patients (6.7%), yet the primary tumors remained unknown in 4 patients (13.3%). In 61 lesions (85.9%), the max SUV ranged from 0.2- < 10, while in 10 lesions (14.1%) the max SUV ranged from 10 to 20. Hypometabolic lesions were reported in 41 (57.7%) lesions, hypermetabolic in 3 lesions (4.2%), whereas 27 lesions (38.0%) showed similar FDG uptake to the corresponding contralateral brain matter. PET/CT overall sensitivity, specificity, positive and negative predictive, and accuracy values were 78.1, 92.6, 83.3, 90, and 88% respectively. Conclusion Brain-included whole-body FDG-PET/CT provides valuable complementary information in the evaluation of patients with suspected BM. However, the diagnostic performance of brain PET-CT carries the possibility of false-negative results with consequent false sense of security. The clinicians should learn about the possible pitfalls of PET/CT interpretation to direct patients with persistent neurological symptoms or high suspicion for BM for further dedicated CNS imaging.

Imaging in staging of malignant lymphoma: a systematic review

Blood ◽  
2008 ◽  
Vol 111 (2) ◽  
pp. 504-516 ◽  
Author(s):  
Thomas C. Kwee ◽  
Robert M. Kwee ◽  
Rutger A. J. Nievelstein
Keyword(s):  
Systematic Review ◽  
Malignant Lymphoma ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Imaging Modality ◽  
Whole Body ◽  
Published Data ◽  
Early Results ◽  
Pet Ct ◽  
Fdg Pet Ct

Computed tomography (CT) is currently the most commonly used means for staging malignant lymphoma. 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), FDG-PET/CT fusion, and whole-body magnetic resonance imaging (WB-MRI) are potential alternatives. The purpose of this study was to systematically review published data on the diagnostic performance of CT, FDG-PET, FDG-PET/CT fusion, and WB-MRI in staging of malignant lymphoma. In addition, technical aspects, procedures, advantages, and drawbacks of each imaging modality are outlined. Three CT studies, 17 FDG-PET studies, and 4 FDG-PET/CT fusion studies were included in this systematic review. The studies were of moderate methodological quality and used different scoring systems to stage malignant lymphoma. CT remains the standard imaging modality for initial staging of malignant lymphoma, while FDG-PET has an essential role in restaging after treatment. Early results suggest that FDG-PET/CT fusion outperforms both CT alone and FDG-PET alone. Data on the diagnostic performance of WB-MRI are lacking. Future well-designed studies, expressing their results according to the Ann Arbor staging system, are needed to determine which imaging modality is most accurate and cost-effective in staging malignant lymphoma.

scholarly journals Comparison of the diagnostic performance and impact on management of 18F-FDG PET/CT and whole-body MRI in multiple myeloma

2021 ◽  
Author(s):  
Olwen Westerland ◽  
◽  
Ashik Amlani ◽  
Christian Kelly-Morland ◽  
Michal Fraczek ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Data ◽  
Bone Disease ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Whole Body ◽  
Bone Lesions ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Purpose Comparative data on the impact of imaging on management is lacking for multiple myeloma. This study compared the diagnostic performance and impact on management of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and whole-body magnetic resonance imaging (WBMRI) in treatment-naive myeloma. Methods Forty-six patients undergoing 18F-FDG PET/CT and WBMRI were reviewed by a nuclear medicine physician and radiologist, respectively, for the presence of myeloma bone disease. Blinded clinical and imaging data were reviewed by two haematologists in consensus and management recorded following clinical data ± 18F-FDG PET/CT or WBMRI. Bone disease was defined using International Myeloma Working Group (IMWG) criteria and a clinical reference standard. Per-patient sensitivity for lesion detection was established. McNemar test compared management based on clinical assessment ± 18F-FDG PET/CT or WBMRI. Results Sensitivity for bone lesions was 69.6% (32/46) for 18F-FDG PET/CT (54.3% (25/46) for PET component alone) and 91.3% (42/46) for WBMRI. 27/46 (58.7%) of cases were concordant. In 19/46 patients (41.3%) WBMRI detected more focal bone lesions than 18F-FDG PET/CT. Based on clinical data alone, 32/46 (69.6%) patients would have been treated. Addition of 18F-FDG PET/CT to clinical data increased this to 40/46 (87.0%) patients (p = 0.02); and WBMRI to clinical data to 43/46 (93.5%) patients (p = 0.002). The difference in treatment decisions was not statistically significant between 18F-FDG PET/CT and WBMRI (p = 0.08). Conclusion Compared to 18F-FDG PET/CT, WBMRI had a higher per patient sensitivity for bone disease. However, treatment decisions were not statistically different and either modality would be appropriate in initial staging, depending on local availability and expertise.

scholarly journals EVALUATING THE ROLE OF FDG PET-CT SCAN AS A SOLE IMAGING MODALITY IN THE MANAGEMENT OF MUO NECK

2020 ◽  
pp. 39-41
Author(s):  
Krishnappa Krishnappa ◽  
Krishna Prasad ◽  
Shruti Satish ◽  
Murali R Nadig
Keyword(s):  
Ct Scan ◽  
Predictive Value ◽  
Fdg Pet ◽  
Imaging Modality ◽  
False Negative ◽  
Unknown Primary ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Aim:to study the role of PET- CT SCAN as a single imaging modality in the diagnosis of MUO neck. methodology: retrospective study analysis of 51 cases of clinical unknown primary with cervical metastasis . RESULTS: FDG PET CT tracer uptake was detected in 24/51. true positive in 18 cases out of 24,false positive in 6 cases, false negative in 2 cases with sensitivity of 90%, specificity of 82%,positive predictive value of 75%,negative predictive value of 93% and accuracy of 84.91%. conclusion: FDG PET CT can be used as a sole imaging modality in the diagnosis of MUO neck.it is complimentary to endoscopy.

scholarly journals ­­A convolutional neural network-based system to detect malignant findings in FDG PET/CT examinations

2020 ◽  
Author(s):  
Keisuke Kawauchi ◽  
Sho Furuya ◽  
Kenji Hirata ◽  
Chietsugu Katoh ◽  
Osamu Manabe ◽  
...  
Keyword(s):  
Neural Network ◽  
Convolutional Neural Network ◽  
Head And Neck ◽  
Fdg Pet ◽  
Imaging Modality ◽  
Whole Body ◽  
Pelvic Region ◽  
Pet Ct ◽  
Medicine Physician ◽  
Fdg Pet Ct

Abstract Background: As the number of PET/CT scanners increases and FDG PET/CT becomes a common imaging modality for oncology, the demands for automated detection systems on artificial intelligence (AI) to prevent human oversight and misdiagnosis are rapidly growing. We aimed to develop a convolutional neural network (CNN)-based system that can classify whole-body FDG PET as 1) benign, 2) malignant, or 3) equivocal. Methods: This retrospective study investigated 3,485 sequential patients with malignant or suspected malignant disease, who underwent whole-body FDG PET/CT at our institute. All the cases were classified into the 3 categories by a nuclear medicine physician. A residual network (ResNet)-based CNN architecture was built for classifying patients into the 3 categories. In addition, we performed region-based analysis of the CNN (head-and-neck, chest, abdomen, and pelvic region). Results: There were 1,280 (37%), 1,450 (42%), and 755 (22%) patients classified as benign, malignant and equivocal, respectively. In patient-based analysis, the CNN predicted benign, malignant and equivocal images with 99.4%, 99.4%, and 87.5% accuracy, respectively. In region-based analysis, the prediction was correct with the probability of 97.3% (head-and-neck), 96.6% (chest), 92.8% (abdomen) and 99.6% (pelvic region), respectively. Conclusion: The CNN-based system reliably classified FDG PET images into 3 categories, indicating that it could be helpful for physicians as a double-checking system to prevent oversight and misdiagnosis.

Diagnostic performance of 18F-FDG PET/CT and whole-body MRI before and early after treatment of multiple myeloma: a prospective comparative study

2018 ◽  
Vol 36 (6) ◽  
pp. 382-393 ◽  
Author(s):  
Mohammad Abd Alkhalik Basha ◽  
Maged Abdel Gelil Hamed ◽  
Rania Refaat ◽  
Mohamad Zakarya AlAzzazy ◽  
Manar A. Bessar ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Comparative Study ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Whole Body ◽  
Whole Body Mri ◽  
Pet Ct ◽  
Prospective Comparative Study ◽  
18F Fdg ◽  
Fdg Pet Ct

scholarly journals ­­A convolutional neural network-based system to detect malignant findings in FDG PET/CT examinations

2019 ◽  
Author(s):  
Keisuke Kawauchi ◽  
Sho Furuya ◽  
Kenji Hirata ◽  
Chietsugu Katoh ◽  
Osamu Manabe ◽  
...  
Keyword(s):  
Neural Network ◽  
Convolutional Neural Network ◽  
Head And Neck ◽  
Fdg Pet ◽  
Imaging Modality ◽  
Neck Region ◽  
Whole Body ◽  
Pet Ct ◽  
Medicine Physician ◽  
Fdg Pet Ct

Abstract Background As the number of PET/CT scanners increases and FDG PET/CT becomes a common imaging modality for oncology, the demands for automated detection systems on artificial intelligence (AI) to prevent human oversight and misdiagnosis are rapidly growing. We aimed to develop a convolutional neural network (CNN)-based system that can classify whole-body FDG PET as 1) benign, 2) malignant, or 3) equivocal.Methods This retrospective study investigated 3,485 sequential patients with malignant or suspected malignant disease, who underwent whole-body FDG PET/CT at our institute. All the cases were classified into the 3 categories by a nuclear medicine physician. A residual network (ResNet)-based CNN architecture was built for classifying patients into the 3 categories. This network was trained with PET images. Five-fold cross-validations were carried out to estimate the classification performance. In addition, we examined whether the CNN could determine the location of the malignant uptake, be it in the head-and-neck region, chest, abdomen, or pelvic region.Results There were 1,280 (37%), 1,450 (42%) and 755 (22%) patients classified as benign, malignant and equivocal, respectively. In patient-based analysis, the CNN predicted benign and malignant images with 99.4% and 99.4% accuracy, respectively. Furthermore, in region-based analysis, the prediction was correct with the probability of 97.3% (head-and-neck), 96.6% (chest), 92.8% (abdomen) and 99.6% (pelvic region), respectively.Conclusion The CNN-based system reliably classified FDG PET images into 3 categories, indicating that it would be helpful for physicians as a double-checking system to prevent oversight and misdiagnosis.

scholarly journals Diagnostic performance of PET in thyroid cancer with elevated anti-Tg Ab

2018 ◽  
Vol 25 (6) ◽  
pp. 643-652 ◽  
Author(s):  
Seong-Jang Kim ◽  
Sang-Woo Lee ◽  
Kyoungjune Pak ◽  
Sung-Ryul Shim
Keyword(s):  
Thyroid Cancer ◽  
Likelihood Ratio ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Whole Body ◽  
Cochrane Library ◽  
Pet Ct ◽  
Fdg Pet Ct

We aimed to explore the role of the diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for the detection of recurrent and/or metastatic diseases in differentiated thyroid cancer (DTC) patients with progressively and/or persistently elevated TgAb levels and negative radioactive iodine whole-body scan (RI-WBS) through a systematic review and meta-analysis. The MEDLINE, EMBASE and Cochrane Library database, from the earliest available date of indexing through June 30, 2017, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for the detection of recurrent and/or metastatic diseases in DTC patients with progressively and/or persistently elevated TgAb levels and negative RI-WBS. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−). Across 9 studies (515 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.84 (95% CI; 0.77–0.89) a pooled specificity of 0.78 (95% CI; 0.67–0.86). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 3.8 (95% CI; 2.5–5.7) and negative likelihood ratio (LR−) of 0.21 (95% CI; 0.14–0.30). The pooled diagnostic odds ratio (DOR) was 18 (95% CI; 10–34). The area (AUC) under the hierarchical summary receiver-operating characteristic (HCROC) curve was 0.88 (95% CI: 0.85–0.90). F-18 FDG PET or PET/CT demonstrated moderate sensitivity and specificity for the detection of recurrent and/or metastatic diseases in DTC patients with progressively and/or persistently elevated TgAb levels and negative RI-WBS.

scholarly journals Brain Metastases Unresponsive to Immunotherapy Detected by 18F-FDG-PET/CT in a Patient with Melanoma

Diagnostics ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 410 ◽  
Author(s):  
Rosa Fonti ◽  
Sara Pellegrino ◽  
Ciro Gabriele Mainolfi ◽  
Elide Matano ◽  
Silvana Del Vecchio
Keyword(s):  
Monoclonal Antibody ◽  
Brain Metastases ◽  
Fdg Pet ◽  
Palliative Therapy ◽  
Advanced Melanoma ◽  
Whole Body ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
The Brain

Recently, newer therapies such as immunotherapy have been increasingly used in the treatment of several tumors, including advanced melanoma. In particular, several studies showed that the combination of ipilimumab, an anti-Cytotoxic T-lymphocyte Associated Protein 4 (CTLA-4) monoclonal antibody and nivolumab, an anti-Programmed Death 1 (PD-1) monoclonal antibody, leads to improved survival in patients with metastatic melanoma. Despite that, immunotherapeutic agents may not reach therapeutic concentration in the brain due to the blood–brain barrier. We report the case of a 50-year-old man with advanced melanoma who underwent whole-body 18F-FDG-PET/CT before and after treatment with immunotherapy showing resistant brain metastases confirmed by subsequent MRI of the brain. Moreover, 18F-FDG-PET/CT was able to detect an immune-related adverse event such as enterocolitis that contributed to the worsening of patient conditions. This case shows how a whole-body methodology such as 18F-FDG-PET/CT can be useful in identifying melanoma cancer patients unresponsive to immunotherapy that may benefit from traditional palliative therapy in the effort to improve their quality of life.

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