Positron emission tomography/computed tomography to improve staging and restaging in Merkel cell carcinoma.

8552 Background: Merkel cell carcinoma (MCC) is a rare (~1,500 cases per year) and highly aggressive (33% mortality) cutaneous neuroendocrine carcinoma that occurs in older white patients on the UV-exposed skin of the head, neck, and extremities. As a patient’s stage at presentation is a strong predictor of survival, and there is a high propensity for locoregional recurrence and distant progression, imaging remains crucial for initial and subsequent management. There is, however, no consensus on the timing or method of imaging for MCC. Methods: We retrospectively reviewed 270 2-fluoro-[18F]-deoxy-2-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) scans performed in 97 patients at the Dana-Farber/Brigham and Women’s Cancer Center from August 2003 to December 2010. Results: The mean SUVmax was 6.5 for primary tumors, 6.4 for regional lymph nodes, 7.2 for distant metastases (all sites), 8.0 for bone/bone marrow metastases, and 9.4 for non-regional metastases in those patients with no identified primary. PET/CT imaging performed for initial management tended to upstage patients with more advanced disease (50% of stage IIIB patients). Metastases to bone/bone marrow (12 patients, 38%) was the 2nd most common site of distant spread after non-regional lymph nodes (19 patients, 59%), followed by skin (8 patients, 25%), liver (6 patients, 19%), lung/pleura (5 patients, 16%), adrenal (3 patients, 9%), muscle (3 patients, 9%), pancreas (2 patients, 6%), and peritoneum (1 patient, 3%). In 10 of 12 patients, PET identified bone/bone marrow metastases that were not seen on CT imaging, which resulted in either upstaging or initiation of more targeted palliative therapy. Conclusions: Added value of PET over CT, such as in the detection of bone/bone marrow metastases, may lead to more accurate staging, and thus prognostication, as well as earlier detection of relapse and initiation of salvage treatment. Its use should be considered in the staging and restaging of MCC.

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Mediastinal Staging for Lung Cancer

Canadian Respiratory Journal ◽

10.1155/2014/890108 ◽

2014 ◽

Vol 21 (3) ◽

pp. 159-161 ◽

Cited By ~ 8

Author(s):

Jacob Gelberg ◽

Sean Grondin ◽

Alain Tremblay

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Positron Emission Tomography ◽

Lymph Nodes ◽

Emission Tomography ◽

Mediastinal Staging ◽

Positron Emission ◽

Pet Ct ◽

Diagnosis Of Cancer ◽

Rule Out

Staging of the mediastinal and hilar lymph nodes plays a crucial role in identifying the best treatment option for patients with confirmed or suspected lung cancer and, in many cases, can simultaneously confirm a diagnosis of cancer. Noninvasive modalities, such as computed tomography (CT), positron emission tomography (PET) and PET-CT, are an important first step in this assessment. Ultimately, invasive staging is frequently required to confirm or rule out the presence of metastatic disease within the lymph nodes. The present focused review describes and compares noninvasive and invasive modalities for mediastinal staging in lung cancer.

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Positron Emission Tomography (PET) Radiopharmaceuticals in Multiple Myeloma

Molecules ◽

10.3390/molecules25010134 ◽

2019 ◽

Vol 25 (1) ◽

pp. 134 ◽

Cited By ~ 1

Author(s):

Christos Sachpekidis ◽

Hartmut Goldschmidt ◽

Antonia Dimitrakopoulou-Strauss

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Multiple Myeloma ◽

Bone Marrow ◽

Bone Disease ◽

Emission Tomography ◽

Whole Body ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg

Multiple myeloma (MM) is a plasma cell disorder, characterized by clonal proliferation of malignant plasma cells in the bone marrow. Bone disease is the most frequent feature and an end-organ defining indicator of MM. In this context, imaging plays a pivotal role in the management of the malignancy. For several decades whole-body X-ray survey (WBXR) has been applied for the diagnosis and staging of bone disease in MM. However, the serious drawbacks of WBXR have led to its gradual replacement from novel imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT). PET/CT, with the tracer 18F-fluorodeoxyglucose (18F-FDG), is now considered a powerful diagnostic tool for the detection of medullary and extramedullary disease at the time of diagnosis, a reliable predictor of survival as well as the most robust modality for treatment response evaluation in MM. On the other hand, 18F-FDG carries its own limitations as a radiopharmaceutical, including a rather poor sensitivity for the detection of diffuse bone marrow infiltration, a relatively low specificity, and the lack of widely applied, established criteria for image interpretation. This has led to the development of several alternative PET tracers, some of which with promising results regarding MM detection. The aim of this review article is to outline the major applications of PET/CT with different radiopharmaceuticals in the clinical practice of MM.

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Routine Bone Marrow Biopsy Has Little or No Therapeutic Consequence for Positron Emission Tomography/Computed Tomography–Staged Treatment-Naive Patients With Hodgkin Lymphoma

Journal of Clinical Oncology ◽

10.1200/jco.2012.42.4036 ◽

2012 ◽

Vol 30 (36) ◽

pp. 4508-4514 ◽

Cited By ~ 165

Author(s):

Tarec Christoffer El-Galaly ◽

Francesco d'Amore ◽

Karen Juul Mylam ◽

Peter de Nully Brown ◽

Martin Bøgsted ◽

...

Keyword(s):

Computed Tomography ◽

Risk Assessment ◽

Positron Emission Tomography ◽

Bone Marrow ◽

Hodgkin Lymphoma ◽

Bone Marrow Biopsy ◽

Emission Tomography ◽

Newly Diagnosed ◽

Positron Emission ◽

Pet Ct

Purpose To investigate whether bone marrow biopsy (BMB) adds useful information to [18F]fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) staging in patients with Hodgkin lymphoma (HL). Patients and Methods Newly diagnosed patients with HL undergoing a pretherapeutic staging that encompasses both PET/CT and BMB were included in this retrospective study. The pattern of skeletal FDG uptake was categorized as uni-, bi-, or multifocal (≥ three lesions). Clinical stage, risk assessment, and treatment plan were determined with and without the contribution of BMB results according to the Ann Arbor classification and the guidelines from the German Hodgkin Study Group. Results A total of 454 patients with HL were included of whom 82 (18%) had focal skeletal PET/CT lesions and 27 (6%) had positive BMB. No patients with positive BMB were assessed as having stage I to II disease by PET/CT staging. BMB upstaged five patients, assessed as being stage III before BMB; none of the 454 patients would have been allocated to another treatment on the basis of BMB results. Focal skeletal PET/CT lesions identified positive and negative BMBs with a sensitivity and specificity of 85% and 86%, respectively. The positive and negative predictive values of focal skeletal PET/CT lesions for BMB results were 28% and 99%, respectively. Conclusion A consistent finding of this study was the absence of positive BMBs in PET/CT-assessed stage I to II disease. The omission of staging BMB would not have changed the risk assessment or treatment strategy in this cohort of 454 newly diagnosed patients with HL.

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The role of positron emission tomography combined with computed tomography in the diagnosis and evaluation of treatment effectiveness of non-small cell lung cancer

Russian Journal of Oncology ◽

10.18821/1028-9984-2016-21-3-160-164 ◽

2016 ◽

Vol 21 (3) ◽

pp. 160-164

Author(s):

Nadezhda A. Meshcheryakova ◽

M. B Dolgushin ◽

M. M Davydov ◽

K. K Laktionov ◽

A. A Odzharova ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Positron Emission Tomography ◽

Lymph Nodes ◽

Small Cell Lung Cancer ◽

Small Cell ◽

Emission Tomography ◽

Small Cell Lung ◽

Positron Emission ◽

Pet Ct

Single photon emission computed tomography (SPECT) with the use of various tumor-tropic radiopharmaceutical preparations (RFP) has shown its effectiveness in the identification of tumor process in the lungs and metastatic lesions of mediastinal lymph nodes. In lung cancer such RFPs as Technetium-99m methoxy isobutyl isonitrile (MIBI) I) and 99mTc-depreotid got the largest traction. Increasingly frequently for the initial assessment of the prevalence ofprimary non-small cell lung cancer (NSCLC) there was used positron emission tomography combined with computed tomography (PET/CT) with 2-[18F]Fluoro-2-deoxy-d-glucose ([18F]FDG). The combined PET/CT image consider metabolic and morphological data, that allows to localize precisely the dissemination of the process and is used for the confirmation of the stage, detection of metabolically active extrathoracic lymph nodes, including those of the standard size (

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Posterior scapular lymph nodes in a patient with follicular lymphoma on whole-body 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT)

Revista Española de Medicina Nuclear ◽

10.1157/13121031 ◽

2008 ◽

Vol 27 (3) ◽

pp. 202-203

Author(s):

S. Mahmood ◽

S.R. Martínez de Llano

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Lymph Nodes ◽

Follicular Lymphoma ◽

Emission Tomography ◽

Whole Body ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg

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Computed Tomography Radiomics for Residual Positron Emission Tomography-Computed Tomography Uptake in Lymph Nodes after Treatment

Cancers ◽

10.3390/cancers12123564 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3564

Author(s):

Chu Hyun Kim ◽

Hyunjin Park ◽

Ho Yun Lee ◽

Joong Hyun Ahn ◽

Seung Hak Lee ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Lymph Nodes ◽

Pathologic Complete Response ◽

Multivariable Analysis ◽

Discrimination Performance ◽

Emission Tomography ◽

Fdg Uptake ◽

Positron Emission ◽

Pet Ct

Although a substantial decrease in 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT) indicates a promising metabolic response to treatment, predicting the pathologic status of lymph nodes (LN) remains challenging. We investigated the potential of a CT radiomics approach to predict the pathologic complete response of LNs showing residual uptake after neoadjuvant concurrent chemoradiotherapy (NeoCCRT) in patients with non-small cell lung cancer (NSCLC). Two hundred and thirty-seven patients who underwent NeoCCRT for stage IIIa NSCLC were included. Two hundred fifty-two CT radiomics features were extracted from LNs showing remaining positive FDG uptake upon restaging PET-CT. A multivariable logistic regression analysis of radiomics features and clinicopathologic characteristics was used to develop a prediction model. Of the 237 patients, 135 patients (185 nodes) met our inclusion criteria. Eighty-seven LNs were proven to be malignant (47.0%, 87/185). Upon multivariable analysis, metastatic LNs were significantly prevalent in females and patients with adenocarcinoma (odds ratio (OR) = 2.02, 95% confidence interval (CI) = 0.88–4.62 and OR = 0.39, 95% CI = 0.19–0.77 each). Metastatic LNs also had a larger maximal 3D diameter and higher cluster tendency (OR = 9.92, 95% CI = 3.15–31.17 and OR = 2.36, 95% CI = 1.22–4.55 each). The predictive model for metastasis showed a discrimination performance with an area under the receiver operating characteristic curve of 0.728 (95% CI = 0.654–0.801, p value < 0.001). The radiomics approach allows for the noninvasive detection of metastases in LNs with residual FDG uptake after the treatment of NSCLC patients.

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[18 F]-Fludarabine Positron Emission Tomography in Chronic Lymphocytic Leukemia Patients: Results of a Phase I Study

Blood ◽

10.1182/blood.v126.23.5267.5267 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5267-5267

Author(s):

Narinée Hovhannisyan ◽

Sylvain P Chantepie ◽

Meziane Ibazizene ◽

Alain Manrique ◽

Oumedaly Reman ◽

...

Keyword(s):

Positron Emission Tomography ◽

Bone Marrow ◽

Chronic Lymphocytic Leukemia ◽

Lymph Nodes ◽

Fdg Pet ◽

Lymphocytic Leukemia ◽

Emission Tomography ◽

Lymphoid Malignancies ◽

Positron Emission ◽

Pet Ct

Abstract Introduction. [18 F]-Fludarabine is a promising novel positron emission tomography (PET) radiotracer for lymphoid malignancies. The rationale supporting its development is the high selectivity of fludarabine uptake within lymphoid cells irrespective of their cycle activity, and the fluorine atom within the drug, which replaced by a [18 F] confers the positron-emitter property. Pre-clinical studies with [18 F]-fludarabine (Dhilly M et al, Mol Imaging Biol 2014,16:118-26; Hovhannisyan N et al, EJNMMI Res 2015,5:23) showed a marked tumor uptake in lymphoma-bearing mice. The aim of this study was to describe anatomical sites with abnormal [18 F]-fludarabine uptake in patients with B-cell chronic lymphocytic leukemia (B-CLL), in whom [18 F]-FDG PET imaging appears to be less informative than in other lymphoid malignancies. This study was designed as a clinical proof of concept. Methods. [18 F]-Fludarabine was produced according to a method already described (Guillouet S et al, Mol Imaging Biol 2014,16:28-35). [18 F]-Fludarabine PET/CT (Discovery RX VCT 64, GE Healthcare) was performed in 5 patients (51-70 years old) with a diagnosis of B-CLL (according to current recommendations), without suspicion of Richter's syndrome. Successive partial body scans (skull vertex to mid-thigh) were acquired for 250 min after intravenous injection of [18 F]-fludarabine with an activity of 4MBq/kg. PET images were analyzed by drawing volumes of interest (VOI) over the uptake sites on a late scan and projected onto all co-registered scans of the same subject. The intensity of tracer uptake was evaluated with the maximum standardized uptake value (SUVmax). The images of [18 F]-fludarabine PET/CT were visually compared with conventional modalities (high-resolution CT) and [18 F]-FDG PET in one patient. Results. No adverse event was recorded during and after the procedure. In the 5 patients studied, the uptake of [18 F]-fludarabine coincides with sites expected to be involved following conventional clinical and CT scan staging (i.e. lymph nodes, spleen, tonsils). Additionally, [18 F]-fludarabine PET/CT displayed a significant uptake in hematopoietic bone marrow, and unexpected uptake in the medulla of some bones (femur, humerus, sphenoid, calvarium), and in Peyer's patches. SUVmax were significantly greater in involved sites in comparison with normal tissues or organs (Figure 1). Within the involved sites, [18 F]-fludarabine demonstrated a wide range of uptake which would indicate heterogeneity and differing micro-environments. For instance, the most active sites of the case illustrated in Figure 1 (scan period 30-50 min) are lymph nodes (SUVmax 7.4), spleen (SUVmax 6.3) and bone marrow (SUVmax 3.8) with aortic uptake (SUVmax 1.5) as background level. Conclusion. These preliminary results showed a clear specificity of this novel radiotracer for lymphoid tissues. [18 F]-Fludarabine PET/CT appears to be a promising tool for the diagnosis and follow-up of B-CLL. These scans indicate variable activity within proliferation sites, information otherwise not accessible by current non-invasive procedures. Further studies for a more accurate comparison with [18 F]-FDG PET, evaluation of response during and after treatment and correlation with B-CLL prognostic criteria are underway. Figure 2. Figure 2. Disclosures No relevant conflicts of interest to declare.

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The Potential Value of Hybrid Positron Emission Tomography/Dual-Source Computed Tomography Imaging in Coronary Bypass Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20111045 ◽

2011 ◽

Vol 14 (5) ◽

pp. 283 ◽

Cited By ~ 2

Author(s):

Andre Plass ◽

Maximilian Y. Emmert ◽

Oliver Gaemperli ◽

Hatem Alkadhi ◽

Philipp Kaufmann ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Myocardial Perfusion ◽

Predictive Value ◽

Bypass Surgery ◽

Emission Tomography ◽

Positron Emission ◽

Pet Ct

Background: We evaluated how comprehensive assessment of coronary artery lesions and their hemodynamic relevance by means of hybrid positron emission tomography (PET) and computed tomography (CT) imaging would affect decision-making in coronary artery bypass surgery (CABG), compared with using invasive coronary angiography (ICA) alone.Methods: After undergoing ICA, 27 patients (21 men and 6 women; mean SD age, 66 � 10 years) planned for cardiac surgery were scheduled for myocardial perfusion stress/rest evaluation with [13N]ammonia PET and CT coronary angiography. Only ICA was available to the surgeon. Postoperatively, the performed CABG was compared with the hypothetical strategy based on hybrid PET/CT findings (regional coronary flow reserve [CFR], myocardial perfusion defects). Procedures included CABG (n = 18) alone, CABG combined with valve replacement (n = 6), and CABG combined with isolated valve replacement (n = 3). A total of 56 bypass grafts (28 venous and 28 arterial) and 66 distal anastomoses were placed.Results: CT evaluation showed 93% concordance (66/71) with ICA regarding significant stenoses, with sensitivity, specificity, positive predictive value, and negative predictive value of 93.1%, 98.7%, 94.4%, and 98.4%, respectively. In the PET scan, 16 patients had 1 ischemic region, and 12 patients had 1 scar region, including 5 patients who presented with mixed conditions (scar and ischemia). One patient had a completely normal myocardium. Compared with the performed surgery, PET/CT fusion evaluation showed that of the performed anastomoses, 48% had documented ischemia (with a CFR <2 in 86%), 38% were nonischemic (although a CFR value <2 was found in 78%), and 14% had scar tissue (fixed perfusion defect).Conclusions: Although <50% of bypasses were placed to areas with myocardial ischemia, the CFR was low in the majority of nonischemic regions, a finding that may have important prognostic relevance. PET/CT fusion imaging could potentially influence planning for CABG and provide incremental prognostic information.

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