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

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.

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FDG-PET/CT patterns in patients with autoimmune encephalitis: a series of 9 cases

10.5327/1516-3180.378 ◽

2021 ◽

Author(s):

Maria Eduarda Slhessarenko Fraife Barreto ◽

Guilherme de Carvalho Campos ◽

Bruna Letícia Ferrari ◽

Lívia Almeida Dutra

Keyword(s):

Fdg Pet ◽

Brain Mri ◽

Autoimmune Encephalitis ◽

Albert Einstein ◽

Cross Sectional Study ◽

Cognitive Changes ◽

Cross Sectional ◽

Pet Ct ◽

Fdg Pet Ct

Background: Autoimmune encephalitis (AIE) is the main differential diagnosis of infectious encephalitis. Brain MRI is normal in up to 50% of cases and studies indicate that changes in FDG-PET/CT are more frequent and early. Objectives: To describe FDG-PET/CT findings in patients with AIE of Hospital Israelita Albert Einstein (HIAE) from 2015-2020. Design and setting: Retrospective cross-sectional study at HIAE. Methods: Medical records of patients with suspected AIE were reviewed. Laboratory results were compiled, and images were reassessed. Results: Amongst 250 records, we found 7.6% (n=19) of AIE, being 8 seropositive (5 anti-NMDA, 1 anti-CASPR2, 1 anti-MOG, 1 anti-VGKC and 1 anti-LGI1), 5 seronegative and 4 limbic encephalitis. The mean age was 48-22 years, 52% male. In encephalitic patients, the most common manifestations were epilepsy (78%), cognitive changes (63%), and behavioral changes (63%). Only 57% had abnormal MRI. We evaluated 23 PET/CTs at different stages of treatment; of the 9 FDG-PET/CTs performed at initial presentation, 88% were abnormal and 30% had normal MRI. Most frequent patterns found were hypometabolism in frontal (59.1%), temporal (39.1%) and left parietal (39.1%) regions. In follow-up, only 2 patients normalized FDG-PET/CT, with clinical improvement. Conclusions:FDG-PET/CT was altered in 88% of patients. In this series, no typical PET/CT pattern was demonstrated for AIE; the most frequent findings were hypometabolism in cortical areas, which also occur in degenerative diseases. We did not find hypermetabolism, or mixed areas of hypo- and hypermetabolism. The specificity of PET/CT for AIE diagnosis should be evaluated in future studies.

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Prediction of lymph node metastase in NSCLC

Onkologische Welt ◽

10.1055/s-0038-1632899 ◽

2010 ◽

Vol 01 (05) ◽

pp. 219-226 ◽

Cited By ~ 1

Author(s):

F. Beyer ◽

B. Buerke ◽

J. Gerss ◽

K. Scheffe ◽

M. Puesken ◽

...

Keyword(s):

Lymph Nodes ◽

Fdg Pet ◽

Automatic Segmentation ◽

Correlation Coefficients ◽

Mediastinal Lymph Nodes ◽

Intra Class Correlation ◽

Axial Diameter ◽

Pet Ct ◽

Fdg Pet Ct

SummaryPurpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT.Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean

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The Role of 18F-FDG PET/CT in Follow up After Treatment in Childhood Langerhans Cell Histiocytosis.

The Egyptian Journal Nuclear Medicine ◽

10.21608/egyjnm.2019.106661 ◽

2019 ◽

Vol 19 (2) ◽

pp. 50-63

Author(s):

Ismail, A ◽

Abdel Gaid, S.

Keyword(s):

Fdg Pet ◽

Langerhans Cell Histiocytosis ◽

Langerhans Cell ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Hybrid Imaging in Evaluation of Abdominal Sarcoidosis

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180531111616 ◽

2018 ◽

Vol 15 (1) ◽

pp. 26-31 ◽

Cited By ~ 1

Author(s):

Isidora Grozdic Milojevic ◽

Dragana Sobic-Saranovic ◽

Nebojsa Petrovic ◽

Slobodanka Beatovic ◽

Marijana Tadic ◽

...

Keyword(s):

Fdg Pet ◽

Therapy Response ◽

Ct Examination ◽

Abdominal Disease ◽

Pet Ct ◽

Fdg Pet Ct ◽

Total Remission ◽

Active Disease

Objective: To determine the prevalence of abdominal involvement, distribution pattern and evaluate role of hybrid molecular imaging in patients with abdominal sarcoidosis. Methods: Between January 2010 and December 2011, 98 patients with chronic sarcoidosis and presence of prolonged symptoms or other findings suggestive of active disease were referred to FDG PET/CT examination. Active disease was found in 82 patients, and they all were screened for the presence of abdominal sarcoidosis on FDG PET/CT. All patients also underwent MDCT and assessment of serum ACE level. Follow up FDG PET/CT examination was done 12.3±5.4 months after the baseline. Results: Abdominal sarcoidosis was present in 31/82 patients with active sarcoidosis. FDG uptake was present in: retroperitoneal lymph nodes (77%), liver (26%), spleen (23%), adrenal gland (3%). Majority of patients had more than two locations of disease. Usually thoracic disease was spread into the extrathoracic localizations, while isolated abdominal sarcoidosis was present in 10% of patients. After first FDG PET/CT examination therapy was changed in all patients. Eleven patients came to the follow up examination where SUVmax significantly decreased in the majority of them. Three patients had total remission, three had absence of abdominal disease but discrete findings in thorax and others had less spread disease. ACE levels did not correlate with SUVmax level. Conclusion: FDG PET/CT can be a useful tool for detection of abdominal sarcoidosis and in the evaluation of therapy response in these patients. Awareness of the presence of intra-abdominal sarcoidosis is important in order to prevent long-standing unrecognized disease.

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Tumor response evaluation in patients with malignant melanoma undergoing immune checkpoint inhibitor therapy and prognosis prediction using 18F-FDG PET/CT: multicenter study for comparison of EORTC, PERCIST, and imPERCIST

Japanese Journal of Radiology ◽

10.1007/s11604-021-01174-w ◽

2021 ◽

Author(s):

Kazuhiro Kitajima ◽

Tadashi Watabe ◽

Masatoyo Nakajo ◽

Mana Ishibashi ◽

Hiromitsu Daisaki ◽

...

Keyword(s):

Metabolic Disease ◽

Malignant Melanoma ◽

Fdg Pet ◽

Immune Checkpoint Inhibitor ◽

Metabolic Response ◽

Checkpoint Inhibitor ◽

Response Evaluation ◽

Pet Ct ◽

Melanoma Patients ◽

Fdg Pet Ct

Abstract Objective In malignant melanoma patients treated with immune checkpoint inhibitor (ICI) therapy, three different FDG-PET criteria, European Organization for Research and Treatment of Cancer (EORTC), PET Response Criteria in Solid Tumors (PERCIST), immunotherapy-modified PERCIST (imPERCIST), were compared regarding response evaluation and prognosis prediction using standardized uptake value (SUV) harmonization of results obtained with various PET/CT scanners installed at different centers. Materials and methods Malignant melanoma patients (n = 27) underwent FDG-PET/CT examinations before and again 3 to 9 months after therapy initiation (nivolumab, n = 21; pembrolizumab, n = 6) with different PET scanners at five hospitals. EORTC, PERCIST, and imPERCIST criteria were used to evaluate therapeutic response, then concordance of the results was assessed using Cohen’s κ coefficient. Log-rank and Cox methods were employed to determine progression-free (PFS) and overall (OS) survival. Results Complete metabolic response (CMR)/partial metabolic response (PMR)/stable metabolic disease (SMD)/progressive metabolic disease (PMD) with harmonized EORTC, PERCIST, and imPERCIST was seen in 3/5/4/15, 4/5/3/15, and 4/5/5/13 patients, respectively. Nearly perfect concordance between each pair of criteria was noted (κ = 0.939–0.972). Twenty patients showed progression and 14 died from malignant melanoma after a median 19.2 months. Responders (CMR/PMR) showed significantly longer PFS and OS than non-responders (SMD/PMD) (harmonized EORTC: p < 0.0001 and p = 0.011; harmonized PERCIST: p < 0.0001 and p = 0.0012; harmonized imPERCIST: p < 0.0001 and p = 0.0012, respectively). Conclusions All harmonized FDG-PET criteria (EORTC, PERCIST, imPERCIST) showed accuracy for response evaluation of ICI therapy and prediction of malignant melanoma patient prognosis. Additional studies to determine their value in larger study populations will be necessary.

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FDG PET/CT imaging of desmoplastic small round cell tumor: findings at staging, during treatment and at follow-up

Pediatric Radiology ◽

10.1007/s00247-015-3315-y ◽

2015 ◽

Vol 45 (9) ◽

pp. 1308-1315 ◽

Cited By ~ 15

Author(s):

Austin Ostermeier ◽

M. Beth McCarville ◽

Fariba Navid ◽

Scott E. Snyder ◽

Barry L. Shulkin

Keyword(s):

Fdg Pet ◽

Ct Imaging ◽

Cell Tumor ◽

Round Cell ◽

Round Cell Tumor ◽

Small Round Cell Tumor ◽

Small Round Cell ◽

Pet Ct ◽

Fdg Pet Ct

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Quantitative analysis of myocardial metabolic heterogeneity is superior to visual assessment for the detection of active cardiac sarcoidosis by F-18 FDG PET-CT imaging

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.345 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

M Malik ◽

M Yazdani ◽

SM Gould ◽

E Reyes

Keyword(s):

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Visual Assessment ◽

Ct Imaging ◽

Myocardial Inflammation ◽

Fdg Uptake ◽

Pet Ct ◽

Metabolic Heterogeneity ◽

Fdg Pet Ct

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial inflammation may occur in the context of a multisystem disease such as sarcoidosis, adversely affecting prognosis. A definitive diagnosis of cardiac sarcoidosis (CS) is essential to implementing life-saving treatment but this is complicated by the invasive nature of endomyocardial biopsy (EMB) and its low accuracy. Positron emission tomography (PET) assists in diagnosis, which relies on visual interpretation of myocardial F-18 FDG uptake. The value of quantitative analysis and its application to clinical practice remain uncertain. Purpose To investigate the power of quantitative F-18 FDG PET-CT imaging analysis for detecting CS in patients with suspected disease. Methods All patients underwent F-18 FDG PET-CT after a 24-hour low-carbohydrate diet and 15-hour fasting as part of their diagnostic work-up for suspected cardiac inflammation. Cardiovascular magnetic resonance acted as gatekeeper to PET-CT in 8 of every 10 scans. Myocardial F-18 FDG uptake was assessed qualitatively and quantitatively using both manually drawn regions of interest and automatic polar maps to measure global and segmental standardised F-18 FDG uptake values (SUV). The coefficient of variation (CoV) was calculated to determine uptake heterogeneity. To confirm diagnosis, follow-up data regarding disease progression, further testing and treatment were collected. To allow for sufficient follow-up time, the first 40 consecutive patients from a prospective registry (n= 214; Sep 2017-Jun 2020) were included. Results A comprehensive clinical picture was obtained successfully in 37 patients (median [IQR], 17 [13.5] months) and a final diagnosis of CS reached in 7 (disease prevalence, 19%). EMB was performed in 2 patients only while 3 underwent PPM/ICD implantation. Significant predictors of CS were fulfilment of Japanese Ministry of Health and Welfare criteria (Wald, 6.44; p = 0.01) and left ventricular dysfunction (Wald 6.72; p = 0.01). Qualitative F-18 FDG PET-CT had a high negative (95%) but low positive (45%) predictive value for CS (sensitivity, 83%; specificity, 77%). F-18 FDG SUV CoV was the strongest imaging predictor (Wald, 6.77; p = 0.009) and was significantly higher in CS than non-CS (CoV median [quartiles], 0.26 [0.21, 0.36] and 0.12 [0.11, 0.14] respectively; p = 0.004). As per ROC curve analysis (AUC, 0.84), a CoV threshold of 0.20 was highly specific (93%) and sensitive (86%) for CS. Conclusion In a referring population with a low prevalence of cardiac sarcoidosis, F-18 FDG PET-CT imaging is sensitive for the detection of myocardial inflammation with active disease unlikely in patients with a negative scan. Quantitative evaluation of metabolic heterogeneity within the myocardium provides a strong, independent marker of active disease and should be considered alongside visual assessment.

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