scholarly journals Role of PET-CT in Aiding Diagnosis of Various Neurological Conditions – A Case Series

2021 ◽  
Vol 10 (7) ◽  
pp. 440-446
Author(s):  
Harleen Singh Pabla ◽  
Gokulakrishnan P.R. ◽  
Arunan Murali ◽  
Venkata Sai P.M.
Keyword(s):  
Metabolic Activity ◽  
Fdg Pet ◽  
Caudate Nuclei ◽  
Fdg Uptake ◽  
18Fdg Pet ◽  
Pet Ct ◽  
Neurological Conditions ◽  
Fdg Pet Ct ◽  
The Brain

BACKGROUND PET-CT is an imaging modality which electronically detects positron-emitting radiopharmaceuticals in the human body and reveals its exact anatomical location.1 PET CT measures the metabolic and functional activity of living tissue noninvasively.1 This technology is utilized in diagnosis, planning treatment and predicting outcomes in various neurological conditions.1 Depending upon various patterns of FDG uptake in different parts of brain, 18FDG PET-CT allows us to differentiate between various types of dementia.2 PET CT allows tracking the course of disease and revealing the severity of the disease.2 In this article, we discuss the imaging findings of normal 18 FDG PET-CT of brain and 8 different neurological conditions with their corresponding brain PET-CT findings. METHODS To study the role of 18FDG-PET/CT in neurological conditions, we identified 8 different patients who underwent 18FDG-PET/CT imaging of brain for clinically suspected different neurological diseases at Department of Radiodiagnosis-Centre of Excellence (CERIS), SRIHER, Chennai, between 2015 and 2019. Siemens Biograph Horizon 16-slice PET/CT scanner with TrueV was used. Syngo.Via Version VB30A software was used. 18F- Fluorodeoxyglucose was the radiotracer used [Dose: 3-7 mCi]. After the scan, different patterns of 18 FDG uptake in the brain were analyzed in each of these patients. RESULTS 18 FDG PET-CT showed reduced uptake in the epileptogenic foci in the brain. Alzheimer’s disease showed decreased FDG uptake in bilateral precuneus, posterior cingulate region, parietal cortex and frontal cortex. Fronto-temporal dementia revealed reduced FDG uptake in anterior cingulate gyrus and anterior temporal lobe. Primary progressive aphasia showed asymmetrical reduced metabolic activity in the bilateral frontal and temporal lobes. Progressive supranuclear palsy revealed reduced metabolic activity in bilateral paramedian frontal region, head of caudate nuclei and midbrain; Multi systemic atrophy showed reduced metabolic activity in midbrain, pons, medulla oblongata and the cerebellum; AIDS related dementia showed global hypometabolism with preserved uptake in basal ganglia. CONCLUSIONS 18FDG-PET/CT has a vital complementary role in the evaluation CNS disorders along with clinical examination, other imaging modalities like CT, MRI, and electroencephalogram (EEG). Radiologists should be aware of these different patterns of FDG uptake to aid the clinical diagnosis and early treatment. KEY WORDS 18 FDG PET-CT, 18FDG Uptake, Hypometabolism, PET-CT Brain

scholarly journals [18F]-Fluorodeoxyglucose Uptake in Lymphoid Tissue Serves as a Predictor of Disease Outcome in the Nonhuman Primate Model of Monkeypox Virus Infection

2017 ◽  
Vol 91 (21) ◽  
Author(s):  
Julie Dyall ◽  
Reed F. Johnson ◽  
Svetlana Chefer ◽  
Christopher Leyson ◽  
David Thomasson ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Immune Response ◽  
Lymph Nodes ◽  
Metabolic Activity ◽  
Fdg Pet ◽  
Ct Imaging ◽  
Lymphoid Tissues ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Fdg Pet Ct

ABSTRACT Real-time bioimaging of infectious disease processes may aid countermeasure development and lead to an improved understanding of pathogenesis. However, few studies have identified biomarkers for monitoring infections using in vivo imaging. Previously, we demonstrated that positron emission tomography/computed tomography (PET/CT) imaging with [18F]-fluorodeoxyglucose (FDG) can monitor monkeypox disease progression in vivo in nonhuman primates (NHPs). In this study, we investigated [18F]-FDG-PET/CT imaging of immune processes in lymphoid tissues to identify patterns of inflammation in the monkepox NHP model and to determine the value of [18F]-FDG-PET/CT as a biomarker for disease and treatment outcomes. Quantitative analysis of [18F]-FDG-PET/CT images revealed differences between moribund and surviving animals at two sites vital to the immune response to viral infections, bone marrow and lymph nodes (LNs). Moribund NHPs demonstrated increased [18F]-FDG uptake in bone marrow 4 days postinfection compared to surviving NHPs. In surviving, treated NHPs, increase in LN volume correlated with [18F]-FDG uptake and peaked 10 days postinfection, while minimal lymphadenopathy and higher glycolytic activity were observed in moribund NHPs early in infection. Imaging data were supported by standard virology, pathology, and immunology findings. Even with the limited number of subjects, imaging was able to differentiate the difference between disease outcomes, warranting additional studies to demonstrate whether [18F]-FDG-PET/CT can identify other, subtler effects. Visualizing altered metabolic activity at sites involved in the immune response by [18F]-FDG-PET/CT imaging is a powerful tool for identifying key disease-specific time points and locations that are most relevant for pathogenesis and treatment. IMPORTANCE Positron emission tomography and computed tomography (PET/CT) imaging is a universal tool in oncology and neuroscience. The application of this technology to infectious diseases is far less developed. We used PET/CT imaging with [18F]-labeled fluorodeoxyglucose ([18F]-FDG) in monkeys after monkeypox virus exposure to monitor the immune response in lymphoid tissues. In lymph nodes of surviving monkeys, changes in [18F]-FDG uptake positively correlated with enlargement of the lymph nodes and peaked on day 10 postinfection. In contrast, the bone marrow and lymph nodes of nonsurvivors showed increased [18F]-FDG uptake by day 4 postinfection with minimal lymph node enlargement, indicating that elevated cell metabolic activity early after infection is predictive of disease outcome. [18F]-FDG-PET/CT imaging can provide real-time snapshots of metabolic activity changes in response to viral infections and identify key time points and locations most relevant for monitoring the development of pathogenesis and for potential treatment to be effective.

scholarly journals The role of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in the differential diagnosis of pericardial disease

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Cheol Won Hyeon ◽  
Hyun Kyung Yi ◽  
Eun Kyoung Kim ◽  
Sung-Ji Park ◽  
Sang-Chol Lee ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Fdg Pet ◽  
Diagnostic Yield ◽  
Emission Tomography ◽  
Pericardial Disease ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

AbstractThis study aimed to assess the role of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) in the differential diagnosis of pericardial disease. The diagnosis is often troublesome because pericardial fluid analysis or biopsy does not always provide answers. 18FDG-PET/CT can visualize both inflammation and malignancy and offers a whole-body assessment. Patients who visited the Pericardial Disease Clinic of Samsung Medical Center with an 18FDG-PET/CT order code were extracted. Exclusion criteria were as follows: (1) the purpose of the differential diagnosis was not pericardial disease; (2) the patient had a known advanced-stage malignancy; (3) the patient already have confirmative diagnosis using a serology, pericardial effusion analysis or biopsy. The analysis included 107 patients. The most common final diagnosis was idiopathic (n = 46, 43.0%), followed by tuberculosis (n = 30, 28.0%) and neoplastic (n = 11, 10.3%). A maximum standardized uptake value (SUVmax) ≥ 5 typically indicates tuberculosis or neoplastic pericarditis except in just one case of autoimmune pericarditis); especially all of the SUVmax scores ≥ 10 had tuberculosis. The diagnostic yield of pericardial biopsy was very low (10.2%). Interestingly, all of the pericardium with an SUVmax < 4.4 had nondiagnostic results. In contrast, targeted biopsies based on 18FDG uptake demonstrated a higher diagnostic yield (38.7%) than pericardium. The sensitivity of 18FDG-PET/CT was 63.6%. The specificity was 71.9%. The positive predictive value was 20.6%. The negative predictive value 94.5%, and the accuracy was 71.0% for excluding malignancy based upon the FDG uptake patterns. It is possible to explore the differential diagnosis in some patients with difficult pericardiocentesis or pericardial biopsy in a noninvasive manner using on the SUVmax or uptake patterns. In addition, the biopsy strategy depending on 18FDG uptake is helpful to achieve biopsy more safely and with a higher yield. 18FDG-PET may enhance the diagnostic efficacy in patients with pericardial disease.

Investigation of Discrepancies between Baseline MRI and PET-CT Studies in Patients with Newly Diagnosed Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5079-5079
Author(s):  
Ronald Walker ◽  
Erik Rasmussen ◽  
Laurie Jones-Jackson ◽  
Elias J. Anaissie ◽  
Terri L. Alpe ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Glucose Metabolism ◽  
Fdg Pet ◽  
Ct Imaging ◽  
Tumor Infiltration ◽  
Imaging Studies ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
The Brain

Abstract Introduction: Magnetic Resonance Imaging (MRI) and 18F-labeled fluorodeoxyglucose (FDG) positron emission tomography - computed tomography (PET-CT) imaging are both useful for diagnosis, staging, and restaging of multiple myeloma (MM), yet they are based on different physical principles and do not give equivalent results. It is widely known that FDG uptake can be transiently inhibited in a variety of malignancies due to recent treatment, whether transient or durable. We investigated patients from Total Therapies 2 and 3 who had baseline PET-CT exams without focal lesions (FL) at time of diagnosis that had 1 or more baseline MRI-defined FL to determine reasons for the discrepancies between imaging studies. Results: Thirty-three (33) TT2 and TT3 patients with baseline MRI-FL but without baseline PET-FL were identified. A detailed review of the clinical records and imaging studies was performed to identify potential reasons for the discrepancies between the imaging studies. One (3%) was a database error with no discrepancy. One patient (3%) had MRI-FL limited to the calvarium, an area difficult to visualize on PET-CT because of normal intense uptake in the brain. Four (12%) had “masking” of the PET FL (the PET-FL were obscured against the background by intense uptake in the surrounding marrow from severe diffuse tumor infiltration), 7 (21%) had FL seen by MRI that were below the PET resolution (sub-5mm), and 10 (30%) had PET suppression from treatment prior to arrival at our institution (glucocorticoids, such as dexamethasone or prednisone most commonly, but other medication-related causes included VDTPACE and bisphosphonates). In ten patients (30%) the causes for the discrepant imaging results were not determined, though indolent disease with low glucose metabolism resulting in poor FDG uptake relative to background is a possible explanation. Conclusion: We conclude that FDG PET-CT and MRI imaging at baseline are important and complementary examinations that do not provide equivalent results. The PET-CT can be transiently and rapidly suppressed by pretreatment with a variety of medications that can inhibit glucose metabolism. Additionally, FDG PET-CT imaging can underestimate the number of FL if there is severe, diffuse metabolically active tumor infiltration (“masking”) obscuring the margins of the PET-defined FL, if the FL are very small (sub-5mm, below FDG PET-CT resolution), if the FL are located in “blind spots” for the PET-CT scan (such as near the brain), or if the PET-CT FL are low in metabolic activity relative to normal tissue (poor FDG uptake). In some cases, no apparent reason was determined. A careful history regarding recent medication is very important for proper interpretation of the results of a sensitive functional imaging study such as FDG PET-CT, as well as an understanding of its physical limitations.

Integrated FDG-PET/CT for detection, therapy monitoring and follow-up of granulocytic sarcoma

2009 ◽  
Vol 48 (05) ◽  
pp. 185-191 ◽  
Author(s):  
M. Häntschel ◽  
M. Öksüz ◽  
M. K. Werner ◽  
M. Lichy ◽  
W. Vogel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
False Positive ◽  
Fdg Pet ◽  
Therapy Monitoring ◽  
Lesion Detection ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Fdg Pet Ct

Summary Aim: Granulocytic sarcomas (GS) are rare extramedullary manifestations of myeloid or lymphoblastic leukaemia. Laboratory examinations are of limited use for diagnosis of extramedullary disease. Radiological imaging based on morphology is challenging. To date, the possible role of FDG-PET/CT as a method for combined metabolic and morphologic imaging is unclear. We present a series of 10 patients to evaluate the potential role of FDGPET/ CT in the management of GS. Patients, materials, methods: A retrospective evaluation of 18 FDG-PET/CT exams in 10 patients with histologically proven GS was performed. All scans included a contrast enhanced CT. The FDG uptake of GS was analyzed and the sensitivity of lesion detection was compared to PET and CT alone. The changes in FDG uptake after therapy were compared to morphological changes detected by CT and follow-up / clinical outcome. Results: 52 untreated or recurrent GS lesions were detected by FDG-PET/CT and all showed an increased FDG uptake with a mean SUVmax and SUVavg of 5.1 and 3.4, respectively. GS was multifocal in 8/10 patients. Combined PET/CT avoided 5 false positive findings compared to PET alone and 13 false negative findings and 1 false positive compared to CT alone. Changes in FDG uptake after therapy correlated with clinical outcome and were more reliable than CT assessment alone. PET/CT identified recurrent GS in 3 patients. Conclusion: Viable GS are FDG-avid. Using this metabolic information and morphologic CT criteria, combined FDG-PET/CT was more accurate in lesion detection than FDG-PET or CT alone. Changes in FDG uptake after therapy might be a useful additional parameter for therapy monitoring. Therefore, FDG-PET/CT appears to be a promising diagnostic and monitoring tool in the management of patients with GS.

scholarly journals Evaluation of radiographic and metabolic changes in bone metastases in response to systemic therapy with 18FDG-PET/CT

2015 ◽  
Vol 49 (2) ◽  
pp. 115-120 ◽  
Author(s):  
Bengul Gunalp ◽  
Ali Ozan Oner ◽  
Semra Ince ◽  
Engin Alagoz ◽  
Aslı Ayan ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Metabolic Activity ◽  
Systemic Therapy ◽  
Fdg Pet ◽  
Therapy Response ◽  
Metabolic Changes ◽  
Metabolic Characteristics ◽  
18Fdg Pet ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background. The aim of the study was to retrospectively evaluate radiographic and metabolic changes in bone metastases in response to systemic therapy with 18FDG-PET/CT and determine their roles on the evaluation of therapy response. Patients and methods. We retrospectively evaluated radiographic and metabolic characteristics of bone metastases in 30 patients who were referred for the evaluation of response to systemic therapy with 18FDG-PET/CT. All patients underwent integrated 18FDG-PET/CT before and after treatment. Results. The baseline radiographic patterns of the target lesions in responders group were lytic, sclerotic, mixed and CT negative; after treatment the radiographic patterns of all target lesions changed to a sclerotic pattern and attenuation increased (p = 0.012) and metabolic activity decreased (p = 0.012). A correlation was found between decreasing metabolic activity and increasing attenuation of the target lesions (r = -0.55) (p = 0.026). Ho wever, in nonresponders group, the baseline radiologic patterns of the target lesions were lytic, blastic, mixed and CT negative; after treatment all lytic target lesions remained the same and one CT negative lesion turned to lytic pattern and the attenuation of the target lesions decreased (p ± 0.12) and metabolic activity increased (p = 0.012). A correlation was found between increasing metabolic activity and decreasing attenuation (r = -0.65) (p = 0.032). An exception of this rule was seen in baseline blastic metastases which progressed with increasing in size, metabolic activity and attenuation. Conclusions. This study shows that the metabolic activity of lesions is a more reliable parameter than the radiographic patterns for the evaluation of therapy response.

scholarly journals 18F-FDG-PET/CT and Osteolytic Bone Disease in Multiple Myeloma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5622-5622
Author(s):  
Brian Østergaard ◽  
Julie R. Mortensen ◽  
Anne L Nielsen ◽  
Jon T. Asmussen ◽  
Oke Gerke ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Metabolic Activity ◽  
Bone Disease ◽  
Fdg Pet ◽  
Focal Lesions ◽  
Osteolytic Lesions ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Osteolytic Bone Disease ◽  
Fdg Pet Ct

Abstract Introduction: FDG-PET/CT is a promising methodology for staging, prognostication, and response evaluation in multiple myeloma (MM). The number of focal FDG lesions and the intensity of FDG uptake (standard uptake value, SUV) at diagnosis are informative of disease aggressiveness. Osteolytic bone disease is a hallmark of MM. Hypothetically; increased focal metabolic activity will precede, induce and correlate to osteolytic lesions. We aimed to elucidate the association between focal FDG positive lesions and osteolytic bone disease in MM patients. Methods: Twenty-two newly diagnosed MM patients, 16 males and 6 females aged 53-81years, were prospectively enrolled and studied with a standardized baseline FDG-PET/CT at diagnosis. A nuclear medicine and a radiology specialist evaluated the PET and CT parts separately and independently. Focal FDG positive lesions were assessed by dedicated software (ROVER™, ABX, Germany) to yield volume and SUV measures. All osteolytic lesions identified on CT were noted by size and localization. Results: FDG-PET and CT together identified a total of 390 lesions. We found more osteolytic lesions on CT (335) than FDG-positive lesions (169); the concordance between the modalities was 30%. 34% (114/335) of lytic lesions were FDG-positive, whereas ⅔ (114/169) of focal FDG-PET positive lesions were lytic according to CT. We found a significant correlation between higher FDG uptake measured as SUVpeak and osteolytic lesions >10 mm, and focal lesions with high FDG uptake had more pronounced osteolysis than focal lesions with less FDG uptake. Still sparse follow-up data did not allow analysis of the predictive value of focal PET positivity and the risk of development of future osteolysis. More compulsive data will be presented at the meeting. Conclusion: FDG-PET/CT offers dual information including metabolic activity (FDG-avidity) and degree of lytic bone disease (low dose whole body CT) in MM. About ⅔ (221/335) of osteolytic lesions were FDG-negative, whereas ⅔ (114/169) of FDG-positive lesions had a lytic component. Disclosures Plesner: Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding.

scholarly journals Role of 18F-FDG PET-CT in CNS Lymphoma-A Case Report

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Zohra FT ◽  
◽  
Hosen J ◽  
Hasnat MA ◽  
Hosen J ◽  
...  
Keyword(s):  
Frontal Lobe ◽  
Fdg Pet ◽  
Cns Lymphoma ◽  
Left Frontal Lobe ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
The Brain ◽  
Pet Ct Scan

The actual role of 18F-FDG PET/CT in evaluating primary brain lymphoma is still an open issue. Brain lymphoma usually show elevated 18F-FDG uptake, often higher than other brain tumors or inflammatory processes, but the metabolic behavior of this lymphoma is not still understood. Central nervous system lymphoma is a rare non-Hodgkin lymphoma in which malignant (cancer) cells from lymph tissue form in the brain and/or spinal cord (primary CNS) or spread from other parts of the body to the brain and/or spinal cord (secondary CNS).A 55 year-old man presented with headache. Magnetic Resonance Imaging (MRI) revealed a well-enhanced mass lesion in the left frontal lobe. A surgical specimen obtained through left orbito-pterional craniotomy revealed a Diffuse Large B-Cell Lymphoma (DLBCL). 18F FDG PET-CT scan showed multiple hypodensehypermetabolic lesions in brain. Multiple hypodense focal hypermetabolic areas were seen in right frontal lobe, left frontal lobe and left temporal lobe. There was also a subcentimetrichypermetabolic sub-carinal lymph node. The activity was diminished on follow-up PET-CT after 8 courses of chemotherapy. This case indicates that FDG PET-CT scan can aid identify the atypical primary CNS lymphoma for staging workup and can be a useful tool to see treatment response.

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