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

2011 ◽  
Vol 14 (5) ◽  
pp. 283 ◽  
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

<p><b>Background:</b> 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.</p><p><b>Methods:</b> 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.</p><p><b>Results:</b> 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).</p><p><b>Conclusions:</b> 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.</p>

scholarly journals Accuracy of [18Fluorine]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography-Computed Tomography Response Assessment Following (Chemo)radiotherapy for Locally Advanced Laryngeal/Hypopharyngeal Carcinoma

2017 ◽  
Vol 11 ◽  
pp. 117955491771300 ◽  
Author(s):  
Finbar Slevin ◽  
Ekin Ermiş ◽  
Sriram Vaidyanathan ◽  
Mehmet Sen ◽  
Andrew F Scarsbrook ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Squamous Cell Carcinoma ◽  
Predictive Value ◽  
Fdg Pet ◽  
Response Assessment ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

Introduction: The accuracy of response assessment positron emission tomography (PET)-computed tomography (CT) following radiotherapy with or without chemotherapy for laryngeal/hypopharyngeal squamous cell carcinoma is uncertain. Methods: In all, 35 patients with laryngeal or hypopharyngeal squamous cell carcinoma who were treated between 2009 and 2014 with (chemo)radiotherapy were identified. The accuracy of response assessment PET-CT was made by correlation with clinical follow-up and pathological findings. Results: Of the 35 patients, 20 (57%) had an overall complete metabolic response. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for response assessment [18Fluorine]-fluoro-2-deoxy-d-glucose (FDG) PET-CT for primary and nodal sites, respectively, were 100%, 73%, 46%, and 100% and 83%, 95%, 83%, and 95%. Conclusions: Response assessment FDG PET-CT following (chemo)radiotherapy for laryngeal and hypopharyngeal carcinomas has a high NPV for both primary site and lymph nodes and can be used to guide treatment decisions. The PPV of residual FDG uptake at the primary tumour site is limited and requires examination and biopsy confirmation.

scholarly journals Impact and prognostic value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan in the evaluation of residual head and neck cancer: Single-center experience from Pakistan

2017 ◽  
Vol 06 (02) ◽  
pp. 081-083
Author(s):  
Saima Riaz ◽  
Humayun Bashir ◽  
Hassan Iqbal ◽  
Arif Jamshed ◽  
Ahmad Murtaza ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Head And Neck ◽  
Predictive Value ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Ct Scans ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background: Overview of clinical impact of positron emission tomography-computed tomography (PET-CT) scans in patients with head and neck carcinomas at our center. Methods: Retrospective review of posttreatment 18F-fluorodeoxyglucose (18F-FDG) PET-CT scans in patients with head and neck carcinomas with risk of residual disease. Clinical outcome served as the reference standard. Results: This study included 93 patients (65.6% males, mean age: 48.8 years ± 17.2 standard deviation) with squamous cell carcinoma as most frequent histopathology (91.4%). PET-CT scans were performed on average 6 months posttreatment. Diagnostic accuracy, positive predictive value, and negative predictive value of PET-CT for disease were found to be 88%, 88%, and 92%, respectively. A median follow-up of 24 months was available for 91 patients. Kaplan–Meier curves showed significantly higher disease-free survival with negative PET-CT as compared to positive PET-CT (P = 0.01) and maximum standardized uptake values of <5.0 (P = 0.01). Conclusion: FDG PET-CT has diagnostic and prognostic implications in treated patient of head and neck cancers.

Clinical impact of positron emission tomography or positron emission tomography/computed tomography in the posttherapy surveillance of endometrial carcinoma: evaluation of 88 patients

2008 ◽  
Vol 18 (6) ◽  
pp. 1332-1338 ◽  
Author(s):  
J.-Y. Park ◽  
E. N. Kim ◽  
D.-Y. Kim ◽  
J.-H. Kim ◽  
Y.-M. Kim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Endometrial Carcinoma ◽  
Predictive Value ◽  
Clinical Impact ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Sensitivity Specificity

The objective of this study was to evaluate the validity and clinical impact of positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) using 18-fluoro-2-deoxy-D-glucose in the posttherapy surveillance of patients with endometrial carcinoma. Eighty-eight patients previously treated for histopathologically diagnosed endometrial adenocarcinoma underwent 99 PET or PET/CT scans at follow-up visits at Asan Medical Center, Seoul, Korea, between 2001 and 2007. The standard of reference for tumor recurrence consisted of histopathologic confirmation or follow-up information at least 6 months after PET or PET/CT. Of the 88 patients, 24 underwent PET (n= 11) and/or PET/CT (n= 14) scans due to suspected disease recurrence. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of PET and/or PET/CT in detecting recurrence in these patients were 100%, 83.3%, 96%, 95%, and 100%, respectively. Especially, PET/CT revealed true-positive findings in three patients with elevated tumor markers but negative CT findings. The remaining 64 patients underwent PET (n= 8) and/or PET/CT (n= 66) as part of routine posttherapy surveillance; these patients were asymptomatic, with no evidence of disease. The sensitivity, specificity, accuracy, PPV, and NPV of PET and/or PET/CT in detecting recurrence in these patients were all 100%. Clinical decisions on treatment were changed in 14 (21.9%) patients by introducing PET or PET/CT into their conventional posttherapy surveillance program. PET and/or PET/CT were highly effective in discriminating true recurrence in patients with suspected recurrence, highly sensitive in detecting recurrence in asymptomatic patients, and had impacts on clinical decisions in a considerable portion of patients.

Abstract 19179: Prognostic Value of Combined Coronary Computed Tomography Angiography and Positron Emission Tomography Perfusion Imaging in Patients With Suspected Coronary Artery Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Teemu Maaniitty ◽  
Iida Soukka ◽  
Antti Saraste ◽  
Valtteri Uusitalo ◽  
Heikki Ukkonen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Positron Emission Tomography ◽  
Coronary Artery ◽  
Perfusion Imaging ◽  
Coronary Computed Tomography Angiography ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Artery Disease

Objectives: Hybrid imaging using coronary computed tomography angiography (CTA) and positron emission tomography (PET) perfusion imaging accurately detects functionally significant coronary artery disease (CAD), but its optimal clinical use remains unknown. We studied the prognostic significance of strategy utilizing sequential CTA for exclusion of CAD followed by PET perfusion imaging for evaluating functional significance of any suspected obstructive lesions with a hybrid PET-CT device in symptomatic patients with suspected intermediate probability of CAD. Methods: We identified a cohort of 864 consecutive patients undergone hybrid PET-CT for the detection of suspected CAD. All patients had CTA and based on CTA findings, haemodynamic significance of any suspected stenoses was evaluated by PET perfusion imaging using H 2 15 O during adenosine-induced stress. Major adverse cardiac events (MACE) including death, myocardial infarction (MI) and unstable angina pectoris (UAP), were collected from the national healthcare statistics. Results: After exclusion of 97 patients undergone early (< 6 months) revascularization, 767 patients with age of 61 ± 10 years (41% males) were followed-up for a median time of 2.5 years. During the follow-up 6 deaths, 5 MIs and 3 UAPs occurred. In 462 patients, obstructive CAD was excluded based on CTA alone and the remaining patients with suspected stenoses (n=305, 39.8%) underwent PET perfusion imaging. In patients with normal or non-obstructive CTA annual incidence of MACE was only 0.16%, whereas in patients with suspected stenosis based on CTA it was 1.36% (p<0.05 vs. no stenosis). In patients with suspected obstructive lesion based on CTA, patients with normal PET perfusion had significantly lower event rate than patients with ischemia (0.54 vs. 2.78%, p<0.05). Conclusion: In patients with suspected obstructive CAD PET perfusion imaging after CT angiography is able to accurately identify those patients with high risk of future MACE. Sequential use of CTA and PET perfusion imaging appears powerful and safe strategy for targeting therapeutic procedures in high risk individuals.

The role of fusion positron emission tomography/computed tomography (PET/CT) scan in patients with resectable pancreatic neoplasms.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 322-322 ◽  
Author(s):  
Saqib Razzaque ◽  
Noman Ashraf ◽  
Jill M. Weber ◽  
Jose Mario Pimiento ◽  
Mokenge Peter Malafa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Predictive Value ◽  
Pancreatic Neoplasms ◽  
Preoperative Staging ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Pet Ct Scan

322 Background: The role of fusion positron emission tomography/computed tomography scans (PET/CT) in staging of patients with pancreatic neoplasms (PN) is poorly defined. Currently PET/CT is not recommended as part of staging workup in patients with potentially resectable PN. Methods: Using a comprehensive cancer PET registry we identified 107 patients with PN who were potentially resectable based on the initial preoperative staging CT scans and endoscopic ultrasound (EUS), from January 2006 - December 2010. Subsequently all these patients had PET/CT performed prior to surgery. Patients with borderline resectable or locally advanced disease were excluded from the analysis. Statistical analyses were performed included sensitivity, specificity, positive predictive value, and negative predictive value. Statistical analyses were performed with STATA IC (Stata Statistical Software, Release 10.0; Strata Corp., College Station, TX). Results: PET/CT altered management and prevented futile surgery in 6.5 % patients by identifying metastases not detected by other modalities. One patient was found to have metastasis to the supraclavicular lymph node, five had occult hepatic lesions and another had peri-esophageal lymph nodes. All sites were biopsied and metastases confirmed by pathology. The sensitivity and specificity of PET/CT scan in detecting metastatic disease in this patient population was 42.1% and 83.3% respectively. Our study indicated a positive predictive value of PET/CT to be 40% and negative predictive value 84.5%, with a false positive rate of 16.6%. Conclusions: PET/CT was instrumental in preventing futile laprotomy in 6.5 % patients. Larger studies utilizing PET/CT in the initial preoperative staging workup are warranted.

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