Treadmill Exercise Inducing Mild to Moderate Ischemia Has No Significant Effect on Skeletal Muscle or Cardiac 18F-FDG Uptake and Image Quality on Subsequent Whole-Body PET Scan

Abstract Positron emission tomography (PET) is a whole-body imaging technique using 18 fluorine-fluorodeoxyglucose (FDG), whose uptake is increased in tumor cells. Published studies have shown PET to be an effective method of staging lymphoma and to be more sensitive than CT at detecting extranodal disease. The purpose of this study was to determine whether the increased marrow uptake of FDG observed in some lymphoma patients during routine staging PET scans represented marrow involvement by disease. PET scans of 50 patients with Hodgkin's (12) and non-Hodgkin's (38) lymphoma were analyzed by three independent observers and the marrow graded as normal or abnormal using a visual grading system. Unilateral iliac crest marrow aspirates and biopsies were performed on all patients. The PET scan and marrow histology agreed in 39 patients (78%), being concordant positive in 13 and concordant negative in 26 patients. In 8 patients the PET scan showed increased FDG uptake but staging biopsy was negative; in 4 of these 8 patients the PET scan showed a normal marrow background with focal FDG “hot spots” distant from the site biopsied. In 3 patients the marrow biopsy specimen was positive but the PET scan normal; 2 of these 3 patients had non-Hodgkin's lymphoma whose malignant cells did not take up FDG at lymph node or marrow disease sites. Therefore, there were only 5 patients (10%) in whom there was a difference between the PET scan and biopsy result which could not be fully explained. Visual interpretation of marrow FDG uptake during whole-body staging PET scans can correctly assess marrow disease status in a high proportion of lymphoma patients. PET has the potential to reduce the need for staging marrow biopsy.

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The value of quantifying 18F-FDG uptake in thyroid nodules found incidentally on whole-body PET???CT

Nuclear Medicine Communications ◽

10.1097/mnm.0b013e3280964eae ◽

2007 ◽

Vol 28 (5) ◽

pp. 373-381 ◽

Cited By ~ 74

Author(s):

Trond V. Bogsrud ◽

Dimitrios Karantanis ◽

Mark A. Nathan ◽

Brian P. Mullan ◽

Gregory A. Wiseman ◽

...

Keyword(s):

Thyroid Nodules ◽

Whole Body ◽

Fdg Uptake ◽

Pet Ct ◽

18F Fdg

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Leucine Potentiates Glucose-mediated 18F-FDG Uptake in Brown Adipose Tissue via β-Adrenergic Activation

Biomedicines ◽

10.3390/biomedicines8060159 ◽

2020 ◽

Vol 8 (6) ◽

pp. 159

Author(s):

Brenda Huska ◽

Sarah Niccoli ◽

Christopher P. Phenix ◽

Simon J. Lees

Keyword(s):

Adipose Tissue ◽

Brown Adipose Tissue ◽

Whole Body ◽

Fdg Uptake ◽

Standardized Uptake Values ◽

Positron Emission ◽

Brown Adipose ◽

18F Fdg ◽

Adrenergic Activation

Significant depots of brown adipose tissue (BAT) have been identified in many adult humans through positron emission tomography (PET), with the amount of BAT being inversely correlated with obesity. As dietary activation of BAT has implications for whole body glucose metabolism, leucine was used in the present study to determine its ability to promote BAT activation resulting in increased glucose uptake. In order to assess this, 2-deoxy-2-(fluorine-18)fluoro-d-glucose (18F-FDG) uptake was measured in C57BL/6 mice using microPET after treatment with leucine, glucose, or both in interscapular BAT (IBAT). Pretreatment with propranolol (PRP) was used to determine the role of β-adrenergic activation in glucose and leucine-mediated 18F-FDG uptake. Analysis of maximum standardized uptake values (SUVMAX) determined that glucose administration increased 18F-FDG uptake in IBAT by 25.3%. While leucine did not promote 18F-FDG uptake alone, it did potentiate glucose-mediated 18F-FDG uptake, increasing 18F-FDG uptake in IBAT by 22.5%, compared to glucose alone. Pretreatment with PRP prevented the increase in IBAT 18F-FDG uptake following the combination of glucose and leucine administration. These data suggest that leucine is effective in promoting BAT 18F-FDG uptake through β-adrenergic activation in combination with glucose.

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Beyond lymph nodes: 18F-FDG PET/CT in detection of unusual sites of extranodal lymphoma

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0011-1 ◽

2019 ◽

Vol 50 (1) ◽

Cited By ~ 3

Author(s):

Amal Ibrahim Ahmed Othman ◽

Merhan Nasr ◽

Moustafa Abdel-Kawi

Keyword(s):

Fdg Pet ◽

Whole Body ◽

Normal Morphology ◽

Fdg Uptake ◽

Contrast Enhanced ◽

Pet Ct ◽

Disease Staging ◽

18F Fdg ◽

Fdg Pet Ct ◽

Histopathological Type

Abstract Background The purpose of this study was to compare between contrast-enhanced computer tomography (CE CT) and 18F-FDG PET/CT in the detection of extranodal involvement in lymphoma and to correlate between SUVmax of the extranodal lesion and the hottest LN. One hundred patients with pathologically proven lymphoma underwent whole body 18F-FDG PET/CT and CECT scans. Images were compared regarding the ability of detection of extranodal lymphomatous sites. Kappa agreement was applied to find the degree of agreement between both modalities. Pearson’s correlation was used for correlating SUVmax of the extranodal lesions and hottest LN. The degree of FDG uptake was correlated with histopathological type. Results There was a poor agreement between PET/CT and CECT in the detection of extranodal sites (k = 0.32). There was a significant positive moderate correlation between SUVmax of the extranodal lesions and hottest LN (r = 0.45). PET/CT study resulted in up staging of 10% and down staging of 5% of cases. Conclusion In lymphoma staging, FDG PET/CT enables more detection of extranodal involved sites that show normal morphology at CECT. It differentiates lymphomatous infiltration from benign causes of increased FDG uptake with subsequent proper disease staging.

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Cardiac Tuberculosis on 18F-FDG PET Imaging—A Great Masquerader of Cardiac Sarcoidosis

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1739379 ◽

2021 ◽

Author(s):

Sumati Sundaraiya ◽

Abubacker Sulaiman ◽

Adhithyan Rajendran

Keyword(s):

Pet Imaging ◽

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Granulomatous Inflammation ◽

Ventricular Myocardium ◽

Left Ventricular ◽

Whole Body ◽

Left Ventricular Myocardium ◽

Fdg Uptake ◽

18F Fdg

AbstractA young gentleman with suspected cardiac sarcoidosis and LV dysfunction whose CMR revealed multifocal subepicardial to mid myocardial linear enhancement in the left ventricular myocardium underwent cardiac 18F-FDG PET imaging. The images revealed patchy regions of increased FDG uptake involving the apical to mid anterolateral, mid to basal anteroseptal/ right ventricular and mildly increased FDG uptake in apical inferior segments of the LV myocardium concordant with CMR findings. Whole body PET CT imaging showed multiple hypermetabolic supra and infra diaphragmatic lymphadenopathy, with no pulmonary lesion identified. Biopsy from the left para aortic lymph node revealed necrotizing granulomatous inflammation consistent with tuberculosis. Based on the histopathological findings of the lymph nodes, diagnosis of cardiac tuberculosis was made, given the similar imaging appearances in both sarcoidosis and TB. This case highlights that cardiac TB although rare, should be included in the differential diagnosis in patients with suspected infiltrative cardiomyopathy, particularly in TB endemic regions.

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The Multicenter Italian Trial Assesses the Performance of FDG-PET /CT Related to Pre-Test Cancer Risk in Patients with Solitary Pulmo n ary Nodules and Introduces a Segmental Thoracic Diagnostic Strategy

Current Radiopharmaceuticals ◽

10.2174/1874471013666200318142210 ◽

2020 ◽

Vol 13 (3) ◽

pp. 243-248

Author(s):

Marco Spadafora ◽

Laura Evangelista ◽

Salvatore Fiordoro ◽

Francesco Porcaro ◽

Marilena Sicignano ◽

...

Keyword(s):

Cancer Risk ◽

Radiation Exposure ◽

Fdg Pet ◽

Whole Body ◽

Predictive Values ◽

Fdg Uptake ◽

Scan Time ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Purpose: The Italian Tailored Assessment of Lung Indeterminate Accidental Nodule (ITALIAN) trial is a trial drawn to determine the performance of 18F-FDG-PET/CT in patients with solitary pulmonary nodules (SPN), stratified for a different kind of risk. An additional end-point was to compare the diagnostic information and estimated dosimetry, provided by a segmental PET/CT (s-PET/CT) acquisition instead of a whole body PET/CT (wb-PET/CT), in order to evaluate if segmental thoracic PET/CT can be used in patients with SPN. Methods: 18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, was retrospectively analyzed. FDG uptake in SPN was assessed by a 4-point scoring (4PS) system and a semiquantitative analysis using the ratio between SUVmax in SPN and SUVmean in mediastinal blood pool (BP), and between SUVmax in SPN and SUVmean in the liver (L). Histopathology and/or follow-up data were used as a standard of reference. Data obtained on the thoracic part of wb-PET/CT, defined as s - PET/CT, were compared with those deriving from wb-PET/CT. Results: SPNs were malignant in 180 patients (36%), benign in 175 (35%), and indeterminate in 147 (29%). The 355 patients diagnosed with a definitive SPN nature (malignant or benign) were considered for the analysis of PET performance. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were 85.6%, 85.7%, 86%, 85.2%, and 85.6%, respectively. Sensitivity and PPV were higher in intermediate and high-risk patients. : 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. Conclusion: In patients with SPN, the pre-test likelihood of malignancy stratification allows to better define PET clinical setting and its diagnostic power. In subjects with low-intermediate pre-test likelihood of malignancy, s-PET/CT might be planned in advance. The adoption of this segmental strategy could reduce radiation exposure, scan-time, and might allow individually targeted protocols.

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Eosinophilic Cystitis Presenting as Possible Pediatric Rhabdomyosarcoma in Conventional Imaging Including 18F-FDG-PET/CT/MRI—A Rare Case

Diagnostics ◽

10.3390/diagnostics11040672 ◽

2021 ◽

Vol 11 (4) ◽

pp. 672

Author(s):

Naja Enevold Olsen ◽

Marie Øbro Fosbøl ◽

Jorgen Thorup ◽

Helle Hjorth Johannesen ◽

Lise Borgwardt

Keyword(s):

Differential Diagnosis ◽

Fdg Pet ◽

Imaging Modality ◽

Whole Body ◽

Fdg Uptake ◽

Eosinophilic Cystitis ◽

Potential Biomarker ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Eosinophilic cystitis (EC) is a relatively rare, but benign inflammatory bladder disease compared to that of the malignant pediatric rhabdomyosarcoma (RMS), in which it can be mimicking on initial suspicion. The origin, symptoms and findings of both EC and RMS are still discussed and hence, lead to the challenge in distinguishing them by cystoscopy and several image modalities. We present a case in which cross-sectional imaging modalities including fluorine-18-fluro-2-deoxy-D-glucose (18F-FDG)-positron emission tomography (PET) / computed tomography (CT) / magnetic resonance imaging (MRI) (18F-FDG-PET/CT/MRI (The imaging modality 18F-FDG-PET/CT/MRI referring to two continuous scans scanned on the same 18F-FDG-tracer dose for both the whole-body 18F-FDG-PET/CT and the regional 18F-FDG-PET/MRI of the pelvis.)) raised suspicion of RMS. Hence, the final diagnosis of EC was established by repeated histopathology. It is important to have EC in mind when seeking differential diagnosis of malignant diseases like RMS in order to provide the correct treatment for the patient and highly homogenously increased 18F-FDG-uptake should raise the suspicion of EC as a differential diagnosis. Furthermore, 18F-FDG-uptake rate is suggested as a future potential biomarker for monitoring of therapeutic response in eosinophilic inflammatory diseases, thus more research on this topic is needed.

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A Proposed Dedicated Breast PET Lexicon: Standardization of Description and Reporting of Radiotracer Uptake in the Breast

Diagnostics ◽

10.3390/diagnostics11071267 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1267

Author(s):

Kanae K. Miyake ◽

Masako Kataoka ◽

Takayoshi Ishimori ◽

Yoshiaki Matsumoto ◽

Masae Torii ◽

...

Keyword(s):

Imaging Modality ◽

Tumor Biology ◽

Whole Body ◽

Fdg Uptake ◽

Dedicated Breast Pet ◽

Radiotracer Uptake ◽

Positron Emission ◽

18F Fdg ◽

Morphology Characterization

Dedicated breast positron emission tomography (dbPET) is a new diagnostic imaging modality recently used in clinical practice for the detection of breast cancer and the assessment of tumor biology. dbPET has higher spatial resolution than that of conventional whole body PET systems, allowing recognition of detailed morphological attributes of radiotracer accumulation within the breast. 18F-fluorodeoxyglucose (18F-FDG) accumulation in the breast may be due to benign or malignant entities, and recent studies suggest that morphology characterization of 18F-FDG uptake could aid in estimating the probability of malignancy. However, across the world, there are many descriptors of breast 18F-FDG uptake, limiting comparisons between studies. In this article, we propose a lexicon for breast radiotracer uptake to standardize description and reporting of image findings on dbPET, consisting of terms for image quality, radiotracer fibroglandular uptake, breast lesion uptake.

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Preparation methods prior to PET/CT scanning that decrease uptake of 18F-FDG by myocardium, brown adipose tissue, and skeletal muscle

Acta Radiologica ◽

10.1177/0284185116633917 ◽

2016 ◽

Vol 58 (1) ◽

pp. 10-18 ◽

Cited By ~ 10

Author(s):

Dan Shao ◽

Xu-Wei Tian ◽

Qiang Gao ◽

Chang-Hong Liang ◽

Shu-Xia Wang

Keyword(s):

Skeletal Muscle ◽

Adipose Tissue ◽

Brown Adipose Tissue ◽

Ct Scanning ◽

High Fat ◽

Fdg Uptake ◽

Brown Adipose ◽

Pet Ct ◽

Low Carbohydrate ◽

18F Fdg

Background The hypermetabolic environment of the myocardium, brown adipose tissue (BAT), and muscle will have an effect on the diagnostic accuracy of 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography (PET)/computed tomography (CT). A low carbohydrate, high fat, and protein-permitted diet before PET/CT scanning can reduce the degree of 18F-FDG uptake by the myocardium, brown adipose tissue, and skeletal muscle. Purpose To determine the effect of a low carbohydrate, high fat and protein-permitted diet on 18F-FDG uptake by myocardium, BAT, and muscle during PET/CT. Material and Methods A total of 126 patients who adhered to two meals before PET/CT scanning (that were prepared using a low carbohydrate, high fat, and protein-permitted diet), i.e. the diet group, were compared with 126 patients who fasted for at least 12 h prior to scanning (i.e. the fasting group). The degree of 18F-FDG uptake within the myocardium, BAT, and muscle were stratified into four grades (range, 0–3) with 0 for negligible uptake, and 3 for intense uptake. Correlations between the diet and fasting groups with respect to degree of 18F-FDG uptake within the myocardium, BAT, and muscle were analyzed. Results The degree of 18F-FDG uptake within the myocardium, BAT, and muscle in the diet group was significantly lower compared with the 18F-FDG uptake within myocardium, BAT, and muscle in the fasting group ( P < 0.001, P = 0.001, P < 0.001). Conclusion A low carbohydrate/high fat diet before 18F-FDG injection can suppress uptake of 18F-FDG within the myocardium, BAT, and skeletal muscle.

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Evolution of 18F-FDG Uptake as A Pitfall of Image Diagnosis for Systemic Anaplastic Large Cell Lymphoma

Diagnostics ◽

10.3390/diagnostics11081387 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1387

Author(s):

Hung Chang ◽

Wen-Yu Chuang

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Large Cell ◽

Pet Scan ◽

Fdg Uptake ◽

Diagnostic Pitfall ◽

18F Fdg ◽

Large Cell Lymphoma ◽

Alk Positive ◽

Tumor Types

In most patients, systemic anaplastic large cell lymphoma (sALCL) is an 18F-FDG-avid tumor. Both ALK-positive and ALK-negative tumors can be evaluated by PET scans as both tumor types uptake 18F-FDG in PET. The PET scan is also valuable in predicting prognosis during and after the treatment course. The evolution of 18F-FDG uptake in patients with sALCL has not been reported. For tumors lacking 18F-FDG uptake, there is a diagnostic pitfall of underestimating the cancer stage and misjudgment of metastases. In the present case, the PET scan results were negative at diagnosis but disseminated 18F-FDG avid lesions were found at relapse. Biopsy of bone marrow and lymph nodes revealed the pathological features were identical to the original tumor at the time of diagnosis. In the wake of such evolutional change, physicians dealing with sALCL should be cautious in interpretation of PET/CT scans.

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