F18-FDG-PET/CT standardised uptake value threshold in discriminating benign vs. malignant lesions. Doubts and certainties in the era of evidence-based medicine

To evaluate the role of 99mTc-DMSA (V) and [18F]FDG PET-CT in management of patients with osteosarcoma, 22 patients were included in our study. All patients underwent both 99mTc-DMSA (V) and whole-body [18F]FDG PET-CT scans within an interval of 1 week. 555–740 MBq of 99mTc-DMSA (V) was injected i.v. the whole-body planar, SPECT images of primary site and chest were performed after 3-4 hours. [18F]FDG PET-CT images were obtained 60 minutes after i.v. injection of 370 MBq of F-18 FDG. Both FDG PET-CT (mean SUVmax = 7.1) and DMSA (V) scans showed abnormal uptake at primary site in all the 22 patients (100% sensitivity for both). Whole-body PET-CT detected metastasis in 11 pts (lung mets in 10 and lung + bone mets in 1 patient). Whole-body planar DMSA (V) and SPECT detected bone metastasis in one patient, lung mets in 7 patients and LN in 1 patient. HRCT of chest confirmed lung mets in 10 patients and inflammatory lesion in one patient. 7 patients positive for mets on DMSA (V) scan had higher uptake in lung lesions as compared to FDG uptake on PET-CT. Three patients who did not show any DMSA uptake had subcentimeter lung nodule. Resuts of both 99mTc-DMSA (V) (whole-body planar and SPECT imaging) and [18F]FDG PET-CT were comparable in evaluation of primary site lesions and metastatic lesions greater than 1 cm. Though 99mTc-DMSA (V) had higher uptake in the lesions as compared to [18F]FDG PET-CT, the only advantage [18F]FDG PET-CT had was that it could also detect subcentimeter lesions.

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Comparison of MR imaging and FDG-PET/CT in the differential diagnosis of benign and malignant vertebral compression fractures

Journal of Neurosurgery Spine ◽

10.3171/2010.10.spine10175 ◽

2011 ◽

Vol 14 (2) ◽

pp. 177-183 ◽

Cited By ~ 16

Author(s):

Won-Ik Cho ◽

Ung-Kyu Chang

Keyword(s):

Mr Imaging ◽

Fdg Pet ◽

Vertebral Compression Fractures ◽

Benign Lesions ◽

Fracture Group ◽

Radiotracer Uptake ◽

Pet Ct ◽

Malignant Lesions ◽

Fdg Pet Ct ◽

Mass Formation

Object Differentiation between malignant and benign vertebral compression fractures (VCFs) is important but sometimes difficult, especially in elderly cancer patients. The authors investigated the findings of MR imaging and FDG-PET/CT for the differentiation of VCFs. Methods Between 2007 and 2008, the authors evaluated and treated 102 VCFs in 96 patients. The final diagnosis, based on biopsy results or clinical follow-up, was benign fracture in 67 lesions in 65 patients and malignant fracture in 35 lesions in 31 patients. Magnetic resonance images were obtained in all patients, and FDG-PET/CT was performed in 17 patients in the benign fracture group and 20 in the malignant fracture group. The prevalence of 3 significant MR imaging findings (posterior cortical bulging, epidural mass formation, and pedicle enhancement) and the presence of radiotracer uptake on FDG-PET/CT were evaluated in the 2 groups. The maximum standardized uptake value (SUVmax) on FDG-PET/CT was compared between the 2 groups, and diagnostic threshold value was sought to confirm malignancy. The diagnostic accuracy of MR imaging and FDG-PET/CT was compared in the differentiation of malignant from benign VCFs. Results Posterior cortical bulging was seen in 26 (74%) of 35 malignant lesions and 30 (45%) of 67 benign ones, epidural mass formation in 27 (77%) of the malignant lesions and 25% of the benign ones, and pedicle enhancement in 30 (91%) of the 33 malignant lesions and 18 (39%) of the 46 benign ones evaluated with Gd-enhanced MR imaging. These differences were statistically significant for each feature. Sensitivity and specificity for predicting malignancy were, respectively, 74% and 55% for posterior cortical bulging, 77% and 74% for epidural mass formation, and 90% and 61% for pedicle enhancement. Simultaneous occurrence of 3 significant features was found in 21 (64%) of the 33 malignant and 8 (17%) of the 46 benign lesions for which complete MR imaging data were available and showed sensitivity of 64% and specificity of 83%. The presence of radiotracer uptake on FDG-PET/CT was seen in all 20 (100%) of the 20 malignant lesions and 12 (71%) 17 of the benign lesions evaluated by FDG-PET/CT and showed a sensitivity of 100% and specificity of 29%. There was a significant difference in mean (± SD) SUVmax for the malignant (6.29 ± 3.50) and benign (2.38 ± 1.90) lesions (p < 0.001). The most reliable threshold for SUVmax was found to be 4.25, which yielded a sensitivity of 85% and a specificity of 71%. Conclusions When MR imaging findings are equivocal, FDG-PET/CT can be considered as an adjunctive diagnostic method for differentiating malignant from benign VCFs. In comparison with MR imaging, FDG-PET/CT showed slightly higher sensitivity and lower specificity.

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Thyroid lesions incidentally detected by 18F-FDG PET-CT ― a two centre retrospective study

Radiology and Oncology ◽

10.2478/raon-2014-0039 ◽

2015 ◽

Vol 49 (2) ◽

pp. 121-127 ◽

Cited By ~ 10

Author(s):

Jan Jamsek ◽

Ivana Zagar ◽

Simona Gaberscek ◽

Marko Grmek

Keyword(s):

Fdg Pet ◽

Malignant Lesion ◽

Standardized Uptake Value ◽

Benign Lesions ◽

Fdg Uptake ◽

Pet Ct ◽

Thyroid Uptake ◽

Malignant Lesions ◽

Fdg Pet Ct ◽

Thyroid Lesions

AbstractBackground. Incidental18F-FDG uptake in the thyroid on PET-CT examinations represents a diagnostic challenge. The maximal standardized uptake value (SUVmax) is one possible parameter that can help in distinguishing between benign and malignant thyroid PET lesions.Patients and methods. We retrospectively evaluated18F-FDG PET-CT examinations of 5,911 patients performed at two different medical centres from 2010 to 2011. If pathologically increased activity was accidentally detected in the thyroid, the SUVmaxof the thyroid lesion was calculated. Patients with incidental18F-FDG uptake in the thyroid were instructed to visit a thyroidologist, who performed further investigation including fine needle aspiration cytology (FNAC) if needed. Lesions deemed suspicious after FNAC were referred for surgery.Results. Incidental18F-FDG uptake in the thyroid was found in 3.89% ― in 230 out of 5,911 patients investigated on PET-CT. Malignant thyroid lesions (represented with focal thyroid uptake) were detected in 10 of 66 patients (in 15.2%). In the first medical centre the SUVmaxof 36 benign lesions was 5.6 ± 2.8 compared to 15.8 ± 9.2 of 5 malignant lesions (p < 0.001). In the second centre the SUVmaxof 20 benign lesions was 3.7 ± 2.2 compared to 5.1 ± 2.3 of 5 malignant lesions (p = 0.217). All 29 further investigated diffuse thyroid lesions were benign.Conclusions. Incidental18F-FDG uptake in the thyroid was found in 3.89% of patients who had a PET-CT examination. Only focal thyroid uptake represented a malignant lesion in our study ― in 15.2% of all focal thyroid lesions. SUVmaxshould only serve as one of several parameters that alert the clinician on the possibility of thyroid malignancy.

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Head-to-Head Comparison of68Ga-Citrate and18F-FDG PET/CT for Detection of Infectious Foci in Patients withStaphylococcus aureusBacteraemia

Contrast Media & Molecular Imaging ◽

10.1155/2017/3179607 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Soile P. Salomäki ◽

Jukka Kemppainen ◽

Ulla Hohenthal ◽

Pauliina Luoto ◽

Olli Eskola ◽

...

Keyword(s):

Soft Tissue ◽

Fdg Pet ◽

Vertebral Osteomyelitis ◽

Whole Body ◽

Time Interval ◽

Standardised Uptake Value ◽

Positron Emission ◽

Pet Ct ◽

Small Cohort ◽

Fdg Pet Ct

Purpose. This study evaluated the potential of68Ga-citrate positron emission tomography/computed tomography (PET/CT) for the detection of infectious foci in patients withStaphylococcus aureusbacteraemia by comparing it with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) PET/CT.Methods.Four patients admitted to hospital due toS. aureusbacteraemia underwent both18F-FDG and68Ga-citrate whole-body PET/CT scans to detect infectious foci.Results.The time from hospital admission and the initiation of antibiotic treatment to the first PET/CT was 4–10 days. The time interval between18F-FDG and68Ga-citrate PET/CT was 1–4 days. Three patients had vertebral osteomyelitis (spondylodiscitis) and one had osteomyelitis in the toe; these were detected by both18F-FDG (maximum standardised uptake value [SUVmax]6.0±1.0) and68Ga-citrate (SUVmax 6.8±3.5,P=0.61). Three patients had soft tissue infectious foci, with more intense18F-FDG uptake (SUVmax 6.5±2.5) than68Ga-citrate uptake (SUVmax 3.9±1.2,P=0.0033).Conclusions.Our small cohort of patients withS. aureusbacteraemia revealed that68Ga-citrate PET/CT is comparable to18F-FDG PET/CT for detection of osteomyelitis, whereas18F-FDG resulted in a higher signal for the detection of soft tissue infectious foci.

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The Role of [18F]FDG-PET/CT in Predicting Malignant Transformation of Plexiform Neurofibromas in Neurofibromatosis-1

International Journal of Surgical Oncology ◽

10.1155/2016/6162182 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

David Tovmassian ◽

Muzib Abdul Razak ◽

Kevin London

Keyword(s):

Systematic Review ◽

Peripheral Nerve ◽

Fdg Pet ◽

Neurofibromatosis 1 ◽

Noninvasive Test ◽

Plexiform Neurofibromas ◽

Pet Ct ◽

Significant Difference ◽

Malignant Lesions ◽

Fdg Pet Ct

Background. Malignant peripheral nerve sheath tumours (MPNSTs) are difficult to diagnose and treat and contribute to significant morbidity and mortality for patients with Neurofibromatosis-1 (NF-1). FDG-PET/CT is being increasingly used as an imaging modality to discriminate between benign and malignant plexiform neurofibromas. Objectives. To assess the value of FDG-PET/CT in differentiating between benign and malignant peripheral nerve lesions for patients with Neurofibromatosis-1. Methods. A systematic review of the literature was performed prior to application of stringent selection criteria. Ultimately 13 articles with 796 tumours were deemed eligible for inclusion into the review. Results. There was a significant difference between mean SUVmax of benign and malignant lesions (1.93 versus 7.48, resp.). Sensitivity ranged from 89 to 100% and specificity from 72 to 94%. ROC analysis was performed to maximise sensitivity and specificity of SUVmax cut-off; however no clear value was identified (range 3.1–6.1). Significant overlap was found between the SUVmax of benign and malignant lesions making differentiation of lesions difficult. Many of the studies suffered from having a small cohort and from not providing histological data on all lesions which underwent FDG-PET/CT. Conclusion. This systematic review is able to demonstrate that FDG-PET/CT is a useful noninvasive test for discriminating between benign and malignant lesions but has limitations and requires further prospective trials.

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Diagnostic Performance of 18F-FDG PET/CT in Infectious and Inflammatory Diseases according to Published Meta-Analyses

Contrast Media & Molecular Imaging ◽

10.1155/2019/3018349 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 19

Author(s):

Giorgio Treglia

Keyword(s):

Infectious Diseases ◽

Fdg Pet ◽

Diagnostic Performance ◽

Inflammatory Diseases ◽

Cochrane Library ◽

Imaging Method ◽

Evidence Based ◽

Pet Ct ◽

Meta Analyses ◽

Fdg Pet Ct

Purpose. To date, several meta-analyses have reported data about the diagnostic performance of 18F-FDG PET/CT in infectious and inflammatory diseases. This article aims to summarize the published evidence-based data about the diagnostic performance of 18F-FDG PET/CT in this setting. Methods. A comprehensive computer literature search of meta-analyses published in PubMed/MEDLINE and Cochrane library database from January 2009 through December 2018 and regarding the diagnostic performance of 18F-FDG PET/CT in infectious and inflammatory diseases was carried out. This combination of key words was used: (i) “PET” OR “positron emission tomography” OR “FDG” OR “fluorodeoxyglucose” AND (ii) meta-analysis. Only records on inflammatory or infectious diseases were selected. Results. The diagnostic performance of 18F-FDG PET/CT in detecting inflammatory and infectious diseases has been summarized taking into account 36 meta-analyses published in the literature. Evidence-based data demonstrated good diagnostic performance of 18F-FDG PET/CT for several inflammatory and infectious diseases, in particular cardiovascular infectious and inflammatory diseases and some musculoskeletal infections. Conclusions. Evidence-based data about the diagnostic performance of 18F-FDG PET/CT in infectious and inflammatory diseases are increasing, with good diagnostic performance of this imaging method for some indications. More prospective multicenter studies and cost-effective analyses are warranted.

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Diagnostic value of additional 18F-FDG PET/CT imaging using a vaginal catheter in patients with paravaginal malignant lesions

Nuclear Medicine Communications ◽

10.1097/mnm.0000000000000577 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1260-1266 ◽

Cited By ~ 1

Author(s):

Sibel Ucak Semirgin ◽

Tarik Basoglu ◽

Behiye Atmaca Saglik ◽

Murathan Sahin ◽

Oktay Yapici

Keyword(s):

Fdg Pet ◽

Diagnostic Value ◽

Ct Imaging ◽

Pet Ct ◽

Malignant Lesions ◽

18F Fdg ◽

Fdg Pet Ct

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Diagnostic Performance of PET or PET/CT with Different Radiotracers in Patients with Suspicious Lung Cancer or Pleural Tumours according to Published Meta-Analyses

Contrast Media & Molecular Imaging ◽

10.1155/2020/5282698 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Filippo Lococo ◽

Barbara Muoio ◽

Marco Chiappetta ◽

Dania Nachira ◽

Leonardo Petracca Ciavarella ◽

...

Keyword(s):

Lung Cancer ◽

Positron Emission Tomography ◽

Fdg Pet ◽

Diagnostic Performance ◽

Emission Tomography ◽

Evidence Based ◽

Positron Emission ◽

Pet Ct ◽

Meta Analyses ◽

Fdg Pet Ct

Purpose. Several meta-analyses have reported data about the diagnostic performance of positron emission tomography or positron emission tomography/computed tomography (PET or PET/CT) with different radiotracers in patients with suspicious lung cancer (LC) or pleural tumours (PT). This review article aims at providing an overview on the recent evidence-based data in this setting. Methods. A comprehensive literature search of meta-analyses published in PubMed/MEDLINE and Cochrane Library database from January 2010 through March 2020 about the diagnostic performance of PET or PET/CT with different radiotracers in patients with suspicious LC or PT was performed. This combination of keywords was used: (A) “PET” OR “positron emission tomography” AND (B) “lung” OR “pulmonary” OR “pleur∗” AND (C) meta-analysis. Only meta-analyses on PET or PET/CT in patients with suspicious LC or PT were selected. Results. We have summarized the diagnostic performance of PET or PET/CT with fluorine-18 fluorodeoxyglucose (18F-FDG) and other radiotracers taking into account 17 meta-analyses. Evidence-based data demonstrated a good diagnostic performance of 18F-FDG PET or PET/CT for the characterization of solitary pulmonary nodules (SPNs) or pleural lesions with overall higher sensitivity than specificity. Evidence-based data do not support the routine use of dual time point (DTP) 18F-FDG PET/CT or fluorine-18 fluorothymidine (18F-FLT) PET/CT in the differential diagnosis of SPNs. Even if 18F-FDG PET/CT has high sensitivity and specificity as a selective screening modality for LC, its role in this setting remains unknown. Conclusions. Evidence-based data about the diagnostic performance of PET/CT with different radiotracers for suspicious LC or PT are increasing, with good diagnostic performance of 18F-FDG PET/CT. More prospective multicenter studies and cost-effectiveness analyses are warranted.

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Role of 2-[18F]FDG as a Radiopharmaceutical for PET/CT in Patients with COVID-19: A Systematic Review

Pharmaceuticals ◽

10.3390/ph13110377 ◽

2020 ◽

Vol 13 (11) ◽

pp. 377

Author(s):

Salvatore Annunziata ◽

Roberto C. Delgado Bolton ◽

Christel-Hermann Kamani ◽

John O. Prior ◽

Domenico Albano ◽

...

Keyword(s):

Systematic Review ◽

Positron Emission Tomography ◽

Fdg Pet ◽

Emission Tomography ◽

Evidence Based ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Some recent studies evaluated the role of fluorine-18 fluorodeoxyglucose (2-[18F]FDG) as a radiopharmaceutical for positron emission tomography/computed tomography (PET/CT) imaging in patients with Coronavirus Disease (COVID-19). This article aims to perform a systematic review in this setting. A comprehensive computer literature search in PubMed/MEDLINE and Cochrane library databases regarding the role of 2-[18F]FDG PET/CT in patients with COVID-19 was carried out. This combination of key words was used: (A) “PET” OR “positron emission tomography” AND (B) “COVID” OR “SARS”. Only pertinent original articles were selected; case reports and very small case series were excluded. We have selected 11 original studies of 2-[18F]FDG PET/CT in patients with COVID-19. Evidence-based data showed first preliminary applications of this diagnostic tool in this clinical setting, with particular regard to the incidental detection of interstitial pneumonia suspected for COVID-19. To date, according to evidence-based data, 2-[18F]FDG PET/CT cannot substitute or integrate high-resolution CT to diagnose suspicious COVID-19 or for disease monitoring, but it can only be useful to incidentally detect suspicious COVID-19 lesions in patients performing this imaging method for standard oncological and non-oncological indications. Published data about the possible role of 2-[18F]FDG PET/CT in patients with COVID-19 are increasing, but larger studies are warranted.

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