Influence of F-18 FDG radiotracer application on image quality and SUV values when performing PET / CT study

18F-FDG PET/CT is the most widely used diagnostic modality for detection of malignant disease. Beside the visual insight of FDG pathways into the human body, PET/CT can give valuable information based on the SUV values. The SUV is a quantitative parameter of metabolic activity. FDG application has 2 major impacts on PET/CT: qualitative aspect (visual insight of FDG in the body) and quantitative aspect (degradation of the SUV values). Based on the literature, FDG extravasation incidence is 31% for all PET/CT studies and in 8% of all cases extravasation has been visually confirmed since the application place has been in the field of view. By constantly developing the technique, work methodology and increasing the quality control of the staff in the PET/CT department, the incidence of extravasation can be significantly reduced based on the results from the literature. In the case when paravenous injection is present on PET/CT images we can use certain software procedures to improve image quality and SUV quanitification.

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FDG-PET/CT in intensive care patients with bloodstream infection

Critical Care ◽

10.1186/s13054-021-03557-x ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Jordy P. Pijl ◽

Mark Londema ◽

Thomas C. Kwee ◽

Maarten W. N. Nijsten ◽

Riemer H. J. A. Slart ◽

...

Keyword(s):

Intensive Care ◽

Image Quality ◽

Fdg Pet ◽

Diagnostic Yield ◽

Unknown Origin ◽

Intensive Care Patients ◽

Pet Ct ◽

Infection Focus ◽

Focus Of Infection ◽

Fdg Pet Ct

Abstract Background 2-Deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is an advanced imaging technique that can be used to examine the whole body for an infection focus in a single examination in patients with bloodstream infection (BSI) of unknown origin. However, literature on the use of this technique in intensive care patients is scarce. The purpose of this study was to evaluate the diagnostic yield of FDG-PET/CT in intensive care patients with BSI. Methods In this retrospective cohort study, all intensive care patients from our Dutch university medical center who had culture-proven BSI between 2010 and 2020 and underwent FDG-PET/CT to find the focus of infection were included. Diagnostic performance was calculated and logistic regression analysis was performed to evaluate the association between FDG-PET/CT outcome and C-reactive protein level (CRP), leukocyte count, duration of antibiotic treatment, duration of ICU stay, quality of FDG-PET/CT, and dependency on mechanical ventilation. In addition, the impact of FDG-PET/CT on clinical treatment was evaluated. Results 30 intensive care patients with BSI were included. In 21 patients, an infection focus was found on FDG-PET/CT which led to changes in clinical management in 14 patients. FDG-PET/CT achieved a sensitivity of 90.9% and specificity of 87.5% for identifying the focus of infection. Poor quality of the FDG-PET images significantly decreased the likelihood of finding an infection focus as compared to reasonable or good image quality (OR 0.16, P = 0.034). No other variables were significantly associated with FDG-PET/CT outcome. No adverse events during the FDG-PET/CT procedure were reported. Conclusion FDG-PET/CT has a high diagnostic yield for detecting the infection focus in patients with BSI admitted to intensive care. Poor PET image quality was significantly associated with a decreased likelihood of finding the infection focus in patients with BSI. This could be improved by adequate dietary preparation and cessation of intravenous glucose and glucose-regulating drugs. Recent advances in PET/CT technology enable higher image quality with shorter imaging time and may contribute to routinely performing FDG-PET/CT in intensive care patients with BSI of unknown origin.

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Clinical and FDG-PET/CT Suspicion of Malignant Disease: Is Biopsy Confirmation Still Necessary?

Diagnostics ◽

10.3390/diagnostics11030559 ◽

2021 ◽

Vol 11 (3) ◽

pp. 559

Author(s):

Talitha Bent ◽

Derya Yakar ◽

Thomas C. Kwee

Keyword(s):

Fdg Pet ◽

Malignant Disease ◽

Invasive Procedure ◽

Clinical Suspicion ◽

Tissue Sampling ◽

Positron Emission ◽

Pet Ct ◽

Significant Difference ◽

Biopsy Confirmation ◽

Fdg Pet Ct

Background: Biopsy of 18F-fluoro-2-deoxy-D-glucose (FDG)-avid lesions suspected for malignancy remains an invasive procedure associated with a variety of risks. It is still unclear if the positive predictive value (PPV) of positron emission tomography (PET)/computed tomography (CT) is sufficiently high to avoid tissue sampling. Therefore, the purpose of this study was to determine the PPV of 18F-FDG-PET/CT for malignancy in patients with a clinical suspicion of active malignant disease. Methods: This single-center retrospective study included 83 patients who had undergone FDG-PET/CT within 60 days before CT- or ultrasonography-guided tissue sampling and whose request form for CT- or US-guided tissue sampling requested mutation analyses. The latter implies a high clinical suspicion of active malignant disease. The nature of each biopsied lesion was determined based on the results of the pathological analysis and/or clinical and imaging follow-up of at least 12 months. Results: In total, eighty-eight FDG-avid lesions were biopsied. The PPV of FDG-PET/CT for malignancy was 98.9% (95% CI: 93.8–99.8%). For patients with an oncological history, the PPV was 98.7% (95% CI: 92.9–99.8%), and for patients with no oncological history, the PPV was 100% (95% CI: 74.1–100.0%). There was no significant difference between the PPV of the group with and without an oncological history (p = 0.71). In two cases, an unsuspected malignancy was diagnosed. Conclusion: Although the PPV of FDG-PET/CT for malignancy in patients with a clinical suspicion of active malignant disease is high, biopsy remains recommended to avoid inappropriate patient management due the non-negligible chance of dealing with FDG-avid benign disease or unexpected malignancies.

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Incidental focal colonic uptake on 18 F-FDG PET/CT studies

Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) ◽

10.1016/j.remnie.2017.10.013 ◽

2018 ◽

Vol 37 (1) ◽

pp. 15-19

Author(s):

L. Servente ◽

V. Gigirey ◽

M. García Fontes ◽

O. Alonso

Keyword(s):

Fdg Pet ◽

Pet Ct ◽

Fdg Pet Ct ◽

Ct Studies

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Clinical Value of Fluorine-18 2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography in Bladder Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.7052 ◽

2010 ◽

Vol 28 (25) ◽

pp. 3973-3978 ◽

Cited By ~ 93

Author(s):

Andrea B. Apolo ◽

Jamie Riches ◽

Heiko Schöder ◽

Oguz Akin ◽

Alisa Trout ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Bladder Cancer ◽

Sensitivity And Specificity ◽

Fdg Pet ◽

Malignant Disease ◽

Emission Tomography ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct

Purpose Fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been approved for imaging in many malignancies but not for bladder cancer. This study investigated the value of FDG-PET/CT imaging in the management of patients with advanced bladder cancer. Patients and Methods Between May 2006 and February 2008, 57 patients with bladder cancer at our center underwent FDG-PET/CT after CT (n = 52) or magnetic resonance imaging (MRI; n = 5). The accuracy of FDG-PET/CT was assessed using both organ-based and patient-based analyses. FDG-PET/CT findings were validated by either biopsy or serial CT/MRI. Clinician questionnaires performed before and after FDG-PET/CT assessed whether those scan results affected management. Results One hundred thirty-five individual lesions were evaluable in 47 patients for the organ-based analysis. Overall sensitivity and specificity were 87% (95% CI, 76% to 94%) and 88% (95% CI, 78% to 95%), respectively. In the patient-based analysis, malignant disease was correctly diagnosed in 25 of 31 patients, resulting in a sensitivity of 81% (95% CI, 63% to 93%). FDG-PET/CT was negative in 15 of 16 patients without malignant lesions for a specificity of 94% (95% CI, 71% to 100%). Pre- and post-PET surveys revealed that FDG-PET/CT detected more malignant disease than conventional CT/MRI in 40% of patients. Post-PET surveys showed that clinicians changed their planned management in 68% of patients based on the FDG-PET/CT results. Conclusion FDG-PET/CT has excellent sensitivity and specificity in the detection of metastatic bladder cancer and provides additional diagnostic information that enhances clinical management more than CT/MRI alone. FDG-PET/CT scans may provide better accuracy in clinical information for directing therapy.

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Leydig cell tumor of the testis: an incidental finding at 18F-FDG PET/CT imaging

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00646-3 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Almalki Yassir

Keyword(s):

Leydig Cell ◽

Fdg Pet ◽

Chronic Rejection ◽

Ct Imaging ◽

The Body ◽

Whole Body ◽

Pet Ct ◽

18F Fdg ◽

The Right ◽

Fdg Pet Ct

Abstract Background Leydig cell tumors (LCTs) represent the most common form of stromal tumors. We reported the 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings of a patient with testicular LCT. Case presentation A 50-year-old man with a history of end-stage renal disease and renal transplantation 19 years ago. One year earlier, he started to have a chronic rejection. During the investigation to determine the cause of chronic rejection, a suspicious lesion in the graft with a collection around it was seen on ultrasound (US) images, raising the possibility of post-transplant lymphoproliferative disorder (PTLD). The patient was referred for further evaluation by whole body 18F-FDG PET/CT imaging. The image finding revealed an incidental hypermetabolic focal lesion in the right testicle—no other specific findings in the remaining parts of the body nor definitive FDG avid lymphadenopathy to suggest PTLD. Testicular US was requested and showed a well-defined right-sided heterogeneous hypoechoic intratesticular focal mass at the upper pole of the right testis with significant internal vascularity on the color Doppler imaging. The patient underwent a right radical orchidectomy, and the tumor was pathologically confirmed as an LCT. Conclusion In our case, 18F-FDG-PET/CT has been helpful in incidentally detecting this rare testicular tumor in a patient with suspected PTLD.

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