Frequency and Clinical Significance of Incidental Prostatic FDG uptake in FDG PET imaging

Abstract Objective: To evaluate FDG-PET imaging for early prediction of response in patients with NHL treated with fractionated radioimmunotherapy (RIT). Methods: Ten patients from a larger ongoing, multicenter, Phase I/II trial of fractionated RIT (2–3 injections 1-week apart of humanized anti-CD22 antibody, epratuzumab, labeled with 90Y) underwent FDG-PET imaging together with CT scans of the chest, abdomen and pelvis at baseline and 6 weeks post-RIT, and then every 3 months until progression. Tumor responses evaluated from CT images were classified using Cheson lymphoma criteria as complete response (CR), unconfirmed CR (CRu), partial response (PR), stable disease (SD) or progression of disease (PD). PET images were evaluated for abnormal focal uptake visually, using standard uptake value (SUV) quantitation, and were classified as CR when all tumor foci disappeared, incomplete response (IR) when FDG uptake decreased with persistent foci, or PD when FDG uptake increased or new foci developed. Results: A total of 36 paired imaging studies were obtained post RIT (including 3 patients after retreatment) and evaluated as CR (n=7), CRu (n=14), SD (n=5) or PD (n=10) by CT and CR (n= 13), IR (n= 8) or PD (n=15) by PET. Of the 14 studies evaluated as CRu by CT, 7 were definitively evaluated by PET as CR, 3 as IR, and 4 as PD. Of 22 studies not evaluated as CRu by CT, PET identified PD in one case evaluated as CR by CT and was otherwise concordant with CT (10 PD/PD, 6 CR/CR, 5 SD/IR). Among PET images acquired at 6 weeks post-RIT, the mean time-to-progression (TTP) was 9.6 months for negative PET images (CR) compared to 4.1 months for positive PET findings (IR, PD) (P=0.16). Conclusion: In our study, FDG-PET appeared superior to conventional CT in evaluating response to fractionated RIT. For CT scans frequently evaluated as CRu, PET resolved uncertainty regarding residual disease, and PET images acquired 6 weeks after RIT predicted later relapse.

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Pilot study to enhance FDG-PET imaging of prostate cancers with the metabolic inhibitor ranolazine.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16551 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16551-e16551

Author(s):

Isabel R. Schlaepfer ◽

Elizabeth R Kessler ◽

Jennifer J Kwak ◽

Lauren Liebman ◽

Paul Maroni ◽

...

Keyword(s):

Prostate Cancer ◽

Pilot Study ◽

Pet Imaging ◽

Fdg Pet ◽

Imaging Modality ◽

Small Sample ◽

Metabolic Inhibitor ◽

Acid Oxidation ◽

Absolute Change ◽

Fdg Uptake

e16551 Background: 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) is a widely-used imaging modality for many cancers; however, its utility in prostate cancer is limited. Fatty acid oxidation (FAO) is a primary source of energy for early prostate cancer. We previously demonstrated that FAO inhibition in prostate cancer mouse models resulted in increased glucose metabolism and enhanced tumor FDG uptake, with peak uptake at 24 hours. To validate these preclinical findings, we conducted a pilot study to evaluate whether a partial FAO inhibitor, ranolazine, increases tumor FDG uptake on PET imaging for prostate cancer. Methods: Prostate cancer patients with untreated localized cancer (arm 1) and with metastatic disease on hormonal or other therapy (arm 2) were enrolled and underwent baseline and post-treatment FDG-PET/CT scans (standard dose of 10 mCi FDG). Ranolazine 1000mg PO BID x 2 doses was given within 24-48 hours of the second scan. The primary objective was to evaluate the rate of successful enhancement of FDG uptake on PET imaging, based on one or more of the following criteria: 30% increase in maximum SUV with an absolute change of 2 units; 30% increase in mean SUV with an absolute change of 0.75 units; or 20% increase in mean SUV with an absolute change of 1 unit. Results: Eleven patients (four in arm 1, seven in arm 2) were enrolled. Ranolazine was well tolerated by all participants, with no adverse effects observed. Both increases and decreases in SUV uptake were observed on the post-ranolazine scans. No patient met the predefined criteria for successful enhancement of FDG uptake. There was an incidental finding of thyroid cancer seen in one patient that was discovered on PET imaging. The study was closed early due to the emerging clinical availability of alternative and effective PET imaging modalities such as [11C] choline, [18F] fluciclovine, [68Ga] PSMA, and [18F] sodium fluoride. Conclusions: Given the small sample size, we were not able to make any firm conclusions. In this limited study, ranolazine treatment did not result in enhanced FDG-PET-tumor detection. ClinicalTrials.gov identifier: NCT01992016. Supported by the William Meyn Foundation; NIH/NCI P30CA46934, 5K12CA086913, CA168934; ACS RSG-16-256-01-TBE; Colorado Translational Research Imaging Center Pilot Award; Paul Sandoval Cancer Research Summer Fellowship. Clinical trial information: NCT01992016.

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Detection of Inflammatory Lesions by F-18 Fluorodeoxyglucose Positron Emission Tomography in Patients with Polymyositis and Dermatomyositis

The Journal of Rheumatology ◽

10.3899/jrheum.111597 ◽

2012 ◽

Vol 39 (8) ◽

pp. 1659-1665 ◽

Cited By ~ 33

Author(s):

TAKAYOSHI OWADA ◽

REIKA MAEZAWA ◽

KAZUHIRO KURASAWA ◽

HARUTSUGU OKADA ◽

SATOKO ARAI ◽

...

Keyword(s):

Positron Emission Tomography ◽

Pet Imaging ◽

Fdg Pet ◽

Inflammatory Myopathy ◽

Emission Tomography ◽

Fluorodeoxyglucose Positron Emission Tomography ◽

Muscle Diseases ◽

Fdg Uptake ◽

Positron Emission ◽

Fluorodeoxyglucose Positron Emission

Objective.To evaluate the usefulness of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in the management of patients with inflammatory myopathy. We examined whether FDG-PET scanning detects myositis or extramuscular lesions in patients with polymyositis (PM) and dermatomyositis (DM).Methods.FDG-PET imaging was performed in 24 patients with active inflammatory myopathy (PM, 11; DM, 13). The images were read by radiologists in a blinded manner. FDG uptake into muscles was judged positive when the intensity of muscles was higher than or equal to that of the liver. As controls, FDG imaging findings of patients with a lung mass and without muscle diseases were used. To investigate associations between FDG-PET findings and clinical/laboratory findings, the patients’ medical records were reviewed retrospectively.Results.Increased FDG uptake in muscles was found in 8 of 24 (33%) patients. In 67 of 69 (97%) controls without muscle diseases, no muscle FDG uptake was detected. The sensitivity of FDG-PET to detect myositis was lower than that of electromyogram (EMG), magnetic resonance imaging, and muscle biopsy. There were no significant differences in clinical manifestations between patients with and without increased FDG uptake in muscles, although patients with FDG muscle uptake had a tendency to have extended myositis with endomysial cell infiltration. FDG-PET detected neoplasms in patients with associated malignancy. FDG uptake in lungs was found in 7 of 18 patients with interstitial lung disease.Conclusion.FDG-PET imaging has limited usefulness for the evaluation of myositis in patients with PM/DM because of its low sensitivity, although it might be useful for detection of malignancy in these patients.

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Positron emission tomography with [18F]fluorodeoxyglucose to evaluate neutrophil kinetics during acute lung injury

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00339.2003 ◽

2004 ◽

Vol 286 (4) ◽

pp. L834-L840 ◽

Cited By ~ 73

Author(s):

Delphine L. Chen ◽

Daniel P. Schuster

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Pet Imaging ◽

Fdg Pet ◽

Pulmonary Sequestration ◽

Fdg Uptake ◽

Positron Emission ◽

Activated Neutrophils ◽

Neutrophil Kinetics

We measured neutrophil glucose uptake with positron emission tomographic imaging and [18F]fluorodeoxyglucose ([18F]FDG-PET) in anesthetized dogs after intravenous oleic acid-induced acute lung injury (ALI; OA group, n = 6) or after low-dose intravenous endotoxin (known to activate neutrophils without causing lung injury) followed by OA (Etx + OA group, n = 7). The following two other groups were studied as controls: one that received no intervention ( n = 5) and a group treated with Etx only ( n = 6). PET imaging was performed ∼1.5 h after initiating experimental interventions. The rate of [3H]deoxyglucose ([3H]DG) uptake was also measured in vitro in cells recovered from bronchoalveolar lavage (BAL) performed after PET imaging. Circulating neutrophil counts fell significantly in animals treated with Etx but not in the other two groups. The rate of [18F]FDG uptake, measured by the influx constant Ki, was significantly elevated ( P < 0.05) in both Etx-treated groups (7.9 ± 2.6 × 10-3ml blood·ml lung-1·min-1in the Etx group, 9.3 ± 4.8 × 10-3ml blood·ml lung-1·min-1in the Etx + OA group) but not in the group treated only with OA (3.4 ± 0.8 × 10-3ml blood·ml lung-1·min-1) when compared with the normal control (1.6 ± 0.4 × 10-3ml blood·ml lung-1·min-1). [3H]DG uptake was increased (73 ± 7%) in BAL neutrophils recovered from the Etx + OA group ( P < 0.05) but not in the OA group. Kiand [3H]DG uptake rates were linearly correlated ( R2= 0.65). We conclude that the rate of [18F]FDG uptake in the lungs during ALI reflects the state of neutrophil activation. [18F]FDG-PET imaging can detect pulmonary sequestration of activated neutrophils, despite the absence of alveolar neutrophilia. Thus [18F]FDG-PET imaging may be a useful tool to study neutrophil kinetics during ALI.

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Predictors of pathologic outcome of focal FDG uptake in the parotid gland identified on whole-body FDG PET imaging

Clinical Imaging ◽

10.1016/j.clinimag.2015.07.005 ◽

2015 ◽

Vol 39 (6) ◽

pp. 1073-1079 ◽

Cited By ~ 1

Author(s):

Marc C. Mabray ◽

Spencer C. Behr ◽

David M. Naeger ◽

Robert R. Flavell ◽

Christine M. Glastonbury

Keyword(s):

Parotid Gland ◽

Pet Imaging ◽

Fdg Pet ◽

Whole Body ◽

Fdg Uptake

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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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Choice of anesthesia and data analysis method strongly increases sensitivity of 18F-FDG PET imaging during experimental epileptogenesis

PLoS ONE ◽

10.1371/journal.pone.0260482 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260482

Author(s):

Ina Jahreis ◽

Pablo Bascuñana ◽

Tobias L. Ross ◽

Jens P. Bankstahl ◽

Marion Bankstahl

Keyword(s):

Data Analysis ◽

Glucose Metabolism ◽

Pet Imaging ◽

Fdg Pet ◽

Regional Analysis ◽

Statistical Parametric Mapping ◽

Tracer Uptake ◽

Chronic Epilepsy ◽

Conscious Rats ◽

Fdg Uptake

Purpose Alterations in brain glucose metabolism detected by 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) positron emission tomography (PET) may serve as an early predictive biomarker and treatment target for epileptogenesis. Here, we aimed to investigate changes in cerebral glucose metabolism before induction of epileptogenesis, during epileptogenesis as well as during chronic epilepsy. As anesthesia is usually unavoidable for preclinical PET imaging and influences the distribution of the radiotracer, four different protocols were compared. Procedures We investigated 18F-FDG uptake phase in conscious rats followed by a static scan as well as dynamic scans under continuous isoflurane, medetomidine-midazolam-fentanyl (MMF), or propofol anesthesia. Furthermore, we applied different analysis approaches: atlas-based regional analysis, statistical parametric mapping, and kinetic analysis. Results At baseline and compared to uptake in conscious rats, isoflurane and propofol anesthesia resulted in decreased cortical 18F-FDG uptake while MMF anesthesia led to a globally decreased tracer uptake. During epileptogenesis, MMF anesthesia was clearly best distinctive for visualization of prominently increased glucometabolism in epilepsy-related brain areas. Kinetic modeling further increased sensitivity, particularly for continuous isoflurane anesthesia. During chronic epilepsy, hypometabolism affecting more or less the whole brain was detectable with all protocols. Conclusion This study reveals evaluation of anesthesia protocols for preclinical 18F-FDG PET imaging as a critical step in the study design. Together with an appropriate data analysis workflow, the chosen anesthesia protocol may uncover otherwise concealed disease-associated regional glucometabolic changes.

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Prediction of Response to Preoperative Chemotherapy in Gastric Carcinoma by Metabolic Imaging: Results of a Prospective Trial

Journal of Clinical Oncology ◽

10.1200/jco.2003.06.574 ◽

2003 ◽

Vol 21 (24) ◽

pp. 4604-4610 ◽

Cited By ~ 236

Author(s):

Katja Ott ◽

Ulrich Fink ◽

Karen Becker ◽

Alexander Stahl ◽

Hans-Joachim Dittler ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Preoperative Chemotherapy ◽

Pet Imaging ◽

Fdg Pet ◽

Patient Survival ◽

Metabolic Response ◽

Resected Specimen ◽

Fdg Uptake ◽

Histopathologic Response

Purpose: We prospectively evaluated the predictive value of therapy-induced reduction of tumor glucose use for subsequent response and patient survival in patients with gastric cancer treated by preoperative chemotherapy. Patients and Methods: Forty-four consecutive patients with locally advanced gastric carcinomas were studied by positron emission tomography with the glucose analog fluorine-18 fluorodeoxyglucose (FDG-PET) at baseline and 14 days after initiation of cisplatin-based polychemotherapy. On the basis of a previous study, a reduction of tumor FDG uptake by more than 35% was used as a criterion for a metabolic response. The metabolic response in FDG-PET was correlated with histopathologic response after completion of therapy (< 10% viable tumor cells in the resected specimen) and patient survival. Results: Thirty-five (80%) of the 44 tumors were visualized with sufficient contrast for quantitative analysis (two of 19 intestinal and seven of 25 nonintestinal tumors showed only low FDG uptake). In the 35 assessable patients, PET imaging after 14 days of therapy correctly predicted histopathologic response after 3 months of therapy in 10 (77%) of 13 responders and 19 (86%) of 22 nonresponders. Median overall survival for patients with a metabolic response has not been reached (2-year survival rate, 90%); for patients without a metabolic response, median survival was only 18.9 months (2-year survival rate, 25%; P = .002) Conclusion: This study prospectively demonstrates that in patients with gastric cancer, response to preoperative chemotherapy can be predicted by FDG-PET early during the course of therapy. By avoiding the morbidity and costs of ineffective therapy, FDG-PET imaging may markedly facilitate the use of preoperative chemotherapy.

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MP53-14 THE CLINICAL SIGNIFICANCE OF INCIDENTAL PROSTATE AVIDITY ON FDG-PET IMAGING

The Journal of Urology ◽

10.1016/j.juro.2014.02.1645 ◽

2014 ◽

Vol 191 (4S) ◽

Author(s):

Patrick Cockerill ◽

Christopher Jaeger ◽

Matthew Tollefson

Keyword(s):

Clinical Significance ◽

Pet Imaging ◽

Fdg Pet

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