Andrea Skanjeti

18F-FDG PET/CT in the Initial Assessment and for Follow-up in Patients With Tuberculosis.

Purpose The aim of this retrospective study was to assess the value of 18F-FDG PET/CT in the initial evaluation and follow-up of patients with tuberculosis (TB). Patients and Methods Thirty-five patients (18 men) with pulmonary or extrapulmonary TB were included. Diagnosis of TB was based either on histology or microbiological assessment in 32 patients and was based on typical morphological features of TB in CT and improvement on antimycobacterial medication in 3 patients. Eighty-eight 18F-FDG PET/CT scans were performed at initial assessment and during treatment, on a Siemens Biograph PET/CT. Diagnostic contrast-enhanced CT scans were performed on the 40-slice multidetector CT of the PET/CT scanner. Mean (SD) anti-TB treatment duration was 16.1 (8.9) months. Results The initial 18F-FDG PET identified 64 affected regions in 34 among 35 patients, whereas CT identified 34 affected organs in 23 patients. Matching image results between PET and CT were observed at first visit in 11 patients (31.4%), with relevant differences in 23 (65.7%). In 1 patient, both modalities remained negative. During follow-up 18F-FDG PET scans, we recorded 15 cases with remission of disease, 16 with residual disease (2 patients with multidrug-resistant infection), and 4 cases with progressive disease or delayed onset of adequate immunological response. In only 3 patients, both modalities, PET and CT, showed completely equivalent results. Conclusions Both components of 18F-FDG PET/CT provide complementary information at initial evaluation and during follow-up; however, 18F-FDG showed more abnormal findings than CT. 18F-FDG PET/CT might be useful for the establishment of individualized treatment regimes, but this requires further prospective studies.

Diffusion-weighted MRI and 18F-FDG-PET/CT imaging: competition or synergy as diagnostic methods to manage sarcoma of the uterus? A systematic review of the literature.

Aim To evaluate the diagnostic performance of fluorine-18-fluorodeoxyglucose PET/computed tomography (18F-FDG-PET/CT) and MRI with diffusion-weighted images (DWI) in uterine sarcomas (US). Patients and methods A systematic review was performed on Medline, ISI web of knowledge, and Scopus databases for studies reporting the diagnostic performance of 18F-FDG-PET/CT and DWI-MRI in US published up to 15 February 2016. Exclusion criteria were articles with fewer than five cases of US, without DWI-MRI, and previous series of patients from the same researcher team. Results Seven studies were selected for DWI-MRI and 11 for 18F-FDG-PET/CT. DWI-MRI was used only to characterize uterine tumors, and showed a good sensitivity but a low specificity. The apparent diffusion coefficient value seems to be the most discriminant between benign and malignant lesion. No data were available on staging and restaging. 18F-FDG-PET/CT improved patients’ management when used for characterization, staging, and restaging because of its quite good accuracy. To date, few data exist on the prognostic role of 18F-FDG-PET/CT. Well-designed multicenter prospective trials are needed to establish definitively the exact role of imaging in the management of US. Conclusion Both DWI-MRI and 18F-FDG-PET/CT have their own advantages, and should be performed in a ‘one stop shop’ scan in the near future by PET/MRI engines.

FDG PET/CT Findings in Abdominal Fat Necrosis After Treatment for Lymphoma.

FDG PET/CT is now validated in non-Hodgkin lymphoma for response assessment in interim and posttreatment lymphoma. We report the case of a 62-year-old man followed by FDG PET/CT for a diffuse large B-cell lymphoma, with initial stage III. The interim FDG PET/CT examination concluded in complete metabolic and morphological response of subdiaphragmatic lymphadenopathy but a persistent abnormal subdiaphragmatic uptake (SUVmax at 9 and Deauville 5-point scale at 5). Therefore, an abdominal biopsy of the corresponding nodules was conducted with a final diagnosis of diffuse fat necrosis.

The role of 18F-FDG-PET/ceCT in peritoneal mesothelioma

Purpose The aim of this study was to assess glucose metabolism of multicystic peritoneal mesothelioma and epithelioid peritoneal mesothelioma by fluorine-18 fluorodeoxyglucose (18F-FDG)-PET/contrast-enhanced computed tomography (ceCT) and to assess its prognostic impact. Materials and methods Twenty-three (14 women) patients, without previous treatment, underwent 18F-FDG-PET/ceCT before peritoneal mesothelioma cytoreductive surgery and intraperitoneal chemotherapy. 18F-FDG-PET/ceCT was interpreted prospectively as positive or negative. Maximum standardized uptake value (SUVmax) of each lesion was measured retrospectively on the basis of postsurgery data. At laparotomy, disease extension was estimated with the Peritoneal Cancer Index. The median follow-up was 27 months (95% confidence interval: 12.9–37.8); progression-free survival (PFS) was recorded. Results Nine patients were affected by multicystic and 14 were affected by epithelioid peritoneal mesothelioma. PET showed mild focal uptake in one case of multicystic peritoneal mesothelioma, whereas in eight patients, no abnormal uptake was observed. PET was positive in 12/14 patients with epithelioid peritoneal mesothelioma. Sensitivity, specificity and accuracy were respectively 86, 89 and 87%; the qualitative assessment was statistically different (P=0.0020, &khgr;2). Multicystic peritoneal mesothelioma histology was significantly associated with lower SUVmaxlesion (P=0.0061), SUVmaxlesion/liver (P=0.0025), Peritoneal Cancer Index, younger age, and it was observed only in women. Recurrence was observed on nine patients affected by epithelioid peritoneal mesothelioma, whereas no recurrences were observed among multicystic peritoneal mesothelioma patients. SUVmaxlesion (P=0.0278) and age (P=0.0241) were significantly associated with PFS in patients with epithelioid peritoneal mesothelioma. Conclusion 18F-FDG-PET/ceCT showed significant differences between multicystic and epithelioid peritoneal mesothelioma, whereas SUVmaxlesion was associated with PFS in the latter. Although multicentre prospective studies are necessary, 18F-FDG-PET/ceCT appears to be a promising tool in patients affected by peritoneal mesothelioma.

18F-FDG-PET/CT of peritoneal tumors: a pictorial essay.

Cancer imaging on the peritoneum is quite difficult on PET/CT because of the particular anatomical features of this membrane. The abdominal cavity can be the seat of very different primary or secondary tumoral lesions, with heterogeneous aggressiveness and variable fluorine-18 fluorodeoxyglucose uptake and patterns. We aimed to depict a spectrum of appearances with abnormal fluorine-18 fluorodeoxyglucose uptakes localized on the peritoneum in frequent conditions such as peritoneal carcinomatosis and in rarer disease such as desmoplastic round cell tumor.

Cat-Scratch Disease: A Pitfall for Lymphoma Evaluation by FDG-PET/CT

FDG-PET/CT is a standard of care in staging and response assessment of Hodgkin lymphoma. Hence, it is important to recognize pitfalls owing to the potential therapeutic impact. We report a case of a 29-year-old woman affected by stage III bulky Hodgkin lymphoma. The interim FDG-PET/CT showed a complete metabolic response. After three new cycles of chemotherapy, the patient showed fever and lymphadenopathy at clinic examination, PET/CT revealed several FDG uptakes at lymph nodes in inguinal and iliac region. Pathologic analyses, after biopsy and serologic examinations, led to the diagnosis of cat-scratch disease.

Usual and unusual pitfalls of 18F-FDG-PET/CT in lymphoma after treatment: a pictorial review

Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) is now a standard of care in initial staging and treatment evaluation of lymphomas. It is also used in the interim evaluation in diffuse large B cell lymphoma and Hodgkin lymphoma. However, several pitfalls may occur during or after treatment, because of the nonspecificity of 18F-FDG for lymphoma disease and treatment as immunotherapy, thus possibly induces misinterpretation and wrong treatment decision. The aim of this pictorial review is to provide an illustrated tutorial of the most frequent pitfalls found on 18F-FDG-PET/CT during or after treatment.

Diffuse Subcutaneous Fat Involvement in a Marginal Zone Lymphoma

Marginal zone lymphoma (MZL) is usually considered not avid for FDG. We report a case of a 57-year-old man with an MZL suspected for transformation. FDG-PET/CT showed a diffuse atypical involvement of subcutaneous fat, without sign suggestive for a transformation. No cutaneous involvement was clinically evident. A random subcutaneous biopsy was performed and showed the presence of MZL.

Book Review on: Radioguided Surgery: Current Applications and Innovative Directions in Clinical Practice. Ken Hermann, Omgo E. Neiweg and Stephen P. Povoski (eds). Springer, Heidelberg, Germany

This theoretical and practical guide was edited by Ken Hermann (a distinguished nuclear physician), Omgo E. Neiweg and Stephen P. Povoski (two eminent surgeons), in collaboration of many international experts. All the authors who have contributed to this publication are well-known experts in the very intriguing field of radioguided surgery. The declared aim of the authors is to provide an original and exhaustive state of art with common clinical applications and to deliver future perspectives and methodological improvements of this specific topic. The book published by Springer, containing more than 500 pages, a huge number of very high quality color illustrations, tables, and diagrams, is structured into almost 30 wellestablished chapters and an index. After a very interesting extension of the historical origins and background of radioguided surgery as well as of physical principles of radiation detection, a significant description of techniques and potentials of the radioguided sentinel lymph node mapping on breast cancer is provided. Breast cancer and melanoma are certainly the malignancies in which radioguided surgery has shown its highest impact on life quality of our patients. The authors report interesting data on the impact of radioguided surgery on survival as well as trends for the future of sentinel lymph node mapping in the new era of personalized therapy. Thereafter, sentinel lymph node mapping and radioguided surgery of primitive cervical, thoracic, abdominal, and pelvic tumors are treated in an extensive way. This is associated with a wide-ranging list of references for each chapter, in order to incite the reader to deepen particular arguments of personal clinical interest. Moreover, an entire chapter is devoted to FDG-directed surgery and interventional procedures, a field in which several challenges are described. This topic has a significant impact given the widespread use of FDG-PET/CT in the last 15 years. At last, future directions of radioguided surgery using radioisotopes as well as new tracers, such as fluorescent or magnetic tracers, are thoroughly examined together with the description of initial experiences about fusion of SPECT with ultrasonography imaging. The last chapter of the book is dedicated to case-based issues and solutions from a theoretical and practical point of view. Thanks to the well-organized, didactic structure that involves the reader as protagonist in achieving the final judgment, this chapter can serve as a comprehensive tool not only for nuclear physicians but also for surgeons, as well as all members of the broader medical community who have a strong interest in this topic. This guide is fluent and easy to read, simple to understand even when dealing with complex issues, and enriched by explanatory images and tables. The final editorial outcome is a very comprehensive, clear, and well-illustrated set of high–quality, wide-ranging intellectual work that fulfills its objective to pave the way for the virtual connection between surgery and nuclear medicine in order to enhance the daily collaboration among physicians of different backgrounds and to offer the best standard of care to our patients. In conclusion, this book represents a qualified, extensive, and updated text on the role of nuclear medicine in the field of radioguided surgery. Therefore, we highly recommend this volume, not only to experts but also to residents, clinicians, and to everyone who wants to be introduced to this emerging topic.

Erratum to: FDG-PET/ceCT is useful to predict recurrence of Pseudomyxoma peritonei.

4 Biophysique Faculté Charles Mérieux Lyon, Lyon, France 5 Radiology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France 6 Gynaecology Department, Groupement Hospitalier Est, Hospices Civils de Lyon, 59, boulevard Pinel, 69677 Bron, France 7 General and oncologic surgery Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France 8 Pathology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France 9 Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France Eur J Nucl Med Mol Imaging (2016) 43:1570 DOI 10.1007/s00259-016-3387-4