Carmelo Caldarella

Diagnostic performance of Fluorine-18-Fluorodeoxyglucose positron emission tomography in patients with chronic inflammatory bowel disease: a systematic review and a meta-analysis.

OBJECTIVE To systematically review and meta-analyze published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in patients with chronic inflammatory bowel disease (IBD). METHODS A comprehensive computer literature search of studies published through May 2012 regarding (18)F-FDG-PET and PET/CT in patients with IBD was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odd ratio (DOR) of (18)F-FDG PET and PET/CT in patients with IBD on a per segment-based analysis were calculated. The area under the ROC curve was calculated to measure the accuracy of (18)F-FDG PET and PET/CT in patients with IBD. RESULTS Nineteen studies comprising 454 patients with suspected IBD were included in the qualitative analysis (systematic review) and discussed. The quantitative analysis (meta-analysis) of seven selected studies (including 219 patients with IBD) provided the following results on a per segment-based analysis: sensitivity was 85% [95% confidence interval (95%CI) 81-88%], specificity 87% (95%CI 84-90%), LR+ 6.19 (95%CI: 2.86-13.41), LR- 0.19 (95%CI: 0.10-0.34), and DOR 44.35 (95%CI: 11.77-167.07). The area under the ROC curve was 0.933. CONCLUSIONS In patients with suspected IBD (18)F-FDG PET and PET/CT demonstrated good sensitivity and specificity, being accurate methods in this setting. Nevertheless, the literature focusing on the use of PET and PET/CT in IBD remains still limited; thus, further large multicenter studies will be necessary to substantiate the diagnostic accuracy of these methods in patients with IBD.

The role of 18F-FDG-PET and PET/CT in patients with sarcoidosis: an updated evidence-based review.

RATIONALE AND OBJECTIVES To provide an updated evidence-based review of the literature on the role of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) or PET/computed tomography (PET/CT) in patients with sarcoidosis. MATERIALS AND METHODS A comprehensive literature search of PubMed/MEDLINE, Scopus, and Embase databases was conducted to find relevant published articles on FDG-PET or PET/CT in patients with sarcoidosis. Only those studies that satisfied all the following criteria were included: (1) FDG-PET or PET/CT performed in patients with histologically confirmed sarcoidosis, (2) sample size of at least 10 patients, and (3) whole-body PET studies performed. Information was collected concerning basic study, patient characteristics, and technical aspects. The main findings of the articles included have been described. RESULTS Reviewing titles and abstracts, 21 articles were selected. The role of FDG-PET or PET/CT was analyzed in assessing disease extent and activity and in treatment response evaluation. Comparison with other tracers had also been investigated. Recent studies evaluated the influence of these methods in the clinical management and their role as predictive tools in patients with sarcoidosis. CONCLUSIONS FDG-PET and PET/CT seem to be useful in staging, evaluating disease activity, and monitoring treatment response in patients with sarcoidosis. PET appears to have higher diagnostic accuracy compared to Gallium-67-citrate scintigraphy. Conversely, there is not enough evidence about the use of other PET tracers in patients with sarcoidosis. FDG-PET and PET/CT seem to have a role as predictive tools and may influence the clinical management in patients with sarcoidosis, but more studies are needed in this regard.

Diagnostic Performance of Dedicated Positron Emission Mammography Using Fluorine-18- Fluorodeoxyglucose in Women With Suspicious Breast Lesions: A Meta-analysis

BACKGROUND The diagnostic performance of dedicated positron emission mammography (PEM) using fluorine-18-fluorodeoxyglucose (FDG) in evaluating suspicious breast lesions has been investigated by several authors, with conflicting results. Aim of our study is to meta-analyze published data about this topic, in order to add evidence-based data in this setting. MATERIALS AND METHODS We carried out a comprehensive computer literature search of studies published in the PubMed/MEDLINE, Scopus, or Embase databases through February 10, 2013, regarding the diagnostic performance of PEM using FDG in women with breast lesions. Only studies comprising ≥ 10 patients who underwent PEM were included in the meta-analysis, for statistical purposes. Pooled sensitivity and specificity on a per lesion-based analysis were calculated to assess the diagnostic performance of PEM using FDG in this setting. RESULTS Our meta-analysis evaluated 8 studies comprising 873 women with breast lesions. Pooled sensitivity and specificity values of PEM using FDG in women with suspected breast malignancy were 85% (95% CI, 83%-88%) and 79% (95% CI, 74%-83%), respectively, on a per lesion-based analysis. The included studies were heterogeneous in their estimate of sensitivity and specificity. CONCLUSION PEM using FDG is a sensitive and specific tool for the evaluation of suspicious breast lesions. The detection of additional lesions and extensive intraductal involvement is improved, with comparable accuracy, over that of MRI in the depiction of invasive breast cancers.

Diagnostic performance of Fluorine-18-Fluorodeoxyglucose positron emission tomography for the diagnosis of osteomyelitis related to diabetic foot: A systematic review and a meta-analysis

OBJECTIVE To systematically review and meta-analyse published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in osteomyelitis related to diabetic foot. METHODS A comprehensive literature search of studies on (18)F-FDG-PET and PET/CT in patients with diabetic foot was performed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odds ratio (DOR) and area under the summary ROC curve of (18)F-FDG-PET and PET/CT in patients with osteomyelitis related to diabetic foot were calculated. RESULTS Nine studies comprising 299 patients with diabetic foot were included in the qualitative analysis (systematic review) and discussed. The quantitative analysis (meta-analysis) of four selected studies provided the following results on a per patient-based analysis: sensitivity was 74% [95% confidence interval (95%CI): 60-85%], specificity 91% (95%CI: 85-96%), LR+ 5.56 (95%CI: 2.02-15.27), LR- 0.37 (95%CI: 0.10-1.35), and DOR 16.96 (95%CI: 2.06-139.66). The area under the summary ROC curve was 0.874. CONCLUSIONS In patients with suspected osteomyelitis related to diabetic foot (18)F-FDG-PET and PET/CT demonstrated a high specificity, being potentially useful tools if combined with other imaging methods such as MRI. Nevertheless, the literature focusing on the use of (18)F-FDG-PET and PET/CT in this setting remains still limited.

The role of fluorine-18-fluorodeoxyglucose positron emission tomography in evaluating the response to tyrosine-kinase inhibitors in patients with metastatic primary renal cell carcinoma

Abstract Background. Positron emission tomography-computed tomography (PET-CT) using fluorodeoxyglucose (FDG) is increasingly used in the evaluation of patients with advanced renal cell carcinoma (RCC), primarily for staging purposes. The aim of this paper is to perform a systematic review about the usefulness of PET-CT using FDG in response assessment after treatment with tyrosine-kinase inhibitors (TKIs) in patients with advanced RCC. Materials and methods. The scientific literature about the role of PET-CT using FDG in the assessment of response to treatment with TKIs in patients affected by advanced RCC was systematically reviewed. Results. Seven studies about the role of PET-CT using FDG in the response assessment after treatment with TKIs (essentially sunitinib and sorafenib) in advanced RCC were retrieved in full-text and analysed, to determine the predictive role of this morpho-functional imaging method on patient outcome. Conclusions. To date, the role of PET-CT using FDG in evaluating the response to TKIs in metastatic RCC patients is still not well defined, partly due to heterogeneity of available studies; however, PET-CT reveals potential role for the selection of patients undergoing therapy with TKIs. The use of contrast-enhanced PET-CT appears to be promising for a “multi-dimensional” evaluation of treatment response in these patients.

Diagnostic Accuracy of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in the Evaluation of the Primary Tumor in Patients with Cholangiocarcinoma: A Meta-Analysis

Objective. To meta-analyze published data about the diagnostic accuracy of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) or PET/computed tomography (PET/CT) for primary tumor evaluation in patients with cholangiocarcinoma (CCa). Methods. A comprehensive literature search of studies published through December 31, 2013, was performed. Pooled sensitivity and specificity were calculated on a per patient based analysis. Subgroup analyses considering the device used (PET versus PET/CT) and the localization of the primary tumor (intrahepatic cholangiocarcinoma (IH-CCa), extrahepatic cholangiocarcinoma (EH-CCa), and hilar cholangiocarcinoma (H-CCa)) were carried out. Results. Twenty-three studies including 1232 patients were included in the meta-analysis. Pooled sensitivity and specificity of 18F-FDG-PET or PET/CT were 81% and 82%, respectively. Pooled sensitivity and specificity, respectively, were 80% and 89% for PET, 82% and 75% for PET/CT, 95% and 83% for IH-CCa, 84% and 95% for H-CCa, and 76% and 74% for EH-CCa. Conclusions.   18F-FDG-PET and PET/CT were demonstrated to be accurate diagnostic imaging methods for primary tumor evaluation in patients with CCa. These tools have a better diagnostic accuracy in patients with IH-CCa than in patients with EH-CCa. Further studies are needed to evaluate the accuracy of 18F-FDG-PET or PET/CT in patients with H-CCa.

Is fluorine-18-fluorodeoxyglucose positron emission tomography useful in monitoring the response to treatment in patients with multiple myeloma?

Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is a useful diagnostic tool for the staging of patients with multiple myeloma (MM). The aim of this study is to perform a systematic review of the usefulness of FDG-PET or PET/CT in monitoring response to treatment in patients with MM. A comprehensive computer literature search of the PubMed/MEDLINE, Scopus and Embase databases was carried out to identify relevant peer-reviewed articles on the use of FDG-PET or PET/CT in monitoring the response to treatment in patients with MM. Ten studies described investigations of the role of FDG-PET or PET/CT in monitoring the response to treatment in 690 patients with MM or solitary plasmacytoma: six of these were conducted prospectively, while four studies were retrospective. These articles were retrieved in full-text version and analyzed. Based on these findings from the literature, FDG-PET or PET/CT appear to be useful in the assessment of treatment response in patients with MM.

Detection rate of 99mTc-MIBI single photon emission computed tomography (SPECT)/CT in preoperative planning for patients with primary hyperparathyroidism: A meta-analysis

Parathyroid scintigraphy using 99mTc‐MIBI single photon emission computed tomography (SPECT)/CT has been proposed as one of the most accurate localization techniques in patients with primary hyperparathyroidism (PHPT). The purpose of this review was to meta‐analyze published data on the detection rate of 99mTc‐MIBI SPECT/CT in the preoperative planning of patients with PHPT.

Diagnostic Performance of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in the Postchemotherapy Management of Patients with Seminoma: Systematic Review and Meta-Analysis

Objective. To meta-analyze published data about the diagnostic performance of fluorine-18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in the postchemotherapy management of patients with seminoma. Methods. A comprehensive literature search of studies published through January 2014 on this topic was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity and specificity, positive and negative predictive values (PPV and NPV), accuracy, and area under the summary ROC curve (AUC) of 18F-FDG-PET or PET/CT on a per examination-based analysis were calculated. Subgroup analyses considering the size of residual/recurrent lesions were carried out. Results. Nine studies including 375 scans were selected. The pooled analysis provided the following results: sensitivity 78% (95% confidence interval (95% CI): 67–87%), specificity 86% (95% CI: 81–89%), PPV 58% (95% CI: 48–68%), NPV 94% (95% CI: 90–96%), and accuracy 84% (95% CI: 80–88%). The AUC was 0.90. A better diagnostic accuracy of 18F-FDG-PET or PET/CT in evaluating residual/recurrent lesions >3 cm compared to those <3 cm was found. Conclusions. 18F-FDG-PET and PET/CT were demonstrated to be accurate imaging methods in the postchemotherapy management of patients with seminoma; nevertheless possible sources of false-negative and false-positive results should be considered. The literature focusing on this setting still remains limited and cost-effectiveness analyses are warranted.

The Role of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in Evaluating the Response to Treatment in Patients with Multiple Myeloma

Background and Aim. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is well recognized as a powerful diagnostic tool in the initial staging of patients with multiple myeloma (MM). The aim of this paper is to perform a systematic review about the usefulness of FDG-PET or PET/CT in evaluating the response to treatment in patients with MM. Methods. The scientific literature about the role of FDG-PET or PET/CT in evaluating the response to treatment in patients affected by MM was systematically reviewed. Results. Ten studies about the role of FDG-PET or PET/CT in evaluating treatment response in MM were retrieved and discussed. Conclusions. FDG-PET or PET/CT seems to be helpful in assessing the response to treatment in patients with MM and in the evaluation of possible sites of recurrent or progressive disease.