Eun Ji Han

FDG-PET/CT as prognostic factor and surveillance tool for postoperative radiation recurrence in locally advanced head and neck cancer

Purpose To evaluate the prognostic value of metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) on initial positron emission tomography-computed tomography (PET-CT) and investigate the clinical value of SUVmax for early detection of locoregional recurrent disease after postoperative radiotherapy in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Materials and Methods A total of 100 patients with locally advanced HNSCC received primary tumor excision and neck dissection followed by adjuvant radiotherapy with or without chemotherapy. The MTV and SUVmax were measured from primary sites and neck nodes. The prognostic value of MTV and SUVmax were assessed using initial staging PET/CT (study A). Follow-up PET/CT scan available after postoperative concurrent chemoradiotherapy or radiotherapy were evaluated for the SUVmax value and correlated with locoregional recurrence (study B). A receiver operating characteristic (ROC) curve analysis was used to define a threshold value of SUVmax with the highest accuracy for recurrent disease assessment. Results High MTV (>41 mL) is negative prognostic factor for disease free survival (p = 0.041). Postradiation SUVmax was significantly correlated with locoregional recurrence (hazard ratio, 1.812; 95% confidence interval, 1.361 to 2.413; p < 0.001). A cut-off value of 5.38 from follow-up PET/CT was identified as having maximal accuracy for detecting locoregional recurrence by ROC analysis. Conclusion MTV at staging work-up was significantly associated with disease free survival. The SUVmax value from follow-up PET/CT showed high diagnostic accuracy for the detection of locoregional recurrence in postoperatively irradiated HNSCC.

Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Locally Advanced Head and Neck Squamous Cell Carcinomas Treated by Surgery

PurposeWe assessed the prognostic value of metabolic tumor volume (MTV) measured using18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) inpatients with locally advanced head and neck squamous cell carcinoma (HNSCC).MethodsWe retrospectively reviewed 56 patients (51 men, five women; mean age 56.0 ± 8.8years) who had locally advanced HNSCC and underwent FDG PET/CT for initial evaluation. All patients had surgical resection and radiotherapy with or without concurrent chemotherapy. The peak standardized uptake value (SUVpeak) and MTV of the target lesion, including primary HNSCC andmetastatic cervical lymph nodes, were measured from FDG PET/CT images. We compared SUVpeak, MTV, and clinicopathologic variables such as age, Eastern Cooperative Oncology Group (ECOG) performance status, pN stage, pT stage, TNM stage, histologic grade and treatment modality to disease-free survival (DFS) and overall survival (OS).ResultsOn the initial FDG PET/CT scans, the median SUVpeak was 7.8 (range, 1.8-19.0) and MTV was17.0 cm3 (range, 0.1-131.0 cm3). The estimated 2-year DFS and OS rates were 67.2% and 81.8%. The cutoff points of SUVpeak 6.2 and MTV 20.7 cm3 were the best discriminative values for predicting clinical outcome. MTV and ECOG performance status were significantly related to DFS and OS on univariate and multivariate analyses (p < 0.05).ConclusionThe MTV obtained from initial FDG PET/CT scan is a significant prognostic factor for disease recurrence and mortality in locally advanced HNSCC treated with surgery and radiotherapy with or without chemotherapy.

Clinical Value of Integrated [18F]Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography/Computed Tomography in the Preoperative Assessment of Papillary Thyroid Carcinoma Comparison With Sonography

The purpose of this study was to evaluate the clinical value of preoperative [18F]fluoro‐2‐deoxy‐d‐glucose (FDG) positron emission tomography/computed tomography (PET/CT) by comparing it to neck sonography in papillary thyroid carcinoma.

Prognostic value of early response assessment using 18F-FDG PET/CT in chemotherapy-treated patients with non-small-cell lung cancer.

ObjectiveWe aimed to evaluate the prognostic value of early response assessment using a volumetric fluorine-18-fluorodeoxyglucose (18F-FDG) PET analysis in chemotherapy-treated patients with non-small-cell lung cancer (NSCLC). Materials and methodsWe retrospectively reviewed 33 patients with NSCLC who received first-line chemotherapy and performed 18F-FDG PET/computed tomography before (baseline PET) and after two cycles of chemotherapy (interim PET). The maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) of the total malignant lesion were measured in baseline (SUV1 and MTV1) and interim (SUV2 and MTV2) PET images, and percentage changes in SUVmax (&Dgr;SUV) and MTV (&Dgr;MTV) were calculated between the two images. We compared PET parameters and clinicopathologic variables in terms of the 2-year overall survival (OS). ResultsThe median follow-up period was 14.3 months and the 2-year OS was 31%. In PET images, the mean SUV1, MTV1, SUV2, MTV2, &Dgr;SUV, and &Dgr;MTV were 13.1±4.5, 307.9±340.0 cm3, 9.5±5.1, 180.4±29.6 cm3, 27±28%, and 42±65%, respectively. In univariable analysis, M stage, TNM stage, and all six PET parameters associated significantly with OS. Both the MTV1 and the &Dgr;MTV were tested against OS controlling for M stage, one at time, and the effect remained significant in multivariable analyses. ConclusionA smaller baseline MTV and greater decrease in MTV between baseline and interim PET images are associated with a significantly prolonged OS. A volume-based 18F-FDG PET analysis would facilitate prediction of clinical outcome and identification of treatment-resistant patients early during chemotherapy and could thus be used in personalized treatment approaches for patients with NSCLC.

Muscular sarcoidosis detected by F-18 FDG PET/CT in a hypercalcemic patient.

Sarcoidosis is a systemic granulomatous disease of unknown etiology that involves many organs, occasionally mimicking malignancy. We herein report a 50-yr-old woman of muscular sarcoidosis of chronic myopathic type, manifested by hypercalcemia and muscle wasting. Besides insignificant hilar lymphadenopathy, her sarcoidosis was confined to generalized atrophic muscles and therefore, F-18 FDG PET/CT alone among conventional imaging studies provided diagnostic clues for the non-parathyroid-related hypercalcemia. On follow-up PET/CT during low-dose steroid treatment, FDG uptake in the muscles disappeared whereas that in the hilar lymph nodes remained. PET/CT may be useful in the evaluation of unexpected disease extent and monitoring treatment response in suspected or known sarcoidosis patients.

FDG PET/CT response in diffuse large B-cell lymphoma: Reader variability and association with clinical outcome.

AbstractF-18-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is essential for monitoring response to treatment in patients with diffuse large B-cell lymphoma (DLBCL) and qualitative interpretation is commonly applied in clinical practice. We aimed to evaluate the interobserver agreements of qualitative PET/CT response in patients with DLBCL and the predictive value of PET/CT results for clinical outcome.PET/CT images were obtained for patients with DLBCL 3 times: at baseline, after 3 cycles of first-line chemotherapy (interim), and after completion of chemotherapy. Two nuclear medicine physicians (with 3 and 8 years of experience with PET/CT) retrospectively assessed response to chemotherapy blinded to the clinical outcome using International Harmonization Project (IHP) criteria and Deauville 5-point score. The associations between PET/CT results and progression-free survival (PFS) and overall survival (OS) were assessed using Cox regression analysis.A total of 112 PET/CT images were included from 59 patients with DLBCL (36 male, 23 female; mean age 53 ± 14 years). Using the IHP criteria, interobserver agreement was substantial (Cohen &kgr; = 0.76) with absolute agreement consistency of 89%. Using the Deauville score, interobserver agreement was moderate (Cohen weighted &kgr; = 0.54) and absolute consistency was 62%. The most common cause of disagreements was discordant interpretation of residual tumor uptake. With median follow-up period of 60 months, estimated 5-year PFS and OS were 81% and 92%, respectively. Neither interim nor posttreatment PET/CT results by both readers were significantly associated with PFS. Interim PET/CT result by the more experienced reader using Deauville score was a significant factor for OS (P = 0.019).Moderate-to-substantial interobserver agreement was observed for response assessments according to qualitative PET/CT criteria, and interim PET/CT result could predict OS in patients with DLBCL. Further studies are necessary to further standardize the PET/CT-based response criteria for more consistent interpretation.

Osteonecrosis Mimicking Bone Metastasis in Femoral Head on 18F-FDG PET/CT: A Case Report

A 77-year-old woman underwent chemotherapy, radiotherapy, and brachytherapy for cervical cancer 9 years ago. On a follow-up 18F-fluorodeoxyglucose (FDG) PET/CT image, focal FDG uptake was noted in a focal osteolytic lesion in the right femoral head. During magnetic resonance imaging, this lesion showed subchondral dark-signal-intensity rim on T1-weighted image and double line sign on T2-weighted image, suggestive of osteonecrosis. The lesion was pathologically confirmed as osteonecrosis after surgery. This case demonstrates that osteonecrosis of the femoral head may demonstrate focal FDG uptake mimicking bone metastasis.

Allergic Reaction to Ginkgo Nut on FDG PET/CT.

We report the case of a 36-year-old woman who previously underwent total thyroidectomy for papillary thyroid carcinoma. F FDG PET/CT images demonstrated multiple lymph nodes with increased FDG uptake in the neck, chest, and abdomen and diffusely increased FDG uptake in the spleen, which were highly suspicious findings for malignant lymphoma. However, subsequent biopsy of axillary lymph node presented reactive hyperplasia. Detailed history revealed that the patient had a history of generalized edema and severe arthralgia after contact with ginkgo nut one week ago. This case highlights allergic reaction mimicking lymphoma on FDG PET/CT.

FDG PET/CT Image of Seminoma in Androgen Insensitivity Syndrome

We report the FDG PET/CT findings of seminoma in a 21-year-old woman with androgen insensitivity syndrome. PET images showed focal FDG uptake in the left pelvic sidewall, and a hypodense lesion with calcifications was noted in the corresponding CT images. Another smaller hypodense lesion with calcifications was noted in the right pelvic sidewall, but faint FDG uptake. Laparoscopic surgery was performed, and both lesions were pathologically confirmed as seminomas.

CLINICAL SIGNIFICANCE OF STRIATAL UPTAKE IN AMYLOID POSITRON EMISSION TOMOGRAPHY

the use of [F]ICMT-11 PET tracer in an AD population, and we have detected an increased [F]ICMT-11 uptake in the Alzheimer’s disease subjects, compared to the HC group. This is in line with ex vivo demonstration of Caspase 3 activity in Alzheimer’s disease. While larger studies are necessary to validate these finding, these preliminary data suggest that [F]ICMT-11 has the potential to detect Caspase 3 activity in Alzheimer’s disease.