Masami Nishio

Comparison of Atorvastatin 5 and 20 mg/d for Reducing F-18 Fluorodeoxyglucose Uptake in Atherosclerotic Plaques on Positron Emission Tomography/Computed Tomography: A Randomized, Investigator-Blinded, Open-Label, 6-Month Study in Japanese Adults Scheduled for Percutaneous Coronary Intervention

BACKGROUND F-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) is a useful tool for the detection of local inflamed atherosclerotic lesions. OBJECTIVE This study used hybrid PET/computed tomography (CT) to examine the effects of 2 doses of atorvastatin on (18)F-FDG uptake in atherosclerotic plaques in Japanese adults with stable angina pectoris who were scheduled to undergo percutaneous coronary intervention (PCI). METHODS This was a prospective, randomized, investigator-blinded, open-label study in patients with dyslipidemia (total cholesterol ≥ 220 mg/dL and/or LDL-C ≥ 140 mg/dL) who were scheduled to undergo PCI for stable angina pectoris and had not received any lipid-lowering drugs within 1 year before enrollment. Patients were randomly allocated to receive atorvastatin 5 or 20 mg/d for 6 months. At baseline (the day after PCI), (18)F-FDG uptake in the ascending aorta and femoral artery was determined using PET/CT imaging, and the mean target-to-background ratio (TBR) was calculated in individual plaques. The same regions were assessed by PET/CT after 6 months of treatment. Changes from baseline to follow-up in the lipid profile, serum malondialdehyde-modified LDL-C (MDA-LDL-C), and serum high-sensitivity C-reactive protein (hs-CRP) were also examined. Drug adherence, adverse events, and changes in medications were monitored at monthly outpatient visits. RESULTS Of 32 patients initially screened, 2 were excluded due to newly diagnosed cancer; thus, 30 patients were randomly assigned to treatment, 15 in each group. Patients were predominantly male (18 [60%]), with a mean (SD) age of 54 (11) years, mean body weight of 65 (12) kg, and mean total cholesterol, HDL-C, and triglyceride concentrations of 240 (29), 48 (14), and 180 (102) mg/dL, respectively. After 6 months, the 20-mg group had significant reductions from baseline in mean (SD) TBR in the ascending aorta (from 1.15 [0.14] to 1.05 [0.12]; percent change, -7.9% [9.4%]; P = 0.007) and the femoral artery (from 1.12 [0.11] to 1.02 [0.11]; percent change, -9.9% [13.8%]; P = 0.012). The corresponding changes from baseline were not statistically significant in the 5-mg group. The differences in percent change in TBR in the 2 locations were not significant between groups. When data from the 2 groups were combined, the overall reduction in TBR from baseline to 6 months was significant in both the ascending aorta (P = 0.003) and the femoral artery (P = 0.021). The decreases in TBR in both arteries were significantly correlated with reductions in LDL-C (ascending aorta: r(2) = 0.230 [P = 0.012]; femoral artery: r(2) = 0.338 [P = 0.003]), MDA-LDL-C (ascending aorta: r(2) = 0.183 [P = 0.028]; femoral artery: r(2) = 0.247 [P = 0.010]), and hs-CRP (ascending aorta: r(2) = 0.132 [P = 0.048]; femoral artery: r(2) = 0.271 [P = 0.007]). One patient in the 5-mg group and 2 patients in the 20-mg group had ∼2-fold increases in serum aminotransferases on a single occasion; however, no specific musculoskeletal or hepatic adverse events were observed, and aminotransferase values decreased to within normal ranges without changes in the atorvastatin dose. CONCLUSION Six months of treatment with atorvastatin 20 mg, but not 5 mg, was associated with a significant reduction in TBR in the ascending aorta and femoral artery in these Japanese adults with dyslipidemia undergoing PCI for stable angina pectoris. University Hospital Medical Information Network Clinical Trials Registry identifier: C000000371.

FDG-PET predicts survival and distant metastasis in oral squamous cell carcinoma.

High [(18)F]-2-fluorodeoxyglucose (FDG)-uptake of primary tumor, assessed by pretreatment positron emission tomography (PET), shows poor overall survival of patients after several therapies in various cancers. An association between FDG-uptake and distant metastasis-free survival in oral squamous cell carcinoma (OSCC) has not been assessed so far. An objective of this study is to investigate an association between FDG-uptake and overall survival of OSCC patients, and to ask whether FDG-uptake is related with distant metastasis-free survival in OSCC. Twenty-four patients who underwent both pretreatment FDG-PET and radical surgery without preoperative therapy were enrolled. We used the maximum standardized uptake value (SUVmax) as FDG-uptake. Overall survival, locoregional recurrence-free survival and distant metastasis-free survival were analyzed by Kaplan-Meier method. In univariate survival analysis, patients with SUVmax>or=12 exhibited significance in both shorter 3-year overall survival (p<0.01) and distant metastasis-free survival (p<0.04) than patients with SUVmax<12. Moreover, by Cox proportional hazards model of multivariate analysis, SUVmax>or=12 was found to be independent of clinical T and N categories, and exhibited significance in both shorter 3-year overall survival (p<0.02) and distant metastasis- free survival (p<0.05) than patients with SUVmax<12. These results suggest that pretreatment FDG-PET is able to provide both non-invasive and effective information for identifying a high- or low-risk group of OSCC patients with distant metastasis.

Regional brain cerebral glucose metabolism and temperament : A positron emission tomography study

Personality, and in particular temperament, is thought to have a biological basis. In the present study, the relationships between regional brain glucose metabolism and temperament have been investigated. Regional brain glucose metabolism was measured using [18F] fluorodeoxyglucose positron emission tomography in 31 healthy subjects. Temperament was assessed using the Temperament and Character Inventory. Temperament dimensions were observed to be significantly correlated with specific brain regions. In particular, novelty seeking was significantly correlated with the superior temporal gyrus, inferior parietal lobule, and the precuneus, which have been reported to be related with impulsiveness, while reward dependence was significantly correlated with the caudate head, which has been shown to be associated with reward processing. The various aspects of temperament may have biological bases in the specific brain regions. The accumulation of results from studies of this kind should provide further evidence connecting personality traits with their biological bases.

Gender difference in relationship between anxiety-related personality traits and cerebral brain glucose metabolism.

Recent functional neuroimaging studies have suggested that specific brain regions might be associated with the formation of anxiety-related personality traits, which are well known to be influenced by gender. Such anxiety-related personality traits are one of the representative predisposing factors for mood and anxiety disorders, whose incidence is also known to be much influenced by gender. However, little is known about the gender differences in brain function related to anxiety-related personality traits. The aim of the present study was to examine gender-related differences in the pattern of the relationships between an anxiety-related personality trait and cerebral brain glucose metabolism. Regional brain glucose metabolism was measured using [(18)F]fluorodeoxyglucose positron emission tomography in 102 healthy subjects (65 males and 37 females). An anxiety-related trait was assessed using the Temperament and Character Inventory dimension Harm Avoidance (HA). HA was negatively correlated with glucose metabolism in the anterior portion of the ventromedial prefrontal cortex (vmPFC) in females but not in males. The anterior vmPFC may be a possible neural target for the prevention or therapy of emotional disorders, especially in females.

A problem in diagnosing N3 disease using FDG-PET in patients with lung cancer —High false positive rate with visual assessment—

ObjectiveTo evaluate the accuracy of diagnosing N3 disease using positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) in patients with pulmonary disease.Subjects and MethodsTwenty patients diagnosed as FDG-PET N3 were enrolled. On FDG-PET, lymph nodes were considered to be positive when increased uptake as compared with that of the surrounding mediastinum was visually observed, or the mean standardized uptake ratio (SUR) was more than 2, 2.5, or 3. On CT, lymph nodes exceeding 1 cm in the shortest diameter were regarded as positive.ResultsThe PET result was true positive (TP) in 2 patients and false positive (FP) in 18 with an overall accuracy (OA) of 10% using visual criteria. Using an SUR of more than 2.5, the result was TP in 2, FP in 3, and true negative (TN) in 15, the false negative (FN) in 0, with an OA of 85%. CT diagnosis was TP in 2, FP in 9, and TN in 9 with an OA of 55%. The accuracy using the SUR criteria of more than 2.5 was superior to that of CT.ConclusionOf 20 patients with the diagnosis of PET N3, we found frequent over-diagnosis in nodal staging using the visual criteria.

Diagnostic Accuracy of 18F-2-deoxy-fluoro-D-glucose Positron Emission Tomography for pN1 Lymph Nodes in Patients with Lung Cancer

Background: The accuracy of 18F-2-deoxy-fluoro-D-glucose positron emission tomography (FDG-PET) for diagnosing nodal status in patients with lung cancer was initially reported as excellent, but, with increasing experience, the problem of false-positive and false-negative assessments has been observed. Purpose: To evaluate the accuracy of FDG-PET for diagnosing nodal status in lung cancer patients with pathologically proven N2 lymph nodes and compare it with that of computed tomography (CT). Material and Methods: Nineteen pN2 patients (13 males and six females) with primary lung cancer undergoing preoperative CT and FDG-PET were investigated. Lymph nodes were considered to be positive when uptake higher than the surrounding mediastinal level was visually observed. Slight symmetrical mediastinal uptake was considered to be negative, representing benign physiological accumulation. Radiological and pathological correlation was investigated, and the association between FDG accumulation and the size of metastatic lymph nodes and metastatic lesions was evaluated. Results: Of the 19 patients, nodal stage determined by using FDG-PET was cN0 in four (21%) cases, cN1 in three (16%), cN2 in nine (47%), and cN3 in three (16%). On CT, nodal stage was cN0 in three (16%) cases, cN1 in seven (37%), cN2 in eight (42%), and cN3 in one (5%). Thus, FDG-PET provided correct N-staging in 47%, under-staging in 37%, and overstaging in 16%. CT staging was correct in 42%, underestimated in 53%, and overestimated in 5%. The maximum area of metastatic foci was 15.8 ±21.3 mm2 (mean ± SD) in false-negative nodes and 75.0±56.3 mm2 in true-positive nodes (P<0.0001). Conclusion: Diagnostic accuracy of FDG-PET (47%) was low and similar to that of CT (42%). The possibility of false-negative as well as false-positive findings should be recognized in interpreting PET images. Micrometastasis appeared to be the greatest cause of false-negative findings.

Intraspinal canal neurolymphomatosis detected by FDG-PET/CT.

A 64-year-old man complained of pain in the left side of his neck and chest. Subsequently, the symptoms were aggravated and paralyzes of the left upper and lower extremities appeared. With the diagnosis of polyneuritis, steroid pulse therapy was started, but he showed no improvement in symptoms. An FDG-PET/CT scan was performed. FDG accumulated in the lumbar spinal canal and along the left brachial and bilateral lumbosacral plexuses, suggesting involvement by malignant tumors. These findings appeared to be consistent with the clinical and cytologic diagnosis of malignant lymphoma. After systemic chemotherapy, all the above-mentioned accumulations disappeared and he achieved a complete remission.

Limitations of FDG-PET and FDG-PET With Computed Tomography for Detecting Synchronous Cancer in Pharyngeal Cancer

OBJECTIVE To analyze the ability of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and the fusion of FDG-PET with computed tomography (FDG-PET/CT) to detect synchronous upper gastrointestinal tract (UGI) cancer in newly diagnosed pharyngeal squamous cell carcinoma (SCC). Synchronous UGI cancer is a significant problem in treating pharyngeal SCC, particularly for Japanese populations reported to be at high risk. Good results have been reported from the use of FDG-PET and FDG-PET/CT in staging head and neck SCC (HNSCC). An additional advantage is that both techniques are expected to prove useful in detecting synchronous cancer. DESIGN Retrospective analysis of medical records. SETTING Aichi Cancer Center, Nagoya, Japan. PATIENTS Forty-three Japanese patients with pharyngeal SCC were assessed for the ability of FDG-PET and FDG-PET/CT to detect synchronous UGI cancer via a comparison with UGI Lugol chromoendoscopy. The patients had undergone 17 FDG-PET and 26 FDG-PET/CT scans before treatment. MAIN OUTCOME MEASURE Sensitivity of FDG-PET and FDG-PET/CT to detect synchronous UGI cancer. RESULTS Pathologically, 6 patients with esophageal SCC (14%) and 4 with stomach adenocarcinoma (9%) were diagnosed on the basis of suspect lesions detected by UGI Lugol chromoendoscopy. One patient was found to have stage T2 esophageal cancer by FDG-PET/CT, but no patients had UGI cancer. The sensitivity of detecting T1 UGI cancer by FDG-PET and FDG-PET/CT was 0%. CONCLUSIONS The choice of diagnostic technique must be based on the site and histologic characteristics of the synchronous tumor. Although FDG-PET and FDG-PET/CT are still the preferred techniques for staging HNSCC, neither replaces Lugol chromoendoscopy for detecting synchronous UGI cancer in high-risk populations.

Appendiceal schwannoma detected by FDG-PET/CT.

Abstract:We report the FDG-PET/CT findings in a patient with an appendiceal schwannoma. The incidence of appendiceal neoplasm in patients in whom appendectomy was performed is low and ranges from 0.6% to 0.8%. Schwannoma is extremely rare among them. We describe a 71-year-old man without symptoms wh

Utility of high-definition FDG-PET image reconstruction for lung cancer staging:

Background High-definition (HD) positron emission tomography (PET) image reconstruction is a new image reconstruction method based on the point spread function system, which improves the spatial resolution of the images. Purpose To compare the utility of HD reconstruction of PET images for staging lung cancer with that of conventional 2D ordered subset expectation maximization + Fourier rebinning (2D) reconstruction. Material and Methods Thirty-five lung cancer patients (24 men, 11 women; median age, 66 years) who underwent surgery after 18F-2-deoxy-fluoro-D-glucose (FDG)-PET-CT were studied. Their PET data were reconstructed with 2D and HD PET reconstruction algorithms. Two radiologists individually TNM staged both sets of images. They also evaluated the quality of the images and the diagnostic confidence that the images afforded them using 5-point scales. Results T, N, and M stages were correctly diagnosed on both the 2D and HD reconstructed images in 23 (66%), 25 (71%), and 30 (86%) of 35 cases, respectively. Overall TNM stage was correctly diagnosed on both types of reconstructed images in 23 cases (66%), underestimated in three (9%), and overestimated in nine (26%). No significant difference in T, N, or M stage or overall TNM stage was observed between the two reconstruction methods. However, the HD reconstructed images afforded a significantly higher level of diagnostic confidence during TNM staging than the 2D reconstructed images and were also of higher quality than the 2D reconstructed images. Conclusion Although HD reconstruction of FDG-PET images did not improve the diagnostic accuracy of lung cancer staging compared with 2D reconstruction, the quality of the HD reconstructed images and the diagnostic confidence level they afforded the radiologists were higher than those of the conventional 2D reconstructed images.