Minggang Su

Lung sequestration and Pott disease masquerading as primary lung cancer with bone metastases on FDG PET/CT.

The chest x-ray from a 37-year-old man with a history of back pain showed a mass in the left lower lung, which prompted an FDG PET/CT study to evaluate the nature of the mass and possible metastases. The images revealed peripherally increased FDG activity in the left lower lung mass. In addition, there was intense FDG activity in 2 adjacent thoracic vertebrae on PET images corresponding to the regions of bone destruction on the concurrent CT. Therefore, a possible diagnosis of lung carcinoma with bone metastases was suggested. However, subsequent tests demonstrated that the left lung mass was in fact a lung sequestration, whereas the spinal lesions were due to Pott disease (tuberculous spondylitis).

The Deauville 5-Point Scale Improves the Prognostic Value of Interim FDG PET/CT in Extranodal Natural Killer/T-Cell Lymphoma.

Purpose The prognostic value of FDG PET/CT in extranodal natural killer/T-cell lymphoma (ENKTL) is still controversial. Furthermore, the utility of the Deauville 5-point scale (DS) in ENKTL is uncertain. Therefore, we designed a prospective study to examine the prognostic value of 3 methods of PET/CT analysis (International Harmonization Project [IHP] criteria, DS, and SUV-based assessment). Patients and Methods Sixty patients with newly diagnosed untreated ENKTL were enrolled. PET/CT evaluation was performed before initial treatment (pretreatment) and midtreatment (interim). Interim PET/CT response was determined based on IHP criteria, DS, and change in FDG uptake (&Dgr;SUVmax). International Harmonization Project criteria, DS, and &Dgr;SUVmax were then examined for the ability to predict progression-free survival (PFS) and overall survival (OS). Results Over a median follow-up of 23.5 months, interim PET/CT based on DS and &Dgr;SUVmax were significant predictors of PFS and OS. After multivariate analysis, DS was an independent predictor of PFS (P < 0.001) and OS (P < 0.001). &Dgr;SUVmax was an independent predictor of OS (P = 0.013) but not PFS (P = 0.054) and with a lower accuracy and positive predictive value than DS. Conclusions Interim PET/CT analysis with DS predicts unfavorable treatment outcomes of ENKTL patients, whereas interim PET/CT analysis based on IHP criteria and SUV-based assessment have limited prognostic value.

Predictive approaches for post-therapy PET/CT in patients with extranodal natural killer/T-cell lymphoma: a retrospective study

Purpose The aim of this study was to assess the prognostic capacity of three methods of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT analysis carried out after therapy in patients with extranodal natural killer/T-cell lymphoma (ENKTL). The three methods of PET/CT analysis included the International Harmonization Project (IHP) criteria, the Deauville five-point scale (5-PS), and standardized uptake value (SUV)-based assessment. Patients and methods Fifty-nine patients diagnosed with ENKTL were enrolled. Each patient underwent three 18F-FDG PET/CT scans: (i) baseline, (ii) after two to four cycles of chemotherapy (early response assessment), and (iii) at the end of treatment (evaluation of the final response). Post-therapy 18F-FDG PET/CT results were determined on the basis of IHP criteria, 5-PS, and change in the maximum 18F-FDG uptake (&Dgr;SUVmax). IHP criteria, 5-PS, and &Dgr;SUVmax were then examined for their ability to predict progression-free survival (PFS) and overall survival (OS). Results Over a median follow-up of 25 months, 5-PS and &Dgr;SUVmax were significant predictors of PFS and OS. After multivariate analysis, 5-PS could predict PFS (P=0.008) and OS (P=0.002) independently. &Dgr;SUVmax was found to be an independent predictor of PFS (P=0.019), but not OS, and had a lower accuracy and positive predictive value than 5-PS. Conclusion Post-therapy PET/CT analysis using the 5-PS is more able to predict survival than analysis with IHP or [INCREMENT]SUVmax in ENKTL patients.

Risk factors for N2 metastasis in patients with non-small-cell lung cancer: multivariate analyses of 18F-FDG PET/CT data.

ObjectivesN staging is a key factor when considering the choice of treatment for non-small-lung cancer. It is possible that there is a correlation between N2 metastasis and some risk factors. The objective of the present study was to evaluate associations between several risk factors and N2 metastasis using univariate and multivariate analyses, which may assist clinicians in therapeutic planning. Materials and methodsThe enrolled patients were divided into two groups on the basis of histopathological results after surgery: those with pN2 disease (N2+ group) and those without (N2− group). Sex, age, location, size, maximum standardized uptake value (SUVmax) on fluorine-18 fluorodeoxyglucose PET, histopathological type, and tumor cell grade were compared between N2+ and N2− groups. Correlations between each significant factor and groups were analyzed using univariate analyses. Independent risk factors were finally identified with multivariate analyses. ResultsA total of 258 patients met the inclusion criteria. Univariate analyses showed significant correlation between size, SUVmax, tumor cell grade, and N2 status (P<0.05). Multivariate logistic regression showed that both SUVmax and tumor cell grade were independent risk factors and had predictive value for N2 disease (P<0.05). There were no N2 node metastases when tumor SUVmax was up to 2.5 and the tumor cell grade was low. However, the likelihood of metastasis increased to 0.29 and 0.28 when tumor SUVmax was greater than 7.5 and when the tumor cell grade was high. ConclusionSUVmax and tumor cell grade are independent risk factors for N2 metastasis.

Bone marrow necrosis secondary to metastatic adenocarcinoma revealed by 18F-FDG PET/CT: A clinical case report

Rationale: Bone marrow necrosis (BMN) is a rare malignancy-associated hematologic disorder characterized by necrosis of myeloid and stromal marrow elements with preservation of cortical bone. Patient concerns: A 43-year-old female complaining of dizziness and vaginal bleeding for more than 2 months was presented to our department. Diagnosis: Due to the laboratory test results, radiographic findings, especially 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) which revealed that bone marrow was characterized by diffuse 18F-FDG uptake with extensive central photopenia, and pathologic results, she was diagnosed with metastatic adenocarcinoma accompanied with BMN. And the cancer most likely originated from reproductive system or breast. Interventions: There was no effective interventions for her before knowing the accurate origin of adenocarcinoma. Outcomes: Two weeks later, unfortunately, she died. Lessons: 18F-FDG PET/CT is a useful diagnostic modality in patients with BMN. Malignant tumor should always be considered in patients with extensive BMN, even in young people.

Lingual tonsillar metastasis from rectal carcinoma: a rare occurrence.

A 66-year-old man presenting with sacral pain 18 months after radical transabdominal resection of rectal mucinous adenocarcinoma underwent F-FDG PET/CT cancer surveillance. Detection of multiple nodules in lingual tonsil and left neck by imaging initially suggested tonsillar squamous carcinoma (as a second primary) with spread to cervical nodes, given the rarity with which rectal carcinoma metastasizes to the head and neck. Ultimately, the tonsillar neoplasm proved to be adenocarcinoma of colorectal origin based on its shared histologic features and compatible immunostaining profile.

Therapeutic status-dependent thymic changes on 18F-FDG PET/CT in an adult patient with lymphoma who underwent 2 phases of chemotherapy.

A 31-year-old woman who underwent 2 phases of chemotherapy for Hodgkin lymphoma subsequently underwent 8 F-FDG PET/CT scans for staging and treatment response evaluation. The images revealed that the Hounsfield unit and SUV of the thymus changed with the therapeutic status; both decreased to the lowest level 0.5 months after chemotherapy and increased to the highest level 8 to 12 months after the end of treatment. Interestingly, we found a positive correlation between the thymic Hounsfield unit and SUV, with a Spearman correlation coefficient of 0.946 (P < 0.001).