Myriam Wartski

High and typical 18F-FDG bowel uptake in patients treated with metformin

PurposeThis prospective and bi-centric study was conducted in order to determine the impact of antidiabetic treatments (AD) on 18F-FDG bowel uptake in type 2 diabetic patients.MethodsFifty-five patients with previously diagnosed and treated type 2 diabetes mellitus (group 1) were divided in two subgroups: AD treatment including metformin (n=32; group 1a) and AD treatment excluding metformin (n=23; group 1b). The 95 patients without diabetes mellitus made up controls (group 2). 18F-FDG uptake in small intestine and colon was visually graded and semi-quantitatively measured using the maximum standardized uptake value.Results18F-FDG bowel uptake was significantly increased in AD patients (group 1) as compared to controls (group 2) (p<0.001). Bowel uptake was significantly higher in AD patients including metformin (group 1a) as compared to AD patients excluding metformin (group 1b) (p<0.01), whose bowel uptake was not significantly different from controls (group 2). A metformin treatment was predictive of an increased bowel uptake in the small intestine (odds ratio OR=16.9, p<0.0001) and in the colon (OR=95.3, p<0.0001), independently of the other factors considered in the multivariate analysis. Bowel uptake pattern in the patients treated with metformin was typically intense, diffuse and continuous along the bowel, strongly predominant in the colon, in both the digestive wall and lumen.ConclusionThis study emphasizes that metformin significantly increases 18F-FDG uptake in colon and, to a lesser extent, in small intestine. It raises the question of stopping metformin treatment before an 18F-FDG PET/CT scan is performed for intra-abdominal neoplasic lesion assessment.

18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging in the staging and prognosis of inflammatory breast cancer

To prospectively assess fluorodeoxyglucose positron emission tomography/computed tomography (FDG‐PET/CT) staging and prognosis value in patients with suspected inflammatory breast cancer (IBC).

In search of an unknown primary tumour presenting with cervical metastases: performance of hybrid FDG-PET-CT.

ObjectivesIn patients with cervical lymph node metastases from unknown primary tumour (UPT), the primary tumour is frequently localized in the head and neck area. Because the detection of the primary tumour is of importance to optimize the patients management and allows a targeted therapy, the performances of hybrid positron emission tomography–computed tomography (PET–CT) using fluorodeoxyglucose (FDG) were evaluated in a retrospective study. MethodsThirty-eight consecutive patients with cervical lymph node metastases, and in whom the primary was not detected by the comprehensive diagnostic work-up including endoscopy and conventional imaging methods, were referred for a PET–CT scan. ResultsPET–CT was positive with an increased FDG focal uptake suggesting the potential primary site in 68% of patients (26/38), which guided the biopsies during a second rigid panendoscopy in 17 of these 26 patients: 13 primary tumours were then histologically proven. PET–CT showed distant lesions in three patients. It had treatment-related implications in 23/38 patients (60%), consisting of modification of radiation planning, surgery or abstention from surgery. ConclusionHybrid FDG-PET–CT is helpful for the detection of a potential head and neck primary tumour. Furthermore, hybrid FDG-PET–CT has the ability to diagnose occult or distant second tumour and metastatic disease and modify patient management.

Breast cancer recurrence diagnosis suspected on tumor marker rising: value of whole-body 18FDG-PET/CT imaging and impact on patient management.

Breast cancer recurrence is often suspected on tumor marker rising in asymptomatic patients. The value of fluorine‐18 fluorodeoxyglucose (18FDG)–positron emission tomography/computed tomography (PET/CT) imaging to detect recurrence and its subsequent impact on patient management were retrospectively assessed.

Diagnosis and localization of renal cyst infection by 18F-fluorodeoxyglucose PET/CT in polycystic kidney disease

Renal cyst infection in polycystic kidney disease is a serious complication. Early diagnosis and localization of infected cyst are crucial and usually require conventional imaging modalities, including ultrasound and computed tomography (CT). However, their contribution is limited because of nonspecific results. We report on a patient with suspected renal cyst infection for which 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan allowed the exact localization of the infected cyst and guided a drainage procedure. FDG-PET/CT imaging could be a valuable tool for early identification of infected renal cyst infection, and may contribute to better patient management.

Use of single MRI and 18F-FDG PET-CT scans in both diagnosis and radiotherapy treatment planning in patients with head and neck cancer: Advantage on target volume and critical organ delineation

The use of a single MRI and 18F‐fluoro deoxyglucose positron emission tomography‐CT (18F‐FDG PET‐CT) was evaluated, both in diagnostic procedure and radiotherapy planning, in patients with head and neck cancer.

Typical and atypical bronchopulmonary carcinoid tumors on FDG PET/CT imaging.

The authors report 2 cases of bronchial carcinoid tumor (BCT). One had a typical and the other had an atypical histologic pattern. BCTs represent 1 to 2% of all lung cancers and are usually located in the hilar or perihilar areas. They can be associated with infectious processes. Typical carcinoids are considered as having low-grade malignancy although atypical carcinoids are of intermediate grade. The authors showed that even a typical carcinoid can show intense F-18 FDG uptake. The number of reports of BCT in PET imaging using FDG in BCT is very limited, but several cases of FDG-negative BCT have been described.

Place de l’imagerie par Tomographie par Émission de Positons pour les tumeurs stromales gastro-intestinales

Resume La TDM abdominopelvienne est consideree comme la methode d’imagerie de reference pour le bilan d’extension et le suivi therapeutique des tumeurs stromales gastro-intestinales. L’interet d’un examen corps entier de TEP au FDG dans le bilan d’extension apparait limite en raison de la rarete des lesions extra-abdominales et de sa sensibilite inferieure a celle de la TDM. Toutefois, la realisation d’une TEP lors du bilan pretherapeutique peut etre indiquee s’il est prevu d’evaluer precocement l’efficacite d’un traitement par imatinib, car elle permet d’observer une reponse des le 8e jour de traitement, beaucoup plus precocement que la TDM. La diminution de l’activite metabolique tumorale est rapide, importante et plus facile a quantifier que des modifications de taille ou de densite analysees en TDM. La TEP peut etre aussi utile en cas de problemes d’interpretation de la TDM tels que des images equivoques suspectes de metastases, un doute sur une reponse au traitement ou au contraire une progression en TDM, notamment lorsqu’il existe une discordance avec les donnees cliniques. La TEP et la TDM peuvent donc etre complementaires et la combinaison de ces 2 modalites avec les appareils de TEP/TDM a montre son interet pour les tumeurs stromales gastro-intestinales. La TEP pourrait etre proposee comme methode d’imagerie d’evaluation de l’efficacite therapeutique dans toute etude prospective utilisant l’imatinib ou de nouvelles molecules. L’indication de cet examen chez les malades porteurs de tumeurs stromales gastro-intestinales doit etre portee lors d’une approche pluridisciplinaire oncologique.

Non-Hodgkin lymphoma localization in the pituitary gland: diagnosis by FDG-PET/CT.

Abstract:Non-Hodgkin lymphoma (NHL) involving the pituitary gland is rare. Intense focal FDG uptake was found in the pituitary gland on F-18 fluorodeoxyglucose positron emission tomography combined with CT (FDG-PET/CT) performed for NHL pretherapeutic staging. Brain magnetic resonance imaging (MRI)

18F-FDG PET/CT to Predict Response to Neoadjuvant Chemotherapy and Prognosis in Inflammatory Breast Cancer

The aim of this prospective study was to assess the predictive value of 18F-FDG PET/CT imaging for pathologic response to neoadjuvant chemotherapy (NACT) and outcome in inflammatory breast cancer (IBC) patients. Methods: Twenty-three consecutive patients (51 y ± 12.7) with newly diagnosed IBC, assessed by PET/CT at baseline (PET1), after the third course of NACT (PET2), and before surgery (PET3), were included. The patients were divided into 2 groups according to pathologic response as assessed by the Sataloff classification: pathologic complete response for complete responders (stage TA and NA or NB) and non–pathologic complete response for noncomplete responders (not stage A for tumor or not stage NA or NB for lymph nodes). In addition to maximum standardized uptake value (SUVmax) measurements, a global breast metabolic tumor volume (MTV) was delineated using a semiautomatic segmentation method. Changes in SUVmax and MTV between PET1 and PET2 (ΔSUV1–2; ΔMTV1–2) and PET1 and PET3 (ΔSUV1–3; ΔMTV1–3) were measured. Results: Mean SUVmax on PET1, PET2, and PET3 did not statistically differ between the 2 pathologic response groups. On receiver-operating-characteristic analysis, a 72% cutoff for ΔSUV1–3 provided the best performance to predict residual disease, with sensitivity, specificity, and accuracy of 61%, 80%, and 65%, respectively. On univariate analysis, the 72% cutoff for ΔSUV1–3 was the best predictor of distant metastasis-free survival (P = 0.05). On multivariate analysis, the 72% cutoff for ΔSUV1–3 was an independent predictor of distant metastasis-free survival (P = 0.01). Conclusion: Our results emphasize the good predictive value of change in SUVmax between baseline and before surgery to assess pathologic response and survival in IBC patients undergoing NACT.