S. Querellou

Does 18F-FDG PET/CT Improve the Detection of Posttreatment Recurrence of Head and Neck Squamous Cell Carcinoma in Patients Negative for Disease on Clinical Follow-up?

Posttreatment surveillance for the recurrence of head and neck squamous cell carcinoma (HNSCC) is a diagnostic challenge. Tissue distortion from radiation and surgery can obscure early detection of recurrence by conventional follow-up approaches such as physical examination, CT, and MRI. Several studies have shown that 18F-FDG PET may be an effective technique for the detection of persistent, recurrent, and distant metastatic HNSCC after treatment. The aim of this prospective study was to determine the benefits of hybrid 18F-FDG PET/CT in detecting a subclinical locoregional recurrence of HNSCC and distant metastases. The study patients were considered cured of HNSCC on the basis of 12 mo of negative findings on conventional follow-up. We also assessed the diagnostic accuracy of 18F-FDG PET/CT in these patients. Methods: Ninety-one patients cured of HNSCC without any clinical evidence of recurrence were included. Whole-body 18F-FDG PET/CT examination was performed 11.6 ± 4.4 mo after the end of the treatment. The gold standard was histopathology or 6 mo of imaging follow-up. Results: The whole-body 18F-FDG PET/CT examinations had negative results in 52 patients and positive results in 39. Nine of these patients who exhibited abnormal 18F-FDG uptake in the head and neck area did not have recurrent HNSCC (false-positive). Thirty had proven recurrence. The sensitivity and specificity of 18F-FDG PET/CT in this study for the diagnosis of HNSCC recurrence were 100% (30/30) and 85% (52/61), respectively. The positive predictive value was 77% (30/39). The negative predictive value was 100% (52/52). The overall accuracy was 90% (82/91). Conclusion: The results of our study confirm the high effectiveness of 18F-FDG PET/CT in the assessment of HNSCC recurrence and suggest that 18F-FDG PET/CT is more accurate than conventional follow-up physical examination alone in the assessment of recurrence after previous curative treatment for HNSCC and could be proposed systematically at 12 mo of the usual follow-up.

Prognostic value of interim FDG PET/CT in Hodgkin’s lymphoma patients treated with interim response-adapted strategy: comparison of International Harmonization Project (IHP), Gallamini and London criteria

PurposeInterim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) has shown to be an accurate predictor of prognosis in Hodgkin’s lymphoma (HL). However, FDG PET response criteria are a matter of ongoing debate. The aim of this study was to confirm the prognostic value of interim PET/CT in HL patients treated with an interim response-adapted strategy and to compare the respective performances of different published criteria.MethodsNewly diagnosed patients with HL underwent interim PET/CT after four courses of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). The treatment strategy was adapted according to prognostic factors at diagnosis and interim PET/CT and CT results. PET images were prospectively interpreted visually: a negative result was defined as no residual uptake above local background. All other findings were considered as positive. Retrospectively, interim PET/CT was analysed according to International Harmonization Project (IHP), Gallamini and London criteriaResultsThe analysis included 90 patients; 6 of 31 patients with positive interim PET/CT and 7 of 59 patients with negative interim result presented treatment failure. The negative predictive value (NPV) and positive predictive value (PPV) for predicting 2-year progression-free survival (PFS) was 95 and 16%, respectively. With the other criteria, NPV remained very high (from 95 to 96%). The PPV increased from 19 to 45% according to the threshold used. Interim PET/CT was significantly correlated with PFS with Gallamini (p = 0.01) and London criteria (p < 0.0001).ConclusionOur study confirms the high NPV of interim PET/CT for predicting treatment outcome in HL and a probably better prognostic value using a higher threshold for positivity even after four cycles of chemotherapy as used in Gallamini and London criteria.

FDG-PET/CT predicts outcome in patients with aggressive non-Hodgkin's lymphoma and Hodgkin's disease.

Early therapy response assessment with metabolic imaging is potentially useful to determine prognosis in aggressive lymphoma and, thus, can guide first-line therapy. Forty-eight patients with aggressive lymphoma [24 Hodgkin’s disease (HD); 24 non-Hodgkin’s lymphoma (NHL)] underwent fluoro-deoxyglucose positron emission tomography (FDG-PET) before chemotherapy (PET1) and at mid-treatment (PET2). Therapeutic response was evaluated using conventional methods at mid-treatment. PET2 results were related to event-free survival (EFS) and overall survival (OS) using Kaplan–Meier analyses. PET1 was positive in all patients. PET2 was negative in 38 patients (18 NHL-20 HD) and positive in 10 (6 NHL-4 HD). Of the PET-negative patients, 61 and 65% achieved complete remission, and only 50 and 25% of PET-positive patients, respectively, for NHL and HD, achieved complete remission. Significant associations were found between PET2 and EFS (p=0.0006) and OS (p=0.04) for NHL, and EFS (p<0.0001) for HD (but not for OS, because no HD patient died). FDG-PET at mid-treatment can predict the outcome of patients with aggressive lymphoma and should be a useful tool to modify an ineffective therapy.

Does 18fluoro‐fluorodeoxyglucose positron emission tomography improve recurrence detection in patients treated for head and neck squamous cell carcinoma with negative clinical follow‐up?

The aim of this study was to determine the benefits of 18fluoro‐fluorodeoxyglucose positron emission tomography (18F‐FDG PET) in the detection of head and neck squamous cell carcinoma (HNSCC) recurrence in patients with negative clinical follow‐up.

Gastric scintigraphy with a liquid-solid radiolabelled meal : performances of solid and liquid parameters

AimTo assess the clinical performance of parameters of liquid–solid gastric emptying (GE) scintigraphy. MethodsFifty-three controls and 476 patients underwent GE scintigraphy using a liquid–solid test meal (non-ulcer dyspepsia, n=180; gastro-oesophageal reflux disease, n=123; dyspepsia after anti-reflux surgery, n=29; diabetes mellitus, n=96; cystic fibrosis prior to heart–lung transplantation, n=48). Time–activity curves were fitted by a power exponential function and half-emptying times (T1/2) were computed. The lag phase (Tlag) and constant emptying (TRE) times of solid emptying were also calculated using a mathematical method (maximum slope tangent method). ResultsTRE and T1/2 of solids were higher in each subgroup of patients vs. controls (P=0.0001) and in cystic fibrosis patients vs. gastro-oesophageal reflux patients (P=0.0001). Tlag was significantly higher only in non-ulcer dyspepsia patients vs. controls (P=0.001). There was no significant difference for liquid parameters. Using the mean±1.96 SD of the solid and liquid T1/2 values obtained in controls, GE was normal (n=251; 53%), delayed (n=183; 38%), accelerated (n=33; 7%) or mixed (n=9; 2%). Delayed solid T1/2 was the most prominent alteration (n=189), and alterations of liquid GE alone were present in only 24 (5%) patients. A good correlation was found between solid T1/2 and TRE (r=0.88), but no correlation between Tlag and TRE, suggesting that these estimates represent independent phases of GE. In 26 patients, all GE parameters of solids and liquids were normal except Tlag (n=8) or TRE (n=18). The lack of significant differences between the different patient subgroups did not allow emptying profiles to be drawn according to patient pathology. ConclusionLiquid GE scintigraphy provided poor and unreliable information in terms of patient discrimination and the drawing of pathophysiological profiles of abnormal GE. Tlag and TRE may confirm GE alteration, especially when solid T1/2 values are at the superior limit of normality, and may improve the performance of GE scintigraphy, rather than using liquid parameters.

Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatica: a prospective longitudinal study

Background Glucocorticoids are the cornerstone treatment of polymyalgia rheumatica (PMR) but induce adverse events. Objectives To evaluate the efficacy and safety of first-line tocilizumab in PMR. Methods In a prospective open-label study (ClinicalTrials.gov: NCT01713842), 20 glucocorticoid-free patients fulfilling Chuangs PMR criteria, with symptom onset within the last 12 months and a PMR activity score (PMR-AS) >10, each received three tocilizumab infusions at 4-week intervals, without glucocorticoids, followed by oral prednisone from weeks 12 to 24 (0.15 mg/kg if PMR-AS ≤10 and 0.30 mg/kg otherwise). The primary end point was the proportion of patients with PMR-AS≤10 at week 12. Results Baseline median PMR-AS was 36.6 (IQR 30.4–43.8). At week 12, all patients had PMR-AS≤10 and received the low prednisone dosage. Median PMR-AS at weeks 12 and 24 was 4.5 (3.2–6.8) and 0.95 (IQR 0.4–2), respectively (p<0.001 vs baseline for both time points). No patient required rescue treatment. Positron emission tomography-CT showed significant improvements. The most common adverse events were transient neutropenia (n=3) and leucopenia (n=5); in one patient, the second tocilizumab infusion was omitted due to leucopenia. Conclusions Tocilizumab monotherapy is effective in recent-onset PMR. Randomised controlled trials are warranted. Trial registration number NCT01713842.

Prognostic value of dual-time-point 18F-FDG PET-CT imaging in patients with head and neck squamous cell carcinoma.

ObjectiveThe objective of this study was to investigate the independent prognostic value of dual-time-point 18F-fluorodeoxyglucose (18F-FDG) PET-CT imaging in patients with head and neck squamous cell carcinoma (HNSCC). MethodsPatients referred to our department to undergo 18F-FDG PET-CT for staging of HNSCC were prospectively included. Each patient was scanned using a Philips Gemini PET-CT system 1 h (early acquisition) and 2 h (delayed acquisition) after injection. An intratumoral retention index (RI) of 18F-FDG was measured for each examination by the dual-time-point method. Event-free survival (EFS) and overall survival (OS) were determined by the Kaplan–Meier method and compared with the conventional maximum standardized uptake value (SUVmax) at 60 min, SUVmax at 120 min, and RI in univariate and multivariate analyses including the usual prognostic factors such as age, sex, primary site, SCC histologic grade, and American Joint Committee on Cancer stage (I, II, III, and IV). ResultsSixty-six consecutive patients (60 men and six women; mean age=61±9 years) were included in the study. In univariate analysis, besides age and stage, RI was predictive of EFS (P=0.01) but not of OS (P=0.1), whereas SUVmax at 60 min was not predictive of EFS (P=0.18) or OS (P=0.08) and SUVmax at 120 min was predictive of OS (P=0.02) but not of EFS (P=0.05). In multivariate analysis, RI persisted as an independent predictive factor for EFS (P=0.02) but not SUVmax at 120 min for OS (P=0.12). ConclusionOur results suggest an additional prognostic interest of RI measured by dual-time-point 18F-FDG PET-CT, independent of usual prognostic factors, in patients with HNSCC.

Prognostic value of fluorine-18 fluorodeoxyglucose positron-emission tomography imaging in patients with head and neck squamous cell carcinoma

High tumor uptake of fluorodeoxyglucose (FDG) is associated with an unfavorable outcome in patients with cancer. We evaluated FDG uptake as a prognostic factor in patients with head and neck squamous cell carcinoma.

Detection of occult wrist fractures by quantitative radioscintigraphy: a prospective study on selected patients.

ObjectiveTo determine the value of quantitative radioscintigraphy (QRS) in the diagnosis of wrist trauma occult fractures. PurposeBecause of the risk of non-union, the diagnosis of wrist fractures, including scaphoid fractures, is essential but remains difficult despite many imaging modalities. The aim of the study was to assess the benefits of QRS in the diagnosis of occult post-trauma wrist fractures. MethodsThis prospective study included all patients presenting at the orthopaedic department at Brest University Hospital for wrist pain after trauma with initial normal plain radiographs. Patients with normal radiographs but strongly suspected of fracture underwent QRS consisting of three-phase bone scintigraphy with quantitative analysis. When a fracture was suspected the radiograph and scintigraphy were fused to precisely locate the fracture if the index was higher than 2. If the index was lower than 1.9, fracture was excluded. Between these two indices, other investigations, such as magnetic resonance imaging, were performed. All patients were followed for at least 3 months and reviewed by the same surgeon. Patients underwent a physical examination and possibly other investigations. ResultsFrom April 2006 to July 2008, 87 patients were enrolled (34 women, 53 men; median age 29 years; range, 15–87 years). Among the 46 pathologic bone scintigrams, 55 occult fractures were highlighted. At follow-up, none presented non-union. One had an undetermined QRS. Among the 40 negative results for QRS at follow-up, only one had a non-union. Sensitivity and negative predictive value were 97 and 98%, respectively for carpal fractures. ConclusionThis study highlights the benefit of QRS, which allows the detection of most occult carpal fractures and reduces the risks of complications such as pseudoarthritis.

Clinical and therapeutic impact of 18F-FDG PET/CT whole-body acquisition including lower limbs in patients with malignant melanoma.

ObjectivesTo assess the added benefit of scanning lower limbs in addition to the usual whole-body positron emission tomography/computed tomography (PET/CT) scan in patients with no known or suspected primary or metastatic melanoma involving the lower limbs. Materials and methodsThis is a retrospective study of 122 consecutive patients [174 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) PET/CT] who underwent FDG PET/CT for staging of melanoma at different time points in the course of the disease from October 2005 to February 2009 at the Brest University Hospital. Reports of whole-body PET/CT scans including lower limbs were reviewed. PET/CT abnormalities on the lower extremities were tabulated by location and correlated with pathology, other imaging studies and at least a 6-month clinical follow-up. The usefulness of lower limbs acquisition in clinical management was evaluated according to imagery findings. ResultsAmong the 174 consecutive PET/CT scans performed in 122 patients, 33 scans in 28 patients highlighted abnormal FDG uptakes considered as equivocal or suggestive of malignancy in the lower limbs. In 28 cases, uptakes were located at once in the lower limbs and in the rest of the body (lung, liver, mediastinal and sub-diaphragmatic lymph nodes, adrenal glands, bone) corresponding to disseminated disease. In five cases, PET/CT uptakes were located only in lower limbs; each pathological uptake corresponded to benign lesions. Lower limbs findings never impacted clinical and therapeutic decision. ConclusionLower limbs additional PET/CT acquisition seems to offer poor additional benefit with none unexpected lesion detected and routine skull base to upper thigh images might be sufficient for this subset of patients.