Scott Perlman

Pilot study using PET/CT as a novel, noninvasive assessment of disease activity in inflammatory bowel disease.

Background: A pilot study was performed investigating the possibility that positron emission tomography (PET) activity using 18‐fluorodeoxyglucose (FDG) with nearly simultaneous computerized tomography (CT) for anatomic accuracy would identify regions of active inflammation in both ulcerative colitis (UC) and Crohns disease (CD). Methods: Prospective clinical data was collected in 12 patients experiencing an exacerbation of their inflammatory bowel disease; 7 with CD and 5 with UC. A PET/CT scan (GE Discovery LS PET/CT scanner) was performed in all patients. Twenty patients undergoing PET/CT because of solitary pulmonary nodules served as controls. We graded the small bowel and 4 colon regions (ascending, transverse, descending, and rectosigmoid) with PET activity scores assigned to each region based on the amount of FDG uptake using the liver as the reference organ. Results: In UC patients, PET activity was seen in 13 of 24 (52%) regions. There was high (23 of 24; 95.8%) correlation between PET activity and disease activity as determined by colonoscopy, disease activity indices, and radiology. In patients with CD, PET activity was seen in 19 of 32 (59.4%) regions. Again, there was a high (26 of 32; 81.3%) correlation between PET activity and clinical disease activity. Of the 20 controls, significant PET activity (Grades 2 and 3) was seen in only 2 of 100 regions (2%). Conclusions: We found that PET activity correlated well with active inflammation in both UC and CD, suggesting that this may be a noninvasive method of identifying disease activity in patients with inflammatory bowel disease.

PET/CT in the Evaluation of Inflammatory Bowel Disease: Studies in Patients Before and After Treatment

PurposeThe purpose of this study was to evaluate the appropriate 2-deoxy-2-[18F]fluoro-d-glucose–positron emission tomography (FDG-PET) determination in patients with inflammatory bowel disease (IBD) before and after clinical improvement to see if this determination correlates with clinical activity.ProceduresWe performed PET–computed tomography (PET/CT) on five patients before and after successful medical therapy in patients with moderately active IBD. Each patient had five bowel segments scored (0–3) for the appropriate FDG-PET determination.ResultsThere were five patients [Crohn’s disease (CD)u2009=u20093, ulcerative colitisu2009=u20092] who were studied an average of 437xa0days (range, 77–807) after initial PET/CT scan. All patients showed significant improvement in physician global assessment scores (pu2009=u20090.004) and underwent repeat PET/CT. The total score of all segments was 32 pretreatment and 14 posttreatment (pu2009<u20090.01). Of 11 pretreatment active segments, nine (82%) segments either became inactive or displayed decreased activity, while two showed no change (pu2009<u20090.001).ConclusionAppropriate FDG-PET determination decreases with successful treatment of inflammation in active IBD and correlates with symptom improvement.

Integrated PET/CT Fusion Imaging and Endoscopic Ultrasound in the Pre-operative Staging and Evaluation of Esophageal Cancer

PurposeAccurate staging of esophageal cancer (ECA) is critical in determining appropriate therapy. Endoscopic ultrasound (EUS), computed tomography (CT) and positron emission tomography (PET) scanning can be used, but limited data exists regarding the use of combined PET/CT fusion imaging and EUS in ECA staging. The objective of this study is to evaluate the role of integrated PET/CT imaging and EUS in the staging of ECA.ProceduresIdentification of patients diagnosed with ECA from 2004 to 2007 that underwent staging PET/CT and EUS. Data regarding tumor detection, lymph node identification, presence of metastatic disease, and affect on patient management were collected and compared between PET/CT and EUS.ResultsEighty-one patients (65 male, 16 female) were identified with mean age of 63.5xa0years who underwent EUS and PET/CT to stage known ECA. PET/CT identified the primary tumor in 74/81 (91.4%) of cases, compared to 81/81 (100%) with EUS. Locoregional adenopathy was seen by PET/CT in 29/81 (35.8%) of cases, compared to 49/81 (60.5%) by EUS (pu2009=u20090.0001). PET/CT identified celiac axis adenopathy in 8/81 (9.9%) of cases, compared to 11/81 (13.6%) with EUS (pu2009=u20090.5050). PET/CT identified 17/81 (21.0%) of patients with distant metastases who subsequently did not undergo attempt at curative surgical resection.ConclusionsIn ECA, EUS is superior to PET/CT for T staging and in identifying locoregional nodes, while PET/CT provides M staging. EUS and integrated PET/CT appear to independently affect treatment decisions, indicating complimentary and necessary roles in the staging of ECA.

Radionuclide ventriculography in severely underweight anorexia nervosa patients before and during refeeding therapy

Congestive heart failure is a well-recognized complication of refeeding therapy in underweight patients with anorexia nervosa but there are few data describing cardiac function during the critical refeeding period. This prospective study examined left ventricular function with conventional electrocardiographic-gated radionuclide ventriculography (RVG) in severely underweight anorexia nervosa patients both before and during refeeding therapy. Eight patients underwent rest and exercise RVG at admission and after regaining approximately 5% to 10% of their ideal body weight. With the admission study serving as a control, the left ventricular ejection fraction and regional wall motion analysis were analyzed before and after refeeding and weight gain. Resting left ventricular ejection fractions were not significantly different between the first and second RVGs (64 +/- 11% vs. 62 +/- 8%, respectively; P greater than .05). Likewise, the left ventricular ejection fraction with maximal exercise did not significantly differ when comparing the first or the second RVG (74 +/- 10% vs. 72 +/- 8%, P greater than .05). During the baseline RVG, the left ventricular ejection fraction increased from 64 +/- 11% (rest) to 74 +/- 10% (maximal exercise) (P less than .001). During the second RVG, the ejection fraction increased from 62 +/- 8% (rest) to 72 +/- 8% (maximal exercise) (P = .003). However, the left ventricular exercise ejection fraction in the second RVG in one patient increased only by one absolute percentage point. Four of the eight patients had regional wall motion abnormalities detected during resting and/or exercise RVG. Abnormal cardiac function occurs in asymptomatic patients with anorexia nervosa undergoing refeeding therapy.

Implementing Hybrid CT/PET: The University of Wisconsin Experience

Oncology Issues November/December 2006 In Brief In late 2001, the University of Wisconsin’s Radiation Oncology Department installed one of the first radiotherapy-dedicated hybrid CT/PET scanners in the country. This scanner is shared between Radiation Oncology and Nuclear Medicine. In the last five years, the technology has proven valuable for diagnostic purposes and radiotherapy treatment planning. While the CT/PET acquisition benefited our hospital and patients, implementation of the new technology was not a seamless process. The adoption of the hybrid CT/PET posed challenges to our institution and, in particular, to the Radiation Oncology and Nuclear Medicine Departments that jointly share the equipment (see box, page 27). Now, a few years after its acquisition, the CT/PET scanner plays a vital role in the functioning of both departments. This new technology has significantly altered the way we design radiation treatment plans for our cancer patients.