Takeshi Murano

A meta-analysis of 18F-Fluoride positron emission tomography for assessment of metastatic bone tumor

PurposeThe aim of this study was to assess the diagnostic performance of 18F-Fluoride positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) compared with bone scintigraphy (BS) planar or BS planar and single photon emission computed tomography (SPECT) in evaluating patients with metastatic bone tumor.Materials and methodsWe performed a meta-analysis of all available studies addressing the diagnostic accuracy of 18F-Fluoride PET, 18F-Fluoride PET/CT, BS planar, and BS planar and SPECT for detecting the metastatic bone tumor. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios, and drew summary receiver operating characteristic curves using hierarchical regression models. We also compared the effective dose and cost-effectiveness estimated by data from the enrolled studies between 18F-Fluoride PET or PET/CT and BS planar or BS planar and SPECT.ResultsWhen comparing all studies with data on 18F-Fluoride PET or PET/CT, sensitivity and specificity were 96.2% [95% confidence interval (CI) 93.5–98.9%] and 98.5% (95% CI 97.0–100%), respectively, on a patient basis and 96.9% (95% CI 95.9–98.0%) and 98.0% (95% CI 97.1–98.9%), respectively, on a lesion basis. The Az values of 18F-Fluoride PET or PET/CT were 0.986 for the patient basis and 0.905 for the lesion basis, whereas those of BS or BS and SPECT were 0.866 for the patient basis and 0.854 for the lesion basis. However, the estimated effective dose and average cost-effective ratio were poorer for 18F-Fluoride PET or PET/CT than those of BS planar or BS planar and SPECT.Conclusion18F-Fluoride PET or PET/CT has excellent diagnostic performance for the detection of metastatic bone tumor, but the estimated effective dose and average cost-effective ratio are at a disadvantage compared with BS planar or BS planar and SPECT.

Evaluation of whole-body cancer screening using 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography: a preliminary report.

Objective18F-2-deoxy-2-fluoro-d-glucose positron emission tomography (FDG-PET) is a promising screening modality targeting whole body. However, the validity of PET cancer screening remains to be assessed. Even the screening accuracy for whole-body screening using FDG-PET has not been evaluated. In this study, we investigated the screening accuracy of PET cancer screening.MethodsA total of 2911 asymptomatic participants (1629 men and 1282 women, mean age 59.79 years) underwent both FDG-PET and other thorough examinations for multiple organs (gastrofiberscopy, total colonofiberscopy or barium enema, low-dose thin section computed tomography and sputum cytology, abdominal ultrasonography, an assay of prostate-specific antigen, mammography, mammary ultrasonography, Pap smear for the uterine cervix, and magnetic resonance imaging for the endometrium and ovaries) between February 2004 and January 2005, and followed sufficiently. The detection rate, sensitivity, specificity, and positive predictive value of FDG-PET were calculated using cancer data obtained from all examinations along with a 1 year follow-up.ResultsFrom among 2911 participants FDG-PET found 28 cancers, 129 cancers were PET negative. PET-positive cancers comprised seven colorectal cancers, four lung cancers, four thyroid cancers, three breast cancers, two gastric cancers, two prostate cancers, two small intestinal sarcomas (gastrointestinal stromal tumors), one malignant lymphoma, one head and neck malignancy (nasopharyngeal carcinoid tumor), one thymoma, and one hepatocellular carcinoma. PET-negative cancers included 22 gastric cancers and 20 prostate cancers that were essentially difficult to detect using FDG-PET. The overall detection rate, sensitivity, specificity, and positive predictive value were estimated to be 0.96%, 17.83%, 95.15%, and 11.20%, respectively.ConclusionsFDG-PET can detect a variety of cancers at an early stage as part of a whole-body screening modality. The detection rate of PET cancer screening was higher than that of other screening modalities, which had already shown evidence of efficacy. However, the sensitivity of PET cancer screening was lower than that of other thorough examinations performed at our institute. FDG-PET has some limitations, and cancer screening using only FDG-PET is likely to miss some cancers.

Analysis of various malignant neoplasms detected by FDG-PET cancer screening program: based on a Japanese Nationwide Survey.

ObjectiveThe most distinctive feature of FDG-PET cancer screening program is the ability to find various kinds of malignant neoplasms in a single test. The aim of this survey is to clarify the range and frequency of various malignant neoplasms detected by FDG-PET cancer screening performed in Japan.Methods“FDG-PET cancer screening” was defined as FDG-PET or positron emission tomography and computed tomography (PET/CT) scan with or without other tests performed for cancer screening of healthy subjects. This survey was based on a questionnaire regarding FDG-PET cancer screening. We analyzed the situation of 9 less frequently found malignant neoplasms including malignant lymphoma, malignancy of head and neck, esophagus, hepatobiliary and gallbladder, pancreas, kidney, cervical and uterine, ovary, and bladder.ResultsThe detailed information of subjects with the suspected 9 kinds of malignant neoplasms mentioned above in the FDG-PET cancer screening program was studied in a total of 1,219 cases from 212 facilities. A statistical significance between PET/CT and PET was found in relative sensitivity and PPV for renal cell cancer. Malignant lymphoma was frequently of indolent type, suspected head and neck cancers had many false-positive results, and pancreatic cancer detected in this program was often in the advanced stage even in asymptomatic subjects. The recommendation of combined screening modality to PET or PET/CT was as follows: gastric endoscopy for assessing early esophageal cancer; abdominal ultrasound for screening hepatobiliary and gallbladder cancer; pelvic magnetic resonance imaging for assessing gynecological and pelvic cancers; and the CA125 blood test for screening ovarian cancer. Delayed image was helpful depending on the type of suspected malignant neoplasm.ConclusionWe analyzed various types of malignant neoplasms detected by the FDG-PET cancer screening program and presented recommended combination of examinations to cover FDG-PET and PET/CT.

Multi-bed-position acquisition technique for deep inspiration breath-hold PET/CT: a preliminary result for pulmonary lesions

ObjectiveThe deep inspiration breath-hold (DIBH) technique for positron emission tomography/computed tomography (PET/CT) is under investigation for its contribution to the accurate diagnosis of pulmonary lesions. “Step and shoot” or multi-bed-position image acquisition is necessary to improve the accuracy of whole-lung evaluation. The purpose of this study was to describe the method and preliminary results of evaluating pulmonary lesions using multi-bed-position deep inspiration breath-hold (MDIBH) PET/CT.MethodsThirteen patients with a total of 32 metastatic pulmonary lesions underwent both whole-body free-breath (FB) and whole-lung MDIBH-PET/CT sessions with suitable axial slice overlap. The self-breath holding technique was used for reproducibility of the DIBH condition. The standard FB-PET/CT was performed under the FB condition, which was followed by the MDIBH-PET/CT performed under the DIBH condition. Accuracy of alignment between CT and PET images and CT image quality were evaluated independently on dependent density, motion artifact, and heterogeneity attenuation. Mean standardized uptake value (SUV) in normal lung [Background (BG)-SUVmean], maximum SUV (SUVmax) of lesion (lesion-SUVmax), tumor background ratios (TBRs), and uptake volumes (UVs) were evaluated quantitatively.ResultsImprovements in artifacts were statistically significant using MDIBH-PET/CT. Improvements in alignment were statistically significant with the MDIBH-PET/CT for the diaphragm, heart and lung apices. CT image quality was statistically significantly higher with the MDIBH-PET/CT than with the FB-PET/CT in all indices. The decreases in BG-SUVmean were statistically significant (in all patients) with an average of −37%. Lesion-SUVmax was increased in 7 of 32 (22%) lesions although average lesion-SUVmax showed no statistical difference between the FB- and the MDIBH-PET/CT images. The increase in TBRs was statistically significant in 31 of 32 lesions (97%) in the MDIBH-PET/CT with an average of 57%. UVs were lower in 23 of 32 lesions (72%) in the MDIBH-PET/CT by −12% on average, although no statistical difference was confirmed between the techniques.ConclusionsThe MDIBH-PET/CT can provide better-aligned fused images, featuring superior image quality, in both PET and CT images. The PET images showed low BG, non-blurring and high TBRs, and the CT images provided diagnostic capability of detecting small pulmonary lesions with negligible radiation exposure.

Comparative study of the value of dual tracer PET/CT in evaluating breast cancer.

The present study was conducted to assess the relationship between tumor uptake and pathologic findings using dual‐tracer PET/computed tomography (CT) in patients with breast cancer. Seventy‐four patients with breast cancer (mean age 54 years) who underwent 11C‐choline and 2‐[18F]fluoro‐2‐deoxy‐d‐glucose (18F‐FDG) PET/CT prior to surgery on the same day were enrolled in the present study. Images were reviewed by a board‐certified radiologist and two nuclear medicine specialists who were unaware of any clinical information and a consensus was reached. Uptake patterns and measurements of dual tracers were compared with the pathologic findings of resected specimens as the reference standard. Mean (±SD) tumor size was 5.9 ± 3.2 cm. All primary tumors were identified on 18F‐FDG PET/CT and 11C‐choline PET/CT. However, 18F‐FDG PET/CT demonstrated focal uptake of the primary tumor with (n = 38; 51%) or without (n = 36; 49%) diffuse background breast uptake. Of the pathologic findings, multiple logistic regression analysis revealed an independent association between fibrocystic change and diffuse background breast uptake (odds ratio [OR] 8.57; 95% confidence interval [CI] 2.86–25.66; P < 0.0001). Tumors with higher histologic grade, nuclear grade, structural grade, nuclear atypia, and mitosis had significantly higher maximum standardized uptake values (SUVmax) and tumor‐to‐background ratios (TBR) for both tracers. Multiple logistic regression analysis revealed that only the degree of mitosis was independently associated with a high SUVmax (OR 7.45; 95%CI 2.21–25.11; P = 0.001) and a high TBR (OR 5.41; 95%CI 1.13–25.96; P = 0.035) of 11C‐choline PET/CT. In conclusion, 11C‐choline may improve tumor delineation and reflect tumor aggressiveness on PET/CT in patients with breast cancer.