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Annals of Nuclear Medicine (v.21, #4)

Diagnostic performance of CT, PET, side-by-side, and fused image interpretations for restaging of non-Hodgkin lymphoma by Munenobu Nogami; Yuji Nakamoto; Setsu Sakamoto; Kazuto Fukushima; Tomohisa Okada; Tsuneo Saga; Tatsuya Higashi; Michio Senda; Toshimitsu Matsui; Kazuro Sugimura (pp. 189-196).

The purpose of this study was to compare the diagnostic performance of positron emission tomography (PET) alone, computed tomography (CT) alone, side-by-side reading, and fused images for restaging or follow-up of patients with malignant lymphoma.Fifty patients with histologically confirmed non-Hodgkin lymphoma underwent an ¹⁸fluoro-2-deoxyglucose (FDG)-PET scan, followed by a CT scan. CT alone, PET alone, side-by-side reading, and fused images were interpreted separately and visually using a five-point grading scale for the following eight regions: cervical, supraclavicular, axillary, mediastinal, para-aortic to iliac, mesenteric, inguinal, and extra-nodal. Diagnostic accuracy was compared on the basis of the final diagnoses determined by histological confirmation and/or clinical course.For all regions combined, the interpretation of PET alone (sensitivity = 86.1%, specificity = 99.4%, accuracy = 91.0%), side-by-side reading (96.0%, 99.4%, 98.9%), and fused images (98.0%, 99.4%, 99.2%) yielded significantly higher diagnostic performance than that of CT alone (59.4%, 96.1%, 91.0%; P < 0.001). The cervical, supraclavicular, and extra-nodal regions were more accurately diagnosed with PET (P < 0.05), whereas the para-aortic to iliac regions were diagnosed more accurately with side-by-side reading and fused images than with CT alone or PET alone (P < 0.05).Although fused images are clinically valuable, side-by-side reading showed equivalent performance, whereas the interpretation of PET alone yielded reasonably high diagnostic performance for restaging or follow-up of patients with malignant lymphoma.

Keywords: CT; PET; Lymphoma; Image fusion

Improved accuracy of brain MRI/SPECT registration using a two-cluster SPECT normalization algorithm and a combinative similarity measure: application to the evaluation of Parkinson's disease by Jiann-Der Lee; Chung-Hsien Huang; Yi-Hsin Weng; Kun-Ju Lin; Chin-Tu Chen (pp. 197-207).

Single-photon emission computed tomography (SPECT) of dopamine transporters with technetium-99-labeled tropane derivative ^99mTc-TRODAT-1 has recently been suggested to offer valuable information in assessing the functionality of dopaminergic systems. To facilitate the non-invasive examination of the dopamine concentration in vivo, registering magnetic resonance imaging (MRI) and SPECT image is important. This article proposes a new similarity measure for MRI/SPECT registration.The proposed similarity measure combines anatomic features that are characterized by specific binding of nuclear medicine and the distribution of image intensity that are characterized by the normalized mutual information (NMI). A preprocess, a novel two-cluster SPECT normalization algorithm, is also proposed.Compared with the conventional NMI-based registration algorithm, the proposed registration framework reduces the target of registration error from >7 mm to approximately 4 mm. The error of the specific-to-non-specific ^99mTc-TRODAT-1 binding ratio (BR), a quantitative measure of TRODAT receptor binding, is also reduced from 0.45 to 0.08 in the healthy subjects and from 0.28 to 0.12 in Parkinson's disease patients.A suitable color map, such as “rainbow,” for image display enables the two-cluster SPECT normalization algorithm to provide clinically meaningful visual contrast. In addition, registering MRI/SPECT based on the proposed similarity measure improves the accuracy compared with the conventional NMI-based algorithm.

Keywords: Image registration; Multimodality image; Normalized mutual information; Single photon emission computed tomography; Similarity measure

2-[Fluorine-18]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography versus whole-body diffusion-weighted MRI for detection of malignant lesions: initial experience by Tsuyoshi Komori; Isamu Narabayashi; Kaname Matsumura; Mitsuru Matsuki; Hiroyuki Akagi; Yasuharu Ogura; Fumitoshi Aga; Itaru Adachi (pp. 209-215).

The new magnetic resonance whole body diffusion-weighted imaging with background body signal suppression (DWIBS) uses short tau inversion recovery-echo planar imaging sequence under normal respiration. DWIBS is different from 2-[fluorine-18]-fluoro-2-deoxy-d-glucose positron emission tomography (¹⁸F-FDG PET) imaging in technology, but their images are similar. We compared the two modalities regarding the detection and characterization of malignant tumors.DWIBS and ¹⁸F-FDG PET/computed tomography (CT) were performed on 16 cancer patients on the same day. The diagnoses were the following: lung cancer (n = 12), colon cancer (n = 2), breast cancer (n = 1), and pulmonary metastasis (n = 1). A total of 27 malignant tumors (15 lung cancer, 5 pulmonary metastases of parathyroid cancer, 3 pulmonary metastases of lung cancer, 3 colon cancer, 1 breast cancer) and seven reference organs around malignant lesions (two liver regions, four normal lymph nodes, one muscle region) were evaluated visually and quantitatively using the apparent diffusion coefficient (ADC) (×10⁻³ mm²/s) and standardized uptake value (SUV).Twenty-five (92.6%) of the 27 malignant lesions were detected visually with DWIBS imaging in contrast to 22 malignant tumors (81.5%) with ¹⁸F-FDG PET/CT imaging. The quantitative evaluation showed that there was a significant difference between the mean SUVs of the reference organs (n = 7, 1.48 ± 0.62) and the malignant (n = 22, 5.36 ± 2.80) lesions (P < 0.01). However, there was no significant difference between the mean ADCs of the reference organs (n = 7, 1.54 ± 0.24) and the malignant (n = 25, 1.18 ± 0.70) lesions.DWIBS can be used for the detection of malignant tumors or benign tumors; however, it may be difficult to differentiate between benign and malignant lesions by ADC.

Keywords: Positron emission tomography/computed tomography; Fluorodeoxyglucose; Diffusion-weighted magnetic resonance imaging; Oncology

FDG-PET of patients with suspected renal failure: standardized uptake values in normal tissues by Ryogo Minamimoto; Nobukazu Takahashi; Tomio Inoue (pp. 217-222).

This study aims to clarify the effect of renal function on 2-[¹⁸F] fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) imaging and determine the clinical significance of renal function in this setting. We compared FDG distribution between normal volunteers and patients with suspected renal failure.Twenty healthy volunteers and 20 patients with suspected renal failure who underwent FDG-PET between November 2002 and May 2005 were selected for this study. We define “patients with suspected renal failure” as having a blood serum creatinine level in excess of 1.1 mg/dl. The serum creatinine level was examined once in 2 weeks of the FDG-PET study. Regions of interest were placed over 15 regions for semi-quantitative analysis: the white matter, cortex, both upper lung fields, both middle lung fields, both lower lung fields, mediastinum, myocardium of the left ventricle, the left atrium as a cardiac blood pool, central region of the right lobe of the liver, left kidney, and both femoris muscles.The mean standardized uptake values (SUVs) of brain cortex and white matter were higher in healthy volunteers than in renal patients. The mean SUVs of the mediastinum at the level of the aortic arch and left atrium as a cardiac blood pool were lower in healthy volunteers than in patients with suspected renal failure. These regions differed between healthy volunteers and patients with suspected renal failure (P < 0.05).We found decreasing brain accumulation and increasing blood pool accumulation of FDG in patients with high plasma creatinine. Although the difference is small, this phenomenon will not have a huge effect on the assessment of FDG-PET imaging in patients with suspected renal failure.

Keywords: FDG-PET; Renal failure; Serum creatinine; Standardized uptake value

A case of sclerosing cholangitis with autoimmune pancreatitis evaluated by FDG-PET by Etsushi Kawamura; Daiki Habu; Shigeaki Higashiyama; Hiroyuki Tsushima; Yoshihiro Shimonishi; Yuji Nakayama; Masaru Enomoto; Joji Kawabe; Akihiro Tamori; Norifumi Kawada; Susumu Shiomi (pp. 223-228).

The extrapancreatic bile duct lesions in autoimmune pancreatitis are termed sclerosing cholangitis (SC with AIP), which is known to complicate AIP somewhat more frequently than other extrapancreatic lesions. In cases of SC with AIP, differentiation from primary SC, pancreatic cancer, and bile duct cancer is often difficult. In our patient, pancreatic cancer had to be ruled out at admission, given the findings of obstructive jaundice, pancreatic duct stenosis, and swelling of the pancreas. Fluorine-18-fluorodeoxyglucose positron emission tomography was useful in checking for the presence of extrapancreatic lesions, including SC, and was also useful in the evaluation of the response to steroid therapy for following the course of AIP.

Keywords: Fluorine-18 fluorodeoxyglucose positron emission tomography; Sclerosing cholangitis with autoimmune pancreatitis; IgG₄

Gallium scintigraphy in a case of tuberculous trochanteric bursitis by Etsushi Kawamura; Joji Kawabe; Chikako Tsumoto; Takehiro Hayashi; Ai Oe; Hiroko Kurooka; Jin Kotani; Shigeaki Higashiyama; Hiroyuki Tsushima; Daiki Habu; Susumu Shiomi (pp. 229-233).

We report a 67-year-old woman with systemic lupus erythematosus and systemic disseminated tuberculosis affecting the femoral trochanteric bursae, a site rarely affected by tuberculosis. For quantification of the inflammation with gallium-67 scintigraphy, we calculated the radioisotope count ratio in the most inflamed areas, the right lateral thorax and bursa of the right greater trochanter. Systemic scanning with this modality allowed evaluation of the extent of lesions and simple quantitative determination of the severity of inflammation, yielding information useful for the follow-up of the patient during the course of tuberculosis treatment.

Keywords: Gallium-67 scintigraphy; Tuberculous bursitis; Trochanteric bursa; Extrapulmonary tuberculosis; Systemic disseminated tuberculosis

Calciphylaxis and bone scintigraphy: case report with histological confirmation and review of the literature by Myo M. Han; Judy Pang; Kanade Shinkai; Ben Franc; Randy Hawkins; Carina M. Aparici (pp. 235-238).

We present a patient with a history of end-stage renal disease, who developed skin lesions in the bilateral calves a month after the initiation of hemodialysis. The lesions were biopsied, and the histological findings were consistent with a diagnosis of calciphylaxis. The patient had a baseline pretreatment bone scan that showed extensive systemic disease. The patient died 20 days after the imaging study. A review of the literature on bone scans and calciphylaxis is presented.

Keywords: Calciphylaxis; Bone scan; Bone scintigraphy; End-stage renal disease

Usefulness of F-18 FDG-PET in a long-term hemodialysis patient with renal cell carcinoma and pheochromocytoma by Nozomi Ozawa; Terue Okamura; Koichi Koyama; Yoshimasa Hamazawa; Hideto Senzaki; Shigeru Tanabe; Shinichi Ikemoto; Yuichi Inoue (pp. 239-243).

A patient who had been on long-term hemodialysis (HD) was diagnosed as having renal cell carcinoma (RCC) and pheochromocytoma. Abdominal computed tomography scanning demonstrated a right renal mass and a right adrenal mass, whereas positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) revealed increased accumulation in both the renal and adrenal masses. FDG-PET is useful for detecting RCC in HD patients because FDG is not excreted in the urine, but it is difficult to distinguish pheochromocytoma from an adrenal metastasis by this imaging method.

Keywords: FDG-PET; Renal cell carcinoma; Pheochromocytoma

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Annals of Nuclear Medicine (v.21, #4)