Check out our New Publishers' Select for Free Articles

Annals of Nuclear Medicine (v.26, #7)

Superior prognostic utility of gross and metabolic tumor volume compared to standardized uptake value using PET/CT in head and neck squamous cell carcinoma patients treated with intensity-modulated radiotherapy by Paul B. Romesser; Muhammad M. Qureshi; Bhartesh A. Shah; Luke T. Chatburn; Scharukh Jalisi; Anand K. Devaiah; Rathan M. Subramaniam; Minh Tam Truong (pp. 527-534).

To compare the prognostic utility of the 2-[¹⁸F] fluoro-2-deoxy-d-glucose (FDG) maximum standardized uptake value (SUV_max), primary gross tumor volume (GTV), and FDG metabolic tumor volume (MTV) for disease control and survival in patients with head and neck squamous cell carcinoma (HNSCC) undergoing intensity-modulated radiotherapy (IMRT).Between 2007 and 2011, 41 HNSCC patients who underwent a staging positron emission tomography with computed tomography and definitive IMRT were identified. Local (LC), nodal (NC), distant (DC), and overall (OC) control, overall survival (OS), and disease-free survival (DFS) were assessed using the Kaplan–Meier product-limit method.With a median follow-up of 24.2 months (range 2.7–56.3 months) local, nodal, and distant recurrences were recorded in 10, 5, and 7 patients, respectively. The median SUV_max, GTV, and MTV were 15.8, 22.2 cc, and 7.2 cc, respectively. SUV_max did not correlate with LC (p = 0.229) and OS (p = 0.661) when analyzed by median threshold. Patients with smaller GTVs (<22.2 cc) demonstrated improved 2-year actuarial LC rates of 100 versus 56.4 % (p = 0.001) and OS rates of 94.4 versus 65.9 % (p = 0.045). Similarly, a smaller MTV (<7.2 cc) correlated with improved 2-year actuarial LC rates of 100 versus 54.2 % (p < 0.001) and OS rates of 94.7 versus 64.2 % (p = 0.04). Smaller GTV and MTV correlated with improved NC, DC, OC, and DFS, as well.GTV and MTV demonstrate superior prognostic utility as compared to SUV_max, with larger tumor volumes correlating with inferior local control and overall survival in HNSCC patients treated with definitive IMRT.

Keywords: Head and neck cancer; PET/CT; Standardized uptake value (SUV); Gross tumor volume (GTV); Metabolic tumor volume (MTV); Intensity-modulated radiotherapy (IMRT)

Head motion evaluation and correction for PET scans with 18F-FDG in the Japanese Alzheimer’s disease neuroimaging initiative (J-ADNI) multi-center study by Yasuhiko Ikari; Tomoyuki Nishio; Yoko Makishi; Yukari Miya; Kengo Ito; Robert A. Koeppe; Michio Senda (pp. 535-544).

Head motion during 30-min (six 5-min frames) brain PET scans starting 30 min post-injection of FDG was evaluated together with the effect of post hoc motion correction between frames in J-ADNI multicenter study carried out in 24 PET centers on a total of 172 subjects consisting of 81 normal subjects, 55 mild cognitive impairment (MCI) and 36 mild Alzheimer’s disease (AD) patients.Based on the magnitude of the between-frame co-registration parameters, the scans were classified into six levels (A–F) of motion degree. The effect of motion and its correction was evaluated using between-frame variation of the regional FDG uptake values on ROIs placed over cerebral cortical areas.Although AD patients tended to present larger motion (motion level E or F in 22 % of the subjects) than MCI (3 %) and normal (4 %) subjects, unignorable motion was observed in a small number of subjects in the latter groups as well. The between-frame coefficient of variation (SD/mean) was 0.5 % in the frontal, 0.6 % in the parietal and 1.8 % in the posterior cingulate ROI for the scans of motion level 1. The respective values were 1.5, 1.4, and 3.6 % for the scans of motion level F, but reduced by the motion correction to 0.5, 0.4 and 0.8 %, respectively. The motion correction changed the ROI value for the posterior cingulate cortex by 11.6 % in the case of severest motion.Substantial head motion occurs in a fraction of subjects in a multicenter setup which includes PET centers lacking sufficient experience in imaging demented patients. A simple frame-by-frame co-registration technique that can be applied to any PET camera model is effective in correcting for motion and improving quantitative capability.

Keywords: FDG PET; Motion correction; J-ADNI; Multicenter

Thallium-201 scintigraphy for the assessment of long-term prognosis in patients with osteosarcoma by Anri Inaki; Junichi Taki; Hiroshi Wakabayashi; Hisashi Sumiya; Yoh Zen; Hiroyuki Tsuchiya; Seigo Kinuya (pp. 545-550).

The aim of this study was to confirm the prognostic value of ²⁰¹Tl scintigraphy in the midcourse of preoperative chemotherapy in patients with osteosarcoma.The 28 patients with biopsy-proven osteosarcoma were enrolled retrospectively in this study. Planar scintigraphy was performed 15 min after injection of 111 MBq ²⁰¹Tl before preoperative chemotherapy and after third course (midcourse) of chemotherapy in all patients. The ²⁰¹Tl uptake ratio was calculated by dividing the count density of the lesion by that of the contralateral normal area. The percentage reduction of the ²⁰¹Tl uptake ratio calculated by 100 × [(pre-chemotherapy ratio – mid-chemotherapy ratio)/pre-chemotherapy ratio] was compared with the histopathological response and long-term survival rate.Good histopathological response was observed in 16 patients. Mean follow-up period was 58.0 ± 41 months. Both overall and event-free survival rates of histopathologically good responders were significantly higher than that of poor responders (P = 0.018 and P = 0.0076). There was also significant correlation between pre-chemotherapeutic effect evaluated with ²⁰¹Tl scintigraphy and overall and event-free survival rate in all patients (P = 0.045 and P = 0.017, respectively), and in patients without metastasis at initial diagnosis (P = 0.043 and P = 0.031, respectively). ²⁰¹Tl scintigraphy performed in the middle of neoadjuvant chemotherapy can predict overall survival and event-free survival in patients with osteosarcoma.

Keywords: Thallium-201; Osteosarcoma; Neoadjuvant chemotherapy; Long-term prognosis

The utility of FDG-PET/CT as an effective tool for detecting recurrent colorectal cancer regardless of serum CEA levels by Yasemin Sanli; Serkan Kuyumcu; Zeynep Gozde Ozkan; Leyla Kilic; Emre Balik; Cuneyt Turkmen; Duygu Has; Goknur Isik; Oktar Asoglu; Yersu Kapran; Isik Adalet (pp. 551-558).

Tumor recurrence of colorectal cancers (CRC) is generally followed up by analyses of the serum carcinoembryonic antigen (CEA) levels. However, recent evidence suggests that tumor recurrence can also be visualized by 18F-fluoro-deoxyglucose emission tomography/computed tomography (FDG-PET/CT) in patients with normal CEA levels. We retrospectively evaluated the diagnostic performance of FDG-PET/CT in patients with suspected recurrence of CRC by comparing PET/CT performance in patients with normal CEA levels with PET/CT performance in patients with elevated CEA levels.A total of 235 patients with CRC who had been treated with surgery and/or chemotherapy/radiotherapy underwent PET/CT for the detection of tumor recurrence. The patients [96 females and 139 males; age (mean ± SD) 59.9 ± 12.6 years; range 18–85] were divided into 2 groups based on whether their CEA levels were normal (<5 ng/ml) (Group 1, n = 118) or elevated (>5 ng/ml) (Group 2, n = 117). All of the patients had suspected recurrence based on raised CEA levels, clinical symptoms, and/or tumor detection using other imaging modalities.Of the 235 patients, 172 (73.1 %) had disease recurrence confirmed by a pathological examination (either biopsy or surgical exploration) or clinical follow-up studies. The FDG-PET/CT study yielded a true positive in detecting recurrence in 169 (71.9 %) patients, a true negative in 53 (22.5 %) patients, a false negative in 3 (1.2 %) patients and a false positive in 10 (4.2 %) patients. CRC recurrence was detected in 64.4 % (76/118) and 88 % (103/117) patients in Group 1 and Group 2 with FDG-PET/CT, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the FDG-PET/CT study for establishing recurrence were 100, 84, 89.4, 100 and 93.2 %, respectively, for Group 1; by contrast, these parameters were 97.1, 84.6, 98, 78.5 and 95.7 %, respectively, for Group 2. The number of patients with hepatic and extra-hepatic metastases, such as lung and abdominal lymph node metastasis, detected with FDG-PET/CT was significantly different in Group 1 than in Group 2; however, the number of patients with local recurrence and peritoneal implants detected with FDG-PET/CT was not different between the two groups.FDG-PET/CT can accurately detect tumor recurrence in patients with suspected recurrent CRC, even for patients with normal CEA levels.

Keywords: Colorectal cancer; Recurrence; CEA levels; FDG-PET/CT

Risk stratification and prognostic assessment by myocardial perfusion-gated SPECT in patients with left bundle-branch block and low-intermediate cardiac risk by Luca Nai Fovino; Giorgio Saladini; Gino Paolo Mormino; Francesca Saladini; Renato Razzolini; Laura Evangelista (pp. 559-570).

In high-risk patients with left bundle-branch block (LBBB), functional but not perfusion parameters yield incremental prognostic information. The aim of our study was to evaluate the prognostic value of gated single photon emission computed tomography (SPECT) in low-intermediate risk LBBB patients.One hundred seventy-six subjects underwent stress-rest dual-day protocol 99mTc sestamibi-gated SPECT and were dichotomized in two groups: without LBBB (Group 1, n = 86) and with LBBB (Group 2, n = 90). Patients were followed for 32 ± 18 months. Cox regression multivariate analysis was used to determine which variable was the best predictor of cardiac event. Event-free survival curves were computed by Kaplan–Meier method.Myocardial perfusion scintigraphy was abnormal in 32 and 60 patients for Groups 1 and 2, respectively (37 vs. 67 %, p < 0.001). In Groups 1 and 2, the mean summed stress score (SSS) was 3.7 ± 5.6 versus 6.7 ± 6.4, while the mean summed difference score (SDS) was 1.6 ± 2.5 versus 2.7 ± 3.3 (both p < 0.005); therefore 34 % of patients in Group 1 and 53 % of those in Group 2 presented myocardial ischemia. All functional parameters were significantly different between the two subsets (all p < 0.005). Follow-up was completed in 161 patients (92 %); 10 events occurred in Group 1 and 20 in Group 2 (14 vs. 25 %). The event-free survival was significantly higher in patients with normal than in those with abnormal scan (85 vs. 63 %, p < 0.005); moreover, the prognosis of patients with LBBB was significantly worse. At multivariate analysis, SDS was found to be the only independent predictor of cardiac events both in all patients and in LBBB population (HR 3.08, and HR 4.99, p < 0.05).This is the first study to assess the prognostic value of gated SPECT in patients with LBBB and low-intermediate cardiac risk. Both perfusion and functional data obtained by gated SPECT are different between patients with and without LBBB. However, SDS is the only predictor of events. Thus, the amount of reversible ischemia at gated SPECT has a discriminative power in stratifying the cardiac risk of LBBB population.

Keywords: Myocardial perfusion imaging; Gated SPECT; Left bundle-branch block; CAD; Prognosis

Is whole-body fluorine-18 fluorodeoxyglucose PET/CT plus additional pelvic images (oral hydration–voiding–refilling) useful for detecting recurrent bladder cancer? by Zhongyi Yang; Jingyi Cheng; Lingling Pan; Silong Hu; Junyan Xu; Yongping Zhang; Mingwei Wang; Jianping Zhang; Dingwei Ye; Yingjian Zhang (pp. 571-577).

Because of the urinary excretion of fluorine-18 fluorodeoxyglucose (¹⁸F-FDG), FDG-PET or PET/CT is thought of little value in patients with bladder cancer. The purpose of our study was to investigate the value of ¹⁸F-FDG PET/CT with additional pelvic images in detection of recurrent bladder cancers.From December 2006 to August 2010, 35 bladder cancer patients (median age 56 years old, ranging from 35 to 96) underwent routine ¹⁸F-FDG PET/CT. To better detect bladder lesions, a new method called as oral hydration–voiding–refilling was introduced, which included that all the patients firstly received oral hydration, then were required to void frequently and finally were demanded to hold back urine when the additional pelvic images were scanned. Lesions were confirmed by either histopathology or clinical follow-up for at least 6 months.Finally, 12 recurrent cases of 35 patients were confirmed by cystoscope. PET/CT correctly detected 11 of them. Among these 11 true positive patients, 5 patients (45.5 %) were detected only after additional pelvic images. Lichenoid lesions on the bladder wall were missed, which caused 1 false negative result. All three false positive cases were testified to be inflammatory tissues by cystoscope. Therefore, the sensitivity, specificity and accuracy of PET/CT were 91.7 % (11/12), 87.0 % (20/23) and 88.6 % (31/35), respectively.PET/CT with additional pelvic images can highly detect recurrent lesions in residual bladder tissues. Our method with high accuracy and better endurance could be potentially applied.

Keywords: Positron emission tomography/computed tomography; Fluorine-18 fluorodeoxyglucose; Bladder cancer

Salivagram revisited: justifying its routine use for the evaluation of persistent/recurrent lower respiratory tract infections in developmentally normal children by Vijay Harish Somasundaram; Padma Subramanyam; Shanmugasundaram Palaniswamy (pp. 578-585).

To assess and establish the utility of radionuclide salivagram in the routine evaluation of developmentally normal children with persistent/recurrent lower respiratory tract infection.113 neurodevelopmentally normal children diagnosed with persistent/recurrent lower respiratory tract infection underwent a salivagram and a milk scan on two consecutive days. Frequency of detection of pulmonary aspiration by either procedure individually and increment in detection rates on combining the two were assessed. The agreement between the tests was also studied.Antegrade pulmonary aspiration was demonstrated using the salivagram in 39.2 % of infants and 16.1 % of children between the ages of 1 and 2 years. No antegrade aspiration was seen in children above the age of 2 years. 44 % of all antegrade aspirations identified were bilateral, while remaining 66 % were into the right lung. Milk scan revealed gastroesophageal reflux in 38 % of children and most commonly in those above the age of 2 years. Diagnosis of pulmonary aspiration as an underlying cause of the lung pathology increased from 38 % with the use of milk scan alone to 53.9 % on combining the procedures. There was a poor agreement between the two procedures (kappa −0.103).Antegrade pulmonary aspiration can be demonstrated as an underlying cause for persistent/recurrent lower respiratory tract infection in developmentally normal children, with age being an important clinical predictor. Combined use of salivagram and milk scan is warranted to objectively evaluate pulmonary aspiration in children.

Keywords: Salivagram; Milk scan; Pulmonary aspiration; Persistent/recurrent pneumonia; Gastroesophageal reflux

Assessment of bone scans in advanced prostate carcinoma using fully automated and semi-automated bone scan index methods by Yoshiko Takahashi; Mana Yoshimura; Kunihito Suzuki; Tsuyoshi Hashimoto; Hideji Hirose; Kenji Uchida; Shingo Inoue; Kiyoshi Koizumi; Koichi Tokuuye (pp. 586-593).

As metastasis of prostate carcinoma occurs in approximately 80 % of terminal prostate carcinoma patients, the prognostic value of the prediction of prostate carcinoma by bone scintigraphy is important. We compared the automated and semi-automated bone scan index (BSI) system with extent of disease (EOD) grade if there is a possibility to substitute for EOD grading.We evaluated the bone scintigraphic images of 158 prostate carcinoma patients (mean age, 69.2 years old; range 50–97). Bone scans were obtained approximately 3 h after the intravenous injection of 740 MBq technetium-99 m-methylene diphosphonate. EOD grade was evaluated by 2 experienced radiologists using bone scintigraphy, magnetic resonance imaging, and computed tomography. We calculated the BSI using the Bonenavi^® system (Fujifilm RI Pharma Co., Ltd.), utilizing data from a Japanese database. The semi-automated BSI of the patients was obtained by modifying the automated BSI independently by 3 radiologists (referred to as “observers” in this study) with 25, 10, and 4 years of experience. We then compared the EOD with the corresponding 4 independent BSIs for each patient. We used the Steel–Dwass test for multiple comparisons of the BSI among different EOD groups of patients. We analyzed the receiver-operating characteristics (ROC) curve to determine the cutoff values of sensitivity and specificity, which were both set at 95 %.There were significant correlations observed among the mean EOD and BSI scores as determined using the Bonenavi^® system for every patient group for all observers and the automated method. There was also a statistically significant difference in the mean BSI among all EOD groups (grades 0, 1, or 2–4) for all observers and the automated method. Each ROC curve showed an ideal shape and was within the optimal cutoff range.On the basis of the present results, BSI as calculated using the Bonenavi^® system significantly correlated with EOD. Sensitivity and specificity as measured by the fully automated method were lower than those of semi-automated BSI with modification by radiologists. Therefore, semi-automated BSI is considered to have the possibility to substitute for EOD grading to predict the survival of prostate carcinoma patients with bone metastases, with only slight interobserver variation.

Keywords: Bone scan index; Prostate carcinoma; Bone metastasis

F-18 FDG uptake in borderline intraductal papillary neoplasms of the bile duct by Aisheng Dong; Hui Dong; Ling Zhang; Changjing Zuo (pp. 594-598).

Intraductal papillary neoplasm of the bile duct (IPN-B) has been recently proposed as the biliary counterpart of intraductal papillary mucinous neoplasm of the pancreas. Histologically, IPN-B can be classified into adenoma, borderline, carcinoma in situ, and invasive carcinoma. Two patients with suspected intraductal tumor underwent fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. One patient showed an FDG-avid tumor in the right liver with SUV_max of 9.4 in early images and 11.3 in delayed images. The patient underwent complete tumor resection. Adenoma with high-grade dysplasia was confirmed by pathology. The other patient showed an FDG-avid polypoid lesion at the distal common bile duct with SUV_max of 5.4. The lesion was endoscopically resected. Histopathologic findings showed adenoma with low-grade dysplasia. These two cases highlight that IPN-B should be included in the differential diagnosis of abnormal biliary intraductal FDG accumulation along with carcinoma, and inflammatory and infectious processes.

Keywords: Intraductal papillary neoplasm of the bile duct; Bile duct; F-18 FDG; PET/CT

Benign fibrous dysplasia on [¹¹C]choline PET: a potential mimicker of disease in patients with biochemical recurrence of prostate cancer by Chris N. Gu; Christopher H. Hunt; Vance T. Lehman; Geoffrey B. Johnson; Felix E. Diehn; Kara M. Schwartz; Laurence J. Eckel (pp. 599-602).

We present the case of a 74-year-old male with biochemical recurrence of prostate cancer who underwent [¹¹C]choline PET/CT. The PET/CT demonstrated an intense focus of uptake within the skull base that was initially felt to potentially represent metastatic disease. Subsequent evaluation with MRI and dedicated thin-section CT revealed this area to be benign fibrous dysplasia of the bone. The focal uptake on PET/CT with [¹¹C]choline in benign fibrous dysplasia represents a potential mimicker of metastatic disease. Due to recognizing this benign process, our patient was able to avoid systemic treatment and/or focal radiation and was treated with cryotherapy for biopsy-proven local recurrence within the prostate bed. While benign fibrous dysplasia can demonstrate increased radiotracer uptake on other modalities (i.e., bone scintigraphy, FDG PET/CT), its appearance on [¹¹C]choline PET/CT has been largely overlooked in the literature. With the increasing use of [¹¹C]choline PET/CT for biochemical recurrent prostate cancer evaluation, it is important to understand this potential mimicker of disease.

Keywords: PET/CT; Prostate cancer; [¹¹C]choline; Fibrous dysplasia

New knowledge about the bremsstrahlung image of strontium-89 with the scintillation camera by Hiroto Narita; Kiyoshi Hirase; Mayuki Uchiyama; Masahiro Fukushi (pp. 603-607).

Strontium-89 (⁸⁹Sr) chloride has been used to treat metastases in bone. A method to visualize the distribution of ⁸⁹Sr chloride with a scintillation camera was developed in 1996. Studies using bremsstrahlung imaging have shown that ⁸⁹Sr accumulates in bone and that the bremsstrahlung generated from biological tissue surrounding bone does not exceed 30 keV. However, it was not clear how low-energy bremsstrahlung from bone can produce peak energy levels of around 75 keV. We speculate that a different (unidentified) factor is involved.The energy spectrum of an ⁸⁹Sr source was acquired with a scintillation camera with or without a low-to-medium-energy general-purpose collimator. The energy window was set at 20–650 keV for 4 windows. A 50-mm thick acrylic block was placed between the scintillation camera and the ⁸⁹Sr source to exclude the effects of bremsstrahlung. The energy spectrum of ⁸⁹Sr covered with lead was acquired using the scintillation camera without a collimator.With the collimator the energy spectrum curve was similar to that without the 50 mm of acrylic. The energy spectrum curve showed peaks at about 75, 170, and 520 keV. Without the collimator the energy spectrum showed a similar curve but no peak at 75 keV peak. The curve was similar to that obtained with the scintillation camera and the collimator; however, the curve obtained when the ⁸⁹Sr source had been placed in a lead container was similar to that obtained when the source was unshielded, and the collimator was not attached to the scintillation camera.If bremsstrahlung of ⁸⁹Sr produces an image, a low-energy spectrum region should decrease when acrylic is placed between the ⁸⁹Sr source and the scintillation camera. However, similar curves were obtained both with the acrylic in place and without the acrylic. Therefore, we believe that the radiation detected by the scintillation camera was not bremsstrahlung due to the beta rays of ⁸⁹Sr. Most ⁸⁹Sr preparations are contaminated by ⁸⁵Sr, and most of the gamma ray energy of ⁸⁵Sr is 514 keV. The scintillation camera detected the characteristic X-ray energy of about 75 keV from the materials of the collimator (lead and others) through interaction with the gamma rays of ⁸⁵Sr.

Keywords: Strontium-89; Strontium-85; Scintillation camera; Bremsstrahlung; Characteristic X-ray

Sections

Personal tools

Annals of Nuclear Medicine (v.26, #7)

Sections

Personal tools

Local resources

Annals of Nuclear Medicine (v.26, #7)