Association Between 18F-Fluorodeoxyglucose Uptake and Mutation Status of Epidermal Growth Factor Receptor in Sinonasal Tract Cancer.

BACKGROUND/AIM: The Warburg effect of cancer has been applied to detect various carcinomas though the 18F-fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography with computed tomography (PET/CT). 18F-FDG-PET/CT in lung cancer predicted the mutation status of epidermoid growth factor receptor (EGFR). This study aimed to investigate whether 18F-FDG uptake parameters were significantly related to EGFR mutation status in patients with sinonasal tract squamous cell carcinoma (STSCC). PATIENTS AND METHODS: Twenty-nine tumor specimens of primary STSCC from patients with definitive treatment were collected. RESULTS: The 18F-FDG uptake from primary tumors was not different between mutant- and wild-status of EGFR on either Mann-Whitney U-test or the receiver operating curve. A metabolic tumor volume of ≥25 with the minimum p-value from the log-rank test for STSCC-specific survival was associated with a significantly shorter STSCC-specific, disease-free, local recurrence-free survival on the univariate and multivariate analyses adjusted for the clinical stage, treatment, and EGFR status. CONCLUSION: 18F-FDG-PET/CT did not predict mutation of the EGFR status in STSCC.

Metabolic Tumour Volume as a Predictor of Survival for Sinonasal Tract Squamous Cell Carcinoma.

BACKGROUND: High uptake of F18-fluorodeoxyglucose parameters for glucose metabolism is related to shorter survival in sinonasal tract cancer with various histological classifications. We investigated whether F18-fluorodeoxyglucose uptake parameters are associated with survival outcomes for patients with only squamous cell carcinoma (SCC) in the sinonasal tract that are treated either with surgery or nonsurgery. METHODS: We retrospectively observed F18-fluorodeoxyglucose uptake parameters on positron emission tomography with computed tomography for the primary tumour of SCC in 39 patients. Log-rank test or a Cox regression model with 95% confidence interval (95%CI) and hazard ratio (HR) were used for monovariable or multivariable analysis, respectively. We determined cut-off values of the F18-fluorodeoxyglucose uptake parameters using the lowest p value for monovariable sinonasal tract cancer-specific survival analysis. RESULTS: Monovariable analysis showed that patients with metabolic tumour volume (MTV) ≥ 21.8 had a shorter cancer-specific, disease-free and local recurrence-free survival than those with MTV < 21.8. After adjusting for age, gender, clinical stage and treatment group in the multivariable analysis, MTV (≥21.8/<21.8) was related to shorter cancer-specific (HR: 3.69, 95%CI: 1.17-12.0), disease-free (HR: 3.38, 95%CI: 1.19-9.71) and local recurrence-free (HR: 5.42, 95%CI: 1.59-20.3) survivals. CONCLUSIONS: MTV as advances in diagnostics of sinonasal tract SCC is a predictor.

Total lesion glycolysis as a predictor of clinical T3-4a laryngeal cancer with laryngectomy or nonlaryngectomy.

ABSTRACT: The purpose of the present study is to investigate whether the 18F-fluorodeoxyglucose (18F-FDG) uptake parameter is related to survival outcomes for patients with clinical T3-T4a laryngeal cancer with various definitive treatments including total laryngectomy (TL). Parameters of 18F-FDG uptake in the primary tumors of 46 cases which were assessed by positron emission tomography with computed tomography were enrolled in the present observation study. Monovariate or multivariate survival analyses were performed with log-rank test or Cox regression model, with the hazard ratio (HR) and 95% confidence interval (CI), respectively. Cutoff values of the 18F-FDG uptake parameters were determined by the lowest P-value for monovariate overall survival. In the monovariate analysis, both metabolic tumor volume ≥13.1 and total lesion glycolysis (TLG) ≥46.5 were significantly associated with shorter overall survival, and TLG ≥46.5 was also related to a reduction in distant metastasis-free survival. In the multivariate analysis adjusting for clinical T classification (cT4/cT3) and treatment group (TL/non-TL), TLG (≥46.5/<46.5) was associated with both poorer overall (HR: 3.16, 95% CI: 1.10-9.49) and distant metastasis-free (HR: 8.91, 95% CI: 1.93-62.6) survival. In conclusion, TLG is a predictor for survival in laryngeal cancer.

Thrombolysis and Mechanical Thrombectomy for Acute Ischemic Stroke in Pregnancy: A Case Report.

Objective: Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy (MT) are effective treatments for acute ischemic stroke (AIS). However, the treatment for AIS in pregnancy is not established because no clinical trials have included pregnant patients. We present a case of middle cerebral artery (MCA) M2 segment occlusion in pregnancy treated with IV thrombolysis and endovascular therapy. Case Presentation: A 36-year-old woman being 6 weeks pregnant presented with right-sided hemiparesis and aphasia. MRI showed a high-intensity area on diffusion-weighted imaging of the left parietal lobe, and MRA showed left MCA M2 segment occlusion. She underwent IV rt-PA and MT and achieved thrombolysis in cerebral infarction 2b revascularization without complications. The protein S concentration was lower than that in the physiological changes during pregnancy. She was diagnosed with embolic stroke related to coagulopathy in pregnancy, and she underwent anticoagulation. At the 3-month follow-up, the modified Rankin Scale was 0. She miscarried at 4 months, and the fetal death was presumed to be obstetric cause. Conclusion: IV rt-PA and MT may be effective and safe treatments for pregnant patients. Estimated fetal radiation exposure during MT is low and is presumed not to affect fetal development. We should mitigate the radiation dose and reduce the dose of iodinated contrast agents, particularly in pregnant patients.

Mechanical Thrombectomy for Acute Middle Cerebral Artery Occlusion Caused by Tumor Embolism: A Case Report.

Objective: We report a case of acute middle cerebral artery (MCA) occlusion caused by tumor embolism. Case Presentation: A 64-year-old man with lung cancer presented with sudden onset left-sided hemiparesis and sensory disturbance. Diffusion-weighted imaging (DWI) revealed hyper-intense foci in the right MCA territory and magnetic resonance angiography (MRA) demonstrated right MCA M2 segment occlusion. Mechanical thrombectomy (MT) was performed with Thrombolysis in Cerebral Infarction 2B recanalization. On histopathology, thrombus composed of fibrin and squamous cell carcinoma was observed. We diagnosed him with tumor embolism from lung cancer that invaded the pulmonary vein and the left atrium. Conclusion: Tumor cells may be confirmed by pathological examination regardless of the morphology of the embolus. Pathological examination of the cerebral embolus is useful for the accurate diagnosis of ischemic stroke subtypes.

Association between treatment package time and clinical predictors in oropharyngeal cancer.

The aim of the present study is to investigate the association of treatment package time with the survival outcomes and clinical parameters in patients with oropharyngeal squamous cell carcinoma.A total of 49 patients who underwent definitive treatment were enrolled. The treatment package time was calculated in days from the start of any treatment to the completion of all treatments, including postoperative treatment and salvage surgery for residual tumor.On univariate analyzes, treatment package time ≥118 days, sake index ≥60, Brinkman index ≥450, maximum standardized uptake value ≥42.45, and the presence of synchronous cancer were significantly associated with shorter oropharyngeal squamous cell carcinoma-specific survival. Moreover, a treatment package time of ≥118 days was significantly correlated with shorter overall survival and distant metastasis-free survival. On multivariate analyzes, Brinkman index ≥450 was significantly associated with shorter oropharyngeal squamous cell carcinoma-specific and locoregional recurrence-free survival, and the presence of synchronous cancer was significantly associated with shorter overall and distant metastasis-free survival.In conclusion, a relatively long treatment package time was a predictor of low survival outcomes in oropharyngeal squamous cell carcinoma by univariate analysis.

[Carotid Artery Stenting in a Tortuous Artery Results:A Case Report].

BACKGROUND: After carotid artery stenting(CAS)in a tortuous artery, the geometrics and elongation of the carotid artery sometimes change. It is not clear whether these changes induce post stent re-stenosis. We report a case of re-stenosis that occurred two years after CAS in a tortuous artery that required carotid endarterectomy with removal of the stent. CASE PRESENTATION: CAS was performed on a 78-year-old male who presented with symptoms of severe stenosis of a tortuous internal carotid artery. Eighteen months after stenting, the echogram revealed moderate stenosis at the distal end of the stent. Six months later, this developed into severe stenosis. Carotid angiography showed that the end of the stent was touching the wall of the internal carotid artery, and blood was passing through the stent wall. A re-CAS was difficult to perform;hence carotid endarterectomy with removal of the stent was performed successfully. He was discharged without any new neurological deficits. CONCLUSION: CAS on a tortuous carotid artery sometimes results in changes to the geometry and elongation of the artery. Potentially, this can lead to changes in the positional relationship between the stent and the artery, alteration of the wall shear stress and re-stenosis. Careful follow-up is needed after CAS on a tortuous artery.

A complementary scheme for automated detection of high-uptake regions on dedicated breast PET and whole-body PET/CT.

In this study, we aimed to develop a hybrid method for automated detection of high-uptake regions in the breast and axilla using dedicated breast positron-emission tomography (db PET) and whole-body PET/computed tomography (CT) images. In our proposed method, high-uptake regions in the breast and axilla were detected using db PET images and whole-body PET/CT images. In db PET images, high-uptake regions in the breast were detected using adaptive thresholding technique based on the noise characteristics. In whole-body PET/CT images, the region of the breast that includes the axilla was first extracted using CT images. Next, high-uptake regions in the extracted breast region were detected on the PET images. By integration of the results of the two types of PET images, a final candidate region was obtained. In the experiments, the accuracy of extracting the region of the breast and detection ability was evaluated using clinical data. As a result, all breast regions were extracted correctly. The sensitivity of detection was 0.765, and the number of false positive cases were 1.8, which was 30% better than those on whole-body PET/CT alone. These results suggested that the proposed method, combining the two types of PET images is effective for improving detection performance.

Uptake of 18F-Fluorodeoxyglucose in Major Salivary Gland Cancer Predicts Survival Adjusting for Pathological Stage.

AIM: To investigate whether 18F-fluorodeoxyglucose uptake is associated with overall survival in patients with major salivary gland cancer using univariate and multivariate analyses after adjusting for pathological stage (eighth edition of the International Union Against Cancer). PATIENTS AND METHODS: A total of 32 patients with major salivary gland cancer treated with curative surgery were enrolled. Parameters for 18F-fluorodeoxyglucose uptake were assessed by positron-emission tomography combined with computed tomography. RESULTS: Using univariate and multivariate analyses after adjusting for pathological stage, a maximum standardized uptake value ≥26, peak standardized uptake value ≥20.3, metabolic tumor volume ≥9.7, and total lesion glycolysis ≥263 were significantly correlated with shorter overall survival. CONCLUSION: Parameters of 18F-fluorodeoxyglucose uptake in major salivary gland cancer are predictive of overall survival after adjusting for the pathological stage.

Peak of Standardized Uptake Value in Oral Cancer Predicts Survival Adjusting for Pathological Stage.

BACKGROUND/AIM: To predict survival outcomes of different patients with the same stage of disease is difficult. The possible correlation between 18F-fluorodeoxyglucose (18F-FDG) uptake parameters and survival outcomes was investigated in oral squamous cell carcinoma patients by multivariate analysis adjusted for the pathological stage according to the 8th edition of the tumor-node-metastasis (TNM) classification of the Union for International Cancer Contro. PATIENTS AND METHODS: 18F-FDG-uptake parameters of 28 patients were assessed by positron emission tomography with computed tomography (PET/CT). RESULTS: A peak of standardized uptake value of primary tumor (p-SUVpeak) of ≥14.1 was significantly correlated with shorter overall survival by univariate and multivariate analyses adjusted for the pathological TNM stage. A p-SUVpeak of ≥14.1 was significantly associated with shorter local recurrence-free survival and disease-free survival. CONCLUSION: A higher p-SUVpeak on pretreatment 18F-FDG-PET/CT is a prognostic parameter of identifying lower survival outcomes.

Total lesion glycolysis on FDG-PET/CT before salvage surgery predicts survival in laryngeal or pharyngeal cancer.

We investigated whether 18F-fluorodeoxyglucose uptake parameters using positron emission tomography combined with computed tomography predicts several survival outcomes, including lung metastasis-free survival, in patients with laryngeal or pharyngeal cancer who underwent salvage surgery. The maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis were calculated as 18F-fluorodeoxyglucose uptake parameters in 51 patients with laryngeal or pharyngeal cancer before salvage surgery. In univariate analysis, the maximum standardized uptake value ≥ 22.8, metabolic tumor volume ≥ 2.4, and total lesion glycolysis ≥ 5.4 were significantly correlated with shorter overall survival. In multivariate analysis with adjustment for clinical stage, patients with total lesion glycolysis ≥ 5.4 exhibited significantly shorter overall survival. Furthermore, total lesion glycolysis ≥ 5.4 was significantly correlated with shorter disease-specific survival, distant metastasis-free survival, and lung metastasis-free survival in univariate analysis. In conclusion, total lesion glycolysis predicts the survival outcomes including lung metastasis in patients with laryngeal or pharyngeal cancer who underwent salvage surgery.

FDG-PET/CT predicts survival and lung metastasis of hypopharyngeal cancer in a multi-institutional retrospective study.

OBJECTIVES: We investigated a possible correlation between the maximum standardized uptake value (SUVmax), which is assessed by pretreatment 18F-fluorodeoxyglucose positron emission tomography with computed tomography, and the overall survival (OS) in patients with hypopharyngeal squamous cell carcinoma from two institutions on long-term follow-up, and examined whether SUVmax is correlated with several survival outcomes, including lung metastasis-free survival. METHODS: A total of 81 patients were enrolled. The survival rate was calculated by the Kaplan-Meier method. Both univariate and multivariate survival analyses were assessed by a Cox proportional hazards model. RESULTS: SUVmax ≥15.2 in institution A (p = 0.0306) or SUVmax ≥8 in institution B (p = 0.0132) was significantly predictor of a lower OS. We disaggregated the data by high SUVmax (SUVmax ≥15.2 from institution A and SUVmax ≥8 from institution B) and low SUVmax (SUVmax <15.2 from institution A and SUVmax <8 from institution B). Patients with a high SUVmax exhibited a significantly lower OS in both univariate (p = 0.001) and multivariate (p = 0.0046) analyses for adjusted for the clinical stage and treatment group. The patients with a high SUVmax exhibited significantly shorter disease-specific (p = 0.0068), distant metastasis-free (p = 0.0428), and lung metastasis-free (p = 0.0328) survivals. CONCLUSIONS: High SUVmax was significantly correlated with a lower OS, disease-specific survival, distant metastasis-free survival, and lung metastasis-free survival in a multi-institutional retrospective study.

Impact of total lesion glycolysis measured by 18F-FDG-PET/CT on overall survival and distant metastasis in hypopharyngeal cancer.

The present study investigated the possible correlation between 18F-2-fluorodeoxyglucose (18F-FDG)-uptake parameters and clinicopathological parameters in hypopharyngeal squamous cell carcinoma (HPSCC). A total of 53 patients, newly diagnosed with HPSCC, received pretreatment 18F-FDG-positron emission tomography/computed tomography (PET/CT). Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and peak standardized uptake values (SUVmax and SUVpeak) were calculated as 18F-FDG-uptake parameters of the primary tumor. Tumor thickness, depth of invasion and pathological tumor volume were pathologically measured. Upon univariate survival analysis, SUVmax ≥28.5, SUVpeak ≥19, MTV ≥12 and TLG ≥42 were significantly associated with a shorter overall survival (OS) time, and MTV ≥12 and TLG ≥42 were significantly associated with a shorter distant metastasis-free survival (DMFS) time. Upon multivariate analysis with adjustment for clinical T category and treatment group, patients with SUVmax ≥28.5 exhibited a significantly shorter OS time, while TLG ≥42 was significantly correlated with shorter OS and DMFS times. Upon simple regression analysis, TLG was found to be significantly associated with tumor thickness and depth of invasion, while MTV was found to be closely associated with pathological tumor volume. In conclusion, pretreatment 18F-FDG-PET/CT is likely to provide valuable prognostic parameters in HPSCC.

[Ruptured Dissecting Distal Superior Cerebellar Artery Aneurysm Successfully Treated with Coil Embolization: A Case Report].

BACKGROUND: Ruptured dissecting superior cerebellar artery aneurysms are rare, and only 12 cases have been reported. We report a case of dissecting aneurysm of the distal superior cerebellar artery presenting with subarachnoid hemorrhage. CASE PRESENTATION: An 80-year-old man presented with a three-day history of headache and diplopia. CT revealed slight subarachnoid hemorrhage and CT angiography demonstrated a dissecting aneurysm located in the distal portion of the left superior cerebellar artery. Initially, we chose conservative therapy. Ten days later, the patient became drowsy. Repeat CT showed that the amount of the subarachnoid hematoma increased and the aneurysm enlarged. Emergent endovascular coil embolization with parent artery occlusion was performed successfully. Postoperative MRI revealed no infarction in the cerebellum or brain stem. Delayed ischemic deficits were not observed after treatment. CONCLUSION: Endovascular parent artery occlusion of the distal superior cerebellar artery is an effective method with low morbidity for treatment of ruptured dissecting distal superior cerebellar artery aneurysms.

Correlation between 18F-FDG-uptake and in vitro chemosensitivity of cisplatin in head and neck cancer.

AIM: High [18F]-2-fluorodeoxyglucose (18F-FDG) -uptake of primary tumor, assessed by pretreatment positron emission tomography combined computed tomography (PET/CT), has indicated poor overall survival (OS) in head and neck cancer (HNC).We investigated the correlation between 18F-FDG-uptake and in vitro chemosensitivity of cisplatin using histoculture drug response assay in HNC. PATIENTS AND METHODS: Twenty-eight patients were evaluated. The maximum standardized uptake value (SUVmax) and inhibition index (I.I.) cisplatin were calculated as 18F-FDG-uptake and in vitro chemosensitivity of cisplatin. RESULTS: Each SUVmax10.5 or I.I.cisplatin<50 could significantly differentiate shorter survival group by OS analyses. I.I.cisplatin of patients with SUVmax≥10.5 was significantly greater. In 19 patients with SUVmax≥10.5, those who received treatment with cisplatin-based chemotherapy exhibited a significant correlation with longer OS. CONCLUSION: Cisplatin hasthe potential to improve OS for HNC patients that were predicted as shorter OS by 18F-FDG-PET/CT.

Efficacy of magnetic resonance imaging at 3 T compared with 1.5 T in small pituitary tumors for stereotactic radiosurgery planning.

PURPOSE: The objective of this study was to determine the value of high-field magnetic resonance imaging and to clarify the characteristics of each image among three-dimensional gradient echo (3D-GRE), two-dimensional spin echo (2D-SE) and inversion recovery (2D-IR) sequences used as contrast-enhanced T1-weighted images for stereotactic irradiation treatment planning of sellar lesions. MATERIALS AND METHODS: Pulse sequences of 2D-SE and 3D-spoiled gradient recalled acquisition in the steady state (3D-SPGR) using GRE at 1.5 T and 2D-IR and 3D-fast SPGR (3D-FSPGR) at 3 T after injection of contrast material were acquired for 14 small pituitary tumors. As quantitative methods, signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were evaluated using a region-of-interest analysis. RESULTS: There was no significant difference in SNR between 1.5-T SPGR and 3-T FSPGR, while 3-T IR was superior to 1.5-T SE. The 2D-SE and -IR provided significantly better CNR than 3D-GRE between tumor and normal structures. CONCLUSIONS: Three Tesla was found to be superior to 1.5 T in distinguishing tumors from the normal sellar structure. Optimal dose planning will utilize each advantage of imaging; 3D-GRE allows high-resolution acquisition and 2D-SE and -IR can offer better tissue contrast.

Hybrid method for the detection of pulmonary nodules using positron emission tomography/computed tomography: a preliminary study.

PURPOSE: In this study, an automated scheme for detecting pulmonary nodules using a novel hybrid PET/CT approach is proposed, which is designed to detect pulmonary nodules by combining data from both sets of images. METHODS: Solitary nodules were detected on CT by a cylindrical filter that we developed previously, and in the PET imaging, high-uptake regions were detected automatically using thresholding based on standardized uptake values along with false-positive reduction by means of the anatomical information obtained from the CT images. Initial candidate nodules were identified by combining the results. False positives among the initial candidates were eliminated by a rule-based classifier and three support vector machines on the basis of the characteristic features obtained from CT and PET images. RESULTS: We validated the proposed method using 100 cases of PET/CT images that were obtained during a cancer-screening program. The detection performance was assessed by free-response receiver operating characteristic (FROC) analysis. The sensitivity was 83.0% with the number of false positives/case at 5.0, and it was 8% higher than the sensitivity of independent detection systems using CT or PET images alone. CONCLUSION: Detection performance indicates that our method may be of practical use for the identification of pulmonary nodules in PET/CT images.

Utility of high-definition FDG-PET image reconstruction for lung cancer staging.

BACKGROUND: High-definition (HD) positron emission tomography (PET) image reconstruction is a new image reconstruction method based on the point spread function system, which improves the spatial resolution of the images. PURPOSE: To compare the utility of HD reconstruction of PET images for staging lung cancer with that of conventional 2D ordered subset expectation maximization + Fourier rebinning (2D) reconstruction. MATERIAL AND METHODS: Thirty-five lung cancer patients (24 men, 11 women; median age, 66 years) who underwent surgery after 18F-2-deoxy-fluoro-D-glucose (FDG)-PET-CT were studied. Their PET data were reconstructed with 2D and HD PET reconstruction algorithms. Two radiologists individually TNM staged both sets of images. They also evaluated the quality of the images and the diagnostic confidence that the images afforded them using 5-point scales. RESULTS: T, N, and M stages were correctly diagnosed on both the 2D and HD reconstructed images in 23 (66%), 25 (71%), and 30 (86%) of 35 cases, respectively. Overall TNM stage was correctly diagnosed on both types of reconstructed images in 23 cases (66%), underestimated in three (9%), and overestimated in nine (26%). No significant difference in T, N, or M stage or overall TNM stage was observed between the two reconstruction methods. However, the HD reconstructed images afforded a significantly higher level of diagnostic confidence during TNM staging than the 2D reconstructed images and were also of higher quality than the 2D reconstructed images. CONCLUSION: Although HD reconstruction of FDG-PET images did not improve the diagnostic accuracy of lung cancer staging compared with 2D reconstruction, the quality of the HD reconstructed images and the diagnostic confidence level they afforded the radiologists were higher than those of the conventional 2D reconstructed images.