Interest of para-aortic lymphadenectomy for locally advanced cervical cancer in the era of PET scanning.

BACKGROUND AND OBJECTIVES: Treatment of locally advanced cervical cancer (LACC) involves pelvic chemoradiotherapy, using an extended field in the case of para-aortic involvement. 18-Fluoro-D-glucose positron emission tomography combined with computer tomography (PET-CT) is an accurate method for the detection of metastatic nodes. The objective of this study was to evaluate the performance of PET-CT for lymph node staging of LACC. METHODS: This bicentric retrospective study included patients with LACC who had a PET-CT scan followed by para-aortic lymphadenectomy between January 2015 and December 2019. Based on pathological findings, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and false-negative (FN) rates of PET-CT for para-aortic node involvement were evaluated. RESULTS: Seventy-one patients who had undergone laparoscopic lymphadenectomy were included in this study. The intraoperative complication rate was 2.8%. Sensitivity, specificity, NPV and PPV for PET-CT were 55% [95% confidence interval (CI) 44.6-67.1], 84% (95% CI 75-92), 93% (95% CI 87-99) and 33% (95% CI 22-44), respectively. FN rates in the case of negative or positive pelvic PET-CT were 5.7% and 9.5%, respectively. CONCLUSIONS: Para-aortic lymphadenectomy is recommended for lymph node staging in the case of negative para-aortic PET-CT. In view of the low FN rate of PET-CT, surgical staging should be discussed regardless of pelvic status if the patient presents high surgical risk, or if this delays the commencement of chemoradiotherapy.

Impact of Systematic Whole-body 18F-Fluorodeoxyglucose PET/CT on the Management of Patients Suspected of Infective Endocarditis: The Prospective Multicenter TEPvENDO Study.

BACKGROUND: Diagnostic and patients' management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients. METHODS: In sum, 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients' management plan were established jointly by 2 experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients' management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established. RESULTS: Among the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (P < .001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (P = .005) (net reclassification index 20% and 4.3%). Patients' managements were modified in 21.4% PV and 31.4% NV patients (P = .25). It was mainly due to perivalvular uptake in PV patients and to extra-cardiac uptake in NV patients and consisted in surgery plan modifications in 7 patients, antibiotic plan modifications in 22 patients and both in 5 patients. Altogether, 18F-FDG-PET/CT modified classification and/or care in 40% of the patients (95% confidence interval: 32-48), which was most likely to occur in those with a noncontributing echocardiography (P < .001) or IE classified as possible at baseline (P = .04), while there was no difference between NV and PV. CONCLUSIONS: Systematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients. CLINICAL TRIALS REGISTRATION: NCT02287792.

Hypermetabolism of the spleen or bone marrow is an additional albeit indirect sign of infective endocarditis at FDG-PET.

PURPOSE: This study aimed at determining the diagnostic implications of indirect signs of infection at FDG-PET-i.e., hypermetabolisms of the spleen and/or bone marrow (HSBM)-when documented in patients with known or suspected infective endocarditis (IE). METHODS: HSBM were defined by higher mean standardized uptake values comparatively to that of the liver on FDG-PET images from patients with a high likelihood of IE and prospectively included in a multicenter study. RESULTS: Among the 129 included patients, IE was ultimately deemed as definite in 88 cases. HSBM was a predictor of definite IE (P = 0.014; odds ratio (OR) 3.2), independently of the criterion of an abnormal cardiac FDG uptake (P = 0.0007; OR 9.68), and a definite IE was documented in 97% (29/30) of patients showing both HSBM and abnormal cardiac uptake, 78% (7/9) of patients with only abnormal cardiac uptake, 67% (42/63) of patients with only HSBM, and 37% (10/27) of patients with neither one. CONCLUSION: In this cohort with a high likelihood of IE, HSBM is an additional albeit indirect sign of IE, independently of the criterion of an abnormal cardiac uptake, and could reinforce the suspicion of IE in the absence of any other infectious, inflammatory, or malignant disease.

Diagnostic performance of 18F-FDG PET-CT for large vessel involvement assessment in patients with suspected giant cell arteritis and negative temporal artery biopsy.

OBJECTIVE: The purpose of our study was to assess the diagnostic performance of 18F-FDG PET-CT for large vessel involvement in patients with suspected giant cells arteritis (GCA) and a negative temporal artery biopsy (TAB). METHODS: We conducted a retrospective study in a cohort of patients with suspected GCA and negative TAB who underwent an 18F-FDG PET-CT. Ten vascular segments were studied using a visual score and a semi-quantitative method based on SUVmax ratio with respect to liver uptake. The diagnosis of GCA was established during a mean follow-up of 42 months, based on the presence of clinical symptoms, laboratory results, and imaging data compatible with GCA, good response to corticosteroid therapy, and no differential diagnosis after a follow-up of at least 18 months. RESULTS: We included 63 patients (30 men and 33 women, aged 67 ± 12 years). 18F-FDG PET-CT showed large vessel involvement in 22 patients, 14 of whom were finally diagnosed with GCA. Forty-one patients were 18F-FDG PET-CT negative, 9 of whom were finally diagnosed with GCA. Overall, 18F-FDG uptake by large vessel yielded 61% sensitivity, 80% specificity, 64% positive predictive value, 78% negative predictive value, and 73% diagnostic accuracy. A significant number of patients were treated by corticosteroids before 18F-FDG PET-CT. However, corticosteroid therapy did not impact significantly the diagnostic performance, although there was a trend to a lower sensitivity in patients receiving corticosteroid therapy for more than 3 days. CONCLUSIONS: 18F-FDG PET-CT is a useful imaging technique to assess large vessel involvement in patients with suspected GCA and negative TAB.

Therapeutic Response to Rituximab in IgG4-Related Hypophysitis Evidenced on 18F-FDG PET and MRI.

Baseline F-FDG PET and MRI were performed in a patient with IgG4-related hypophysitis, showing a 15-mm hypervascular hypermetabolic lesion with sellar and suprasellar extension. Lack of response after 10 months of first-line corticosteroid therapy was demonstrated on both F-FDG PET and MRI. Three months later, after 2 injections of 1 g of rituximab associated with continued corticosteroid therapy, MRI showed substantial shrinkage of the pituitary lesion with minimal residual Gd enhancement, whereas F-FDG PET evidenced complete metabolic response. As such, joint F-FDG PET and MRI assessment during therapy may have a potential interest for treatment response evaluation in pituitary IgG4-related disease.

Influence of CT-based attenuation correction in assessment of left and right ventricular functions with count-based gated blood-pool SPECT.

OBJECTIVE: Influence of CT-based attenuation correction (CT-AC) in assessment of left and right ventricular functions with count-based gated blood-pool SPECT (GBPS) was evaluated in a mixed population. METHODS: Thirty-two patients (81% male; mean age 56 ± 12) referred for various symptoms or heart diseases were prospectively included. Data from 32 GBPS acquisitions were reconstructed using an iterative algorithm with (IRAC) and without (IRNC) CT-AC and analyzed using previously described segmentation software based on the watershed algorithm. LV and RV EF and volumes were assessed with and without CT-AC and compared. RESULTS: EF and volumes were correlated (P < .001 for all parameters with r = 0.97 for LV and RV EF; r = 0.96 for LV EDV; r = 0.98 for LV ESV; r = 0.96 for RV EDV and ESV). The mean values using IRAC and IRNC were different for all parameters with lower EF (respectively, 49% ± 19% vs 51 %± 18%; P = .002 for LV EF and 50% ± 14% vs 54%±15%; P < .001 for RV EF) and higher volumes (respectively, 142 ± 41 mL vs 133 ± 40 mL; P < .001 and 79 ± 45 mL vs 71 ± 42 mL; P < .001 for LV EDV and ESV; 91 ± 32 mL vs 86 ± 31 mL; P = .003 and 48 ± 28 mL vs 43 ± 26 mL; P < .001 for RV EDV and ESV). Limits of agreement were -11% to 6% and -11% to 4% for LV and RV EF. We found wider limits of agreement for LV volumes (-13 to 32 mL for EDV and -10 to 27 mL for ESV) than for RV volumes (-13 to 23 mL for EDV and -9 to 20 mL for ESV). Taking into account all volumes, we found a trend with a significant positive correlation between means and differences in volumes assessed with and without CT-AC. CONCLUSION: Assessment of both left and right ventricular functions by count-based GBPS with CT-AC showed higher volumes and lower EF. Differences were slight, especially for the range of normal to subnormal ventricular volumes.

Diagnosis of silent myocardial ischemia during the staging of HIV-associated lymphoma with FDG PET/CT.

Fasting 18F fluoro-deoxy-glucose positron emission tomography examinations are routinely performed for the staging of HIV-associated lymphomas. In addition to possible comorbidity factors, the chronic inflammation that occurs in HIV-infected patients together with the metabolic side effects of antiretroviral therapy increases the risk for coronary artery disease. Moreover, HIV-infected patients are likely to develop polyneuropathies due to the viral infection or to the side effects of long-term protease or nucleoside reverse transcription inhibitor treatments.We report a case that illustrates the need to suspect the diagnosis of silent myocardial ischemia among HIV-positive patients with myocardial F-18 fluoro-deoxy-glucose uptake involving a coronary artery territory.