Observer variation study of the assessment and diagnosis of incidental colonic FDG uptake.

PURPOSE: The aim of this study was to evaluate the interpretations of incidental colonic 18F-FDG uptake made by 10 experienced readers and to more clearly identify the pattern of suspicious colonic FDG uptake. The potential contributions of delayed FDG-PET scanning and of immune fecal occult blood testing (FOBT) in making a diagnosis were also analyzed. MATERIALS AND METHODS: Visual interpretations by 10 readers were made for 147 FDG uptake sites from 126 PET scans (cancer, 38 sites; adenoma, 43 sites; and no abnormality, 66 sites) with colonic FDG uptake. Assessments for the early FDG-PET images were (1) FDG uptake pattern, (2) FDG uptake degree, and (3) likelihood of malignancy. For the delayed images, the assessments were (1) change in the FDG uptake position, (2) change in FDG uptake degree, and (3) likelihood of malignancy. The results of FOBT were analyzed independently of the visual interpretations. RESULTS: Interobserver agreement (κ) was 0.501 for assessing FDG uptake patterns, while agreement on assessing changes in uptake degree and changes in uptake position between early and delayed imaging were low (κ = 0.213-0.229). Logistic regression analysis indicated that 'FDG uptake patterns' and 'FDG uptake degree' were significantly related to decide on the suspicion of malignancy (p < 0.001) and the final result (p < 0.001). "Small localized" and "large irregular localized" types had a high probability of a lesion regardless of either (1) FDG uptake degree or (2) variation in the uptake between the early and the delayed image. The delayed image decreased false-positive cases for some FDG uptake patterns, but it had little impact on distinguishing clearly between "cancer or adenoma" and "normal". The addition of FOBT had little impact on the diagnosis. CONCLUSION: There was highest agreement among readers with respect to the recognition of specified colonic FDG uptake patterns, and this pattern recognition had the most influence on the diagnosis. "Small localized" and "large irregular localized" types had a high probability of a lesion. The addition of delayed imaging and of FOBT results to the early imaging did not have much impact on the diagnosis.

[Assessment of diagnostic criteria for FDG-PET cancer screening program according to the interpretation of FDG-PET and combined examination].

OBJECTIVE: The aim of this study is to establish the diagnostic criteria for FDG-PET cancer screening program of four kinds of organ (breast, thyroid, lung and colon/rectum) according to the interpretation of FDG-PET cancer screening program of the case with proved clinical outcome. METHODS: Among FDG-PET cancer screening examinations performed in two PET centers during 2003 to 2006, two hundreds of examinations with proved clinical outcome were evaluated. Interpretation of breast ultrasonography, thyroid ultrasonography, chest CT and fecal occult blood testing, which were regarded as combined examinations, were performed together with the interpretation of FDG-PET images. RESULTS: As a result of the interpretation, localized FDG accumulating site in all four organs should be recommended for further inspections. In addition, essential point for diagnosis was considered as follows; (1) check over the slight localized FDG accumulation with screening of breast region, (2) combine chest CT with FDG-PET for the evaluation of lung region and (3) check up the shift of FDG accumulation between early and delayed phase with screening of colon/rectum region. CONCLUSIONS: According to the interpretation results of this study, we establish diagnostic criteria of FDG-PET and combined examination of four kinds of organ.

NEC density and liver ROI S/N ratio for image quality control of whole-body FDG-PET scans: comparison with visual assessment.

PURPOSE: Patient noise equivalent count (NEC), NEC density, and liver region of interest (ROI) S/N have been proposed as physical indicators of image quality, but have not been thoroughly compared with visual assessments. In this study, those indicators were contrasted with blind visual evaluations for whole-body fluorodeoxyglucose-positron emission tomography (FDG-PET) images acquired under a variety of scanning conditions and body weights. METHODS: Images were acquired on 15 normal subjects using a SET-3000B/L PET scanner with a continuous bed motion. Body weight ranged from 50.2 to 95.7 kg, with injected activity ranging from 71 to 333 MBq (1.40 to 3.67 MBq/kg) and a scan duration from 10 to 30 min. Patient NEC (PNEC; counts/cm) was calculated as the NEC rate divided by bed speed. NEC density (counts/cm(3)) was defined as the PNEC divided by the cross-sectional area derived from transmission data. Both PNEC and NEC density were averaged from neck to abdomen. Liver S/N was obtained as the pixel mean/SD within the ROI. Blind reviews by 18 professionals were used to visually evaluate image quality. RESULTS: Average visual score correlated with liver S/N, PNEC, and NEC density, with a rank correlation coefficient of 0.81, 0.86, and 0.91, respectively (each p < 0.0003). The "acceptable" quality roughly corresponded to a liver S/N of 10, PNEC of 380 kcounts/cm, and NEC density of 550 counts/cm(3) or more. CONCLUSIONS: NEC density, representing count statistics per body volume, reflects the visual image quality assessment and may be utilized for quality control of whole-body FDG-PET images together with the liver ROI S/N ratio.

Normal uptake of 18F-FDG in the testis: an assessment by PET/CT.

OBJECTIVE: The aim of this study was to assess the physiological uptake of 18F-fluoro-2-deoxyglucose (FDG) by an apparently normal testis with combined positron emission tomography-computed tomography (PET/CT) and its correlation with age, blood glucose level, and testicular volume. METHODS: The testicular uptake of 18F-FDG, expressed as the standardized uptake value (SUV), was measured on PET/CT images in 203 men. The correlation between SUV and age, blood glucose level, and testicular volume was assessed. RESULTS: The SUV in the total of 406 testes was 2.44 +/- 0.45 (range 1.23-3.85). The SUV was 2.81 +/- 0.43 (2.28-3.85) for 30-39 years (n = 12), 2.63 +/- 0.45 (1.77-3.75) for 40-49 years (n = 64), 2.46 +/- 0.35 (1.44-3.15) for 50-59 years (n = 82), 2.51 +/- 0.41 (1.50-3.46) for 60-69 years (n = 86), 2.43 +/- 0.47 (1.42-3.29) for 70-79 years (n = 86), and 2.18 +/- 0.45 (1.23-3.03) for 80-89 years (n = 76). When we calculated the mean SUV of bilateral testes in each patient, there were significant statistical differences between those in the age group of 30-39 years and 80-89 years, 40-49 years and 80-89 years, and 50-60 years and 80-89 years, when using an unpaired test with Bonferroni correction. The laterality index (|L - R|/(L + R) x 2) in 203 men was 0.066 +/- 0.067 (0-0.522). There was a mild correlation between the mean SUV and age (r = -0.284, P < 0.001) as well as between the mean SUV and mean volume (r = +0.368, P < 0.001). There was no correlation between the mean SUV and glucose blood level (r = -0.065, P = 0.358). CONCLUSIONS: Some uptake of FDG is observed in the normal testis and declines slightly with age. Physiological FDG uptake in the testis should not be confused with pathological accumulation.

Assessment of choline uptake for the synthesis and release of acetylcholine in brain slices by a dynamic autoradiographic technique using [11C]choline.

The uptake of choline for the synthesis and release of acetylcholine was investigated in brain slices by dynamic positron autoradiography using [11C]choline. Brain slices (330 microm) were incubated with [11C]choline in oxygenated Krebs-Ringer medium at 34 degrees C and serial two-dimensional time-resolved images of the uptake and release of radioactivity were recorded on Storage Phosphor screens. [11C]choline uptake increased with the period of incubation and was 1.9 times higher in the striatum than cerebral cortex. The uptake in the striatum was significantly diminished by hemicholinium-3 (HC-3), an inhibitor of high-affinity choline uptake. Pretreatment of brain slices with 50 mM K(+) for 20 min enhanced the uptake in striatum. The uptake of [11C]choline in brain slices was saturable using nonlabeled choline. Two uptake systems, a high-affinity and a low-affinity system, were confirmed to exist by kinetic analysis using Lineweaver-Burk plots. The 11C radioactivity that had accumulated in the striatum disappeared on treatment with veratridine, a depolarization agent, in the presence of HC-3. This pattern of disappearance was consistent with that of the appearance of unlabeled and labeled acetylcholine in the medium. These results indicate that this method is useful for obtaining information regarding the uptake of choline for the synthesis and release of acetylcholine in live brain tissues.

In vivo assessment of adenoviral vector-mediated gene expression of dopamine D(2) receptors in the rat striatum by positron emission tomography.

For functional assessment of gene therapy in experimental animals, in vivo assessment of transferred genes will provide a major advance over an in vitro analysis which must be done post-hoc. In the current study we conducted positron emission tomography (PET) analysis in rats following injection of the adenoviral vector encoding the cDNA for the rat dopamine D(2) receptors (D(2)R) (AdCMV.DopD(2)R) into rat brain to provide a quantitative evaluation of D(2)R overexpression. Quantitative measurements as well as images by PET and ex vivo autoradiography demonstrated the significant increase of D(2)R binding of [(11)C]raclopride, a specific D(2)R radioligand, in the AdCMV.DopD(2)R-injected rat striatum 2 or 3 days after vector injection. Longitudinal in vivo assessment of the gene expression by PET demonstrated decreased binding of [(11)C]raclopride with time, which was in agreement with the observation in a cross-sectional autoradiographic study. The results of the current study demonstrate that PET can be used for longitudinal in vivo assessment of D(2)R expression mediated by adenoviral vector in rat brain.