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OBJECTIVE: To evaluate the value of SPECT/CT (single photon emission computed tomography/computed tomography) in foot and ankle arthrodesis and development of secondary osteoarthritis in the adjacent joints. MATERIALS AND METHODS: SPECT/CT of 140 joints in the foot and ankle (34 upper ankle (UA), 28 lower ankle (LA), 27 talonavicular (TN), 12 calcaneo-cuboidal (CC), and 39 other smaller joints after arthrodesis in 72 patients were evaluated retrospectively regarding fusion grade in CT (0 = no fusion, 1 = < 50% fusion, 2 = > 50% fusion, 3 = complete fusion) and radiotracer uptake (0 = no uptake, 1 = mild uptake, 2 = moderate uptake, 3 = high uptake) on SPECT/CT. Severity of osteoarthritis (1 = mild, 2 = moderate, 3 = severe) and radiotracer uptake grade in adjacent joints was also assessed. In 54 patients, clinical information about interventions in the follow-up was available. RESULTS: According to the SPECT/CT, arthrodesis was successful (grade 2 or 3 CT fusion and grade 0 or 1 uptake) in 73% (25/34) of UA joints, 71% (20/28) of LA joints, 67% (18/27) TN, 100% (12/12) CC joints, and 62% (24/39) of other smaller joints. In 12 joints, there were discrepant findings in SPECT/CT (fusion grade 2 and uptake grade 2 or 3 (n = 9); or, fusion grade 0 or 1 and uptake grade 1 (n = 3)). The fusion rate 6-12 months after arthrodesis was 42% (14/33), 59% (20/34) after 13-24 months, and 89% (65/73) after more than 24 months, respectively. Average radiotracer uptake in arthrodesis decreased with age: 6-12 months: 1.60, 12-24 months: 1.32, > 24 months: 0.38. There was a significant negative correlation between radiotracer uptake grade and CT fusion grade. Osteoarthritis was observed in 131 adjacent joints. During the post scan follow-up, additional arthrodeses were performed in 33 joints, of which 11 joints were re-arthrodesis and 22 were new arthrodeses in osteoarthritic adjacent joints. All these 11 joints with failed arthrodesis had grade 0 of CT fusion and grade 2 or 3 of radiotracer uptake. All 22 adjacent joints with osteoarthritis, which subsequently underwent arthrodesis, had grade 2 or 3 radiotracer uptake, and the primary arthrodesis joints were healed and fused in all these cases. CONCLUSION: Bone SPECT/CT is a valuable hybrid imaging tool in the evaluation of foot and ankle arthrodesis and gives additional useful information about the development of secondary osteoarthritis in the adjacent joints with higher value for the assessment of secondary osteoarthritis. A practical four-type classification ('Lucerne Criteria') combining metabolic and morphologic SPECT/CT information for evaluation of arthrodesis joints has been proposed.
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Tobillo , Osteoartritis , Humanos , Lactante , Estudios Retrospectivos , Resultado del Tratamiento , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Artrodesis/métodos , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Positron emission tomography (PET) myocardial perfusion imaging (MPI) can be used to evaluate left ventricular (LV) volumes and function. We performed a head-to-head comparison of LV function and volumes obtained simultaneously using [13N]-ammonia-PET and cardiac magnetic resonance (CMR), with the latter serving as the reference standard. METHODS AND RESULTS: In this prospective study, 51 patients underwent [13N]-ammonia-PET MPI and CMR using a hybrid PET/MR device. Left ventricular end-systolic volumes (LVESV), end-diastolic volumes (LVEDV), stroke volumes (LVSV), ejection fractions (LVEF), and segmental wall motion were analyzed for both methods and were compared using correlational and Bland-Altman (BA) analysis; segmental wall motion was compared using ANOVA. The agreement between [13N]-ammonia-PET and CMR for LVEF was good, with minimal bias (- .6%) and narrow BA limits of agreement (- 7.9% to 6.8%), but [13N]-ammonia-PET systematically underestimated LV volumes, with high bias in LVESV (- 11.2 ml), LVEDV (- 28.9 ml), and LVSV (- 17.5 ml). Mean segmental wall motion in [13N]-ammonia-PET differed significantly among the corresponding normokinetic (6.6 ± 2 mm), hypokinetic (5.1 ± 2 mm), and akinetic (3.3 ± 2 mm) segments in CMR (P < .01). CONCLUSION: LVEF and LV wall motion can be accurately assessed using [13N]-ammonia-PET MPI, although LV volumes are significantly underestimated compared to CMR.
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Enfermedad de la Arteria Coronaria , Disfunción Ventricular Izquierda , Humanos , Función Ventricular Izquierda , Estudios Prospectivos , Amoníaco , Tomografía Computarizada por Rayos X , Tomografía de Emisión de Positrones/métodos , Volumen Sistólico , Espectroscopía de Resonancia Magnética , PerfusiónRESUMEN
PURPOSE: Prostate-specific membrane antigen (PSMA)-targeted PET is increasingly used for staging prostate cancer (PCa) with high accuracy to detect significant PCa (sigPCa). [68 Ga]PSMA-11 PET/MRI-guided biopsy showed promising results but also persisting limitation of sampling error, due to impaired image fusion. We aimed to assess the possibility of intraoperative quantification of [18F]PSMA-1007 PET/CT uptake in core biopsies as an instant confirmation for accurate lesion sampling. METHODS: In this IRB-approved, prospective, proof-of-concept study, we included five consecutive patients with suspected PCa. All underwent [18F]PSMA-1007 PET/CT scans followed by immediate PET/CT-guided and saturation template biopsy (3.1 ± 0.3 h after PET). The activity in biopsy cores was measured as counts per minute (cpm) in a gamma spectrometer. Pearson's test was used to correlate counts with histopathology (WHO/ISUP), tumor length, and membranous PSMA expression on immunohistochemistry (IHC). RESULTS: In 43 of 113 needles, PCa was present. The mean cpm was overall significantly higher in needles with PCa (263 ± 396 cpm) compared to needles without PCa (73 ± 44 cpm, p < 0.001). In one patient with moderate PSMA uptake (SUVmax 8.7), 13 out of 24 needles had increased counts (100-200 cpm) but only signs of inflammation and PSMA expression in benign glands on IHC. Excluding this case, ROC analysis resulted in an AUC of 0.81, with an optimal cut-off to confirm PCa at 75 cpm (sens/spec of 65.1%/87%). In all 4 patients with PCa, the first or second PSMA PET-guided needle was positive for sigPCa with high counts (156-2079 cpm). CONCLUSIONS: [18F]PSMA-1007 uptake in PCa can be used to confirm accurate lesion sampling of the dominant tumor intraoperatively. This technique could improve confidence in imaging-based biopsy guidance and reduce the need for saturation biopsy. TRIAL REGISTRATION NUMBER: NCT03187990, 15/06/2017.
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Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Próstata , Radioisótopos de Galio , Humanos , Biopsia Guiada por Imagen , Masculino , Agujas , Niacinamida/análogos & derivados , Oligopéptidos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Estudios Prospectivos , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/cirugíaRESUMEN
OBJECTIVES: To assess the frequency, intensity, and clinical impact of [18F]FDG-avidity of axillary lymph nodes after vaccination with COVID-19 vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) in patients referred for oncological FDG PET/CT. METHODS: One hundred forty patients referred for FDG PET/CT during February and March 2021 after first or second vaccination with Pfizer-BioNTech or Moderna were retrospectively included. FDG-avidity of ipsilateral axillary lymph nodes was measured and compared. Assuming no knowledge of prior vaccination, metastatic risk was analyzed by two readers and the clinical impact was evaluated. RESULTS: FDG PET/CT showed FDG-avid lymph nodes ipsilateral to the vaccine injection in 75/140 (54%) patients with a mean SUVmax of 5.1 (range 2.0 - 17.3). FDG-avid lymph nodes were more frequent in patients vaccinated with Moderna than Pfizer-BioNTech (36/50 [72%] vs. 39/90 [43%] cases, p < 0.001). Metastatic risk of unilateral FDG-avid axillary lymph nodes was rated unlikely in 52/140 (37%), potential in 15/140 (11%), and likely in 8/140 (6%) cases. Clinical management was affected in 17/140 (12%) cases. CONCLUSIONS: FDG-avid axillary lymph nodes are common after COVID-19 vaccination. The avidity of lymph nodes is more frequent in Moderna compared to that in Pfizer-BioNTech vaccines. To avoid relatively frequent clinical dilemmas, we recommend carefully taking the history for prior vaccination in patients undergoing FDG PET/CT and administering the vaccine contralateral to primary cancer. KEY POINTS: ⢠PET/CT showed FDG-avid axillary lymph nodes ipsilateral to the vaccine injection site in 54% of 140 oncological patients after COVID-19 vaccination. ⢠FDG-avid lymphadenopathy was observed significantly more frequently in Moderna compared to patients receiving Pfizer-BioNTech-vaccines. ⢠Patients should be screened for prior COVID-19 vaccination before undergoing PET/CT to enable individually tailored recommendations for clinical management.
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Vacunas contra la COVID-19 , COVID-19 , Vacuna nCoV-2019 mRNA-1273 , Vacuna BNT162 , Fluorodesoxiglucosa F18 , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Estudios Retrospectivos , SARS-CoV-2 , VacunaciónRESUMEN
BACKGROUND: To assess whether low-dose CT for attenuation correction of myocardial perfusion single-photon emission computed tomography (SPECT) allows for identification of anemic patients and grading anemia severity. METHODS AND RESULTS: Patients who underwent a preoperative blood-test and low-dose CT scan, as a part of a cardiac SPECT exam, between 01 January 2015 and 31 December 2017 were enrolled in this retrospective study. Hemoglobin (Hb) levels and hematocrit were derived from clinical records. CT images were visually assessed (qualitative analysis) for the detection of inter-ventricular septum sign (IVSS) and aortic rim sign (ARS) and quantitative analysis were performed. The diagnostic accuracy for detecting anemia was compared using Hb values as the standard of reference. A total of 229 patients were included (110 with anemia; 57 mild; 46 moderate; 7 severe). The AUC of IVSS and ARS were 0.830 and 0.669, respectively (p<0.0001). The quantitative analysis outperformed ARS and IVSS; (AUC of 0.893, p=0.29). The optimal anemia cut-off using Youden index was 4.5 HU. CONCLUSION: Quantitative analysis derived from low-dose CT images, as a part of cardiac SPECT exams, have a diagnostic accuracy similar to that of hematocrit for the detection of anemia and may allow discriminating different anemia severities.
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Anemia , Imagen de Perfusión Miocárdica , Humanos , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada por Rayos X/métodos , Anemia/diagnóstico por imagen , Imagen de Perfusión Miocárdica/métodos , PerfusiónRESUMEN
The aim of the study was to analyze the use of block sequential regularized expectation maximization (BSREM) with different ß-values for the detection of brain metastases in digital fluorine-18 labeled 2-deoxy-2-fluoro-D-glucose (18F-FDG) PET/CT in lung cancer patients. We retrospectively analyzed staging/restaging 18F-FDG PET/CT scans of 40 consecutive lung cancer patients with new brain metastases, confirmed by MRI. PET images were reconstructed using BSREM (ß-values of 100, 200, 300, 400, 500, 600, 700) and OSEM. Two independent blinded readers (R1 and R2) evaluated each reconstruction using a 4-point scale for general image quality, noise, and lesion detectability. SUVmax of metastases, brain background, target-to-background ratio (TBR), and contrast recovery (CR) ratio were recorded for each reconstruction. Among all reconstruction techniques, differences in qualitative parameters were analyzed using non-parametric Friedman test, while differences in quantitative parameters were compared using analysis of variances for repeated measures. Cohen's kappa (k) was used to measure inter-reader agreement. The overall detectability of brain metastases was highest for BSREM200 (R1: 2.83 ± 1.17; R2: 2.68 ± 1.32) and BSREM300 (R1: 2.78 ± 1.23; R2: 2.68 ± 1.36), followed by BSREM100, which had lower accuracy owing to noise. The highest median TBR was found for BSREM100 (R1: 2.19 ± 1.05; R2: 2.42 ± 1.08), followed by BSREM200 and BSREM300. Image quality ratings were significantly different among reconstructions (p < 0.001). The median quality score was higher for BSREM100-300, and both noise and metastases' SUVmax decreased with increasing ß-value. Inter-reader agreement was particularly high for the detectability of photopenic metastases and blurring (all k > 0.65). BSREM200 and BSREM300 yielded the best results for the detection of brain metastases, surpassing both BSREM400 and OSEM, typically used in clinical practice.
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Neoplasias Encefálicas , Neoplasias Pulmonares , Neoplasias Encefálicas/diagnóstico por imagen , Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radiofármacos , Estudios RetrospectivosRESUMEN
PURPOSE: Improved logistics and availability led to a rapid increase in the use of [18F]-PSMA-1007 for prostate cancer PET imaging. Initial data suggests increased uptake in benign lesions compared to [68 Ga]-PSMA-11, and clinical observations found increased unspecific bone uptake (UBU). We therefore investigate the frequency and characteristics of UBU in [18F]-PSMA-1007 PET. METHODS: We retrospectively analyzed [18F]-PSMA-1007 PET scans from four centers for the presence of UBU, defined as a focal mild-to-moderate uptake (SUVmax < 10.0) not obviously related to a benign or malignant cause. If present, up to three leading UBUs were quantified (SUVmax), localized, and correlated to clinical parameters, such as age, PSA, injected dose, Gleason score, tumor size (T1-T4), and type of PET scanner (analog vs. digital). Additionally, clinical and imaging follow-up results and therapeutic impact were evaluated. RESULTS: UBUs were identified in 179 out of 348 patients (51.4%). The most frequent localizations were ribs (57.5%) and pelvis (24.8%). The frequency of UBUs was not associated with PSA, Gleason score, tumor size, age, or the injected [18F]-PSMA-1007 dose. UBUs were significantly more frequent in images obtained with digital PET/CT scans (n = 74, 82%) than analog PET/CT scans (n = 221, 40.3%) (p = .0001) but not in digital PET/MR (n = 53, 51%) (p = .1599). In 80 out of 179 patients (44.7%), the interpretation of UBUs was critical for therapeutic management and therefore considered clinically relevant. For 65 UBUs, follow-ups were available: three biopsies, three radiotherapies with PSA follow-up, and 59 cases with imaging. After follow-up, UBUs were still considered unclear in 28 of 65 patients (43%), benign in 28 (43%), and malignant in nine (14%) patients. CONCLUSION: UBUs occur in two-thirds of patients imaged with [18F]-PSMA-1007 PET/CT and are significantly more frequent on digital PET scanners than analog scanners. UBUs should be interpreted carefully to avoid over-staging.
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Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Próstata , Ácido Edético , Humanos , Masculino , Niacinamida/análogos & derivados , Oligopéptidos , Tomografía de Emisión de Positrones , Neoplasias de la Próstata/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: Ultrasound-guided biopsy (US biopsy) with 10-12 cores has a suboptimal sensitivity for clinically significant prostate cancer (sigPCa). If US biopsy is negative, magnetic resonance imaging (MRI)-guided biopsy is recommended, despite a low specificity for lesions with score 3-5 on Prostate Imaging Reporting and Data System (PIRADS). Screening and biopsy guidance using an imaging modality with high accuracy could reduce the number of unnecessary biopsies, reducing side effects. The aim of this study was to assess the performance of positron emission tomography/MRI with 68Ga-labeled prostate-specific membrane antigen (PSMA-PET/MRI) to detect and localize primary sigPCa (ISUP grade group 3 and/or cancer core length ≥ 6 mm) and guide biopsy. METHODS: Prospective, open-label, single-center, non-randomized, diagnostic accuracy study including patients with suspected PCa by elevation of prostate-specific antigen (PSA) level and a suspicious lesion (PIRADS ≥3) on multiparametric MRI (mpMRI). Forty-two patients underwent PSMA-PET/MRI followed by both PSMA-PET/MRI-guided and section-based saturation template biopsy between May 2017 and February 2019. Primary outcome was the accuracy of PSMA-PET/MRI for biopsy guidance using section-based saturation template biopsy as the reference standard. RESULTS: SigPCa was found in 62% of the patients. Patient-based sensitivity, specificity, negative and positive predictive value, and accuracy for sigPCa were 96%, 81%, 93%, 89%, and 90%, respectively. One patient had PSMA-negative sigPCa. Eight of nine false-positive lesions corresponded to cancer on prostatectomy and one in six false-negative lesions was negative on prostatectomy. CONCLUSION: PSMA-PET/MRI has a high accuracy for detecting sigPCa and is a promising tool to select patients with suspicion of PCa for biopsy. TRIAL REGISTRATION: This trial was retrospectively registered under the name "Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) Guided Biopsy in Men with Elevated PSA" (NCT03187990) on 06/15/2017 ( https://clinicaltrials.gov/ct2/show/NCT03187990 ).
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Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Próstata , Biopsia , Isótopos de Galio , Radioisótopos de Galio , Humanos , Biopsia Guiada por Imagen , Imagen por Resonancia Magnética , Masculino , Estudios Prospectivos , Neoplasias de la Próstata/diagnóstico por imagenRESUMEN
OBJECTIVES: To compare block sequential regularized expectation maximization (BSREM) and ordered subset expectation maximization (OSEM) for the detection of in-transit metastasis (ITM) of malignant melanoma in digital [18F]FDG PET/CT. METHODS: We retrospectively analyzed a cohort of 100 [18F]FDG PET/CT scans of melanoma patients with ITM, performed between May 2017 and January 2020. PET images were reconstructed with both OSEM and BSREM algorithms. SUVmax, target-to-background ratio (TBR), and metabolic tumor volume (MTV) were recorded for each ITM. Differences in PET parameters were analyzed with the Wilcoxon signed-rank test. Differences in image quality for different reconstructions were tested using the Man-Whitney U test. RESULTS: BSREM reconstruction led to the detection of 287 ITM (39% more than OSEM). PET parameters of ITM were significantly different between BSREM and OSEM reconstructions (p < 0.001). SUVmax and TBR were higher (76.5% and 77.7%, respectively) and MTV lower (49.5%) on BSREM. ITM missed with OSEM had significantly lower SUVmax (mean 2.03 vs. 3.84) and TBR (mean 1.18 vs. 2.22) and higher MTV (mean 2.92 vs. 1.01) on OSEM compared to BSREM (all p < 0.001). CONCLUSIONS: BSREM detects significantly more ITM than OSEM, owing to higher SUVmax, higher TBR, and less blurring. BSREM is particularly helpful in small and less avid lesions, which are more often missed with OSEM. KEY POINTS: ⢠In melanoma patients, [18F]FDG PET/CT helps to detect in-transit metastases (ITM), and their detection is improved by using BSREM instead of OSEM reconstruction. ⢠BSREM is particularly useful in small lesions.
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Melanoma , Tomografía Computarizada por Tomografía de Emisión de Positrones , Algoritmos , Fluorodesoxiglucosa F18 , Humanos , Procesamiento de Imagen Asistido por Computador , Melanoma/diagnóstico por imagen , Radiofármacos , Estudios RetrospectivosAsunto(s)
Angiografía por Tomografía Computarizada , Enfermedad de la Arteria Coronaria , Humanos , Rubidio , Angiografía Coronaria , Puente de Arteria Coronaria/efectos adversos , Tomografía de Emisión de Positrones , Isquemia , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Vasos CoronariosRESUMEN
PURPOSE: To assess the value of SPECT/CT in patients with carpal boss (CB). METHODS: In 24 wrists with CB (18 right-sided, 6 left-sided) in 21 patients, planar images and SPECT/CT images were obtained. Three patients had bilateral CB. The grade of uptake (0 absent, 1 low, 2 moderate, 3 high) on planar imaging and SPECT/CT was assessed and compared with CT findings, clinical symptoms and follow-up findings. RESULTS: CB affected carpometacarpal joint II in 4 wrists, carpometacarpal joint III in 17 wrists and both carpometacarpal joints II and III in 3 wrists. Of the 24 CB, 12 (50 %) were active (i.e. increased radionuclide uptake) on planar images and 18 (75 %) on SPECT/CT images. Of the 17 symptomatic CB, 10 (59 %) were active on planar images and 14 (82 %) were active (mean grade 1.9, range 1 - 3) on SPECT/CT images. Of the 7 asymptomatic CB, 2 were active on planar images and 4 were active (mean grade 1.25, range 1 - 2) on SPECT/CT images. CT alone showed CB in all patients and an accessory ossicle (os styloideum) in 8 wrists. MR imaging was available in 7 patients and positive for CB in 5 (sensitivity 71 %). Plain radiographs were available in 17 patients and positive in 10 (59 %). Therapeutic infiltration of the CB was performed in 9 patients, and resection of the CB in 7 patients. CONCLUSION: SPECT/CT provides important morphological and metabolic information for the clinical assessment of CB, but because SPECT/CT tends to overestimate the clinical importance of CB, we recommend that planar images should still be obtained.
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Articulaciones Carpometacarpianas/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Imagen Multimodal , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Artropatías/terapia , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
ABSTRACT: Localized pulmonary amyloidosis forming a solitary mass known as "amyloidoma of the lung" is rare. Differentiation from lung cancer can be difficult due to suspicious features on CT and high 18 F-FDG uptake. We present a case of a 77-year-old woman with an incidental lung lesion on abdominal CT. Further evaluation with chest CT and 18 F-FDG PET/CT maintained the suspicion of lung cancer. However, histology revealed amyloidoma without signs of malignancy. Knowledge of imaging similarities between pulmonary amyloidomas and malignancies is important for interpreting 18 F-FDG PET/CT of lung tumors; however, only biopsy can confirm the rare differential diagnosis such as pulmonary amyloidoma.
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Amiloidosis , Neoplasias Pulmonares , Neoplasias de los Tejidos Blandos , Femenino , Humanos , Anciano , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Fluorodesoxiglucosa F18 , Tomografía Computarizada por Tomografía de Emisión de Positrones , Pulmón/patología , Neoplasias de los Tejidos Blandos/patología , Amiloidosis/diagnóstico por imagen , Amiloidosis/patologíaRESUMEN
PURPOSE: The purpose of this study was to evaluate and quantify the prevalence of increased uptake in SPECT/CT in symptomatic and asymptomatic foot and ankle joints in patients with osteoarthritis. METHODS: In 63 patients with osteoarthritis (OA), the painful symptomatic foot (SF) and asymptomatic contralateral foot (AF) were imaged with bone SPECT/CT. Presence, localization, and maximum standardized uptake value (SUVmax) of the active joints were assessed for SF and AF. CT OA grade (grade 1: mild, grade 2: moderate, grade 3: severe) and presence of five morphological features of OA (joint space narrowing, subchondral sclerosis, subchondral cysts, irregular joint margins, and osteophytes) were evaluated. RESULTS: In total 32 (51%) patients showed additional uptake in the AF, whereas 31 (49%) patients showed it only in the SF. SF showed more active joints than AF (106 vs. 43). CT OA grades positively correlated with SUVmax (Kendall's tau b = 0.62, P < 0.001). SUVmax values (per foot) in SF were higher in patients with uptake in bilateral feet (SF+, AF+) [median (IQR): 17.9 (10.7-23.3)] as compared with patients with active sites only in the SF (SF+, AF-) [10.4 (6.4-19.1); P < 0.001]. Number of active OA joints in SF was higher in patients with bilateral uptake (P = 0.017). CONCLUSION: In conclusion, half of the patients exhibited increased uptake in the contralateral asymptomatic foot. SUVmax showed a significant correlation to CT osteoarthritis grade, in the symptomatic and asymptomatic foot. Future follow-up studies will provide further insights into the prognostic and therapeutic value of these findings.
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OBJECTIVES: Compared to conventional computed tomography (CT), fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) detects higher rates of lymph node and distant metastases in patients with ovarian cancer. However, FDG-PET/CT is not routinely performed during preoperative work-up. Therefore, we investigated the prognostic value of preoperative FDG-PET/CT in advanced epithelial ovarian cancer (EOC) and its predictive value for surgical resection in patients with no residual disease. The potential significance of PET-positive supradiaphragmatic lymph nodes (SDLNs) for these parameters was evaluated. METHODS: All patients with FIGO IIA-IVB EOC diagnosed between March 2014 and January 2021 at our certified gynaecological cancer centre, who underwent FDG PET/CT before primary surgery were retrospectively included. RESULTS: Fifty-three consecutive patients were included in the study. Eighteen (34 %) patients had PET-positive SDLNs. We could not demonstrate a significant correlation between PET-positive SDLNs and median overall survival (OS; SDLN-positive: 58.76 months, SDLN-negative: 60.76 months; p = 0.137) or intra- or perioperative outcomes. CONCLUSIONS: FDG PET/CT has a higher detection rate for SDLNs in patients with ovarian cancer than CT has, as described in the literature. Moreover, PET-positive SDLNs failed to predict intraoperative outcomes or overall survival.
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Neoplasias Ováricas , Tomografía Computarizada por Tomografía de Emisión de Positrones , Humanos , Femenino , Carcinoma Epitelial de Ovario/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Fluorodesoxiglucosa F18 , Estudios Retrospectivos , Estadificación de Neoplasias , Neoplasias Ováricas/patología , Tomografía de Emisión de Positrones/métodos , Ganglios Linfáticos/patología , RadiofármacosRESUMEN
OBJECTIVE: 18F-fluorocholine PET/CT is considered the imaging gold standard for detection of hyperfunctioning parathyroid glands . However, increased uptake might also occur in the thyroid gland. The aim of our study was to assess the incidence and significance of 18F-fluorocholine uptake in the thyroid gland in patients with hyperparathyroidism. MATERIALS AND METHODS: This retrospective study includes 195 consecutive patients with hyperparathyroidism, who underwent 18F-fluorocholine PET/CT, for detection of hyperfunctioning parathyroid glands. PET/CT images were reviewed by two nuclear medicine physicians for the presence of focal or diffuse thyroid uptake. PET/CT results were compared with laboratory parameters, ultrasonography, EU-TIRADS classification in the presence of thyroid nodules, cytology, and final histology. RESULTS: 25 patients (13%) showed 18F-fluorocholine uptake in the thyroid gland: focal thyroid uptake (FTU) in 7 patients (4%), diffuse thyroid uptake (DTU) in 8 patients (4%), and combined uptake (FTUâ +â DTU) in 10 patients (5%), with a total of 20 active thyroid nodules. There was no correlation between EU-TIRADS classification and PET parameters. One highly 18F-fluorocholine active thyroid nodule and one isoactive thyroid nodule turned out to be papillary thyroid cancers in the final histology; 50% of the patients with DTU had Hashimoto's thyroiditis. CONCLUSION: Incidental 18F-fluorocholine uptake in the thyroid gland was observed in 13% of patients. As reported for 18F-FDG, focal 18F-fluorocholine uptake might represent thyroid cancer and should be evaluated with ultrasound and, if indicated, with fine-needle aspiration cytology. Diffuse 18F-fluorocholine uptake most likely represents multinodular goiter or Hashimoto's thyroiditis.
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ABSTRACT: Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign anomaly with low prevalence. Lipomatous hypertrophy of the interatrial septum is asymptomatic in most of the cases and rarely leads to atrial arrhythmias, obstructive flow symptoms, or sudden death. It is mostly diagnosed as an incidental finding in cross-sectional imaging and echocardiography, and increased 18F-FDG uptake on LHIS has been described. We present a case of repeated increased 18F-PSMA uptake in LHIS. Although very rare, familiarity with the typical features and prevalence of LHIS in PET/CT can avoid misinterpretation for metastatic disease.
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Tabique Interatrial , Neoplasias Cardíacas , Lipoma , Humanos , Fluorodesoxiglucosa F18 , Tabiques Cardíacos/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Hipertrofia/diagnóstico por imagen , Tabique Interatrial/diagnóstico por imagen , Tabique Interatrial/patología , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patologíaRESUMEN
ABSTRACT: Tenosynovial giant cell tumor, previously known as pigmented villonodular synovitis, is a benign low-grade fibrohistiocytic proliferation with hemosiderin deposits in synovial joints. Mostly affecting the knee, it can also manifest in other synovial joints, infrequently also in the wrist. Tenosynovial giant cell tumor typically causes intense radionuclide uptake in all phases in planar bone scintigraphy, making a differentiation from other bone tumors or osteomyelitis difficult, especially in cases associated with extensive bone destruction. We present a case of an unusually advanced and extended tenosynovial giant cell tumor of the wrist in bone scintigraphy, SPECT/CT, radiograph, and MRI.
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Tumor de Células Gigantes de las Vainas Tendinosas , Tumores de Células Gigantes , Sinovitis Pigmentada Vellonodular , Humanos , Tumores de Células Gigantes/patología , Muñeca/patología , Tomografía Computarizada por Rayos X , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
ABSTRACT: We present the case of a 68-year-old woman with a painful tibial tumor and fatigue. Histology and laboratory studies were consistent with a brown tumor secondary to initially unrecognized, severe primary hyperparathyroidism. 18 F-fluorocholine PET/CT revealed a large hypermetabolic parathyroid mass and multiple bone foci considered as brown tumors. Unilateral neck exploration confirmed a large parathyroid adenoma. Serum calcium and parathyroid hormone levels normalized quickly, and symptoms subsided gradually after parathyroidectomy. Brown tumors are a rare complication of severe hyperparathyroidism. 18 F-fluorocholine PET/CT allows the localization of parathyroid adenomas and brown tumors, and can be used as a single imaging modality.
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Hiperparatiroidismo Primario , Osteítis Fibrosa Quística , Neoplasias de las Paratiroides , Femenino , Humanos , Anciano , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Hiperparatiroidismo Primario/diagnóstico por imagen , Hiperparatiroidismo Primario/complicaciones , Glándulas Paratiroides , Osteítis Fibrosa Quística/complicaciones , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/diagnóstico por imagen , ColinaRESUMEN
OBJECTIVE: To evaluate the detection rate and performance of 18F-FDG PET alone (PET), the combination of PET and low-dose thick-slice CT (PET/lCT), PET and diagnostic thin-slice CT (PET/dCT), and additional computer-aided detection (PET/dCT/CAD) for lung nodules (LN)/metastases in tumor patients. Along with this, assessment of inter-reader agreement and time requirement for different techniques were evaluated as well. METHODS: In 100 tumor patients (56 male, 44 female; age range: 22-93 years, mean age: 60 years) 18F-FDG PET images, low-dose CT with shallow breathing (5 mm slice thickness), and diagnostic thin-slice CT (1 mm slice thickness) in full inspiration were retrospectively evaluated by three readers with variable experience (junior, mid-level, and senior) for the presence of lung nodules/metastases and additionally analyzed with CAD. Time taken for each analysis and number of the nodules detected were assessed. Sensitivity, specificity, positive and negative predictive value, accuracy, and Receiver operating characteristic (ROC) analysis of each technique was calculated. Histopathology and/or imaging follow-up served as reference standard for the diagnosis of metastases. RESULTS: Three readers, on an average, detected 40 LN in 17 patients with PET only, 121 LN in 37 patients using ICT, 283 LN in 60 patients with dCT, and 282 LN in 53 patients with CAD. On average, CAD detected 49 extra LN, missed by the three readers without CAD, whereas CAD overall missed 53 LN. There was very good inter-reader agreement regarding the diagnosis of metastases for all four techniques (kappa: 0.84-0.93). The average time required for the evaluation of LN in PET, lCT, dCT, and CAD was 25, 31, 60, and 40 s, respectively; the assistance of CAD lead to average 33% reduction in time requirement for evaluation of lung nodules compared to dCT. The time-saving effect was highest in the less experienced reader. Regarding the diagnosis of metastases, sensitivity and specificity combined of all readers were 47.8%/96.2% for PET, 80.0%/81.9% for PET/lCT, 100%/56.7% for PET/dCT, and 95.6%/64.3% for PET/CAD. No significant difference was observed regarding the ROC AUC (area under the curve) between the imaging methods. CONCLUSION: Implementation of CAD for the detection of lung nodules/metastases in routine 18F-FDG PET/CT read-out is feasible. The combination of diagnostic thin-slice CT and CAD significantly increases the detection rate of lung nodules in tumor patients compared to the standard PET/CT read-out. PET combined with low-dose CT showed the best balance between sensitivity and specificity regarding the diagnosis of metastases per patient. CAD reduces the time required for lung nodule/metastasis detection, especially for less experienced readers.
RESUMEN
ABSTRACT: A 78-year-old man with multiple squamous cell carcinomas of the skin underwent 18F-FDG-PET/CT for restaging after 4 cycles of cemiplimab. The scan showed new disseminated FDG-avid skin lesions. Dermatologic examination and biopsy revealed bullous pemphigoid. Discontinuation of cemiplimab and treatment with corticosteroids led to clinical improvement, after which treatment with cemiplimab was resumed. A broad spectrum of inflammatory adverse events can occur in patients treated with immune checkpoint inhibitors, and FDG avidity of these lesions may mimic metastases. Knowledge of such imaging pitfalls is essential for interpreting 18F-FDG-PET/CT, particularly if they occur in the same organ as the primary tumor.