First comparison of performances between the new whole-body cadmium-zinc-telluride SPECT-CT camera and a dedicated cardiac CZT camera for myocardial perfusion imaging: Analysis of phantom and patients.

BACKGROUND: Dedicated cardiac Cadmium-zinc-telluride (CZT) cameras show superior performances compared with Anger systems, particularly in terms of spatial resolution and count sensitivity. This study evaluated the performances of a new polyvalent whole body CZT camera (DNM 670CZT) compared with a cardiac dedicated CZT camera (DNM 530c) for myocardial perfusion SPECT. METHODS: The spatial resolution was evaluated with three linear sources filled with 99mTc. We used a cardiac phantom to evaluate count sensitivity, sharpness index, contrast-to-noise ratio, wall thickness, non-uniformity index, perfusion scores and ventricle volumes for both cameras. The impact of matrix size, and acquisition time was investigated. Concordance between the two cameras was evaluated in patients using QPS/QGS software for quantitative segmental perfusion, motion and thickness scores. RESULTS: The spatial resolution was identical with the two cameras. Count sensitivity of the DNM 670CZT was twofold lower compared with the DNM 530c, leading to lower sharpness index and contrast-to-noise ratio. The wall thickness and the myocardial volumes were similar. Visual and quantitative assessments of the perfusion patterns have shown a good concordance of the two cameras on phantoms and in patients. CONCLUSION: This study demonstrated the feasibility of myocardial perfusion SPECT imaging using the new whole-body DNM 670CZT camera.

Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH).

OBJECTIVES: To evaluate the concordance between DECT perfusion and ventilation/perfusion (V/Q) scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Eighty patients underwent V/Q scintigraphy and DECT perfusion on a 2nd- and 3rd-generation dual-source CT system. The imaging criteria for diagnosing CTEPH relied on at least one segmental triangular perfusion defect on DECT perfusion studies and V/Q mismatch on scintigraphy examinations. RESULTS: Based on multidisciplinary expert decisions that did not include DECT perfusion, 36 patients were diagnosed with CTEPH and 44 patients with other aetiologies of PH. On DECT perfusion studies, there were 35 true positives, 6 false positives and 1 false negative (sensitivity 0.97, specificity 0.86, PPV 0.85, NPV 0.97). On V/Q scans, there were 35 true positives and 1 false negative (sensitivity 0.97, specificity 1, PPV 1, NPV 0.98). There was excellent agreement between CT perfusion and scintigraphy in diagnosing CTEPH (kappa value 0.80). Combined information from DECT perfusion and CT angiographic images enabled correct reclassification of the 6 false positives and the unique false negative case of DECT perfusion. CONCLUSION: There is excellent agreement between DECT perfusion and V/Q scintigraphy in diagnosing CTEPH. The diagnostic accuracy of DECT perfusion is reinforced by the morpho-functional analysis of data sets. KEY POINTS: • Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by surgery. • The triage of patients with pulmonary hypertension currently relies on scintigraphy. • Dual-energy CT (DECT) can provide standard diagnostic information and lung perfusion from a single acquisition. • There is excellent agreement between DECT perfusion and scintigraphy in separating CTEPH and non-CTEPH patients.

Lung perfusion characteristics in pulmonary arterial hypertension (PAH) and peripheral forms of chronic thromboembolic pulmonary hypertension (pCTEPH): Dual-energy CT experience in 31 patients.

PURPOSE: To compare lung perfusion in PAH and pCTEPH on dual-energy CT (DECT) examinations. MATERIALS AND METHODS: Thirty-one patients with PAH (group 1; n = 19) and pCTEPH (group 2; n = 12) underwent a dual-energy chest CTA with reconstruction of diagnostic and perfusion images. Perfusion alterations were analysed at a segmental level. V/Q scintigraphy was available in 22 patients (group 1: 13/19; group 2: 9/12). RESULTS: CT perfusion was abnormal in 52.6 % of group 1 patients and in 100 % of group 2 patients (p = 0.0051). The patterns of perfusion alteration significantly differed between the two groups (p < 0.0001): (1) in group 1, 96.6 % of segments with abnormal perfusion showed patchy defects; (2) in group 2, the most frequent abnormalities consisted of patchy (58.5 %) and PE-type (37.5 %) defects. Paired comparison of CT perfusion and scintigraphy showed concordant findings in 76.9 % of group 1 (10/13) and 100 % of group 2 (9/9) patients, with a predominant or an exclusive patchy pattern in group 1 and a mixed pattern of abnormalities in group 2. CONCLUSION: Lung perfusion alterations at DECT are less frequent and more homogeneous in PAH than in pCTEPH, with a high level of concordant findings with V/Q scintigraphy. KEY POINTS: • Depiction of chronic pulmonary embolism exclusively located on peripheral arteries is difficult. • The main differential diagnosis of pCTEPH is PAH. • The pattern of DECT perfusion changes can help differentiate PAH and pCETPH. • In PAH, almost all segments with abnormal perfusion showed patchy defects. • In pCTEPH, patchy and PE-type defects were the most frequent abnormalities.

Predictors of ventricular remodelling in patients with reperfused acute myocardial infarction and left ventricular dysfunction candidates for bone marrow cell therapy: insights from the BONAMI trial.

PURPOSE: Few data are available regarding the relation of left ventricular (LV) mechanical dyssynchrony to remodelling after acute myocardial infarction (MI) and stem cell therapy. We evaluated the 1-year time course of both LV mechanical dyssynchrony and remodelling in patients enrolled in the BONAMI trial, a randomized, multicenter controlled trial assessing cell therapy in patients with reperfused MI. METHODS: Patients with acute MI and ejection fraction (EF) ≤ 45 % were randomized to cell therapy or to control and underwent thallium single-photon emission computed tomography (SPECT), radionuclide angiography, and echocardiography at baseline, 3 months, and 1 year. Eighty-three patients with a comprehensive 1-year follow-up were included. LV dyssynchrony was assessed by the standard deviation (SD) of the LV phase histogram using radionuclide angiography. Remodelling was defined as a 20 % increase in LV end-systolic volume index (LVESVI) at 1 year. RESULTS: At baseline, LVEF, wall motion score index, and perfusion defect size were significantly impaired in the 43 patients (52 %) with LV remodelling (all p < 0.001), without significant increase in LV mechanical dyssynchrony. During follow-up, there was a progressive increase in LV SD (p = 0.01). Baseline independent predictors of LV remodelling were perfusion SPECT defect size (p = 0.001), LVEF (p = 0.01) and a history of hypertension (p = 0.043). Bone marrow cell therapy did not affect the time-course of LV remodelling and dyssynchrony. CONCLUSIONS: LV remodelling 1 year after reperfused MI is associated with progressive LV dyssynchrony and is related to baseline infarct size and ejection fraction, without impact of cell therapy on this process.

Condylar hyperplasia: correlation between clinical, radiological, scintigraphic, and histologic features.

PURPOSE: The objectives of this study were to compare demographic, clinical, radiographic, scintigraphic, and histologic differences between the 2 main types of condylar hyperplasia (CH) and to suggest a new therapeutic management based on such findings. METHODS: This was a retrospective study based on 28 patients who presented either vertical (group 1) or horizontal (group 2) forms of CH and underwent surgical treatment. Every patient had a complete preoperative clinical and radiological examination as well as a single-photon emission computed tomography scan. A histologic analysis of each resected condyle was performed. These various parameters were then compared in the 2 patient groups. RESULTS: The mean age at time of the diagnosis was 25.8 years (range, 12-50 years), and there were 22 females and 6 males. Nineteen patients had the vertical form of CH, and 9 had the horizontal form. Scintigraphic analysis showed moderate to extensive radionucleotide uptake in cases with rapid growth. Four cases had negative single-photon emission computed tomography scan uptake, and all were vertical forms, but there was no statistically significant difference between the 2 groups. The histologic analysis showed both a global thickening of the cartilage cap and of the prechondroblastic cells layer with no statistically significant difference between the 2 groups. CONCLUSIONS: Condylar hyperplasia is a pathologic condition affecting mainly young females and whose origin remains unknown. Single-photon emission computed tomography scans as an indicator of the rapidity of the disease progress are essential in assessing the condylar hyperplasia and to guide the therapeutic approach.

Memantine for axial signs in Parkinson's disease: a randomised, double-blind, placebo-controlled pilot study.

BACKGROUND: Given that memantine is thought to decrease N-methyl-D-aspartic-acid-related (NMDA) glutamatergic hyperactivity and improve locomotion in rats, we sought to assess the drug's impact on axial symptoms in advanced Parkinson's disease (PD). METHODS: We performed a 90-day, randomised, double-blind, study with two parallel arms: 20 mg/day memantine versus placebo (ClinicalTrials.gov:NCT01108029). The main inclusion criterion was the presence of a severe gait disorder and an abnormal, forward-leaning stance. The following parameters were analysed under standardised conditions before and after acute administration of L-dopa: gait (stride length as primary criterion), the United-Parkinson's-Disease-Rating-Scale (UPDRS) motor score and its axial subscore, the hypertonia and strength of the axial extensors and flexors (isokinetic dynamometer), the Dyskinesia Rating Scale score (DRS) and its axial subscore. RESULTS: Twenty-five patients were included. The memantine and placebo group did not differ significantly in terms of stride length. However, in the memantine group, we observed significantly better results (vs placebo) for the overall UPDRS score (F(1,21)=4.9; p=0.039(-1)) and its axial subscore (F(1,21)=7.2; p=0.014(-1.1)), axial hypertonia, the axial and overall DRS and axial strength. CONCLUSIONS: Memantine treatment was associated with lower axial motor symptom and dyskinesia scores but did not improve gait. These benefits must be confirmed in a broader population of patients.

MDCT of right ventricular function: comparison of right ventricular ejection fraction estimation and equilibrium radionuclide ventriculography, part 1.

OBJECTIVE: The aim of this study was to calculate right ventricular ejection fraction by use of ECG-gated MDCT and to compare the results with those of equilibrium radionuclide ventriculography. SUBJECTS AND METHODS: Forty-nine consecutively examined patients (30 men, 19 women; mean age, 59 years) with known or suspected right ventricular dysfunction secondary to bronchopulmonary (n = 30) or pulmonary vascular (n = 19) disease underwent ECG-gated 16-MDCT angiography of the heart (rotation time, 0.42 second; 120 kV; 300 mAs; collimation, 12 x 0.75 mm; pitch, 0.2) after CT angiographic examination of the entire thorax according to a standard protocol. Biphasic administration of a 30% contrast agent was systematically performed (phase 1, 90 mL at 3 mL/s; phase 2, 30 mL at 1.5 mL/s); no patient received additional medication. Right ventricular ejection fraction was calculated after two reviewers in consensus determined the reconstruction windows and segmentation of the right ventricular cavity on a series of diastolic and systolic short-axis images. The results were compared with those of equilibrium radionuclide ventriculography. RESULTS: At data acquisition, the mean (+/- SD) heart rate of the study group was 82 +/- 13.87 beats per minute (BPM) (range, 51-115 BPM). ECG showed a sinus rhythm in 30 (61%) of the patients and irregular cardiac rhythm in 19 (39%) of the patients. Agreement between the two techniques was estimated by intraclass correlation coefficient (0.77), the method of Bland and Altman (limits of concordance, -14.9 and 13.7), and percentage of variability between two measurements expressed by mean absolute percentage error (12.1%). The estimated effective dose for heart examination was 7.48 mSv with CT and 5 mSv with scintigraphy. The mean effective dose for the chest and heart CT examinations was 11.64 mSv. CONCLUSION: Right ventricular ejection fraction can be reliably estimated with 16-MDCT in unselected patients.

MDCT of right ventricular function: impact of methodologic approach in estimation of right ventricular ejection fraction, part 2.

OBJECTIVE: The purpose of this study was to evaluate the impact of the methodologic approach for MDCT estimation of right ventricular ejection fraction (RVEF). MATERIALS AND METHODS: In 49 consecutive patients (30 men, 19 women; mean age, 59 years) known to have or suspected of having right ventricular (RV) dysfunction secondary to pulmonary disease, 16-MDCT of the heart was performed after standard CT angiographic examination of the entire thorax, with determination of RVEF by two reviewers who had limited experience in cardiac CT. The reconstruction windows were determined using the ECG tracing (reviewer 1) or using transverse test images obtained in 5% steps through the entire R-R interval showing the largest and smallest RV cavity areas (reviewer 2). After manual segmentation of the ventricular cavity on diastolic and systolic short-axis reformations by each reviewer, the end-diastolic and end-systolic RV volumes were calculated, with subsequent determination of the RVEF. CT results were compared with those of equilibrium radionuclide ventriculography. RESULTS: Agreement between the two methods for determining the end-systolic and end-diastolic phases was observed in 61% of cases (n = 30) for the systole and 59% of cases (n = 29) for the diastole. Discordant selections were observed in 39% of cases (n = 19) for determination of the systole and in 41% of cases (n = 20) for determination of the diastole, ranging from 5% to 15% of the R-R interval, suggesting that selection of the reconstruction window on the ECG tracing does not differ significantly from that obtained by the visual analysis of transverse test images. Focusing on the 59 common selections of the reconstruction windows made by the two reviewers, no statistically significant differences were found in the determination of mean (+/- SD) end-diastolic volumes (reviewer 1, 176.21 +/- 67 mL vs reviewer 2, 175.55 +/- 71.24 mL; p = 0.98) and end-systolic (reviewer 1, 97.3 +/- 26.49 mL vs reviewer 2, 96.33 +/- 65.72 mL; p = 0.65), suggesting the lack of operator dependence in the manual-contour drawing process. No significant difference was found between the mean values of RVEF obtained by each reviewer with MDCT and equilibrium radionuclide ventriculography, and there was excellent interobserver agreement with MDCT (intraclass correlation coefficient, 0.86). Using a Bland-Altman approach, the limits of concordance between the two reviewers ranged between -10.2 and 10.9. The mean absolute percentage error for measuring RVEF between the two reviewers was 9.7%. A moderate agreement was found between RVEFs obtained on CT by each reviewer and scintigraphy (intraclass correlation coefficients, 0.76 for reviewer 1 and 0.64 for reviewer 2). CONCLUSION: These results show that RVEF can be accurately assessed with ECG-gated MDCT using commercially available software.

Prevalence of asymptomatic coronary disease in fibrosing idiopathic interstitial pneumonias.

BACKGROUND: Because of growing body of interest on the association between fibrosing idiopathic interstitial pneumonias (f-IIP) and ischaemic heart disease, we initiated this prospective study to evaluate the prevalence of asymptomatic coronary artery disease (CAD) in patients with f-IIP. METHODS: Forty-two patients with f-IIP underwent noninvasive screening for CAD that included (a) a chest CT examination enabling calculation of the coronary artery calcium (CAC) score, then depiction of coronary artery stenosis; and (b) stress myocardial perfusion scintigraphy (MPS). Patients with significant coronary abnormalities, defined by a CAC score >400 or coronary artery stenosis >50% at CT and/or perfusion defect >5% at MPS, were referred to the cardiologist. Coronary angiography was indicated in presence of a perfusion defect >10% at MPS or significant left main or proximal left anterior descending stenosis whatever MPS findings. RESULTS: Combining CT and MPS, significant abnormalities were detected in 32/42 patients (76%). The cardiologist: (a) did not consider further investigation in 21 patients (CT abnormalities but no ischaemia at MPS: 12/21; false-positive findings at MPS: 3/21; poor respiratory condition: 6/21); (b) proceeded to coronary angiography in 11 patients which confirmed significant stenoses in 5 patients (5/42; 12%). In the worst-case-scenario (i.e., inclusion of 6 patients with significant coronary artery abnormalities who were not investigated due to poor respiratory condition), the prevalence of CAD reached 26% (11/42). CONCLUSION: In the studied population of patients with f-IIP, asymptomatic CAD ranged between 12% and 26%.

Impaired exercise response in sarcoid patients with normal pulmonary functio.

BACKGROUND AND AIM OF THE WORK: Sarcoidosis is a granulomatous disease with frequent pul monary involvement. Patients generally exhibit a 25-30% reduction in maximal aerobic capacit (VO2max). As most investigations have included patients with both normal and abnormal resting pulmonary function tests (PFT), the mechanisms responsible for this limitation remain unclear. We initiated a prospective study to characterize the cardio-respiratory response to exercise in sarcoid patients with normal resting PFT. METHODS: 19 untreated male patients with biopsy-proven sarcoidosis and 19 age- an sex-matched sedentary healthy controls (38 +/- 8.7 vs 37 +/- 8.7 yrs ; Body Mass Index: 24 +/- 3.05 vs 23 +/- 3.05) were included in the study. All patients had normal resting PFT including diffusing capacity for CO (DLCO) > 80% predicted and normal cardiac status at rest as assessed by EKG and echocardiography. A maximal cycling test was performed in all subjects. RESULTS: True maximal effort was obtaine in all subjects (plasma lactate 9.1 +/- 2.6 vs 11.0 +/- 2.2 mmol l(-1), pH 7.35 +/- 0.04 vs 7.34 +/- 0.04) (patients vs controls). Patients exhibited a 30% lower maximal workload and/or VO2max (2,128 +/- 413 vs 2,909 +/- 387 ml x min(-1)) than controls. Maximal ventilation (79 +/- 21.7 vs 110 +/- 21.7 l x min(-1)) and tital volume (VT) (2,313 +/- 517 ml vs 2,856 +/- 339) were significantly lower in patients than in controls while dead space t tital volume ratio (VD/V(T)) (0.18 +/- 0.09 vs 0.11 +/- 0.04) was higher in patients than in controls. PaO2, PAiO2, and PAi-aO2 at VO2max were not significantly different between patient and controls. Peak exercise EKG was normal in all but one patient. Interestingly, heart rate was significantly lower in patients for all relative exercise intensities > or = 60% VO2max including maximum (159 +/- 21.7 vs 182 +/- 13) CONCLUSION: The present observations indicate a significant maximal exercise limitation in sarcoid patients without significant pulmonary impairment which could be related at least in part to an impaired heart rate response to exercise.

Higher predictive value of tumour and node [18F]-FDG PET metabolic volume and TLG in advanced lung cancer under chemotherapy.

INTRODUCTION: The prognostic value of standardized uptake values (SUVs) at initiation of and during chemotherapy remains controversial in lung cancer patients. However, metabolic volume (MV) and total lesion glycolysis (TLG) have shown promise in lung cancer stratification before treatment. Our aim was to define the prognostic value of MV and TLG in a homogenous group of advanced-stage lung cancer patients treated with bevacizumab and paclitaxel. MATERIALS AND METHODS: Fifty (18)F-fluorodeoxyglucose PET-computed tomography examinations were studied. SUV, MV and TLG were measured for each detectable lesion (classified as primary tumour, node or distant metastasis). MV values were added to compute tumour MV (MVt), nodal MV (MVn), metastatic MV (MVm) and whole-body MV (MVwb). TLGt, TLGn, TLGm and TLGwb were computed using the same method. Maximal SUVt, SUVn, SUVm and SUVwb were measured. Patients were stratified according to each parameter. Overall survival was compared between parameter-stratified groups using the log rank test. RESULTS: At initiation of bevacizumab and paclitaxel therapy (n=12), only TLGwb and TLGn had strong prognostic value with hazard ratios (HRs) of 11.8 and 5.6, respectively (P<0.03). During treatment with bevacizumab and paclitaxel (n=38), SUVwb (HR: 4.9), MVwb (HR: 4.9), TLGwb (HR: 8.9), SUVt (HR: 15.1), MVt (HR: 15.6) and TLGt (HR: 15.6) had significant prognostic value (P<0.05). Metastasis measurements showed no significant prognostic value. CONCLUSION: MV and TLG are powerful prognostic factors in advanced-stage lung adenocarcinoma being treated with chemotherapy. Focusing on the intrathoracic primary tumour increases the prognostic value of PET in these patients.

[Management of renal atrophy in hypertensive patients: experience in Lille]. / Conduite à tenir devant une atrophie rénale chez le patient hypertendu: l'expérience lilloise.

INTRODUCTION: In the absence of specific treatment, patients with renal vascular disease develop renal atrophy. This population frequently has hypertension refractory to medical treatment. The patients who may respond to revascularization or at the worst to a nephrectomy must be identified to optimize their therapeutic management. METHODS: We conducted an observational retrospective study of hypertensive patients with unilateral renal atrophy (renal height < 9 cm) followed at the Lille University Hospital Center from 1998 to 2006. Hypertension, renal clearance (by scintigraphy with MAG3), and hypersecretion of renin (segmental/selective venous renin samples) were studied. We subsequently classified the patients into 3 groups. Medical treatment was optimized for all. RESULTS: The mean follow-up period was 1.3+/-0.2 years. Eight patients were treated medically (group 1). Endovascular revascularization was used to treat the subjects for which atrophic kidney function accounted for more than 10% of their total renal function and with stenosis of the renal artery (>70%) (group 2, n=19). Those with a small nonfunctional kidney (<10% of total renal function) and hypersecretion of renin (ratio>1.5 in relation to the contralateral kidney) underwent a nephrectomy (group 3, n=8). The reduction in systolic blood pressure (SBP) was 27 mm Hg and diastolic blood pressure (DBP) 14 mm Hg for the overall study population (p < 0.001), without any significant aggravation of renal function. In group 1, the reduction in blood pressure was lower, with medical treatment alone; SBP fell by 13 mm Hg and DBP by 4mm Hg (p=ns) ; this group had the lowest initial blood pressure. In group 2, revascularization made it possible to improve SBP by 26 mm Hg and DBP by 14 mm Hg (p < 0.01) without significant impairment of renal function. Group 3 showed the most spectacular improvement in blood pressure, with SBP dropping by 40 mm Hg and DBP by 19 mm Hg (p=0.016). But it was also in this group that we observed an aggravation in the rate of glomerular filtration with a nonsignificant reduction of 12.8 mL/min, nonetheless superior to that expected according to the preoperative scintigraphy. CONCLUSION: The results of this work underline the importance of multidisciplinary management of patients with small ischemic kidneys. Preselection of patients in unstable clinical situations (refractory hypertension, progressive kidney failure, flash pulmonary edema) by isotopic and endocrinal renal evaluation provides a basis for deciding on treatment. The existence of a renin ratio >1.5 can identify the patients most likely to respond to nephrectomy. The reduction of renal function following nephrectomy must be considered in the discussion about treatment. The functional threshold initially defined at 10% may be lowered to 5%, to limit this postoperative reduction.

Primary tumor standardized uptake value measured on fluorodeoxyglucose positron emission tomography is of prognostic value for survival in non-small cell lung cancer: update of a systematic review and meta-analysis by the European Lung Cancer Working Party for the International Association for the Study of Lung Cancer Staging Project.

INTRODUCTION: Few validated prognostic factors are available for survival in patients with lung cancer. [F]-fluoro-2-deoxy-d-glucose positron emission tomography has been shown to be of additional value to conventional imaging for staging lung cancer. The prognostic value of this lung tumor metabolic activity was studied in a first systematic review of studies published until 2006. METHODS: As further studies have appeared since 2006, this report has as objective to confirm and to estimate with less variability the prognostic value of primary tumor standardized uptake value (SUV) measured with [F]-fluoro-2-deoxy-d-glucose positron emission tomography on the basis of an updated search of eligible studies. RESULTS: Ten additional studies were eligible for the updated review and eight of them provided, in the publication, data allowing survival results aggregation. All together, 21 studies were analyzed. Comparing patients with low and high SUV, using preferentially the median SUV value of each study as threshold, we obtained a poor prognostic value for high SUV compared with low SUV with an overall combined hazard ratio of 2.08, significantly different from one with a 95% confidence interval ranging from 1.69 to 2.56. No interaction between older and newer studies was detectable (P = 0.60) as well as between studies having selected non metastatic patients or studies without selection criterion related to stage (P = 0.46). CONCLUSIONS: We confirmed the results of our previous review showing that SUV is potentially a very interesting factor for predicting patient outcome. We believe that a meta-analysis based on individual patient data would be of great value as allowing to assess the independent prognostic value, to take into account some factors responsible for heterogeneity between studies (SUV assessment method, disease stage, and histology), and to update survival data. We are planning to conduct such a meta-analysis on behalf of the International Association for the Study of Lung Cancer Staging Project.

Primary tumor standardized uptake value (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project.

HYPOTHESIS: The 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography is an imaging tool for assessing clinical tumor, node, metastasis in non-small cell lung cancer (NSCLC). Primary tumor standardized uptake value (SUV) has been studied as a potential prognostic factor for survival. However, the sample sizes are limited leading to conduct a meta-analysis to improve the precision in estimating its effect. METHODS: We performed a systematic literature search. For each publication, we extracted an estimate of the hazard ratio (HR) for comparing patients with a low and a high SUV and we aggregated the individual HRs into a combined HR, using a random-effects model. RESULTS: We found 13 eligible studies dedicated to NSCLC. Most of them included patients with stages I to III/IV and used a SUV assessment corrected for body weight. Number of patients ranged from 38 to 315 (total: 1474); 11 studies identified a high SUV as a poor prognostic factor for survival although two studies found no significant correlation between SUV and survival. SUV measurement and SUV threshold for defining high SUV were study dependent, eight studies looked for a so-called best cutoff (maximizing the logrank test statistic) without adjusting the p value for multiplicity. Overall, the combined HR for the 13 reports was 2.27 (95% confidence interval [CI]: 1.70-3.02); excluding the studies proposing a "best" cutoff, it was 2.08 (95% CI: 1.431-3.04). CONCLUSION: Our meta-analysis suggests that the primary tumor SUV measurement has a prognostic value in NSCLC; these results should be confirmed in a meta-analysis on individual patients' data.