Preoperative prediction of microvascular invasion of hepatocellular carcinoma using 18F-FDG PET/CT: a multicenter retrospective cohort study.

PURPOSE: The aim of this study was to assess the potential of tumor 18F-fluorodeoxyglucose (FDG) avidity as a preoperative imaging biomarker for the prediction of microvascular invasion (MVI) of hepatocellular carcinoma (HCC). METHODS: One hundred and fifty-eight patients diagnosed with Barcelona Clinic Liver Cancer stages 0 or A HCC (median age, 57 years; interquartile range, 50-64 years) who underwent 18F-FDG positron emission tomography with computed tomography (PET/CT) before curative surgery at seven university hospitals were included. Tumor FDG avidity was measured by tumor-to-normal liver standardized uptake value ratio (TLR) of the primary tumor on FDG PET/CT imaging. Logistic regression analysis was performed to identify significant parameters associated with MVI. The predictive performance of TLR and other clinical variables was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: MVI was present in 76 of 158 patients with HCCs (48.1%). Multivariable logistic regression analysis revealed that TLR, serum alpha-fetoprotein (AFP) level, and tumor size were significantly associated with the presence of MVI (P < 0.001). Multinodularity was not significantly associated with MVI (P = 0.563). The area under the ROC curve (AUC) for predicting the presence of MVI was best with TLR (AUC = 0.704), followed by tumor size (AUC = 0.685) and AFP (AUC = 0.670). We were able to build an improved prediction model combining TLR, tumor size, and AFP by using multivariable logistic regression modeling (AUC = 0.756). CONCLUSIONS: Tumor FDG avidity measured by TLR on FDG PET/CT is a preoperative imaging biomarker for the prediction of MVI in patients with HCC.

Predictive Value of 18F-FDG PET/CT for Axillary Lymph Node Metastasis in Invasive Ductal Breast Cancer.

BACKGROUND: This study assessed whether primary tumor maximum standardized uptake value (pSUVmax) measured by 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) could improve the prediction of axillary lymph node (ALN) metastasis in invasive ductal breast cancer (IDC). METHODS: In this study, 128 IDC patients who underwent pretreatment 18F-FDG PET/CT and surgical resection of primary tumor with sentinel lymph node biopsy, ALN dissection, or both were analyzed. All the patients were classified as five molecular subtypes. The optimal cutoff values of pSUVmax for all the patients and each molecular subtype for the prediction of ALN metastasis were determined using receiver operating characteristic (ROC) analysis. Furthermore, the prognostic accuracy of ALN metastasis was assessed using c-statistics. RESULTS: The findings showed ALN metastasis in 52 patients (40.6%). The 18F-FDG PET/CT procedure had a sensitivity of 48.1% and a specificity of 94.7% for ALN metastasis. In the ROC analysis of pSUVmax for ALN metastasis, the optimal cutoff value was 3.9 for all the patients, 2.8 for the luminal A subtype, 3.3 for the luminal B (human epidermal growth factor receptor 2 [HER2]-negative) subtype, 5.3 for the luminal B (HER2-positive) subtype, 12.7 for the HER2-positive subtype, and 11.5 for the triple-negative subtype. A predictive ALN metastasis model using nodal 18F-FDG uptake finding gave a c-statistic of 0.714, and a model combination of nodal 18F-FDG uptake finding with pSUVmax of all the patients gave a c-statistic of 0.736 (P = 0.3926). However, the combination of nodal the 18F-FDG uptake finding with the pSUVmax of each molecular subtype gave a c-statistic of 0.791 (P = 0.0047). CONCLUSIONS: Combining the pSUVmax of each molecular subtype with the nodal 18F-FDG uptake finding can improve the prediction of ALN metastasis in IDC.

Prognostic value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with Barcelona Clinic Liver Cancer stages 0 and A hepatocellular carcinomas: a multicenter retrospective cohort study.

PURPOSE: We evaluated the prognostic value of pretreatment (18)F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A hepatocellular carcinoma (HCC) who had received curative treatment or transarterial chemoembolization (TACE). METHODS: Between 2009 and 2010, 317 patients diagnosed with HCC at seven hospitals were enrolled. Among these, 195 patients underwent curative treatments including resection, liver transplantation, and radiofrequency ablation. TACE was performed in 122 patients. The tumor-to-normal liver standardized uptake value ratio (TLR) of the primary tumor was measured using pretreatment FDG PET/CT. The prognostic significance of TLR and other clinical variables was assessed using Cox regression models. Differences in the overall survival (OS) associated with TLR or other significant clinical factors were examined using the Kaplan-Meier method. RESULTS: Over a median follow-up period of 46 months, 77 patients died from cancer. In the curative cohort, higher TLR (≥2) was significantly associated with death (hazard ratio [HR] = 2.68; 95 % CI, 1.16-6.15; P = 0.020) in multivariable analysis. Patients with a higher TLR had significantly worse OS than patients with a lower TLR (5-year overall survival, 61 % vs. 79.4 %; P = 0.006). In the TACE cohort, the Model for End-Stage Liver Disease (MELD) score (≥8) was a significant independent prognostic factor for OS (HR = 3.34; 95 % CI, 1.49-7.48; P = 0.003), whereas TLR was not associated with OS. The Kaplan-Meier curves showed significantly poorer OS in patients with higher MELD scores (≥8) than in those with lower MELD scores (5-year survival rate, 33.1 % vs. 79.6 %; P < 0.001). CONCLUSIONS: Pretreatment TLR measured using FDG PET/CT was an independent prognostic factor for OS in patients with BCLC stage 0 or A HCC undergoing curative treatment. In contrast, underlying liver function appeared to be important in predicting the prognosis of patients undergoing TACE.

A rare case of coronary fistula evaluated by first-pass radionuclide angiography.

Coronary artery fistula (CAF) is a rare anomaly that originates from the coronary artery and drains into the cardiac chamber or the adjacent vasculature. We report a case of CAF in a 77 years old woman with dyspnea on exertion. Using coronary angiography and cardiac multidetector computed tomography, this patient was diagnosed with CAF draining into the left bronchial arteries. First-pass radionuclide angiography (FPRNA) showed early pulmonary recirculation through a left to right shunt. The pulmonary to systemic blood flow ratio was 1.24. The patient received supportive care with vasodilator and antiplatelet therapy. First-pass radionuclide angiography was used to provide physiologic informations, to plan the treatment course for this patient.

Whole-Body Metabolic Tumor Volume, as Determined by (18)F-FDG PET/CT, as a Prognostic Factor of Outcome for Patients With Breast Cancer Who Have Distant Metastasis.

OBJECTIVE: This study was performed to evaluate the prognostic relevance of PET parameters measured by (18)F-FDG PET/CT in patients with invasive ductal carcinoma of the breast (IDC) who had distant metastasis at the time of initial diagnosis. MATERIALS AND METHODS: Forty women with IDC who had distant metastasis at the time of initial diagnosis and who underwent FDG PET/CT before receiving treatment were enrolled in the study. Clinicopathologic parameters and metabolic PET parameters, including the maximum standardized uptake value (SUVmax) of the primary tumor (pSUVmax), the SUVmax of the axillary lymph node (nSUVmax), the highest SUVmax of whole malignant lesions (wSUVmax), the whole-body (WB) metabolic tumor volume (MTV), and WB total lesion glycolysis (TLG), were analyzed to determine their usefulness in predicting overall survival (OS). Univariate and multivariate analyses were performed with the use of Kaplan-Meier and Cox proportional hazards models. RESULTS: Twenty-one of the 40 patients (52.5%) died during follow-up (mean follow-up, 36.4 months; range, 0.8-71.4 months). Nonsurvivors had a statistically significantly higher mean (± SD) WB MTV than did survivors (424.0 ± 683.9 vs 92.1 ± 96.3 cm(3); p = 0.0430). T category, performance of palliative surgery, presence of visceral metastasis, wSUVmax, WB MTV, and WB TLG were identified by univariate analysis as prognostic factors for OS, whereas age, N category, hormone receptor status, status, triple-negative breast cancer status (defined as a tumor for which estrogen receptor, progesterone receptor, and ERBB2 statuses were all negative), pSUVmax, and nSUVmax were not. Multivariate analysis revealed that only WB MTV independently predicted OS (hazard ratio, 4.10; 95% CI, 1.17-14.31; p = 0.0280). CONCLUSION: The WB MTV value, as determined by FDG PET/CT performed before treatment, was found to be an independent prognostic factor for OS in patients with IDC who had distant metastasis at the time of initial diagnosis.

Prediction for recurrence using F-18 FDG PET/CT in pathologic N0 lung adenocarcinoma after curative surgery.

BACKGROUND: The aim of this study was to investigate risk factors for recurrence in patients with lung adenocarcinoma (LAD) who were pathologically N0 (pN0) after curative surgical resection. METHODS: A total of 102 LAD patients (M/F = 55/47, mean age, 62.6 ± 9.4 years) diagnosed as pN0 after curative surgery were included in this study. Clinical, biochemical, radiologic, and pathologic findings were reviewed and analyzed for recurrence. Metabolic parameters [SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG)] on pretreatment F-18 FDG PET/CT were also obtained and analyzed for recurrence. RESULTS: Of 102 patients, 38 (37.3%) were found to experience recurrence for 33.6 ± 16.3 months. SUVmax, MTV, and TLG were significantly higher in patients with recurrence. The optimal cutoff values determined using a receiver-operating characteristic curve were 6.90 for SUVmax, 10.78 cm(3) for MTV, and 39.68 for TLG. Univariate analysis showed that tumor size, tumor marker, SUVmax, MTV, and TLG were prognostic factors for recurrence. In multivariate analyses, after adjusting for age, sex, tumor size, pathologic T stage, and tumor marker, high SUVmax, MTV, and TLG showed an association with an increased risk of recurrence. CONCLUSIONS: Metabolic parameters on pretreatment F-18 FDG PET/CT can predict recurrence in pN0 LAD patients who underwent curative surgery. Therefore, patients with high metabolic parameters on PET can be considered as candidates for adjuvant therapy to reduce recurrence and should be monitored carefully for early detection of possible recurrence.

Clinical applications of SPECT/CT after first I-131 ablation in patients with differentiated thyroid cancer.

OBJECTIVE: This study aimed to determine which thyroid cancer patients would benefit from SPECT/CT in addition to whole-body planar scintigraphy (RxWBS) for the detection and characterization of I-131 focal uptake after first ablation. DESIGN AND PATIENTS: Neck and thoracic SPECT/CT was performed in 187 patients with I-131 focal uptake suggestive of remnant thyroid tissue (Rem group, n = 152) or presumed lymph node (LN) metastases (mLN group, n = 35) on RxWBS. Clinical and pathologic parameters were analysed and compared in patients with and without additional SPECT/CT findings. RESULTS: wIn the Rem group, SPECT/CT revealed additional occult findings on RxWBS in 13 patients (8·6%). The serum thyroglobulin levels at the time of ablation were significantly higher in patients with additional SPECT/CT findings than in patients without additional findings (4·3 ± 3·4 ng/ml vs 1·6 ± 2·7 ng/ml, P = 0·001). In the mLN group, SPECT/CT demonstrated only remnant thyroid tissues without evidence of lymph node metastasis in 14 (40·0%) patients, whereas in the remaining 21 (60·0%) patients, I-131 uptake was confirmed in the corresponding neck and mediastinal lymph nodes on SPECT/CT. CONCLUSIONS: Even in the Rem group, additional SPECT/CT could provide useful information for detecting hidden metastasis, especially in patients with high serum thyroglobulin levels. SPECT/CT should be recommended for patients with focal uptake lymph node metastasis on RxWBS.

Metabolic parameters using ¹8F-FDG PET/CT correlate with occult lymph node metastasis in squamous cell lung carcinoma.

PURPOSE: The aim of this study was to investigate predictability of occult lymph node metastasis (OLM) using metabolic parameters on pretreatment (18)F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/CT in squamous cell non-small cell lung carcinoma (SC-NSCLC) patients who were clinically node negative (cN0) before surgery. METHODS: A total of 63 cN0 SC-NSCLC patients (M/F = 61/2, mean age 64.1 ± 8.0) who underwent curative surgery with lymph node dissection were enrolled in this study. Metabolic tumor volume (MTV) of the primary tumor was obtained with a standardized uptake value (SUV) threshold of 2.5. Total lesion glycolysis (TLG) was calculated by multiplication of the MTV and its SUVmean. Metabolic parameters (SUVmax, MTV, and TLG) and clinicopathological factors were analyzed for OLM. RESULTS: Of 63 patients, 12 (19.0 %) had OLM. Significantly higher SUVmax, MTV, TLG, and pathological tumor size were observed in patients with OLM. The optimal cutoff values for prediction of OLM determined using a receiver-operating characteristic (ROC) curve were 8.8 for SUVmax, 18.9 cm(3) for MTV, 88.4 for TLG, and 2.8 cm for pathological tumor size. Univariate analysis showed correlation of SUVmax, MTV, and TLG with the rate of OLM. In multivariate analyses, high SUVmax and MTV showed an association with an increased risk of OLM, after adjusting for age, sex, pathological tumor size, T stage, and location. CONCLUSION: Metabolic parameters on pretreatment (18)F-FDG PET/CT were significant predictors for OLM in cN0 SC-NSCLC patients. Surgical planning can be tailored based on the parameters in order to reduce the risk of hidden residual lymph node metastases in patients.

Pure uric acid stone prediction model using the variant coefficient of stone density measured by thresholding 3D segmentation-based methods: A multicenter study.

Urinary stones are common urological diseases with increasing prevalence and incidence worldwide. Among the various types of stones, uric acid stones can be dissolved by oral chemolysis without any surgical procedure. Therefore, our study demonstrates that variant coefficient of stone density measured by thresholding a three-dimensional segmentation-based method from noncontrast computed tomography images can be used to identify pure uric acid stones from non-pure uric acid stones. This study provides a preoperative pure uric acid stone prediction model that could reduce invasive procedural treatments. The pure uric acid stone prediction model may offer optimized clinical decision-making for patients with urinary stones. BACKGROUND AND OBJECTIVES: While most urinary stones are managed with interventional therapy, uric acid (UA) stones can be dissolved by oral chemolysis without invasive procedures. This study aimed to develop and validate a pure UA (pUA) stone prediction model using a variant coefficient of stone density (VCSD) measured by thresholding a three-dimensional (3D) segmentation-based method. METHODS: Patients with urolithiasis treated at Keimyung University Dongsan Hospital between January 2017 and December 2020 were divided into training and internal validation sets, and patients from Kyungpook National University Hospital between January 2017 and December 2018 were used as an external validation set. Each stone was segmented by a thresholding 3D segmentation-based method using an attenuation threshold of 130 Hounsfield units. VCSD was calculated as the stone heterogeneity index divided by the mean stone density. RESULTS: A total of 1175 urinary stone cases in 1023 patients were enrolled in this study. Of these, 224 (19.1%) were pUA stone cases. Among the potential predictors, thresholding 3D segmentation-based VCSD, age, sex, radio-opacity, hypertension, diabetes, and urine pH were identified as independent pUA stone predictors, and VCSD was the most powerful indicator. The pUA stone prediction model showed good discrimination, yielding area under the receiver operating characteristic curve of 0.960 (95% confidence interval (CI): 0.940-0.979, P < 0.001), 0.931 (95% CI: 0.875-0.987, P < 0.001), and 0.938 (95% CI: 0.912-0.965, P < 0.001) in the training, internal validation, and external validation sets, respectively. CONCLUSIONS: VCSD measured using 3D segmentation was a decisive independent predictive factor for pUA stones. Furthermore, the established prediction model with VCSD can serve as a noninvasive preoperative tool to identify pUA stones.

Development of lung cancer risk prediction models based on F-18 FDG PET images.

OBJECTIVE: We aimed to evaluate whether the degree of F-18 fluorodeoxyglucose (FDG) uptake in the lungs is associated with an increased risk of lung cancer and to develop lung cancer risk prediction models using metabolic parameters on F-18 FDG positron emission tomography (PET). METHODS: We retrospectively included 795 healthy individuals who underwent F-18 FDG PET/CT scans for a health check-up. Individuals who developed lung cancer within 5 years of the PET/CT scan were classified into the lung cancer group (n = 136); those who did not were classified into the control group (n = 659). The healthy individuals were then randomly assigned to either the training (n = 585) or validation sets (n = 210). Clinical factors including age, sex, body mass index (BMI), and smoking history were collected. The standardized uptake value ratio (SUVR) and metabolic heterogeneity (MH) index were obtained for the bilateral lungs. Logistic regression models including clinical factors, SUVR, and MH index were generated to quantify the probability of lung cancer development using a training set. The prediction models were validated using a validation set. RESULTS: The lung SUVR and lung MH index in the lung cancer group were significantly higher than in the control group (p < 0.001 and p < 0.001, respectively). In the combined prediction model 1, age, sex, BMI, smoking history, and lung SUVR were significantly associated with lung cancer development (age: OR 1.07, p < 0.001; male: OR 2.08, p = 0.015; BMI: OR 0.93, p = 0.057; current or past smoker: OR 5.60, p < 0.001; lung SUVR: OR 1.13, p < 0.001). In the combined prediction model 2, age, sex, BMI, smoking history, and lung MH index showed a significant association with lung cancer development (age: OR 1.06, p < 0.001; male: OR 1.87, p = 0.045; BMI: OR 0.93, p = 0.010; current or past smoker: OR 4.78, p < 0.001; lung MH index: OR 1.33, p < 0.001). In the validation data, combined prediction models 1 and 2 exhibited very good discrimination [area under the receiver operator curve (AUC): 0.867 and 0.901, respectively]. CONCLUSIONS: The metabolic parameters on F-18 FDG PET are related to an increased risk of lung cancer. Metabolic parameters can be used as biomarkers to provide information independent of the clinical parameters, related to lung cancer risk.

Prognostic value of the metabolic score obtained via [18F]FDG PET/CT and a new prognostic staging system for gastric cancer.

We developed and validated a new staging system that includes metabolic information from pretreatment [18F]Fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) for predicting disease-specific survival (DSS) in gastric cancer (GC) patients. Overall, 731 GC patients undergoing preoperative [18F]FDG PET/CT were enrolled and divided into the training (n = 543) and validation (n = 188) cohorts. A metabolic score (MS) was developed by combining the maximum standardized uptake value (SUVmax) of the primary tumor (T_SUVmax) and metastatic lymph node (N_SUVmax). A new staging system incorporating the MS and tumor-node-metastasis (TNM) stage was developed using conditional inference tree analysis. The MS was stratified as follows: score 1 (T_SUVmax ≤ 4.5 and N_SUVmax ≤ 1.9), score 2 (T_SUVmax > 4.5 and N_SUVmax ≤ 1.9), score 3 (T_SUVmax ≤ 4.5 and N_SUVmax > 1.9), and score 4 (T_SUVmax > 4.5 and N_SUVmax > 1.9) in the training cohort. The new staging system yielded five risk categories: category I (TNM I, II and MS 1), category II (TNM I, II and MS 2), category III (TNM I, II and MS ≥ 3), category IV (TNM III, IV and MS ≤ 3), and category V (TNM III, IV and MS 4) in the training cohort. DSS differed significantly between both staging systems; the new staging system showed better prognostic performance in both training and validation cohorts. The MS was an independent prognostic factor for DSS, and discriminatory power of the new staging system for DSS was better than that of the conventional TNM staging system alone.

Selective neurodegeneration of the hippocampus caused by chronic cerebral hypoperfusion: F-18 FDG PET study in rats.

BACKGROUND: Chronic cerebral hypoperfusion (CCH) is known to induce Alzheimer's disease (AD) pathology, but its mechanism remains unclear. The purpose of this study was to identify the cerebral regions that are affected by CCH, and to evaluate the development of AD pathology in a rat model of CCH. METHODS: A rat model of CCH was established by bilaterally ligating the common carotid arteries in adult male rats (CCH group). The identical operations were performed on sham rats without arteries ligation (control group). Regional cerebral glucose metabolism was evaluated at 1 and 3 months after bilateral CCA ligation using positron emission tomography with F-18 fluorodeoxyglucose. The expression levels of amyloid ß40 (Aß40), amyloid ß42 (Aß42), and hyperphosphorylated tau were evaluated using western blots at 3 months after the ligation. Cognitive function was evaluated using the Y-maze test at 3 months after the ligation. RESULTS: At 1 month after the ligation, cerebral glucose metabolism in the entorhinal, frontal association, motor, and somatosensory cortices were significantly decreased in the CCH group compared with those in the control group. At 3 months after the ligation, cerebral glucose metabolism was normalized in all regions except for the anterodorsal hippocampus, which was significantly decreased compared with that of the control group. The expression of Aß42 and the Aß42/40 ratio were significantly higher in the CCH group than those in the control group. The phosphorylated-tau levels of the hippocampus in the CCH group were significantly lower than those in the control group. Cognitive function was more impaired in the CCH group than that in the control group. CONCLUSION: Our findings suggest that CCH causes selective neurodegeneration of the anterodorsal hippocampus, which may be a trigger point for the development of AD pathology.

A machine learning-based radiomics model for the prediction of axillary lymph-node metastasis in breast cancer.

OBJECTIVE: The aim of this study was to develop and validate machine learning-based radiomics model for predicting axillary lymph-node (ALN) metastasis in invasive ductal breast cancer (IDC) using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). METHODS: A total of 100 consecutive IDC patients who underwent surgical resection of primary tumor with sentinel lymph-node biopsy and/or ALN dissection without any neoadjuvant treatment were analyzed. Volume of interests (VOIs) were drawn more than 2.5 of standardized uptake value in the primary tumor on the PET scan using 3D slicer. Pyradiomics package was used for the extraction of texture features in python. The radiomics prediction model for ALN metastasis was developed in 75 patients of the training cohort and validated in 25 patients of the test cohort. XGBoost algorithm was utilized to select features and build radiomics model. The sensitivity, specificity, and accuracy of the predictive model were calculated. RESULTS: ALN metastasis was found in 43 patients (43%). The sensitivity, specificity, and accuracy of F-18 FDG PET/CT for the diagnosis of ALN metastasis in the entire patients were 55.8%, 93%, and 77%, respectively. The radiomics model for the prediction of ALN metastasis was successfully developed. The sensitivity, specificity, and accuracy of the radiomics model for the prediction of ALN metastasis in the test cohorts were 90.9%, 71.4%, and 80%, respectively. CONCLUSION: The machine learning-based radiomics model showed good sensitivity for the prediction of ALN metastasis and could assist the preoperative individualized prediction of ALN status in patients with IDC.

Prognostic value of metabolic parameters on 18F-fluorodeoxyglucose positron tomography/computed tomography in classical rectal adenocarcinoma.

We aimed to investigate the prognostic value of the metabolic parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in classical rectal adenocarcinoma (CRAC). We retrospectively reviewed 149 patients with CRAC who underwent preoperative 18F-FDG PET/CT at initial diagnosis followed by curative surgical resection. 18F-FDG PET/CT metabolic parameters including maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) for disease-free survival (DFS) and overall survival (OS) were evaluated for prognostic significance by univariate and multivariate analyses, along with conventional risk factors including pathologic T (pT) stage, lymph node (LN) metastasis, lymphovascular invasion (LVI), perineural invasion (PNI), and preoperative carcinoembryonic antigen (CEA) level. On univariate analysis, high pT stage, positive LN metastasis, LVI, PNI, MTV, and TLG were significant prognostic factors affecting DFS (all P < 0.05), while CEA level, high pT stage, positive LN metastasis, LVI, PNI, MTV, and TLG affected OS (all P < 0.05). On multivariate analysis, positive LN metastasis, LVI, MTV, and TLG were independent prognostic factors affecting DFS (all P < 0.05), while CEA level, positive LN metastasis, and MTV affected OS (all P < 0.05). Thus, the volume-based metabolic parameters from preoperative 18F-FDG PET/CT scans are independent prognostic factors in patients with CRAC.

Nomogram using F-18 fluorodeoxyglucose positron emission tomography/computed tomography for preoperative prediction of lymph node metastasis in gastric cancer.

BACKGROUND: Lymph node (LN) metastasis is an important prognostic factor in patients with gastric cancer (GC). However, the evaluation of LN metastasis status in the preoperative setting is not accurate. Therefore, precise preoperative prediction of LN metastasis status is crucial for optimal treatment in patients with GC. AIM: To develop a preoperative nomogram for LN metastasis using F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) and preoperative laboratory test findings in GC. METHODS: In this study, the data of 566 GC patients who underwent preoperative F-18 FDG PET/CT and subsequent surgical resection were analyzed. The LN metastasis prediction model was developed in the training cohort and validated in the internal validation cohort. Routine preoperative laboratory tests, including albumin and carbohydrate antigen (CA) 19-9 were performed in all patients. Univariate and multivariable logistic regression was performed to validate the preoperative predictive indicators for LN metastasis. RESULTS: Of the 566 patients, 232 (41%) had confirmed histopathologic LN metastasis. Univariate logistic regression revealed that the tumor location, blood hemoglobin, serum albumin levels, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, CA 19-9, maximum standardized uptake value (SUVmax) of the primary tumor (T_SUVmax), and SUVmax of LN (N_SUVmax) were significantly associated with LN metastasis. In multivariate analysis, T_SUVmax (OR = 1.08; 95%CI: 1.02-1.15; P = 0.011) and N_SUVmax (OR = 1.49; 95%CI: 1.19-1.97; P = 0.002) were found to be significant predictive factors for LN metastasis. The LN metastasis prediction model using T_SUVmax, N_SUVmax, serum albumin, and CA 19-9 yielded an area under the curve (AUC) of 0.733 (95%CI: 0.683-0.784, P = 0.025) in the training cohort and AUC of 0.756 (95%CI: 0.678-0.833, P < 0.001) in the test cohort. CONCLUSION: T_SUVmax and N_SUVmax measured by preoperative F-18 FDG PET/CT are independent predictive factors for LN metastasis in GC.

Comparison of Image Quality and Semi-quantitative Measurements with Digital PET/CT and Standard PET/CT from Different Vendors.

PURPOSE: This study aimed to evaluate the concordance and equivalence of results between the newly acquired digital PET/CT(dPET) and the standard PET/CT (sPET) to investigate possible differences in visual and semi-quantitative analyses. METHODS: A total of 30 participants were enrolled and underwent a single 18F-FDG injection followed by dual PET/CT scans, by a dPET scan, and immediately after by the sPET scan or vice versa. Two readers reviewed overall image quality using a 5-point scale and counted the number of suggestive 18F-FDG avid lesions. The SUV values were measured in the background organs and in hypermetabolic target lesions. Additionally, we objectively evaluated image quality using the liver signal-to-noise ratio (SNR). RESULTS: The dPET identified 4 additional 18F-FDG avid lesions in 3 of 30 participants with improved visual image quality. The standard deviations of SUV of the background organs were significantly lower with DigitalPET than with sPET, and dPET could acquire images with better SNR (11.13 ± 2.01 vs. 8.71 ± 1.32, P < 0.001). The reliability of SUV values between scanners showed excellent agreement. Bland-Altman plot analysis of 81 lesions showed an acceptable agreement between scanners for most of the SUVmax and SUVpeak values. No relationship between the SUV values and time delays of dual PET/CT acquisition was found. CONCLUSIONS: The dPET provides improved image quality and lesion detectability than the sPET. The semi-quantitative values of the two PET/CT systems of different vendors are comparable. This pilot study will be an important basis for possible interchangeable use of either system in clinical practice.

Prognostic Value of Restaging F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography to Predict 3-Year Post-Recurrence Survival in Patients with Recurrent Gastric Cancer after Curative Resection.

OBJECTIVE: The aim of this study was to investigate the prognostic value of the maximum standardized uptake value (SUVmax) measured while restaging with F-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to predict the 3-year post-recurrence survival (PRS) in patients with recurrent gastric cancer after curative surgical resection. MATERIALS AND METHODS: In total, 47 patients with recurrent gastric cancer after curative resection who underwent restaging with 18F-FDG PET/CT were included. For the semiquantitative analysis, SUVmax was measured over the visually discernable 18F-FDG-avid recurrent lesions. Cox proportional-hazards regression models were used to predict the 3-year PRS. Differences in 3-year PRS were assessed with the Kaplan-Meier analysis. RESULTS: Thirty-nine of the 47 patients (83%) expired within 3 years after recurrence in the median follow-up period of 30.3 months. In the multivariate analysis, SUVmax (p = 0.012), weight loss (p = 0.025), and neutrophil count (p = 0.006) were significant prognostic factors for 3-year PRS. The Kaplan-Meier curves demonstrated significantly poor 3-year PRS in patients with SUVmax > 5.1 than in those with SUVmax ≤ 5.1 (3-year PRS rate, 3.5% vs. 38.9%, p < 0.001). CONCLUSION: High SUVmax on restaging with 18F-FDG PET/CT is a poor prognostic factor for 3-year PRS. It may strengthen the role of 18F-FDG PET/CT in further stratifying the prognosis of recurrent gastric cancer.

Computed Tomography (CT) Protocols Associated with Cardiac and Bone Single-Photon Emission Computed Tomography/CT (SPECT/CT) in Korea.

PURPOSE: Single-photon emission computed tomography/computed tomography (SPECT/CT) is an advanced hybrid nuclear medicine technology that generates both functional and anatomical images in a single study. As utilization of SPECT/CT in Korea has been increasing, the purpose of this study was to survey its application of cardiac and skeletal SPECT/CT imaging for protocol optimization. METHODS: We surveyed CT protocols established for cardiac and skeletal SPECT/CT. We searched the guidelines for the CT protocols for SPECT/CT and reviewed the literature recently published. RESULTS: Among 36 hybrid SPECT scanners equipped with four or more multi-channel detector CTs (MDCTs), 18 scanners were used to perform cardiac studies at both very low current CT (30-80 mA; 11.1%) and ultra-low current CT (13-30 mA; 88.9%). Among the 33 canners, very low current (≤ 80 mA) CT or low current CT (80-130 mA) was used in 23.5%, and 41.8% for spine disorders, and in 36.4% or 30.3% for foot/ankle disorders, respectively. In the CT reconstructions, slice thickness of 5 mm for cardiac studies was most commonly used (94.4%); thinner slices (0.6-1.0 mm) for spine and foot/ankle studies were used in 24.2% and 45.5%, respectively. We also reviewed the international guidelines. CONCLUSIONS: The results and current recommendations will be helpful for optimizing CT protocols for SPECT/CT. Optimization of SPECT/CT protocols will be required for generating the proper strategy for the specific lesions and clinical purpose.

KSNM/KSID/KOSHIC Guidance for Nuclear Medicine Department Against the Coronavirus Disease 2019 (COVID-19) Pandemic.

The dramatic spread of Coronavirus Disease 2019 (COVID-19) has profound impacts on every continent and life. Due to human-to-human transmission of COVID-19, nuclear medicine staffs also cannot escape the risk of infection from workplaces. Every staff in the nuclear medicine department must prepare for and respond to COVID-19 pandemic which tailored to the characteristics of our profession. This article provided the guidance prepared by the Korean Society of Nuclear Medicine (KSNM) in cooperation with the Korean Society of Infectious Disease (KSID) and Korean Society for Healthcare-Associated Infection Control and Prevention (KOSHIC) in managing the COVID-19 pandemic for the nuclear medicine department. We hope that this guidance will support every practice in nuclear medicine during this chaotic period.

F-18 fluorodeoxyglucose positron emission tomography/computed tomography image of gastric mucormycosis mimicking advanced gastric cancer: A case report.

BACKGROUND: Mucormycosis is a very rare fungal infection, and its prognosis is poor. Most common sites of infection are the sinuses, lung, or skin, and gastric involvement is uncommon. The standard antifungal therapy is the treatment of choice for gastric mucormycosis. However, the symptoms of gastric mucormycosis are varied and the early diagnosis is not easy. CASE SUMMARY: I report a 53-year-old alcoholic man, who was admitted due to epigastric pain. The upper gastrointestinal endoscopy revealed a huge ulcer lesion in the stomach, which was suspected to be gastric cancer. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) showed diffusely intense FDG uptake at the ulcer lesion of the stomach, and several enlarged hypermetabolic lymph nodes were noted at the left gastric chain. Although, endoscopy and F-18 FDG PET/CT findings suggested advanced gastric cancer with regional lymph node metastases, there was no cancer cells in the biopsy results and multiple fungal hyphae were noted in the periodic acid-Schiff stained image. CONCLUSION: He was diagnosed with gastric mucormycosis and successfully underwent amphotericin B and posaconazole treatment.