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OBJECTIVE The purpose of the current study was to investigate the diagnostic performance of F-18 fluorodeoxyglucose (FDG) PET/computed tomography (CT) for diagnosis of polymyalgia rheumatic (PMR) through a meta-analysis. METHODS The PubMed, Cochrane and EMBASE database, from the earliest available date of indexing up to 29 February 2020, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for diagnosis of PMR. RESULTS Across the 11 results of seven studies selected for analysis (684 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.76 [95% confidence interval (CI), 0.67-0.83] with heterogeneity (I = 74.9, P

Objectives As PET has become a standard of treatment in patients with cancer, publications of oncologic PET have grown sharply. We aimed to organize the data of meta-analyses of oncologic PET and assess the quality of studies. Materials and methods The inclusion criteria were studies that meta-analyzed to combine the data from multiple studies of oncologic PET. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to assess the reporting quality of the included studies. Results A total of 254 meta-analyses were eligible for inclusion in the study. The peak number of publications increased up to 42 in 2014. Lung (n=39, 15.4%) is the most common site of tumor included in meta-analysis with oncologic PET. Overall, 84% of studies were categorized into diagnostic test accuracy reviews (n=214). Studies published in 2010 or later (n=213) showed higher PRISMA scores than those published in 2009 or before. Conclusion A large number of meta-analyses are published in the field of oncologic PET. Meta-analyses in oncologic PET seem to be cited more often than regular research papers. The overall quality of studies is low; however, they showed improvement after PRISMA statement.

OBJECTIVES: PET using F-fluorodeoxyglucose (FDG) has proven to be valuable in staging and monitoring of treatment response in breast cancer. We aimed to assess the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with breast cancer. METHODS: A systematic search of MEDLINE and EMBASE was performed using the keywords of breast cancer, PET, and volume. Inclusion criteria were F-FDG PET used as an initial imaging tool; studies limited to patients with breast cancer who had not undergone any treatment before PET scans; and studies reporting survival data. Event-free survival (EFS) and overall survival (OS) were considered markers of outcome. RESULTS: Nine studies comprising 975 patients were included in this study. The pooled hazard ratio (HR) for adverse events was 33.73 (P < 0.00001; I = 0%) with MTV from primary tumor and 2.89 (P < 0.00001; I = 45%) with TLG from primary tumor, meaning that primary tumors with high volumetric parameters were associated with progression or recurrence. However, the combined HRs for EFS of MTV, and TLG, and those for OS of MTV from whole-body tumor were NS. The pooled HR for OS of TLG from whole-body tumor was 2.95 (P = 0.18; I = 71%). CONCLUSION: Volumetric parameters from F-FDG PET are significant prognostic factors for outcome in patients with breast cancer. Patients with a high MTV or TLG from primary tumor have a higher risk of adverse events. Patients with a high TLG from whole-body tumor have a higher risk of deaths.

OBJECTIVE We aimed to determine the factors contributing toward diffusely increased renal uptake on bone scintigraphy using technetium-99m (Tc-99m) diphosphono-propanedicarboxylic acid (DPD) in patients with end-stage renal disease. PATIENTS AND METHODS One-hundred and forty-three bone scintigraphies, performed between June 2007 and July 2013, in 135 patients with chronic kidney disease were analyzed retrospectively, including 22 bone scintigraphies (15 patients; eight women; seven men) with glomerular filtration rates less than 15 ml/min/1.73 m. Patients with nephrocalcinosis were excluded. The clinical records of medication and underlying disease were reviewed retrospectively. The presence of renal artery calcification was visually estimated and the Hounsfield unit (HU) of renal parenchyma was measured by abdominal and pelvic nonenhanced computed tomography. RESULTS Two patients underwent peritoneal dialysis and 13 underwent hemodynamic dialysis. Diffusely increased renal Tc-99m DPD uptake was observed on 15 of 22 (68%) bone scintigraphy images. Laboratory test results were not significantly different between the patients with or without increased renal uptake. A history of inflammatory conditions or antibiotic administration did not correlate with kidney visualization. The significant factor for diffuse renal tracer uptake on multivariate analysis was renal artery calcification (odds ratio: 18.42; 95% confidence interval: 2.01-79.43; P

BACKGROUND The objective of the study was to investigate whether metabolic tumor volume (MTV) measured by fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (PET/CT) after stratification of serum thyroid stimulating hormone (TSH) levels could predict malignancy in patients with thyroid F-FDG incidentaloma. MATERIALS AND METHODS A total 262 patients with focal thyroid F-FDG incidentaloma undergoing cancer evaluation for nonthyroid cancer or a health checkup were enrolled in this study. We retrospectively evaluated the relationship of the maximum standardized uptake value (SUVmax) and MTV in the prediction of malignant thyroid F-FDG incidentaloma. RESULTS The prevalence of malignancy was 20.9% (37/177). Malignant thyroid incidentaloma had a statistically significant higher value of SUVmax (malignant: median 4.6, range 1.9-34.9; benign: median 4.1, range 0-28; P=0.030). The value of MTV4 in malignant thyroid incidentaloma was significantly higher than that of benign thyroid incidentaloma (malignant: median 0.16, range 0.02-1.19; benign: median 0.10, range 0-0.65; P=0.032). However, the values of MTV3.5, MTV3, and MTV2.5 did not differ significantly between the groups. After stratification of serum TSH levels (an SUVmax>5 was used as the cutoff point) the sensitivity and specificity for prediction of malignancy were found to be 61.1% [95% confidence interval (CI): 35.7-82.7%] and 68.7% (95% CI: 56.2-79.4%), respectively. The area under the curve (AUC) was 0.655 (95% CI: 0.545-0.755; P=0.0239). When MTV4 greater than 0.07 cm was used as the cutoff point, the sensitivity and specificity for prediction of malignancy were 81.2% (95% CI: 54.4-96.0%) and 50.0% (95% CI: 37.0-63.0%), respectively. The AUC was 0.650 (95% CI: 0.534-0.755; P=0.0451). On comparison receiver operating characteristic curve analysis, no significant difference was found between SUVmax and MTV4 in the prediction of thyroid carcinoma (P=0.4346). However, a combination of SUVmax and MTV4 resulted in an AUC of 0.669 (95% CI: 0.554-0.772; P=0.0183). CONCLUSION The SUVmax and MTV4 measured by F-FDG PET/CT after stratification of serum TSH levels could predict thyroid cancer in patients with thyroid F-FDG incidentaloma. A combination of SUVmax and MTV4 may be more useful for the differentiation of malignant from benign thyroid incidentaloma.

The aim of this study was to evaluate the usefulness of the tumor burden as characterized by the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by F-18 fluoro-2-deoxyglucose (F-18 FDG) PET-computed tomography (CT) in predicting recurrence-free survival (RFS) and overall survival (OS) in surgically resected non-small-cell lung cancer (NSCLC) patients.We retrospectively reviewed 91 patients with pathologically documented stages I-IIIA NSCLC. MTV and TLG were obtained according to various thresholds of the standard uptake value (SUV) of primary tumor using preoperative F-18 FDG PET-CT. We used comparison receiver-operating characteristic curve analysis to test the statistical significance of the differences among the multiple volumetric parameters calculated by various SUV cutoff values. RFS and OS were evaluated with the Kaplan-Meier method and Cox regression analysis.On comparison receiver-operating characteristic curve analysis, no significant difference was found among the volumetric parameters calculated using various thresholds of SUV. Regardless of the thresholds, patients with smaller MTV and lower TLG showed longer RFS and OS. MTV and TLG measured by F-18 FDG PET-CT were found to have better predictive performance than SUVmax for recurrence and death. According to multivariate analyses, MTV2.5 was revealed as a significant prognostic factor for RFS. Tumor size over 3 cm was selected as a significant prognostic indicator of OS.Volume-based parameters of F-18 FDG PET-CT may have a role in providing prognostic information in NSCLC patients who have received surgical treatment.

Concurrent inflammation or anemia at the time of PET/computed tomography (CT) could be one of several causes of diffuse splenic (18)F-fluorodeoxyglucose ((18)F-FDG) uptake. In this study, we focused on cytokines to investigate interactions during this phenomenon and clarify the significance of splenic (18)F-FDG uptake in PET/CT.We selected 40 patients (17 women and 23 men) with cholangiocarcinoma, pancreatic cancer, or gallbladder cancer who had undergone PET/CT. These patients were subdivided into two groups (group A: patients showing splenic (18)F-FDG uptake exceeding hepatic uptake; group B: patients showing hepatic (18)F-FDG uptake exceeding splenic uptake). Blood sampling was performed for each patient on the same day as PET/CT, and 22 types of cytokines and hematologic indices were analyzed.Group A showed higher levels of interleukin (IL)-1β (P=0.0478), IL-1RA (P=0.0044), IL-4 (P=0.0118), IL-6 (P=0.0375), IL-7 (P=0.0478), and IL-13 (P=0.0081) compared with group B. However, interferon-inducible protein-10 (IP-10; P=0.1714), IL-9 (P=0.8022), IL-8 (P=0.1631), IL-5 (P=0.5273), IL-3 (P=0.3097), IL-23 (P=0.1194), IL-2 (P=0.1099), IL-1α (P=0.4439), IL-17α (P=0.8811), IL-16 (P=0.3201), IL-15 (P=0.0580), interferon-γ (IFN-γ; P=0.5308), growth-regulated oncogene (GRO; P=0.2847), granulocyte macrophage-colony-stimulating factor (GM-CSF; P=0.0913), granulocyte-colony-stimulating factor (G-CSF; P=0.5244), and soluble CD40 ligand (sCD40L; P=0.1714) levels in group A were not statistically significantly different compared with those in the control group. In addition, the white blood cell counts and C-reactive protein levels in group A showed higher values compared with group B. IL-13 among the cytokines and C-reactive protein among the hematologic indices were significant predictors of splenic (18)F-FDG uptake exceeding hepatic (18)F-FDG uptake.This study showed that splenic F-FDG uptake is related to IL-1β, IL-1receptor antagonist, IL-4, IL-6, IL-7, and IL-13. These cytokines may reflect the activation of humoral immunity of the spleen.

The aim of this study was to investigate whether diffuse increased splenic fluorodeoxyglucose (FDG) uptake may be an indirect sign of an acute pyogenic cause of infectious spondylitis (IS).A retrospective review identified consecutive records of patients with IS who underwent F-18 FDG positron emission tomography-computed tomography scans between January 2007 and July 2008 and recruited 23 patients (57.8 ± 15.6 years, range: 20-81 years, eight men, 15 women) and their hematological laboratory data. The regions of interest were used to measure the maximum standardized uptake value (SUVmax) for the bone marrow (BM), liver, and spleen in each patient. We calculated the spleen/liver ratio (S/L ratio) by dividing the spleen SUVmax by liver SUVmax and the spleen/BM ratio (S/B ratio) by dividing spleen SUVmax by BM SUVmax as a parameter to assess the splenic FDG uptake.The acute pyogenic cause of the IS group showed statistically significantly higher values of spleen SUVmax (median, 1.71 vs. 1.16, P=0.0108), S/L ratio (median, 1.08 vs. 0.88, P=0.0454), and S/B ratio (median, 1.30 vs. 0.94, P=0.0055) than the chronic tuberculous cause of the IS. The optimal cut-off values for the quantitative indices were spleen SUVmax1.49, S/B ratio0.957, and S/L ratio0.889.On the basis of the results presented, this study demonstrated that some quantitative indices from F-18 FDG positron emission tomography/computed tomography images could be indirect signs of an acute pyogenic cause of the IS. Among the various quantitative indices, spleen SUVmax, S/B ratio, and S/L ratio were potent indicators for an acute pyogenic cause of the IS.