Search

Lymphomatoid granulomatosis is a rare extranodal Epstein-Barr virus-driven B-cell lymphoproliferative disease, involving predominantly lung, less often skin, kidney, and central nervous system. Here, we present a pediatric case with primary immunodeficiency, diagnosed with pathologically proven pulmonary grade-III lymphomatoid granulomatosis.18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging demonstrated18F-FDG avid pulmonary masses with central air-bronchograms and cavitations. Although the definitive diagnosis depends on biopsy,18F-FDG PET/CT serves as a complementary imaging tool to evaluate the extent of the disease and response to treatment.

Background Leydig cell tumors (LCTs) represent the most common form of stromal tumors. We reported the 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings of a patient with testicular LCT. Case presentation A 50-year-old man with a history of end-stage renal disease and renal transplantation 19 years ago. One year earlier, he started to have a chronic rejection. During the investigation to determine the cause of chronic rejection, a suspicious lesion in the graft with a collection around it was seen on ultrasound (US) images, raising the possibility of post-transplant lymphoproliferative disorder (PTLD). The patient was referred for further evaluation by whole body 18F-FDG PET/CT imaging. The image finding revealed an incidental hypermetabolic focal lesion in the right testicle—no other specific findings in the remaining parts of the body nor definitive FDG avid lymphadenopathy to suggest PTLD. Testicular US was requested and showed a well-defined right-sided heterogeneous hypoechoic intratesticular focal mass at the upper pole of the right testis with significant internal vascularity on the color Doppler imaging. The patient underwent a right radical orchidectomy, and the tumor was pathologically confirmed as an LCT. Conclusion In our case, 18F-FDG-PET/CT has been helpful in incidentally detecting this rare testicular tumor in a patient with suspected PTLD.

Introduction Anxiety is an emotional reaction often experienced by patients who undergo Positron Emission Tomography/Computed Tomography (PET/CT) with 18F-2-fluoro-2-deoxy- d -glucose (18F-FDG). This systematic review aimed to summarise the evidence currently available considering the anxiety experienced by adult oncological patients concerning pre and post 18F-FDG PET/CT examination and the factors contributing to anxiety. Methods A systematic review search of CINAHL, PsycINFO, PubMed, Scopus and Web Science databases and other manual search sources, was conducted from November to February 2021. The research included articles published from January 2000 to December 2020. It included quantitative studies, which analysed the anxiety experienced by oncological patients who had undergone 18F-FDG PET/CT. Results Ten articles met the inclusion criteria for this systematic review. The studies selected were published between 2011 and 2020 and carried out in five countries. Anxiety experienced by patients was evaluated at the various stages of the 18F-FDG PET/CT, eight studies assessed it in the pre-examination, seven studies in the post-examination and five studies at both times. Four main anxiety factors were found: patients' clinical situation, first-time patients’ examination, scan procedure, and patients concern with the examination result. Conclusion Moderate to high levels of anxiety are present in most of the patients who undergo the examination. This review also highlights several factors related to the anxiety levels through different procedure moments. Implications for practice The results of this research will allow health professionals to adjust non-pharmacological strategies to decrease anxiety levels in oncological patients undergoing 18F-FDG PET/CT.

Rationale: since non-invasive tests for prediction of liver fibrosis have a poor diagnostic performance for detecting low levels of fibrosis, it is important to explore the diagnostic capabilities of other non-invasive tests to diagnose low levels of fibrosis. We aimed to evaluate the performance of radiomics based on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in predicting any liver fibrosis in individuals with biopsy-proven metabolic dysfunction-associated fatty liver disease (MAFLD).Methods: a total of 22 adults with biopsy-confirmed MAFLD, who underwent 18F-FDG PET/CT, were enrolled in this study. Sixty radiomics features were extracted from whole liver region of interest in 18F-FDG PET images. Subsequently, the minimum redundancy maximum relevance (mRMR) method was performed and a subset of two features mostly related to the output classes and low redundancy between them were selected according to an event per variable of 5. Logistic regression, Support Vector Machine, Naive Bayes, 5-Nearest Neighbor and linear discriminant analysis models were built based on selected features. The predictive performances were assessed by the receiver operator characteristic (ROC) curve analysis.Results: the mean (SD) age of the subjects was 38.5 (10.4) years and 17 subjects were men. 12 subjects had histological evidence of any liver fibrosis. The coarseness of neighborhood grey-level difference matrix (NGLDM) and long-run emphasis (LRE) of grey-level run length matrix (GLRLM) were selected to predict fibrosis. The logistic regression model performed best with an AUROC of 0.817 [95% confidence intervals, 0.595-0.947] for prediction of liver fibrosis.Conclusion: these preliminary data suggest that 18F-FDG PET radiomics may have clinical utility in assessing early liver fibrosis in MAFLD.

Background The non-functional PNETs are often discovered incidentally, they are commonly malignant and commonly present at a late stage with large size. We evaluate in this study the usefulness of 18F-FDG PET/CT in the detection and staging of non-functioning PNETs. Results Thirty patients with non-functioning PNETs were involved in this prospective study over a period starting from September 2016 to March 2021. Age ranged from 33 to 79 years. 18F-FDG PET/CT detected 26 patients had SUV max ≥ 2.5 of primary lesions and 4 lesions had SUV max Conclusion The increased use of 18F-FDG PET/CT in the investigation of patient with PNETs allows for more accurate staging and therefore more appropriate management decision.

Hepatic artery aneurysm (HAA) is a rare, yet clinically important, condition. While the causes of HAA are poorly understood, it is estimated that mortality following spontaneous rupture is as high as 40%. We discuss the case of a 77-year-old man who presented to our hospital due to a 10 mm pulmonary lesion in the left lower lung lobe, which was identified by a computed tomography scan of the lung at another institution. An examination with 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in our department, but no significant uptake of 18F-fluorodeoxyglucose was found in the lung, and HAA was diagnosed only incidentally. A magnetic resonance imaging angiography supported the differential diagnosis of HAA, and the aneurysm was confirmed by targeted angiography. It was located in the common hepatic artery and was coiled during an intervention session. HAA accounts for 20% of all visceral aneurysms and, with a poorly understood natural history, is difficult to diagnose clinically, but early detection and treatment of HAA can improve prognosis.

Background Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is a currently widely used strategy for locally advanced esophageal cancer (EC). However, the conventional imaging methods have certain deficiencies in the evaluation and prediction of the efficacy of nCRT. This study aimed to explore the value of functional imaging in predicting the response to neoadjuvant chemoradiotherapy (nCRT) in locally advanced esophageal squamous cell carcinoma (ESCC). Methods Fifty-four patients diagnosed with locally advanced ESCC from August 2017 to September 2019 and treated with nCRT were retrospectively analyzed. DW-MRI scanning was performed before nCRT, at 10–15 fractions of radiotherapy, and 4–6 weeks after the completion of nCRT. 18F-FDG PET/CT scans were performed before nCRT and 4–6 weeks after the completion of nCRT. These 18F-FDG PET/CT and DW-MRI parameters and relative changes were compared between patients with pathological complete response (pCR) and non-pCR. Results A total of 8 of 54 patients (14.8%) were evaluated as disease progression in the preoperative assessment. The remaining forty-six patients underwent operations, and the pathological assessments of the surgical resection specimens demonstrated pathological complete response (pCR) in 10 patients (21.7%) and complete response of primary tumor (pCR-T) in 16 patients (34.8%). The change of metabolic tumor volume (∆MTV) and change of total lesion glycolysis (∆TLG) were significantly different between patients with pCR and non-pCR. The SUVmax-Tpost, MTV-Tpost, and TLG-Tpost of esophageal tumors in 18F-FDG PET/CT scans after neoadjuvant chemoradiotherapy and the ∆ SUVmax-T and ∆MTV-T were significantly different between pCR-T versus non-pCR-T patients. The esophageal tumor apparent diffusion coefficient (ADC) increased after nCRT; the ADCduring, ADCpost and ∆ADCduring were significantly different between pCR-T and non-pCR-T groups. ROC analyses showed that the model that combined ADCduring with TLG-Tpost had the highest AUC (0.914) for pCR-T prediction, with 90.0% and 86.4% sensitivity and specificity, respectively. Conclusion 18F-FDG PET/CT is useful for re-staging after nCRT and for surgical decision. Integrating parameters of 18F-FDG PET/CT and DW-MRI can identify pathological response of primary tumor to nCRT more accurately in ESCC.

Background Histological transformation (HT) of follicular lymphoma to a more aggressive lymphoma is a serious event affecting patients’ outcomes. To date, no strong clinical HT predictors present at diagnosis have yet been identified. The fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is highlighted as a non-invasive diagnostic tool for the detection of HT, but its ability to predict HT at early stage of disease has not been clear. Therefore, this study investigated the predictive values of the pre-transformation standardized uptake value (SUVmax) for the risk of transformation in FL. Methods This retrospective study involved 219 patients with FL between June 2008 and October 2019 who had undergone 18F-FDG PET/CT scan. One hundred and thirty-two, 64, and 78 patients underwent PET at baseline (PETbaseline), interim (PETinterim) and end-of-induction therapy (PETend), respectively. Qualitative assessment was performed using the 5-point Deauville scale. Statistical analysis was done using Cox regression models, receiver operating characteristic (ROC) analysis, and Kaplan–Meir survival curves. Results Of the 219 patients included, 128 had low-grade FL (grade 1–2) and 91 had high-grade FL (grade 3a). HT eventually occurred in 30 patients. The median time to HT was 13.6 months. Among clinical indicators, advance pathological grade was shown as the most significant predictor of HT (HR = 4.561, 95% CI 1.604–12.965). We further assessed the relationship between PET and HT risk in FL. Univariate Cox regression determined that SUVbaseline and SUVend were significant predictors for HT, while neither SUVinterim nor qualitative assessment of Deauville score has predictive value for HT. Due to the noticeable impact of high pathological grade on the HT risk, we conducted the subgroup analysis in patients with low/high pathological grade, and found SUVbaseline could still predict HT risk in both low-grade and high-grade subgroups. Multivariate analysis adjusted by FLIPI2 score showed the SUVbaseline (HR 1.065, 95% CI 1.020–1.111) and SUVend (HR 1.261, 95% CI 1.076–1.478) remained as significant predictors independently of the FLIPI2 score. According to the cut-off determined from the ROC analysis, increased SUVbaseline with a cutoff value of 14.3 and higher SUVend with a cutoff value of 7.3 were highly predictive of a shorter time to HT. Conclusions In follicular lymphoma, quantitative assessment used SUVmax at the pre-treatment and end-of-treatment PET/CT scan may be helpful for early screen out patients at high risk of transformation and guide treatment decisions.

The diagnostic and treatment methods of multiple myeloma (MM) have been rapidly evolving owing to advances in imaging techniques and new therapeutic agents. Imaging has begun to play an important role in the management of MM, and international guidelines are frequently updated. Since the publication of 2015 International Myeloma Working Group (IMWG) criteria for the diagnosis of MM, whole-body magnetic resonance imaging (MRI) or low-dose whole-body computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/CT have entered the mainstream as diagnostic and treatment response assessment tools. The 2019 IMWG guidelines also provide imaging recommendations for various clinical settings. Accordingly, radiologists have become a key component of MM management. In this review, we provide an overview of updates in the MM field with an emphasis on imaging modalities.

Objective To assess the feasibility of dose escalation guided by 18F-deoxyglucose positron emission tomography/computer tomography (18F-FDG PET/CT) for esophageal cancer (EC). Methods and materials Ten random patients treated with definitive chemoradiotherapy and pre-therapeutic 18F-FDG PET/CT were included in this study. Retrospectively, a threshold of 50% of SUVmax was used to define the high FDG uptake region of the GTV (GTVPET). Three intensity-modulated radiation therapy (IMRT) plans were generated, delivering three dose levels to three different planning target volumes (PTVs). 50.4 ​Gy delivered to PTV50.4 was defined on computed tomography (CT) as Plan50.4, 63 ​Gy was delivered to PTV63 was defined as GTV plus a uniform margin of 0.5 ​cm as Plan63, and 70 ​Gy delivered to PTV70 was defined as GTVPET plus a 0.5 ​cm margin as Plan70. A dosimetric comparison was performed based on normal tissue complication probability (NTCP) for the lung and heart. Results Clinically acceptable dose escalation failed for 2 of 10 patients in Plan63 due to heart dose constraints. One patient failed heart dose constraint for Plan70. Two patients failed spinal cord constraint for Plan63. Three patients failed lung dose constraints for both Plan63 and Plan70, two of which were even not suitable for Plan50.4 for the same reason. NTCP modeling for lung showed increased risk for Plan63 and Plan70 compared to Plan50.4. The difference between Plan63 and Plan70 was insignificant. NTCP modeling for heart showed an increased risk from 6.38% of Plan50.4 to 8.88% of Plan70 (P ​= ​0.009) or 9.79% of Plan63 (P ​= ​0.007). The risk of heart mortality was significantly higher for Plan63 than Plan70 (P ​= ​0.047). Conclusions Selective boosting of sub-volumes based on 18F-FDG PET/CT is feasible way with a modest increase in the risk of cardiac and lung toxicities.

Ziwei Zhou,* Zhe Guo,* Qingqiao Hu, Wei Ding, Chongyang Ding, Lijun Tang Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lijun Tang; Chongyang DingDepartment of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, People’s Republic of ChinaTel +14751830090; +15951614327Email tanglijun@njmu.edu.cn; chongyangding@163.comObjective: To explore regional brain glucose metabolic abnormalities of pretreatment stage I/II extranodal natural killer/T-cell lymphoma (ENKTL) patients using positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) and assess its prognostic value.Methods: Sixty pretreatment stage I/II ENKTL patients were enrolled in this retrospective study and divided into survival (n = 45) and death (n = 15) groups according to their status at the end of follow-up. A control group consisted of 60 healthy subjects. Regional cerebral glucose metabolism was evaluated on a voxel-by-voxel basis using statistical parametric mapping (SPM8) under a certain significance level (P < 0. 001) and voxel threshold (K = 100 voxels).Results: Decreased metabolism was noted in patients, involving the bilateral prefrontal and orbitofrontal cortex, partial parietal and occipital cortex, cingulate gyrus and cerebellum; the sensorimotor cortex was largely spared. Increased metabolism was observed in the bilateral putamen, amygdala, and parahippocampal gyrus. Compared with the survival group, the death group had higher metabolism in the bilateral amygdala, putamen, left thalamus, uncus, and parahippocampal gyrus. Only B symptoms were associated with the increased metabolism of basal ganglia and thalamus (BGT). Patients with high metabolic tumor volume, total lesion glycolysis (TLG) and BGT metabolism had a poor prognosis. TLG and maximum standardized uptake value (SUVmax) LBGT/SUVmaxRight cerebellum were associated with Eastern Cooperative Oncology Group (ECOG) and prognostic index of natural killer lymphoma and Epstein-Barr virus-DNA (PINKE) scores. In multivariate analysis, only ECOG was an independent prognostic factor of both progression-free survival (PFS) and overall survival (OS). PINKE was an independent prognostic factor of OS.Conclusion: Pretreatment stage I/II ENKTL patients exhibited abnormal regional cerebral glucose metabolism. Higher pretreatment glucose metabolism in BGT could predict a relatively poor prognosis but did not surpass the predictive values of ECOG and PINKE in stage I/II ENKTL patients.Keywords: extranodal natural killer/T- cell lymphoma, regional cerebral glucose metabolism, 18F-FDG PET/CT, statistical parametric mapping, prognostic value

Objective The aim of this study is to investigate the role of 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) in the evaluation of multicentric Castleman disease (MCD). Methods Thirty-five patients with pathologically confirmed MCD who underwent 18F-FDG PET/CT were retrospectively included. The FDG uptake and CT findings of lymph nodes, pulmonary involvement, spleen, and bone marrow were assessed and the maximum standardized uptake value (SUVmax) of each lesion was measured. The locations of lymph nodes were also evaluated. Results 18F-FDG PET/CT showed increased uptake in multiple nodal regions in 34 out of 35 MCD patients. The most frequently involved nodal sites were the cervical, iliac, axillary, and inguinal areas, and the least common was paraaortic and abdominal nodes. The involved lymph nodes were not confluent and presented a relatively symmetric pattern on PET/CT images. The highest SUVmax of lymph nodes per patient ranged from 2 to 19 with a mean value of 5.61 ± 3.12. Pulmonary manifestation including cysts, nodules, and interstitial lung disease were found in 10 patients, eight of whom demonstrated mild to moderate uptake in the lungs. 18F-FDG PET/CT also revealed other findings including hypermetabolic spleen (n = 8) and bone marrow (n = 23), elevated uptake in salivary glands (n = 8). Four patients also underwent follow-up PET/CT scans after therapy, and three of them displayed decreased metabolism. Conclusion 18F-FDG PET/CT is a useful tool in the diagnosis, evaluation, and follow-up of MCD by providing systemic manifestations of lymphadenopathy, pulmonary involvement, and hypermetabolic spleen or bone marrow. Furthermore, the lymphadenopathy in MCD presented a predominantly peripheral distribution, relatively symmetric, moderately hypermetabolic, and not confluent pattern on 18F-FDG PET/CT.

Background There is conflicting results of few published human 18F-FDG PET/CT studies about BAT activation in breast cancer (BC). The aim of the study is to evaluate the association between the levels of BAT metabolic activity detected by 18F-FDG PET/CT and clinicopathological characteristics of a tumor in patients with primary BC. Results BAT was activated in 16 out of 157 (10.2%) consecutive female patients with BC who underwent 18F-FDG PET/CT for initial evaluation. The majority of patients (15/16) had bilateral uptake in the supraclavicular regions. The mean values of the highest SUVmax and total metabolic activity (TMA) of activated BAT were 13.3 ± 9.9 and 79.6 ± 45, respectively. Median outdoor temperature was significantly lower in the activated BAT group (P value=0.035). Patients with BAT activation tended to have a lower median primary tumor size and primary SUVmax, but not statistically significant than those without BAT activation. BAT activation was significantly more frequent among younger age groups (14/16) and patients with lower body mass index (BMI) (10/16), but it was insignificantly more frequent among estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), human epidermal growth factor receptor2 negative (HER2-), invasive ductal carcinoma (IDC), grade II, luminal B subtype, high Ki-67 expression level, patients with positive nodal metastasis, and in patients without distant metastasis. TMA was significantly higher among HER2+ patients (P value=0.019), but insignificantly higher among the younger age groups, stages I and II, invasive lobular carcinoma (ILC), grade I, luminal B subtype, ER+, PR−, higher Ki-67 expression level, patients with positive nodal, and distant metastasis. BMI and patient’s age were the significant independent predictor factors for BAT activation on multivariate regression analysis. Conclusion BAT activation in young age females is sex hormone-dependent, positively associated with less aggressive molecular subtypes of BC, less frequent in patients with distant metastasis. BAT activation may be a prognostic factor that carries a better prognosis in BC.

Fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT has been commonly used in pediatric patients with newly diagnosed neuroblastoma (NB) for diagnosis. We retrospectively reviewed 40 pediatric patients with newly diagnosed NB who underwent 18F-FDG PET/CT. Clinicopathological factors and metabolic parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on PET/CT were evaluated as predictive factors for progression-free survival (PFS) and overall survival (OS) by univariate and multivariate analysis. Spearman rank correlation analyses were used to estimate the correlations between clinical factors and PET findings. The mean follow-up after 18F-FDG-PET/CT was 32.9 months. During the follow-up period 15 (37.5%) patients experienced progression, and 9 (22.5%) died. MTV (P=0.001) and TLG (p=0.004) remained significant predictive factors for tumor progression, along with lactate dehydrogenase (LDH), neuron-specific enolase (NSE) and bone metastasis. Univariate analysis showed that bone metastasis, LDH (>1064 IU/L), NSE (>364.4 ug/L), MTV (>191 cm3) and TLG (>341.41 g) correlated with PFS, and LDH (>1064 IU/L), NSE (>364.4 ug/L) and MTV (>191 cm3) correlated with OS (p

Background: Reprogrammed glucose metabolism is a hallmark of cancer making it an attractive therapeutic target, especially in cancers with high glucose uptake such as non-small cell lung cancer (NSCLC). Tools to select patients with high glucose uptake in the majority of tumor lesions are essential in the development of anti-cancer drugs targeting glucose metabolism. Type 2 diabetes mellitus (T2DM) patients may have tumors highly dependent on glucose uptake. Surprisingly, this has not been systematically studied. Therefore, we aimed to determine which patient and tumor characteristics, including concurrent T2DM, are related to high glucose uptake in the majority of tumor lesions in NSCLC patients as measured by 2-deoxy-2-[fluorine-18]fluoro-D-glucose (F-18-FDG) positron emission tomography (PET)/computed tomography (CT) scans.Methods: Routine primary diagnostic F-18-FDG PET/CT scans of consecutive NSCLC patients were included. Mean standardized uptake value (SUVmean) of F-18-FDG was determined for all evaluable tumor lesions and corrected for serum glucose levels according to the European Association of Nuclear Medicine Research Ltd guidelines. Patient characteristics potentially determining degree of tumor lesion glucose uptake in the majority of tumor lesions per patient were investigated.Results: The cohort consisted of 102 patients, 28 with T2DM and 74 without T2DM. The median SUVmean per patient ranged from 0.8 to 35.2 (median 4.2). T2DM patients had higher median glucose uptake in individual tumor lesions and per patient compared to non-diabetic NSCLC patients (SUVmean 4.3 vs 2.8, P = 1 mL per patient (odds ratio 0.8, 95% confidence interval 0.7-0.9).Conclusions: F-18-FDG PET/CT scans can identify sub-groups of NSCLC patients with high glucose uptake in the majority of their tumor lesions. T2DM patients had higher tumor lesion glucose uptake than non-diabetic patients. However, this was not independent of other factors such as the histological subtype and number of tumor lesions per patient.

Background The prognostic value of 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma (ENKTL) is not well established. We aimed to develop nomograms for individualized estimates of progression-free survival (PFS) and overall survival (OS) in patients with ENKTL using 18F-FDG PET/CT parameters and clinical parameters. Methods A total of 171 patients with newly diagnosed ENKTL undergoing 18F-FDG PET/CT scanning were retrospectively analyzed. Nomograms were constructed according to multivariate Cox proportional hazards regression. The predictive and discriminatory capacities of the nomograms were then measured using the concordance index (C-index), calibration plots, and Kaplan-Meier curves. The C-index, the area under receiver operating characteristic (ROC) curve (AUC), and decision curve analysis (DCA) were used to contrast the predictive and discriminatory capacities of the nomograms against with the International Prognostic Index (IPI) and Korean Prognostic Index (KPI). Results Multivariate analysis demonstrated that pretreatment SUVmax≥9.5, disease stage II and III-IV, elevated lactate dehydrogenase (LDH), and elevated β2-microglobulin (β2-MG) had the strongest association with unfavorable PFS and OS. In addition, hemoglobin (Hb) p Conclusions This study established nomograms that incorporate pretreatment SUVmax and clinical parameters, which could be effective tools for individualized prognostication of both PFS and OS in patients with newly diagnosed ENKTL.

Background Left ventricular assist devices (LVADs) are increasingly used for the treatment of advanced heart failure. LVADs improve quality of life and decrease mortality, but the driveline carries substantial risk for major infections. These device-related LVAD and driveline infections are difficult to diagnose with conventional imaging. We reviewed and analysed the current literature on the additive value of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) imaging for the diagnosis of LVAD-related infections.” Materials/methods We performed a systematic literature review using several databases from their inception until the 31st of December, 2019. Studies investigating the diagnostic performance of FDG-PET/CT in patients with suspected LVAD infection were retrieved. After a bias risk assessment using QUADAS-2, a study-aggregate meta-analysis was performed on a per examination-based analysis. Results A total of 10 studies were included in the systematic review, eight of which were also eligible for study-aggregate meta-analysis. For the meta-analysis, a total of 256 FDG-PET/CT scans, examining pump/pocket and/or driveline infection, were acquired in 230 patients. Pooled sensitivity of FDG-PET/CT was 0.95 (95% confidence interval (CI) 0.89–0.97) and pooled specificity was 0.91 (95% CI 0.54–0.99) for the diagnosis of device-related infection. For pump/pocket infection, sensitivity and specificity of FDG-PET/CT were 0.97 (95%CI 0.69–1.00) and 0.93 (95%CI 0.64–0.99), respectively. For driveline infection, sensitivity and specificity were 0.96 (95%CI 0.88–0.99) and 0.99 (95%CI 0.13–1.00) respectively. Significant heterogeneity existed across studies for specificity, mostly caused by differences in scan procedures. Predefined criteria for suspicion of LVAD and/or driveline infection were lacking in all included studies. Conclusions FDG-PET/CT is a valuable tool for assessment of device-related infection in LVAD patients, with high sensitivity and high, albeit variable, specificity. Standardization of FDG-PET/CT procedures and criteria for suspected device-related LVAD infections are needed for consistent reporting of FDG-PET/CT scans.

Background The aim of the study was evaluation of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET/CT) in the detection of active disease in the patients with suspected recurrence of the medullary thyroid carcinoma (MTC). Patients and methods 18F-FDG PET/CT investigation was performed in 67 patients, investigated from 2010 to 2019. _ Follow up was performed from 6 to 116 months after surgery (median 16.5 months, x± SD = 29±28.9 months). Twenty five of 67 patients underwent 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy, 11 underwent somatostatin receptor scintigraphy (SRS) with 99mTc-HYNIC TOC while 11 123I-metaiodobenzylguanidine (MIBG) scintigraphy. Results From 67 patients, 35 (52.2%) had true positive 18F-FDG PET/CT findings (TP). Average maximal standardized uptake value (SUVmax) for all TP lesions was 5.01+3.6. In 25 (37.3%) patients findings were true negative (TN). Four (6%) patients had false positive (FP) findings while three (4.5%) were false negative (FN). Thus, sensitivity of the 18F-FDG PET/ CT was 92.11%, specificity 86.21%, positive predictive value 89.74%, negative predictive value 89.29% and accuracy 89.55%. In 27 patients (40%) 18F-FDG PET/CT finding influenced further management of the patient. Conclusions 18F-FDG PET/CT has high accuracy in the detection of metastases/recurrences of MTC in patients after thyroidectomy as well as in evaluation and the appropriate choice of the therapy.

Objectives The aim of this study was to [1] characterize distribution of Erdheim-Chester Disease (ECD) by 18F-FDG PET/CT and [2] determine the utility of metabolic (18F-FDG PET/CT) imaging versus anatomic imaging (CT or MRI) in evaluating ECD patients for clinical trial eligibility. Methods 18F-FDG PET/CT and corresponding CT or MRI studies for ECD patients enrolled in a prospective registry study were reviewed. Sites of disease were classified as [1] detectable by 18F-FDG PET only, CT/MRI only, or both and as [2] measurable by modified PERCIST (mPERCIST) only, RECIST only, or both. Descriptive analysis was performed and paired t test for between-group comparisons. Results Fifty patients were included (mean age 51.5 years; range 18–70 years). Three hundred thirty-three disease sites were detected among all imaging modalities, 188 (56%) by both 18F-FDG PET and CT/MRI, 67 (20%) by 18F-FDG PET only, 75 (23%) by MRI brain only, and 3 (1%) by CT only. Of 178 disease sites measurable by mPERCIST or RECIST, 40 (22%) were measurable by both criteria, 136 (76%) by mPERCIST only, and 2 (1%) by RECIST only. On the patient level, 17 (34%) had mPERCIST and RECIST measurable disease, 30 (60%) had mPERCIST measurable disease only, and 0 had RECIST measurable disease only (p Conclusion Compared with anatomic imaging, 18F-FDG PET/CT augments evaluation of disease extent in ECD and increases identification of disease sites measurable by formal response criteria and therefore eligibility for clinical trials. Complementary organ-specific anatomic imaging offers the capacity to characterize sites of disease in greater anatomic detail. Trial registration ClinicalTrials.gov Identifier: NCT03329274

A retrospective, single-center analysis of 14 cases of Candida endocarditis (from 355 candidemia cases during the years 2012–2019) revealed a high in-hospital mortality (57.1%), a high proportion of healthcare-associated infections (13/14) and a high treatment preference for echinocandins. Transthoracic echocardiography and 18F-FDG PET/CT had a sensitivity of 54.5% and 57.1%, respectively. Patients were older than previously described and most patients with Candida endocarditis had persistent candidemia for ≥ 3 days despite antifungal therapy. Electronic supplementary material The online version of this article (10.1007/s11046-020-00492-3) contains supplementary material, which is available to authorized users.

Purpose: To explore whether radiomic features of fluorine-18-fluorodeoxyglucose ($^{18}F-FDG$) positron emission tomography-computed tomography (PET/CT) has association with bone marrow infiltration (BMI) in comparison to other conventional PET metrics. Material and methods: Forty-four patients (with pathologically proven lymphoma disease) underwent staging $^{18}F-FDG PET/CT$ scan. Primary tumour was semi-automatically or manually segmented with a threshold standardised uptake value (SUV) of 3. A total of 73 features were extracted from eight different textures. Spearman correlation was used to test the correlation of features with conventional quantitative metrics such as SUV, metabolic tumour volume, and total lesion glycolysis. Specificity and sensitivity (including 95% confidence intervals [CI]) for each of the studied parameters were derived using receiver operative characteristic (ROC) curves. Univariate and multivariate analyses were used to identify independent predictors associated with BMI. Results: Correlation between conventional PET metrics and features ranged between 0.50 and 0.97 for positive correlation (33 significant association features) and ranged from -0.52 to -0.97 for inverse correlation (three significant association features) for both strong and moderate correlations. Analysis of ROC curves showed that high-intensity long-run emphasis 4 bin, high-intensity large zone emphasis 64 bin, long-run emphasis (LRE) 64 bin, large-zone emphasis 64 bin, max spectrum 8 bin, busyness 64 bin, and code similarity 32 and 64 bin were significant discriminators of BMI among other features (area under curve > 0.682, p < 0.05). Univariate analyses of texture features showed that code similarity and long-run emphasis (both 64 bin) were significant predictors of bone marrow involvement. Multivariate analyses revealed that LRE (64 bin, p = 0.031) with an odds ratio of 1.022 and 95% CI of (1.002-1.043) were independent variables for bone marrow involvement. Conclusions: $^{18}F-FDG PET/CT$ radiomic features are synergistic to visual assessment of BMI in patients diagnosed with lymphoma using $^{18}F-FDG PET/CT$. Further assessment of long-run emphasis is highly warranted.

Hodgkin lymphoma (HL) has a bimodal age distribution curve, with a second peak in people aged more than 60 years. Interim PET/CT (iPET/CT) is highly predictive for PFS and OS in young HL, but it has not been sufficiently studied in the elderly. In this retrospective dual-center study, 82 patients with HL and aged 65 or more who performed iPET/CT were included. At iPET/CT, 60 patients had a complete metabolic response, 18 partial responses, and 4 progressions of disease. Baseline PET/CT metabolic features were not significantly correlated with the metabolic response at interim. In patients with interim complete metabolic response, PFS and OS were significantly longer than in patients without complete response(

Background 18F-FDG PET/CT metabolic parameters have been applied as prognostic factors in multi-malignancies. However, the role in locally advanced pancreatic cancer (LAPC) was not confirmed. In this study, we investigated the prognostic value of 18F-FDG PET/CT metabolic parameters in LAPC patients treated with stereotactic body radiation therapy (SBRT). Methods Seventy three LAPC patients who received SBRT therapy and pre-treatment 18F-FDG PET/CT imaging from January 2012 to January 2016 were included in this retrospective study. The study aim was to evaluate the relationship between metabolic parameters with clinical factors, and the value of metabolic parameters in the prognosis of LAPC. The median of parameters was set as the cut-off value for statistical analysis. Univariate survival analysis was performed by the Kaplan Meier method and log-rank test, and multivariate analysis was carried out by a Cox proportional hazards model. Results Patients with lymph node metastasis or longer tumor diameters were associated with higher TLG (P P P Conclusions TLG was found to be the independent prognostic factor of OS and PFS. Among clinical factors, radiotherapy dose and chemotherapy were independent prognostic factors of OS and PFS.