Search

The clinical landscape of lymphomas has changed dramatically over the last 2 decades, including significant progress made in the understanding and utilization of imaging modalities and the available treatment options for both indolent and aggressive lymphomas. Since the introduction of hybrid PET/CT scanners in 2001, the indications of 18F-fluorodeoxyglucose (FDG) PET/CT in the management of lymphomas have grown rapidly. In today's clinical practice, FDG PET/CT is used in successful management of the vast majority patients with lymphomas., (Copyright © 2023 Elsevier Inc. All rights reserved.)

During the last 2 decades, f-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG PET/CT) has transformed the clinical head and neck cancer imaging for patient management and predicting survival outcomes. It is now widely used for staging, radiotherapy planning, posttherapy assessment, and for detecting recurrence in head and neck cancers and is widely included in NCCN and other evidence based clinical practice guidelines. Future Directions would include evaluating the potential value of FAPI PET/CT for head and neck cancers, opportunity to use volumetric and tumor heterogeneity parameters and deploying AI in diagnostic and therapeutic assessments., Competing Interests: Disclosure No conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Fibroblast-activation protein is a promising target for oncologic molecular imaging. Studies show that fibroblast activation protein inhibitor (FAPI) radiotracers are accurate diagnostics with favorable tumor-to-background ratios across various cancers. Therefore, we performed a systematic review and metaanalysis to assess the diagnostic performance of FAPI PET/CT in comparison with [ 18 F]FDG PET/CT, the most widely used radiotracer in oncology. Methods: We conducted a systematic search in MEDLINE, Embase, Scopus, PubMed, Cochrane Central Register of Controlled Trials, relevant trial registries, and bibliographies. The search consisted of combinations of terms for 3 topics: neoplasia, PET/CT, and FAPI. Two authors independently screened retrieved articles using predefined inclusion and exclusion criteria and extracted the data. Study quality was assessed using the criteria of QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). For each study, the sensitivity, specificity, and 95% CIs were calculated to determine diagnostic accuracy for primary, nodal, and metastatic lesions. A random-effects metaanalysis was used for pooling the data, and heterogeneity was assessed (I 2 index). Results: Thirty-nine studies (1,259 patients) investigating the use of FAPI PET/CT were included. On a patient-based analysis, pooled sensitivity was 0.99 (95% CI, 0.97-1.0) for the detection of primary lesions. Pooled sensitivity for nodal and distant metastases was 0.91 (95% CI, 0.81-0.96) and 0.99 (95% CI, 0.96-1.0), respectively. On a paired analysis between FAPI and [ 18 F]FDG PET/CT, FAPI had a higher sensitivity in the detection of primary, nodal, and metastatic lesions (all P  < 0.001). The differences in sensitivities between FAPI and [ 18 F]FDG were statistically significant. In terms of heterogeneity, analyses on primary lesions were moderately affected, distant metastatic lesions were highly affected, and the nodal metastatic analyses had negligible heterogeneity. Conclusion: The diagnostic performance of FAPI PET/CT is superior to that of [ 18 F]FDG in the detection of primary, nodal, and distant metastases. However, further studies are needed to better evaluate its utility and indication in specific cancer types and clinical settings., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

Introduction: FDG PET/CT was prospectively studied in 287 cN0 head and neck cancer patients in ACRIN 6685, and additional analysis of neck FDG uptake upon recurrence-free survival (RFS) and overall survival (OS) was performed., Patients and Methods: Two hundred eight had analyzable data. Survival analysis was performed to compare RFS and OS based on neck FDG visual assessment (VA) and SUV max . For SUV max , the optimal thresholds were calculated using conditional inference trees on a randomly selected 70% training data set and validated using the remaining 30% of data. Kaplan-Meier curves with log-rank tests were generated for the patient groups based on VA and optimal SUV max thresholds, and the hazards ratios (HRs) and 95% confidence intervals (CIs) were also calculated. Hypothesis testing was set at a significance level of 0.05., Results: A total of 73.9% of bilateral cN0 and 50.0% of unilateral cN0 were alive at the end of the study with the remaining being dead or lost to follow-up. Overall survival median follow-up time was 24.0 months (interquartile range, 15.8-25.3; range, 0-37.0). A total of 63.3% of bilateral cN0 and 42.5% of unilateral cN0 patients remained disease free during the study. Recurrence-free survival median follow-up time was 23.9 months (interquartile range, 12.4-25.2; range, 0-35.6). Visual assessment of necks by our panel of radiologists was significantly associated with RFS (HR [95% CI], 2.30 [1.10-4.79]; P = 0.02), but not with OS (HR [95% CI], 1.64 [0.86-3.14]; P = 0.13). The optimal SUV max thresholds were 2.5 for RFS and 5.0 for OS. For SUV max assessment, applying the optimal thresholds to the 30% test data yielded HRs (95% CIs) of 2.09 (0.61-7.14; P = 0.23) for RFS and 3.42 (1.03-11.41; P = 0.03) for OS. The SUV max threshold of 5.0 was significantly associated with RFS (HR [95% CI], 5.92 [1.79-19.57]; P < 0.001)., Conclusions: Neck FDG uptake by VA is significant for RFS. An SUV max threshold of 5.0 is significantly associated with OS and RFS., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. This study was supported by the National Cancer Institute through grants no.U01 CA079778, U01 CA080098, CA180820, and CA180794. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

PET/computed tomography (CT) is a valuable tool in post-therapy follow-up of head and neck cancers. PET/CT is sensitive and specific, can detect recurrences that otherwise may be missed on routine clinical examination or conventional imaging, and also can have an impact on patient management. National Comprehensive Cancer Network guidelines recommend PET/CT be performed within 3 months to 6 months after therapy. After this baseline scan, however, further routine PET/CT surveillance in asymptomatic patients has unclear benefit. Additional post-therapy PET/CT imaging should be individualized to patients based on considerations such as tumor type, stage, prognostic factors, symptoms, and clinical assessment., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Head and neck cancers are commonly encountered cancers in clinical practice in the United States. Fluorine-18-fluorodeoxyglucose ( 18 F-FDG) PET/CT has been clinically applied in staging, occult primary tumor detection, treatment planning, response assessment, follow-up, recurrent disease detection, and prognosis prediction in these patients. Alternative PET tracers remain investigational and can provide additional valuable information such as radioresistant tumor hypoxia. The recent introduction of 18 F-FDG PET/MR imaging has provided the advantage of combining the superior soft tissue resolution of MR imaging with the functional information provided by 18 F-FDG PET. This article is a concise review of recent advances in PET imaging in head and neck cancer., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To establish the detection rate of prostate cancer recurrence following definitive therapy by 18F-fluciclovine PET/computed tomography (CT) in patients with biochemical recurrence (BCR) and prostate-specific antigen (PSA) levels less than 2.00 ng/mL., Methods: In this retrospective study, 78 patients with a PSA level of less than 2.00 ng/mL were selected from the 211 patients who underwent at least one 18F-fluciclovine PET/CT scan at our institution for the detection of biochemical recurrent prostate cancer between April 2017 and December 2018. Inherent differences in the characteristics of patients with and without a positive scan were investigated for possible associations using multivariable analysis., Results: One or more positive sites of recurrence were identified in 44 out of 78 patients (56.4%). Patients with a Gleason score between 8 and 10 were more likely to have a positive scan compared to patients with Gleason scores of 6-7 [adjusted odds ratio: 3.53, 95% confidence interval (1.13-10.99), P = 0.03]. No other significant association was found between PSA, T classification, and detection rate., Conclusion: 18F-fluciclovine PET/CT demonstrated a detection rate of 56.4% among patients with a PSA below 2.0 ng/mL. The results of this study support the use of 18F-fluciclovine PET/CT for the detection of recurrent prostate cancer at lower PSA levels, even at PSA levels less than 0.5 ng/mL., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: FDG-PET/CT (fluorodeoxyglucose-positron emission tomography/computed tomography) is effective to assess for occult neck nodal disease. We report risks and patterns of nodal disease based on primary site and nodal level from data on the dissected cN0 per the results from ACRIN 6685., Study Design: Prospective nonrandomized enrollment included participants with first-time head and neck squamous cell carcinoma and at least 1 cN0 neck side to be dissected., Setting: Twenty-four ACRIN-certified centers internationally (American College of Radiology Imaging Network)., Methods: A total of 287 participants were enrolled. Preoperative FDG-PET/CT findings were centrally reviewed and compared with pathology. Incidence, relative risk, pattern of lymph node involvement, and impact upon neck dissection were reported., Results: An overall 983 nodal levels were dissected (n = 261 necks, n = 203 participants). The highest percentages of ipsilateral positive nodes by primary location and nodal level were oral cavity (level I, 17/110, 15.5%), pharynx (level II, 6/30, 20.0%), and larynx (level VI, 1/3, 33.3%)., Conclusion: Levels at greatest risk for nodal disease in cN0 in terms of ipsilateral neck dissection are level I (oral cavity), II (pharynx), and VI (larynx). These data should be considered when treating patients presenting with cN0. This is the first study to comprehensively report the incidence, location, and risk of metastases in cN0 in the FDG-PET/CT era.

Twenty-five years ago, oligometastatic disease was proposed as an intermediary clinical state of cancer with unique implications for therapies that may impact cancer evolution and patient outcome. Identification of limited metastases that are potentially amenable to targeted therapies fundamentally depends on the sensitivity of diagnostic tools, including new-generation imaging methods. For men with biochemical recurrence after definitive therapy of the primary prostate cancer, PET/CT using either the FDA-approved radiolabeled amino acid analogue 18 F-fluciclovine or investigational radiolabeled agents targeting prostate-specific membrane antigen (PSMA) enables identification of early metastases at lower serum PSA levels than was previously feasible using conventional imaging. Evidence supports PSMA PET/CT as the most sensitive imaging modality available for identifying disease sites in oligometastatic prostate cancer. PSMA PET/CT will likely become the modality of choice after regulatory approval and will drive the development of trials of emerging metastasis-directed therapies such as stereotactic ablative body radiation and radioguided surgery. Indeed, numerous ongoing or planned clinical trials are studying advances in management of oligometastatic prostate cancer based on this heightened diagnostic capacity. In this rapidly evolving clinical environment, radiologists and nuclear medicine physicians will play major roles in facilitating clinical decision making and management of patients with oligometastatic prostate cancer.

Head and neck cancers are commonly encountered malignancies in the United States, of which the majority are attributed to squamous cell carcinoma. 18 F-FDG-PET/CT has been well established in the evaluation, treatment planning, prognostic implications of these tumors and is routinely applied for the management of patients with these cancers. Many alternative investigational PET radiotracers have been extensively studied in the evaluation of these tumors. Although these radiotracers have not been able to replace 18 F-FDG-PET/CT in routine clinical practice currently, they may provide important additional information about the biological mechanisms of these tumors, such as foci of tumor hypoxia as seen on hypoxia specific PET radiotracers such as 18 F-Fluoromisonidazole ( 18 F-FMISO), which could be useful in targeting radioresistant hypoxic tumor foci when treatment planning. There are multiple other hypoxia-specific PET radiotracers such as 18 F-Fluoroazomycinarabinoside (FAZA), 18 F-Flortanidazole (HX4), which have been evaluated similarly, of which 18 F-Fluoromisonidazole ( 18 F-FMISO) has been the most investigated. Other radiotracers frequently studied in the evaluation of these tumors include radiolabeled amino acid PET radiotracers, which show increased uptake in tumor cells with limited uptake in inflammatory tissue, which can be useful especially in differentiating postradiation inflammation from residual and/or recurrent disease. 18 F-Fluorothymidine (FLT) is localized intracellularly by nucleoside transport and undergoes phosphorylation thereby being retained within tumor cells and can serve as an indicator of tumor proliferation. Decrease in radiotracer activity following treatment can be an early indicator of treatment response. This review aims at synthesizing the available literature on the most studied non-FDG-PET/CT in head and neck cancer., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: We investigated the role of Ga-68 DOTATATE PET/CT in comparison to F-18 FDG PET/CT in patients with low and intermediate versus high-grade neuroendocrine tumors (NETs)., Methods: We identified 81 patients who underwent Ga-68 DOTATATE PET/CT at our institution between May 2017 and December 2018 and met inclusion criteria of biopsy-proven NET with known Ki-67 index, histologic grade, or differentiation. Patients were divided into two groups. Control group included Ki-67 ≤20%, grade 1 or 2, or well-differentiated tumors. Experimental group included Ki-67 >20%, grade 3, or poorly-differentiated tumors., Results: Mean age was 57 years, with 36 males and 45 females. Most common primary sites were small bowel, pancreas, and lung. Most common distant metastatic sites were liver and bone. In the control group (n = 67), median Ki-67 was 4% (range 1-30%). 55/67 (82.1%) DOTATATE and 6/11 (54.5%) FDG scans were positive (P = 0.04). Positive scans showed >10 lesions in 25/55 (45.5%) DOTATATE and 1/6 (16.7%) FDG scans (P = 0.18). 40/55 (72.7%) positive DOTATATE and 3/6 (50%) FDG scans showed distant disease (P = 0.25). In the experimental group (n = 14), median Ki-67 was 68% (range 25-95%). All 14 DOTATATE and all nine FDG scans were positive. Positive scans showed >10 lesions in 4/14 (28.6%) DOTATATE and 5/9 (55.6%) FDG scans (P = 0.20). 10/14 (71.4%) positive DOTATATE and 7/9 (77.8%) FDG scans showed distant disease (P = 0.74)., Conclusion: All patients with high grade, poorly-differentiated NETs had positive DOTATATE PET/CTs. In these patients, DOTATATE PET/CT did not significantly differ from FDG PET/CT in identifying >10 lesions or distant disease.

OBJECTIVE. The purpose of this article is to review the utility of 18 F-fluciclovine PET/CT in the evaluation of recurrent prostate cancer. CONCLUSION. Fluorine-18-labeled fluciclovine PET/CT has shown promise in the evaluation of recurrent prostate cancer. Its performance has been superior to that of other imaging modalities. It has had good diagnostic accuracy, especially in the detection of extra-prostatic disease recurrence, and the findings have an impact on treatment planning. Gallium-68-labeled prostate-specific membrane antigen PET/CT has also had excellent performance in the detection of biochemically recurrent prostate cancer with detection rates superior to those of fluciclovine PET/CT.

OBJECTIVE. The purpose of this study is to evaluate the prognostic value of quantitative metabolic parameters from pretreatment PET/CT scans of patients with squamous cell cervical cancer. MATERIALS AND METHODS. This retrospective study included 120 patients with biopsy-proven squamous cell carcinoma of the cervix who underwent FDG PET/CT for initial tumor staging. The primary tumor maximum standardized uptake value (SUV max ) and mean standardized uptake value (SUV mean ), tumor glycolytic activity, metabolic tumor volume (MTV), and metabolic intratumoral heterogeneity index (calculated as the AUC for the cumulative standardized uptake value [SUV]-volume histogram [CSH] index) were obtained. Information on patient demographic characteristics and tumor staging were collected. Median follow-up was 27.5 months. Overall survival (OS) and progression-free survival (PFS) were calculated using a multivariate Cox proportional hazards regression model and log-rank (Mantel-Cox) test to generate Kaplan-Meier survival plots. RESULTS. The mean (± SD) age of the patients was 54.4 ± 13.1 years. Twenty-two patients had stage I disease; 58, stage II; 23, stage III; and 17, stage IV. Thirty-three patients died, 82 were living, and five were lost to follow-up and were censored; 29 patients had disease progression. The median survival was 74.9 months (95% CI, 63.6-86.9 months). A higher MTV was significantly associated with reduced OS in multivariate analysis (hazard ratio, 1.085; 95% CI, 1.036-1.136; p = 0.0005). A higher AUC-CSH index (denoting lower tumor heterogeneity) was significantly associated with increased OS (hazard ratio, 0.662; 95% CI, 0.448-0.979; p = 0.04) and PFS (hazard ratio, 0.683; 95% CI, 0.471-0.991; p = 0.045) in multivariate analysis. Kaplan-Meier survival analysis using the median value for MTV (61 mL) significantly predicted OS ( p = 0.0009). CONCLUSION. Tumor heterogeneity on pretreatment PET/CT is associated with OS and PFS in patients with cervical cancer. MTV is significantly associated with OS.

Objective: The purpose of this article is to summarize the clinical utility of 18 F-FDG PET/CT in the evaluation of lung cancer recurrence with an emphasis on typical anatomic and metabolic patterns of recurrence, expected posttherapeutic changes, and common pitfalls of FDG PET/CT. FDG PET/CT is useful in assessing therapeutic response and in determining the extent of recurrent disease and provides a guide for targeted biopsy., Conclusion: FDG PET/CT plays a crucial role in the evaluation of therapeutic response in lung cancer and guides management.

OBJECTIVE. The objective of our study was to investigate the impact of point-spread function (PSF) reconstruction and lesion size on 68 Ga-tetraazacyclododecanetetraacetic acid-DPhe1-Tyr3-octreotate (DOTATATE) PET/CT quantitative parameters. MATERIALS AND METHODS. A total of 38 patients with 42 68 Ga-DOTATATE PET/CT studies and 125 lesions were included. Scans were reconstructed with and without PSF modulation. For each lesion, the maximum standardized uptake value (SUV max ) and peak standardized uptake value (SUVpeak), metabolic tumor volume (MTV), total lesion somatostatin avidity, and tumor somatostatin receptor expression heterogeneity using the AUC method were measured. Intraclass correlation coefficient (ICC) and Bland-Altman analyses were used to compare PSF and non-PSF values. A subgroup analysis was performed to determine the impact of lesion size. RESULTS. Of the 125 lesions, 51 were in the liver, 31 in lymph nodes, 17 in bone, eight in pancreas, four in lung, and 14 in other sites. The ICCs between PSF and non-PSF values were excellent for SUV max , SUVpeak, MTV, and total lesion somatostatin avidity (ICC = 0.97-0.99), and the ICC was good for tumor somatostatin receptor expression heterogeneity (ICC = 0.81). Comparison of PSF with non-PSF values showed a bias (mean percentage change ± SD) of 27.5% ± 14.7% for SUV max , 15.5% ± 9.5% for SUVpeak, -18.6% ± 37.6% for MTV, 0.8% ± 28.1% for total lesion somatostatin avidity, and -7.1% ± 11.0% for tumor somatostatin receptor expression heterogeneity. Comparison of PSF with non-PSF values for lesions less than 2 cm ( n = 75) showed corresponding biases greater than those for lesions 2 cm or larger ( n = 50). CONCLUSION. PSF reconstruction effected higher values for SUV max and SUVpeak, produced decreased values for tumor somatostatin receptor expression heterogeneity, and had a variable effect on MTV and total lesion somatostatin avidity depending on lesion size.

Purpose: The objective of this study was to determine the negative predictive value (NPV) of positron emission tomography (PET)/computed tomography (CT) for the clinically N0 neck on the basis of neck dissection., Methods: Participants with newly diagnosed, first-time, head and neck squamous cell carcinoma (HNSCC) and at least one clinically N0 neck side for which dissection was planned were included. A total of 287 participants were prospectively enrolled from 23 American College of Radiology Imaging Network-qualified institutions. PET/CT was compared with findings at neck dissection., Results: PET/CT scans and pathology findings were available for 270 N0 neck sides from 212 participants. For visual assessment, the NPV specific to the clinical-N0 sides was 0.868 (95% CI, 0.803 to 0.925). For dichotomized maximum standardized uptake value, the NPVs specific to the nodal basins were 0.940 (95% CI, 0.928 to 0.952) and 0.937 (95% CI, 0.925 to 0.949) at prespecified cutoffs of 2.5 and 3.5, respectively. The optimal cutoff maximum standardized uptake value was determined to be 1.8, with an NPV of 0.942 (95% CI, 0.930 to 0.953). The PET/CT-informed surgical treatment plan was changed in 51 of 237 participants (22%) compared with the PET/CT-blinded surgical plan. In 34 participants (14%), this led to planned dissection of additional nodal levels. In 12 participants (5%), this led to fewer planned dissected nodal levels. Negative PET/CT scans in N0 necks was true negative in 87% and false negative in 13%., Conclusion: [ 18 F]fluorodeoxyglucose-PET/CT has high NPV for the N0 neck in T2 to T4 HNSCC. The surgical treatment plans on the basis of PET/CT findings may be changed in approximately 22% of this group. These findings suggest that [ 18 F]fluorodeoxyglucose-PET/CT may assist the clinician in deciding on the best therapy for the clinically N0 neck in HNSCC. Well-designed clinical trials should be performed to test the outcome of omitting neck dissection by using PET/CT.

A number of PET agents are useful for evaluation of skeletal metastatic disease, and have significant advantages over 99mTc-MDP scintigraphy, including superior diagnostic accuracy, higher spatial resolution, and shorter imaging times- often with the ability to depict soft tissue local recurrence and metastasis in the same examination. While these agents have excellent diagnostic utility, they are not 100% specific for skeletal metastasis, and so normal patterns of biodistribution, benign osseous lesions that may demonstrate radiotracer uptake, and the significance of morphologic changes on CT such as osteolysis or osteosclerosis must be kept in mind to ensure accurate interpretation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The American College of Radiology (ACR) and American College of Nuclear Medicine (ACNM) collaborated to develop a clinical practice document for the performance of fluciclovine positron-emission tomography (PET) / computed tomography (CT) in the evaluation of patients with suspected prostate cancer recurrence based on the elevation of prostate-specific antigen (PSA) level (biochemical recurrence) after prior therapy. Prostate cancer is the third leading cause of cancer death in the United States. Up to 50% of patients diagnosed with prostate cancer will develop biochemical failure after initial therapy. The differentiation of local from extraprostatic recurrence plays a critical role in patient management. The use of functional imaging targeting features of cancer metabolism has proven highly useful in this regard. Amino acid transport is upregulated in prostate cancer. Fluciclovine (anti-1-amino-3-F-18-fluorocyclobutane-1-carboxylic acid, FACBC, Axumin™) is an artificial amino acid PET tracer which demonstrates utility in the diagnosis of recurrent prostate cancer with significant added value to conventional imaging.

There are recent advances, namely, a standardized method for reporting therapy response (Hopkins criteria), a multicenter prospective cohort study with excellent negative predictive value of F-FDG PET/CT for N0 clinical neck, a phase III multicenter randomized controlled study establishing the value of a negative posttherapy F-FDG PET/CT for patient management, a phase II randomized controlled study demonstrating radiation dose reduction strategies for human papilloma virus-related disease, and Food and Drug Administration approval of nivolumab for treatment of recurrent head and neck squamous cell carcinoma.

Over the past 20 y, PET/CT has had many technologic and developmental advancements for patient care. PET/CT has evolved from being used as a diagnosis and staging tool to now having an impact on treating cancer through a collaboration with radiation oncology. There are multiple considerations when integrating PET/CT into radiation therapy planning, such as the needs of the PET/CT center, the types of scans to offer, workflow considerations between the PET/CT center and the radiation therapy planning center, PET/CT center growth and demand on schedules, and the impact PET/CT will have on radiation treatment planning. Careful planning and implementation are important in offering patients optimum care that integrates PET/CT in radiation therapy planning., (© 2018 by the Society of Nuclear Medicine and Molecular Imaging.)

Radiopharmaceuticals targeting cell surface expression of somatostatin receptors (SSTRs) are particularly useful in the evaluation of neuroendocrine tumors. Gallium-68 DOTA-Tyr-octreotatate (Ga-DOTATATE) primarily binds to SSTR type 2 receptors. Ga DOTATATE PET/CT is proven to have high impact on the management of neuroendocrine patients compared to traditional anatomical imaging as well as provides additional information over that of conventional nuclear medicine studies (indium-III DTPA-octreotide). It can result in change in management of approximately 75% of patients with neuroendocrine tumors. Ga DOTATATE and F FDG PET/CT imaging are complementary, with the degree of uptake varying depending on the degree of differentiation of the tumor. Well-differentiated tumors maintain their SSTRs and are positive on Ga DOTATATE PET/CT scan, while dedifferentiated tumors are less likely to demonstrate uptake of Ga DOTATATE but will demonstrate uptake with F FDG PET/CT. In addition, Ga DOTATATE PET/CT identifies patients with SSTR expression in their tumors, who have progressed on somatostatin analog therapy, for treatment with Lu DOTATATE.

Lung cancer is the leading cause of cancer-related mortality in the United States, and accurate staging plays a vital role in determining prognosis and treatment. The recently revised eighth edition of the TNM staging system for lung cancer defines new T and M descriptors and updates stage groupings on the basis of substantial differences in survival. There are new T descriptors that are based on the findings at histopathologic examination, and T descriptors are reassigned on the basis of tumor size and extent. No changes were made to the N descriptors in the eighth edition of the TNM staging of lung cancer, because the four N categories that are based on the location of the diseased nodes can be used to consistently predict prognosis. The eighth edition includes a new M1b descriptor for patients with a single extrathoracic metastatic lesion in a single organ (M1b), because they have better survival and different treatment options, compared with those with multiple extrathoracic lesions (M1c). Examination with fluorine 18 fluorodeoxyglucose (FDG) PET/CT is the standard of care and is an integral part of the clinical staging of patients with lung cancer. To provide the treating physicians with accurate staging information, radiologists and nuclear medicine physicians should be aware of the updated classification system and should be cognizant of the site-specific strengths and limitations of FDG PET/CT. In this article, the eighth edition of the TNM staging system is reviewed, as well as the role of FDG PET/CT in the staging of non-small cell lung carcinoma. © RSNA, 2018.

Treatment of high-risk prostate cancer (HRPCa) is challenging. Local staging and metastatic evaluation are important for the patient management. Recently, prostate-specific membrane antigen (PSMA)-based imaging modalities such as PSMA PET/CT and PET/MRI have received significant attention for detection of recurrent prostate cancer sites with elevated prostate-specific antigen levels, after therapy. Current evidence suggests that these imaging modalities may also have a role for the management of patients with HRPCa. In this review, we discuss PSMA-based imaging modalities in the management of patients with HRPCa.

Objective: The purpose of this article is to provide a review of the use of 68 Ga tetraazacyclododecanetetraacetic acid-DPhe1-Tyr3-octreotate (DOTATATE) PET/CT, a functional imaging modality for assessment of well-differentiated neuroendocrine tumors (NETs). It has become the preferred imaging modality for initial diagnosis, selection of patients for peptide receptor radionuclide therapy, and localization of unknown primary tumors. The National Comprehensive Cancer Network guideline has added 68 Ga-DOTATATE PET/CT as an appropriate test in the management of NETs., Conclusion: In combination with FDG PET/CT, 68 Ga-DOTATATE PET/CT can noninvasively assess tumor heterogeneity, especially in G2 and G3 NETs, for personalized management of patients.

Objective: In this article, we review the literature on PET/CT in the management of dementia, present evidence for best clinical practices, and discuss recent advances in the field., Conclusion: Standard-of-care imaging for dementia includes CT and MRI, primarily for excluding vascular lesions or masses, detecting atrophy, and monitoring disease severity. PET/CT is a powerful functional modality that can differentiate dementia types and influence management. Fluorine-18-FDG PET/CT reveals the spatial pattern of glucose metabolism in the brain. More recently, radiotracers for PET have been developed that bind to amyloid protein, tau protein, and neuroinflammatory markers.

Objective: The aim of this study was to determine whether various fluorine-18-fluorodeoxyglucose PET/CT-derived parameters used in oncology vary significantly depending on the interpretation software systems used in clinical practice for multiple human solid tumors., Patients and Methods: A total of 120 fluorine-18-fluorodeoxyglucose PET/CT studies carried out in patients with pancreatic, lung, colorectal, and head and neck cancers were evaluated retrospectively on two different vendor software platforms including Mirada and MIMVista. Regions of interest were placed on the liver to determine the liver mean standardized uptake value at lean body mass (SUL) and on each tumor to determine the SULmax, SULpeak. Total lesion glycolysis (TLG) and metabolic tumor volume (MTV) were determined using fixed thresholds of 50% of SULmax and SULpeak. Inter-reader, intersystem intraclass correlations, systematic bias, and variability reflected by the 95% limits of agreement, and precision were determined., Results: There was excellent inter-reader reliability between the readers and the two software systems, with intraclass correlations more than 0.9 for all PET metrics, with P values less than 0.0001. The bias and SD on Bland-Altman analysis between the two software platforms for tumor SULmax, SULpeak, Max50MTV, and Peak50MTV, respectively, for Reader 1 were -1.52±2.24, 0.80±3.67, -0.80±13.01, and -4.49±20.6. For Reader 2, the biases were -1.62±1.95, 0.18±3.60, -0.27±4.64, and -3.13±8.30. The precision between the two systems was better for SULmax and SULpeak, with less variance observed, than for volume-based metrics such as Max50MTV and Peak50MTV or TLG., Conclusion: Excellent correlation has been found between two tested software reading platforms for all PET-derived metrics in a dual-reader analysis. Overall, the SULmax and SULpeak values had less bias and better precision compared with the MTV and TLG.

This clinical practice parameter has been developed collaboratively by the American College of Radiology (ACR), the Society for Pediatric Radiology (SPR), and the Society of Thoracic Radiology (STR). This document is intended to act as a guide for physicians performing and interpreting positron emission tomography-computed tomography (PET/CT) of cardiac diseases in adults and children. The primary value of cardiac PET/CT imaging include evaluation of perfusion, function, viability, inflammation, anatomy, and risk stratification for cardiac-related events such as myocardial infarction and death. Optimum utility of cardiac PET/CT is achieved when images are interpreted in conjunction with clinical information and laboratory data. Measurement of myocardial blood flow, coronary flow reserve and detection of balanced ischemia are significant advantages of cardiac PET perfusion studies. Increasingly cardiac PET/CT is used in diagnosis and treatment response assessment for cardiac sarcoidosis.

Patient satisfaction with health-care delivery is essential today. Using a psychometrically validated questionnaire-SERVPERF-we quantitatively measured patients' perceptions of the quality of service at the point of care in a PET/CT center, and we used this information to guide subsequent quality improvement interventions. SERVPERF is a survey instrument that measures performance for various services. It has demonstrated reliability and validity across various industries. The standard for measuring patient perception of quality in hospitals-the "Hospital Consumer Assessment of Health Care Providers and Systems" survey-does not include questions about the care received in a typical radiology department and is not performed at the point of care. Methods: 429 patients undergoing PET/CT examinations filled out an anonymous modified SERVPERF questionnaire on completion of imaging and reported their level of agreement with each of the 27 items by circling a Likert-type scale from 1 to 7. Each item was designed to elicit a response on the patient's perception of performance on a metric of quality. Data were summarized as the mean of each item. The frequency of low scores (≤3) was also calculated. Results: The items with the lowest mean score were "The department's physical facilities are visually appealing" (6.158) and "Documentation such as sign-in sheet, handouts, and brochures are visually appealing" (6.162). The item with the highest frequency of low scores (≤3) was, "The department provides services at the promised time" (11/429 responses). Conclusion: Our study showed that patient perception of quality in a diagnostic radiology department can be measured with a standardized survey at the point of care delivery and used to direct patient-centered quality improvement interventions., (© 2017 by the Society of Nuclear Medicine and Molecular Imaging.)

Skeletal and soft tissue sarcomas need early and accurate diagnosis, staging, and treatment for optimal outcome. 18 F-FDG PET/computed tomography (CT) is indicated in staging of patients with high-grade sarcomas and acts as a surrogate marker of histopathologic grade, guiding biopsy to most aggressive portion of the tumor. Pretherapy and posttherapy 18 F-FDG PET/CT metabolic parameters are reliable indicators of survival in patients with sarcoma with an important role in posttreatment response assessment, enabling the treatment plan to be modified in nonresponders. 18 F-FDG PET/CT is particularly useful in the evaluation of molecular targeted therapies, which induce metabolic change before structural change., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Gastric cancer is a disease with low survival rates and high morbidity, requiring accurate and prompt diagnosis and treatment. Although limited in the evaluation of the primary tumor as such, the metabolic information of primary tumors in an 18 F-FDG PET/CT study can assist in surgical and treatment planning and differentiating gastric cancers. It detects nodal disease with good specificity and positive predictive value, thus enabling appropriate therapy for individual patients. It provides valuable information about distant metastases, altering therapy decisions. It has reasonably good performance in detecting recurrent disease and in the follow-up of patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Recent advances in genomic profiling and sequencing of melanoma have provided new insights into the development of the basis for molecular biology to more accurately subgroup patients with melanoma. The development of novel mutation-targeted and immunomodulation therapy as a major component of precision oncology has revolutionized the management and outcome of patients with metastatic melanoma. PET imaging plays an important role in noninvasively assessing the tumor biological behavior, to guide individualized treatment and assess response to therapy. This review summarizes the recent genomic discoveries in melanoma in the era of targeted therapy and their implications for functional PET imaging., (Published by Elsevier Inc.)

Esophageal cancer commonly has a poor prognosis, which requires an accurate diagnosis and early treatment to improve outcome. Other modalities for staging, such as endoscopic ultrasound imaging and computed tomography (CT) scans, have a role in diagnosis and staging. However, PET with fluorine-18 fluoro-2-deoxy-d-glucose/CT (FDG PET/CT) scanning allows for improved detection of distant metastatic disease and can help to prevent unnecessary interventions that would increase morbidity. FDG PET/CT scanning is valuable in the neoadjuvant chemotherapy assessment and predicting survival outcomes subsequent to surgery. FDG PET/CT scanning detects recurrent disease and metastases in follow-up., (Copyright © 2017 Elsevier Inc. All rights reserved.)

18 F-FDG PET/CT has been described as an accurate tool for initial diagnosis of pancreatic adenocarcinoma. It differentiates benign from malignant causes; detects local and, especially, distant spread of disease; and is a very good predictor of patient prognosis. Pancreatic neuroendocrine tumors are rare tumors that originate from the islet cells of the pancreas. Currently, 68 Ga-DOTA-labeled somatostatin analogs are considered the best modality for detection of well-differentiated neuroendocrine tumors. 18 F-FDG PET/CT has a role in patients with poorly differentiated tumors. Recent studies have demonstrated improved survival in patients with metastatic neuroendocrine tumors treated with radiolabeled somatostatin analogs., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Fluorine-18 fluorodeoxyglucose ( 18 F-FDG) PET-computed tomography (CT) plays a significant role in diagnosis, staging, therapy selection, and therapy assessment of multiple pediatric malignancies and facilitating precision medicine delivery in pediatric patients. In patients with Hodgkin lymphoma, interim fludeoxyglucose 18 F-FDG PET/CT is highly sensitive and specific for predicting survival and multiple trials with FDG PET/CT-based adaptive therapies are currently ongoing. It is superior to iodine-131 metaiodobenzylguanidine ( 131 I-MIBG) scintigraphy and bone scintigraphy for detecting metastases in neuroblastoma patients and sarcoma patients. It may predict histologic differentiation and neoadjuvant therapy assessment in Wilms tumor., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The purpose of this article is to summarize the evidence for the value of PET/CT for the management of patients with head and neck squamous cell cancer and suggest best clinical practices., Conclusion: FDG PET/CT is a valuable imaging tool for identifying unknown primary tumors in patients with known cervical node metastases leading to management change and is the standard of care for the initial staging of stage III and IV head and neck squamous cell carcinomas (HNSCCs), for assessing therapy response when performed at least 12 weeks after chemoradiation therapy, and for avoiding unnecessary planned neck dissection. Neck dissection is avoided if PET/CT findings are negative-regardless of the size of the residual neck nodes-because survival outcomes are not compromised. FDG PET/CT is valuable in detecting recurrences and metastases during follow-up when suspected because of clinical symptoms and serves as a prognostic marker for patient survival outcomes, for 5 years. Using FDG PET/CT for routine surveillance of HNSCC after 6 months of treatment without any clinical suspicion should be discouraged.

Purpose: This study aimed to evaluate the comparative effectiveness of follow-up fluorine-18-fluorodeoxyglucose (F-FDG)-PET/CT and chest CT in the detection of local, regional, and distant metastatic diseases in lung cancer., Patients and Methods: Follow-up F-FDG-PET/CT and chest-CT pairs of biopsy-proven lung cancer patients were reviewed retrospectively (May 2004-June 2013). Histopathological, clinical, or imaging follow-up data of at least 6 months was considered the reference standard. The κ statistics, the percentage agreement between the two techniques, and per-scan basis diagnostic performances were reported., Results: A total of 270 patients with a total of 423 paired F-FDG-PET/CT and chest-CT scans were included (median time interval between two scans=2 days). The two imaging modalities showed concordance of 82.7% (κ=0.71) for local disease, 82% (κ=0.65) for regional disease, and 77.3% (κ=0.55) for distant metastasis. Overall, F-FDG-PET/CT identified more lesions compared with chest CT both in the regional lymph nodes (308 vs. 204 regional zone involvement) and in cases of distant metastasis (253 vs. 182 metastatic sites). In the evaluation of local disease, F-FDG-PET/CT appeared to have fairly similar sensitivity (96 vs. 95.4%) and specificity (82.1 vs. 83%) compared with chest CT. In the evaluation of regional lymph nodes and distant metastases, F-FDG-PET/CT showed higher sensitivity (regional nodes: 96 vs. 89.8%; distant metastases: 91.9 vs. 70.7%) and comparable specificity (regional nodes: 87.1 vs. 88.9%; distant metastases: 87.1 vs.88.1%)., Conclusion: The sensitivity of F-FDG-PET/CT is superior to that of chest CT in the detection of regional and distant metastasis, while having comparable specificity.

Objective: The aim of this study was to evaluate the impact of intratumoral metabolic heterogeneity and quantitative FDG PET/CT imaging parameters for predicting patient outcomes in primary oropharyngeal squamous cell cancer (OPSCC)., Patients and Methods: We retrospectively investigated 105 patients with HPV-positive OPSCC. SUVmax and metabolic tumor volume (MTV) were measured for the primary tumors and when available for the metastatic sites. Primary tumor intratumoral metabolic heterogeneity was calculated as the area under a cumulative SUV volume histograms curve (AUC-CSH). The median follow-up time was 35.4 months (range, 3-92 months). Outcome end point was event-free survival (EFS). Kaplan-Meier survival plots and Cox regression analyses were performed., Results: Of the 105 patients included, 19 patients relapsed and 11 deceased during the study period. AUC-CSH indexes were associated with EFS using PET gradient-based (P = 0.034) and 50% threshold (P = 0.02) segmentation methods, on multivariate analysis. Kaplan-Meier survival analysis using optimum cutoff of 16.7 SUVmax and 12.7 mL total MTV were significant predictors of EFS. Combining SUVmax and AUC-CSH index in 3 subgroups, patients with higher intratumoral heterogeneity and higher SUVmax were associated with worse outcome (log-rank, P = 0.026). Similarly, patients with higher intratumoral heterogeneity tumors and higher MTV had worse prognosis (log-rank, P = 0.022)., Conclusions: Intratumoral metabolic heterogeneity using FDG PET was a prognostic factor for EFS in patients with primary HPV (+) OPSCC. The combined predictive effect of FDG avidity, metabolic tumor burden, and intratumoral heterogeneity provided prognostic survival information in these patients.

The Centers for Medicare and Medicaid Services coverage includes 3 posttherapy 18 F-FDG PET/CT scans per patient and per tumor type. Any additional follow-up 18 F-FDG PET/CT scans will be reimbursed at the discretion of a local Medicare administrator, if deemed medically necessary. This study aimed to investigate common clinical indications for performing a fourth or additional follow-up 18 F-FDG PET/CT scans that could affect the management of patients. Methods: This was a retrospective institutional review of 433 oncology patients (203 men; mean age, 55 y), including a total of 1,659 fourth or subsequent follow-up PET/CT scans after completion of primary treatment. Twelve indications for performing a fourth or subsequent follow-up PET/CT scan were determined, and the impact of each of the 12 indications on patients' management was evaluated. Results: The primary tumors were breast cancer (92 patients, 426 scans), non-Hodgkin lymphoma (77 patients, 208 scans), Hodgkin disease (41 patients, 182 scans), colorectal cancer (70 patients, 286 scans), melanoma (69 patients, 271 scans), and lung cancer (84 patients, 286 scans). The indications were categorized in 4 groups: PET/CT for diagnosis of tumor recurrence (303/1,659, 18.3%), PET/CT before starting therapy for tumor recurrence (64/1,659, 3.9%), PET/CT to assess therapy response for tumor recurrence (507/1,659, 30.6%), and follow-up PET/CT after completion of treatment for tumor recurrence (785/1,659, 47.3%). Overall, fourth and subsequent follow-up 18 F-FDG PET/CT scans resulted in change in management in 31.6% of the scans (356 of 1,128) when the scans were obtained for medical necessities (indications 1-11), and in 5.6% of the scans (30/531) when the scans were obtained without any medical necessity (indication 12). Conclusion: The fourth and subsequent PET/CT scans obtained after completion of primary treatment led to a change in management in 31.6% of the scans when acquired for appropriate clinical reasons. Performing follow-up PET/CT without appropriate medical reason had a low impact on patients' management and should be avoided., (© 2017 by the Society of Nuclear Medicine and Molecular Imaging.)

Objective: To compare the accuracy of same-day therapy-assessment PET/computed tomography (PET/CT) and conventional contrast-enhanced computed tomography (CECT) in patients with oropharyngeal squamous cell carcinoma (OPSCC)., Methods: A total of 110 (95 men and 15 women; mean age 59 years) patients with biopsy-proven OPSCC were evaluated with same-day PET/CT and CECT pair scans as part of follow-up therapy assessment. Scans were performed within 6 months after the completion of primary treatment (median time: 3.1 months; range: 0.5-6 months). PET/CT and CECT scans were reviewed retrospectively for residual primary site disease, and right and left cervical lymph node involvement. Histopathology or 6 month clinical/imaging follow-up were used as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the primary site and cervical nodal disease., Results: Of 110 OPSCC patients, 90.9% were human papilloma virus positive, 80.8% were stage 4, and 76.4% received chemoradiation as the primary treatment. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT were similar in the evaluation of the primary cancer site (PET/CT: 75.0, 91.5, 25.0, 99.0, and 90.9, respectively, versus CECT: 75.0, 90.6, 23.1, 99.0, and 90.0, respectively). In evaluating cervical lymph node involvement, PET/CT appeared to have higher accuracy (96.8 vs. 81.7%), specificity (97.7 vs. 81.7%), and PPV (45.8 vs. 16.5%), comparable NPV (99.4% for both), and lower sensitivity (65 vs. 75%) compared with same-day CECT., Conclusion: Same-day PET/CT and CECT scans had comparable accuracy in the evaluation of primary tumor sites after completion of therapy in patients with OPSCC. PET/CT showed higher accuracy in the evaluation of cervical lymph node involvement.

Objective: The purpose of this article is to summarize the evidence regarding the role of FDG PET/CT in treatment response assessment and surveillance of lung cancer and to provide suggested best practices., Conclusion: FDG PET/CT is a valuable imaging tool for assessing treatment response for patients with lung cancer, though evidence for its comparative effectiveness with chest CT is still evolving. FDG PET/CT is most useful when there is clinical suspicion or other evidence for disease recurrence or metastases. The sequencing, cost analysis, and comparative effectiveness of FDG PET/CT and conventional imaging modalities in the follow-up setting need to be investigated.

A variety of methods have been developed to assess tumor response to therapy. Standardized qualitative criteria based on 18F-fluoro-deoxyglucose PET/computed tomography have been proposed to evaluate the treatment effectiveness in specific cancers and these allow more accurate therapy response assessment and survival prognostication. Multiple studies have addressed the utility of the volumetric PET biomarkers as prognostic indicators but there is no consensus about the preferred segmentation methodology for these metrics. Heterogeneous intratumoral uptake was proposed as a novel PET metric for therapy response assessment. PET imaging techniques will be used to study the biological behavior of cancers during therapy., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Precision Medicine is about selecting the right therapy for the right patient, at the right time, specific to the molecular targets expressed by disease or tumors, in the context of patient's environment and lifestyle. Some of the challenges for delivery of precision medicine in oncology include biomarkers for patient selection for enrichment-precision diagnostics, mapping out tumor heterogeneity that contributes to therapy failures, and early therapy assessment to identify resistance to therapies. PET/computed tomography offers solutions in these important areas of challenges and facilitates implementation of precision medicine., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: This study compared the diagnostic test accuracy of magnetic resonance imaging (MRI) with that of (18)F-fluoro-2-glucose-positron emission tomography/computed tomography (FDG-PET/CT) imaging in assessment of response to neoadjuvant chemotherapy (NAC) in breast cancer., Methods: A systematic search was performed in PubMed and EMBASE (last updated in June 2015). Studies investigating the performance of MRI and FDG-PET or FDG-PET/CT imaging during or after completion of NAC in patients with histologically proven breast cancer were eligible for inclusion. We considered only studies reporting a direct comparison between these imaging modalities to establish precise summary estimates in the same setting of patients. Pathologic response was considered as the reference standard. Two authors independently screened and selected studies that met the inclusion criteria and extracted the data., Results: A total of 10 studies were included. The pooled estimates of sensitivity and specificity across all included studies were 0.71 and 0.77 for FDG-PET/CT (n = 535) and 0.88 and 0.55 for MRI (n = 492), respectively. Studies were subgrouped according to the time of therapy assessment. In the intra-NAC setting, FDG-PET/CT imaging outperformed MRI with fairly similar pooled sensitivity (0.91 vs. 0.89) and higher specificity (0.69 vs. 0.42). However, MRI appeared to have higher diagnostic accuracy than FDG-PET/CT imaging when performed after the completion of NAC, with significantly higher sensitivity (0.88 vs. 0.57)., Conclusion: Analysis of the available studies of patients with breast cancer indicates that the timing of imaging for NAC-response assessment exerts a major influence on the estimates of diagnostic accuracy. FDG-PET/CT imaging outperformed MRI in intra-NAC assessment, whereas the overall performance of MRI was higher after completion of NAC, before surgery., Implications for Practice: The timing of therapy assessment imaging exerts a major influence on overall estimates of diagnostic accuracy. (18)F-fluoro-2-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) imaging outperformed magnetic resonance imaging (MRI) in intra-neoadjuvant chemotherapy assessment with fairly similar pooled sensitivity and higher specificity. However, MRI appeared to be more accurate than FDG-PET/CT in predicting pathologic response when used in the post-therapy setting., (©AlphaMed Press.)

Objective: The purpose of this study was to evaluate the impact of quantitative PET parameters in the overall survival of patients with recurrent colorectal cancer., Materials and Methods: A total of 105 patients with a biopsy-proven recurrence of colorectal cancer who underwent PET/CT were included in the study. A gradient segmentation method was used to calculate maximum and peak standardized uptake values (SUVmax, SUVpeak), total lesion glycolysis (TLGtotal), and metabolic tumor volume (MTVtotal). These parameters were measured for each recurrent lesion at the primary, locoregional, and distant sites. The median follow-up time was 31.3 months. Overall survival (OS) was the primary outcome and was calculated using Kaplan-Meier survival plots and Cox regression analyses., Results: The mean ± SD for SUVmax, SUVpeak, TLGtotal, and MTVtotal of the included patients was 7.3 ± 5.3, 5.3 ± 3.3, 280.8 ± 1181 g, and 79.8 ± 294 mL, respectively. The median OS for patients who were alive was 50 months in comparison with 23.4 months among patients who died. Age (p = 0.041), tumor grade (p = 0.010), median TLG (p = 0.031), and median MTV (p = 0.009) remained significantly associated with OS in the multivariate Cox regression analysis. Kaplan-Meier survival analysis performed on the basis of the median PET/CT parametric values showed that SUVmax (threshold, 5.63; hazard ratio [HR] = 1.7; 95% CI, 1-2.8; p = 0.02), MTVtotal (threshold, 13.85 mL; HR = 2.2; 95% CI, 1.3-3.9; p = 0.003), and TLGtotal (threshold, 36.14 g; HR = 1.9; 95% CI, 1.1-3.3; p = 0.01) were significant predictors of OS during follow-up. An integrated risk stratification model with SUVmax and MTVtotal into three subgroups predicted patient survival outcomes (HR = 1.8; 95% CI, 1.25-2.65; log-rank p = 0.003)., Conclusion: SUVmax, MTVtotal, TLGtotal, and integrated score with FDG avidity and total tumor burden provide survival information for patients with biopsy-proven recurrent colorectal cancer.