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The authors aimed to assess the risk of recurrence in patients with nonsmall-cell lung cancer after surgery with no evidence of disease (NED) demonstrated on (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). A total of 140 subjects with adenocarcinoma or squamous cell carcinoma of the lung were included in this study. Patients had FDG PET/CT scans within a year after surgery between January 2007 and December 2014. Patients with PET/CT scans with NED were included. Following an NED PET/CT scan, recurrence or metastasis was found in 14 patients (10.0%), and deaths in 4 (2.9%) during a median follow-up of 636 days. Although the rates of recurrence or metastasis were very low, the risk for recurrence continuously increased after 600 days up to 0.03%. The risk was higher in patients with positive margin at surgery, lymphovascular invasion, N2 stage, and TNM stage III/IV. In conclusion, according to the smoothed hazard functions, there was a very low risk of recurrence until 600 days after normal (18)F-FDG PET scans. The risk was higher in patients with positive margin at surgery, lymphovascular invasion, N2 stage, and TNM stage III/IV.

Electrodiagnostic studies can obtain information 2 or 3 weeks after an acute nerve injury. Previous studies have shown increased glucose metabolism in denervated muscles 1 week after injury using 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) positron emission tomography (PET). Therefore, this study aimed to evaluate the changes in glucose metabolism in denervated muscles using serial monitoring by [(18)F]FDG PET scans.Denervation was induced in eight male Sprague-Dawley rats (aged 7 weeks old) weighing 200-250 g. The right legs of the rats were denervated by resecting the sciatic nerve in the thigh after the initial skin incision. Two rats were sacrificed 1 and 10 weeks after denervation. Skeletal muscles (gastrocnemius and tibialis anterior) were excised from both the right and left legs of the rats. Staining with hematoxylin and eosin, glucose transporter (GLUT)-1, GLUT-4, and hexokinase II was undertaken. PET/computed tomography (CT) scans were performed on the six remaining rats a total of five times at 1, 2, 5, 8, and 10 weeks after denervation. Regions of interest were drawn on integrated PET/CT images to measure the degree of [(18)F]FDG uptake in the right and left lower leg muscles. Target-to-background ratios (TBRs) were calculated by dividing the FDG uptake of the lower leg muscles by that of the upper leg muscles.The TBRs of the denervated muscles were higher than those of the control muscles at both 1 (6.84 ± 1.98 vs. 1.18 ± 0.11, p = 0.009) and 2 (4.10 ± 2.05 vs. 1.86 ± 0.73, p = 0.0374) weeks after denervation. After 5 (2.18 ± 0.78 vs. 1.35 ± 0.47, p = 0.1489), 8 (1.76 ± 0.18 vs. 1.69 ± 0.18, p = 0.5127), and 10 (1.76 ± 0.52 vs. 1.56 ± 0.37, p = 0.5637) weeks, the difference in the TBRs between the denervated and controls became non-significant.[(18)F]FDG PET can visualize increased glucose metabolism in a denervated muscle early as 1 week after injury. Therefore, PET could be adopted as a noninvasive imaging modality for acute nerve injuries. In addition, [(18)F]FDG PET may help to understand the role of the nervous system in the control of peripheral tissues.

The objective of this study was to investigate the relationship between diversity of (18)F-fluorodeoxyglucose ((18)F-FDG) uptake of primary tumor in positron emission tomography (PET) and various clinicopathologic factors in breast cancer of same pathologic T1, T2 stage.A total of 258 patients with invasive ductal breast cancer were enrolled in this study. All patients underwent (18)F-FDG PET-CT before surgery. Patients were divided into two groups according to tumor size based on the pathologic T stage, and maximum standardized uptake value (SUVmax) of 2.5, respectively.On the univariate analysis, estrogen receptor (ER), tumor size, lymphovascular invasion, p53, pathologic N status (pN) and Nottingham tumor grade (NG) were associated with high SUVmax in T1 and T2 breast cancer. On the multivariate logistic regression, tumor size and NG remained significant variables dividing high and low SUVmax. In the T1 group, ER, p53 and NG were significantly associated with high SUVmax on the univariate analysis. In this group, p53 and NG remained significant variables for dividing high and low SUVmax on the multivariate logistic regression. In the T2 group, only NG was associated with high SUVmax on the univariate analysis.NG showed an association with (18)F-FDG uptake in both T1 and T2 breast cancer independently; however, p53 in T1 breast cancer.

Exact classifying between malignant and benign tumors in the parotid gland is important because the cancer has relatively poor prognosis. There have been several studies that F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) can differentiate between malignant and benign parotid gland tumors. However, the role of FDG PET is still controversial because many benign parotid gland tumors, such as Warthin’s tumor and pleomorphic adenoma, show high FDG uptake. We hypothesized that metabolic heterogeneity would differentiate malignant parotid tumors because tumoral heterogeneity is an important characteristic in the malignancies. From January 2010 to April 2015, we retrospectively reviewed the 46 patients who showed FDG uptake at the parotid gland. To differentiate malignant parotid gland tumors, we obtained maximum SUV and mean SUV. Metabolic tumor volume and total lesion glycolysis were measured as metabolic volumetric parameters. We also included heterogeneity parameters of FDG PET such as heterogeneity factor (HF) and the coefficient of variation for all patients. There was significant difference of HF between malignant (−0.30 ± 0.25; range −0.937 to −0.084) and benign parotid gland tumors (−0.06 ± 0.05; range −0.291 to −0.012; p

This study was aimed to define the predictive values of preoperative Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) parameters and compared to define effective parameters for prediction of overall survival (OS) and recurrent free survival (RFS) in locally advanced esophageal cancer (LAEC).This study included 44 patients with LAEC who received F-18 FDG PET/CT. Univariate and multivariate analyses were used to calculate survival, and the survival curves were estimated by clinical factors and F-18 FDG PET/CT-derived parameters.Higher values of F-18 FDG PET/CT parameters (SUVmax, SUVmean, metabolic tumor volume [MTV], total lesion glycolysis [TLG]) and advanced tumor-node-metastasis (TNM) staging showed higher mortality. The Cox proportional hazard regression model demonstrated advanced TNM stage and high MTV as poor OS factors. The early TNM stage, lower MTV, lower TLG, lymph node (LN) (-), and lower heterogeneity factor (HF) were also associated with better RFS. The MTV was the potent predictor for RFS.In conclusion, although the newly described parameter of HF measured by F-18 FDG PET/CT could be a prognostic factor, the MTV is the most potent prognostic predictor in LAEC.

PURPOSE The aim of this study was to investigate the value of morphologic, functional, and metabolic biomarkers acquired concurrently at PET/MRI in patients with thymic epithelial tumors. PATIENTS AND METHODS During 1 year, 9 patients with suspected thymic epithelial tumors at contrast-enhanced chest CT were prospectively enrolled and underwent preoperative 18F-FDG PET/MRI. Two chest radiologists prospectively reviewed the CT and MRI scans of PET/MRI in consensus, and 2 nuclear physicians reviewed the PET images. Visual assessment of the tumor morphology, functional biomarkers such as apparent diffusion coefficient from diffusion-weighted images, and metabolic biomarkers (including SUVmax, metabolic tumor volume, total lesion glycolysis, and heterogeneity index) were recorded. All patients underwent operation, and their pathologic reports served as the reference standard. RESULTS Thymic epithelial tumors were demonstrated in all 9 patients at pathologic examination. Tumor contour (P = 0.012) and shape (P = 0.033) had an association with the World Health Organization subtype, and the presence of septum (P = 0.048) on MRI scans had an association with the Masaoka stage. In terms of functional and metabolic biomarkers, SUVmax (ρ = 0.683, P = 0.042) and SUV/apparent diffusion coefficient (ρ = 0.703, P = 0.035) correlated with the Masaoka stage. Metabolic tumor volume (P = 0.024), heterogeneity index (P = 0.024), and total lesion glycolysis (P = 0.048) were useful for classification between low- and high-risk thymic epithelial tumors. CONCLUSIONS Although limited by the small number of patients enrolled, morphologic, functional, and metabolic biomarkers derived from PET/MRI scans were useful for the stratification of thymic epithelial tumors.

Introduction: The purpose of this study was to evaluate the association of tumor heterogeneity as assessed by positron emission tomography/computed tomography (PET/CT) with pathological factors of breast cancer, and the prediction of nodal metastasis through tumor heterogeneity. Methods: From January 2013 to December 2013, 102 patients with invasive ductal carcinoma of the breast were enrolled into this study. [18F]Fluorodeoxyglucose PET/CT was performed before surgery. The metabolic tumor volume (MTV) of each lesion was calculated and a series of standardized uptake value (SUV) thresholds (e.g. 40%, 50%, 60%, 70%, and 80% of SUVmax) was obtained. A threshold-volume (dV/dT) curve was acquired by plotting thresholds to MTV values automatically calculated with these thresholds. Tumor heterogeneity was calculated from the slope of the threshold-volume curve and defined as heterogeneity factor (HF). Results: HF differed significantly according to T stage (p < 0.0001), N stage (p = 0.0131) and American Joint Committee on Cancer (AJCC) stage (p = 0.0006). Among the pathological parameters, dermal lymphatic involvement (p = 0.0039) showed the significant correlations with HF. Lymphovascular invasion (p = 0.0005) was the only independent factor for predicting nodal metastasis. Conclusions: Tumor heterogeneity measured by 18F-FDG PET/CT is significantly associated with dermal lymphatic involvement. However, PET might not be able to predict nodal metastasis in breast cancer.

Objective The purpose of the current study was to investigate the diagnostic performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) for the detection of cervical lymph node (LN) metastasis in clinically node negative head and neck squamous cell cancer (cN0 HNSCC) patients through a systematic review and meta-analysis. Methods The PubMed and EMBASE database, from the earliest available date of indexing through April 30, 2018, were searched for studies evaluating the diagnostic performance of F-18 FDG PET or PET/CT for the detection of LN metastasis in cN0 HNSCC patients. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−), and constructed summary receiver operating characteristic (SROC) curves. Results Across 18 studies (1044 patients), the pooled sensitivity for F-18 FDG PET or PET/CT for the detection of LN metastasis was 0.58 and a pooled specificity of 0.87 for patient based analysis. Neck side based analysis showed the pooled sensitivity of 0.67 and a pooled specificity of 0.85. Level based study demonstrated the pooled sensitivity of 0.53 and a pooled specificity of 0.97 (95% CI; 0.95–0.98). In meta-regression analysis, no definite variable was the source of the study heterogeneity. Conclusion The current meta-analysis showed the low sensitivity and moderate specificity of F-18 FDG PET/CT for the detection of cervical LN metastasis in cN0 HNSCC patients. Level based analysis of F-18 FDG PET or PET/CT has a high specificity and NPV for the detection of cervical metastatic LN detection.

We aimed to explore the role of the diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for characterization of incidental colorectal focal FDG uptake through a systematic review and meta-analysis. The MEDLINE, EMBASE, and Cochrane Library database, from the earliest available date of indexing through April 30, 2018, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for characterization of incidental colorectal focal FDG uptake. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−), and constructed summary receiver operating characteristic curves. Across 8 studies (1451 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.87 (95% CI 0.82–0.90) without heterogeneity (χ2 = 10.84, p = 0.37) and a pooled specificity of 0.83 (95% CI 0.76–0.89) with heterogeneity (χ2 = 130.1, p = 0.00). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 5.2 (95% CI 3.6–7.4) and negative likelihood ratio (LR−) of 0.16 (95% CI 0.12–0.22). The pooled DOR was 32 (95% CI 20–51). F-18 FDG PET/CT demonstrated good sensitivity and specificity for characterization of incidental colorectal focal FDG uptake. At present, the literature regarding the use of F-18 FDG PET/CT for characterization of incidental colorectal focal FDG uptake remains still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of F-18 FDG PET/CT for characterization of incidental colorectal focal FDG uptake.

Introduction: We aimed to assess the diagnostic accuracy of radiolabeled prostate-specific membrane antigen positron emission tomography (PSMA PET) or positron emission tomography/computed tomography (PET/CT) for primary lymph node (LN) staging in newly diagnosed intermediate to high-risk prostate cancer (PCa) patients. Material and Methods: The MEDLINE, PubMed, EMBASE, and Cochrane Library database from the earliest available date of indexing through May 31, 2018, were searched for studies evaluating the diagnostic performance of radiolabeled PSMA PET or PET/CT for primary LN staging in newly diagnosed intermediate to high-risk PCa. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR–), and constructed summary receiver operating characteristic curves. Results: Across 6 studies (298 patients), the pooled sensitivity was 0.71 (95% CI 0.59–0.81) and a pooled specificity of 0.95 (95% CI 0.87–0.99). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 15.6 (95% CI 5.6–43.0) and negative likelihood ratio (LR–) of 0.30 (95% CI 0.21–0.43). The pooled diagnostic odds ratio (DOR) was 51 (95% CI 21–126). Conclusion: Radiolabeled PSMA PET/CT shows a moderate sensitivity and high specificity for the detection of metastatic LNs in patients with newly diagnosed intermediate to high-risk PCa.

The purpose of the current study was to investigate the diagnostic performance of F-18 Fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) for localization of hyperfunctioning parathyroid gland in patients with hyperparathyroidism (HPT) through a systematic review and meta-analysis. The MEDLINE/PubMed and EMBASE database, from the earliest available date of indexing through April 30, 2018, were searched for studies evaluating the diagnostic performance of F-18 FCH PET/CT for localization of hyperfunctioning parathyroid gland in patients with HPT. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−), and constructed summary receiver operating characteristic curves. Across eight studies (272 patients), the pooled sensitivity for F-18 FCH PET/CT was 0.90 (95% CI, 0.86–0.94) without heterogeneity (I2 = 7.1) and a pooled specificity of 0.94 (95% CI, 0.90–0.96) with heterogeneity (I2 = 79.8). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 5.3 (95% CI, 1.2–24.3) and negative likelihood ratio (LR−) of 0.15 (95% CI, 0.08–0.29). The pooled diagnostic odds ratio (DOR) was 38 (95% CI, 8–174). Hierarchical summary receiver operating characteristic (ROC) curve indicates that the areas under the curve were 0.9492 (SE, 0.0215). In meta-regression analysis, no definite variable was the source of the study heterogeneity. The current meta-analysis showed the high sensitivity and specificity of F-18 FCH PET/CT for localization of hyperfunctioning parathyroid gland. At present, the literature regarding the use of F-18 FCH PET/CT for localization of hyperfunctioning parathyroid gland remains still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of F-18 FCH PET/for localization of hyperfunctioning parathyroid gland in patients with HPT.

The brain plays a critical role in controlling and inhibiting pre-potent responses to foods. We investigated the predictive value of dopamine transporter (DAT) availability in the striatum of healthy subjects using 123I-FP-CIT single-photon emission computed tomography (SPECT). In total, 84 participants with available data on their weight for the 60 months after SPECT were included. Specific binding of 123I-FP-CIT to DAT was calculated using region-of-interest analysis, and the putamen-to-caudate nucleus ratio (PCR) was determined. After comparing the weights at 12, 24, 36, 48, and 60 months after SPECT with the baseline weight, we categorized participants into three groups: weight gain (> 5%), stable (−5%–5%), and weight loss (< −5%). PCRs of the weight-loss, stable, and weight-gain groups significantly differed at 36 and 48 months. According to post-hoc analysis, PCRs were lower in the weight gain group at 36 and 48 months compared with at the remaining time points. Overall, our results suggest that PCRs calculated based on DAT availability could be used to predict future weight changes. It is possible that the interactions between the caudate nucleus and the putamen, rather than the individual behavior of each structure, might play an important role in weight regulation. Further studies are needed to investigate the time-dependence of the predictive value of DAT.

The aim of this study is to investigate the performance of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) or positron emission tomography/computed tomography (PET/CT) for the assessment of disease activity in patients with large vessel vasculitis (LVV) through a meta-analysis. The MEDLINE via PubMed and EMBASE were searched for the studies evaluating the performance of F-18 FDG PET or PET/CT in the assessment of disease activity in patients with LVV. Pooled sensitivity, specificity, diagnostic odds ratios (DORs), and summary receiver-operating characteristic (sROC) curve were estimated across the included studies. Possible publication bias was assessed by Deek’s funnel plot asymmetry tests. A total of 439 PET images from 298 patients pooled from nine studies showed that the pooled sensitivity was 0.88 [95% confidence interval (CI) 0.79-0.93] without heterogeneity (χ2 = 14.42, P = .07) and the pooled specificity was 0.81 (95% CI 0.64-0.91) with heterogeneity (χ2 = 63.72, P = .00) for the detection of active LVV. The pooled DOR was 30 (95% CI 8-107). Hierarchical sROC curve indicates that the area under the curve was 0.91 (95% CI 0.89-0.94). There was no significant publication bias (P = .42), and meta-regression analysis revealed that none of the variables was the source of the study heterogeneity. F-18 FDG PET has a good performance for the detection of active disease status in patients with LVV. Revised criteria for the assessment of disease activity incorporated with F-18 FDG PET or PET/CT should be introduced and validated. Further studies are warranted to determine if PET-based treatment of LVV can improve outcomes.

The purpose of this investigation was to evaluate the diagnostic accuracy ofThe MEDLINE/PubMed and Embase databases, from the earliest available date of indexing through March 31, 2018, were searched for results investigating the diagnostic accuracy ofAcross 10 studies (286 patients), the pooled sensitivity was 0.96 (95% confidence interval [CI], 0.89-0.98) without heterogeneity (IThis study showed the high sensitivity and moderate specificity of

We aimed to explore the role of the diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for the detection of recurrent and/or metastatic diseases in differentiated thyroid cancer (DTC) patients with progressively and/or persistently elevated TgAb levels and negative radioactive iodine whole-body scan (RI-WBS) through a systematic review and meta-analysis. The MEDLINE, EMBASE and Cochrane Library database, from the earliest available date of indexing through June 30, 2017, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for the detection of recurrent and/or metastatic diseases in DTC patients with progressively and/or persistently elevated TgAb levels and negative RI-WBS. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−). Across 9 studies (515 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.84 (95% CI; 0.77–0.89) a pooled specificity of 0.78 (95% CI; 0.67–0.86). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 3.8 (95% CI; 2.5–5.7) and negative likelihood ratio (LR−) of 0.21 (95% CI; 0.14–0.30). The pooled diagnostic odds ratio (DOR) was 18 (95% CI; 10–34). The area (AUC) under the hierarchical summary receiver-operating characteristic (HCROC) curve was 0.88 (95% CI: 0.85–0.90). F-18 FDG PET or PET/CT demonstrated moderate sensitivity and specificity for the detection of recurrent and/or metastatic diseases in DTC patients with progressively and/or persistently elevated TgAb levels and negative RI-WBS.

We assessed patient discomfort and identified factors predictive of discomfort while receiving radioactive iodine (RAI) ablation.Between August 2015 and April 2016, 52 patients with differentiated thyroid cancer were enrolled in this study. All patients received recombinant human thyroid stimulating hormone (rhTSH) aided RAI ablation using 3.7 GBq or 5.55 GBq of RAI. Discomfort during their stay for RAI ablation was evaluated using a symptom questionnaire. We analyzed the relationship between the patient's clinical data and the scores for the 15 items of the symptom questionnaire. We compared scores of questionnaires between male and female, under 45 years old and 45 and older, RAI activity of 3.7 GBq and 5.55 GBq. Also, scores of daily questionnaires were tested for differences.Most patients did not have severe discomfort, but some patients had mild discomfort during their stay for RAI ablation, despite using rhTSH. Important determinants of discomfort were sex and age. Female patients reported more symptoms of fatigue, facial edema, cold intolerance, and nausea. Older patients (45 and older) complained of insomnia more often. However, the dose of RAI ablation (3.7 GBq vs 5.55 GBq) did not affect the scores of questionnaires.Sex and age were important predictors of patient's discomfort during RAI ablation. Clinicians need to explain more about treatment and predicted discomforts to such patients before RAI ablation.Wir untersuchten unter ablativer Ra- dioiodtherapie (RIT) auftretende Beschwerden und identifizierten prognostische Faktoren für Beschwerden bei den Patienten.Von August 2015 bis April 2016 wurden 52 Patienten mit differenziertem Schilddrüsenkarzinom in die Studie aufgenommen. Alle Patienten erhielten eine durch rekombinantes humanes Thyreoidea-stimulierendes Hormon (rhTSH) gestützte ablative RIT mit 3,7 GBq oder 5,55 GBq. Die Beschwerden während des Aufenthaltes wegen der RIT wurden anhand eines Symptom-Fragebogens evaluiert. Wir analysierten den Zusammenhang zwischen den klinischen Daten der Patienten und den Scores in den 15 Items des Fragebogens. Die Fragebogen-Scores wurden wie folgt verglichen: Männer vs. Frauen,45-jährige vs. ≥ 45-jährige sowie RIT-Aktivität von 3,7 GBq vs. 5,55 GBq. Außerdem wurden die Scores der täglichen Fragebögen auf Unterschiede getestet.Die meisten Patienten hatten keine wesentlichen Beschwerden, bei manchen traten im Laufe des RIT- Aufenthaltes trotz rhTSH-Gabe leichte Beschwerden auf. Wichtige Determinanten für Beschwerden waren das Alter und das Geschlecht. Patientinnen berichteten häufiger über Symptome wie Müdigkeit, Gesichtsödem, Kälteunverträglichkeit und Übelkeit. Ältere Patienten (≥ 45 Jahre) klagten häufiger über Schlaflosigkeit. Die Dosis der ablativen RIT (3,7 GBq vs. 5,55 GBq) hatte jedoch keinen Einfluss auf die Fragebogen-Scores.Geschlecht und Alter waren wichtige Prädiktoren für Beschwerden unter einer ablativen RIT. Daher sollten Ärzte die Patienten vor einer ablativen RIT besser über die Behandlung und vorhersehbare Beschwerden aufklären.

The authors investigated relations between obesity, age, and sex and the availabilities of striatal dopamine transporter (DAT) and extrastriatal serotonin transporter (SERT) by 123I-FP-CIT single-photon emission computed tomography. The study population consisted of 192 healthy controls with screening 123I-FP-CIT scans. Specific bindings of 123I-FP-CIT to DAT and SERT were calculated using regions of interest. Specific binding ratios (SBRs) of DAT and SERT except pons (r = 0.2217, p = 0.0026), were not correlated with body mass index (BMI). SBRs of midbrains correlated negatively with the BMIs of obese subjects (r = −0.3126, p = 0.0496), and positively with the those of non-obese subjects (r = 0.2327, p = 0.0053). SBRs of caudate nucleus (r = −0.3175, p

OBJECTIVE: We aimed to explore the role of the diagnostic accuracy of (18)F fluodeoxyglucose PET ((18)F-FDG PET) or PET/CT for characterization of adrenal lesions through a systematic review and meta-analysis. METHODS: The MEDLINE, EMBASE, and Cochrane Library database, from the earliest available date of indexing through 30 April 2017, were searched for studies evaluating the diagnostic performance of (18)F-FDG PET or PET/CT for characterization of adrenal lesions. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR + and LR–), and constructed summary receiver operating characteristic curves. RESULTS: Across 29 studies (2421 patients), the pooled sensitivity for (18)F-FDG PET or PET/CT was 0.91 [95% CI (0.88–0.94)] with heterogeneity (χ(2) = 141.8, p = 0.00) and a pooled specificity of 0.91 [95% CI (0.87–0.93)] with heterogeneity (χ(2) = 113.7, p = 0.00). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 9.9 [95% CI (7.1–13.7)] and negative likelihood ratio (LR–) of 0.09 [95% CI (0.07–0.13)]. The pooled diagnostic odds ratio was 105 [95% CI (63–176)]. In metaregression analysis, study design, publication year, study location (western vs others), interpretation criteria of PET or PET/CT images, quantification of PET or PET/CT [SUV(max )(maximum standardized uptake value) vs SUV (standardized uptake value) ratio], patient group, and analysis method (patient-based vs lesion-based) were the sources of the study heterogeneity. However, in multivariate metaregression, no definite variable was the source of the study heterogeneity. CONCLUSION: (18)F-FDG PET or PET/CT demonstrated good sensitivity and specificity for the characterization of adrenal masses. At present, the literature regarding the use of (18)F-FDG PET or PET/CT for the characterization of adrenal masses remains still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of (18)F-FDG PET or PET/CT characterization of adrenal masses. ADVANCES IN KNOWLEDGE: (18)F- FDG PET or PET/CT showed good sensitivity and specificity for the characterization of adrenal masses and could provide additional information for that purpose.

A 63-year-old man presented with a 1.5-year history of progressive personality changes. Clinical evaluations revealed severe frontal dysfunction and bilateral frontal atrophy/glucose hypometabolism. He was diagnosed as probable behavioral variant frontotemporal dementia. He continued to decline, and died at the age of 66. At autopsy, numerous tau-positive gilial threads and coiled bodies were observed in the white matter. Tau-positive astrocytic plaques and neuronal cytoplasmic inclusions were also seen in cerebral cortices, which were compatible with corticobasal degeneration. J Korean Neurol Assoc 33(3):178-182, 2015

Eun-Joo Kim, MD, Eun-Hye Oh, MD, Ki-Tae Kim, MD, Yoori Jung, MD, Jeong Hee Lee, MD, Jae-Hyeok Lee, MD, Young Min Lee, MD, Seong-Jang Kim, MD, Jin-Hong-Shin, MD, Myung-Jun Shin, MD, Myung Jun Lee, MD, Jae Woo Ahn, MD, Suk Sung, MD, Kyung-Un Choi, MD, Dae Soo Jung, MD, William W. Seeley, MD, Gi Yeong Huh, MD Departments of Neurology, Pathology, Psychiatry, Nuclear Medicine, Rehabilitation Medicine, Anatomy, and Forensic Medicine, Pusan National University School of Medicine, Yangsan, Korea Memory and Aging Center, University of California San Francisco, CA, USA

Background The purpose of this study was to determine whether the maximum standardized uptake value (SUVmax) of the primary tumor on pretreatment 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) has prognostic significance in patients with adenoid cystic carcinoma (ACC) of the head and neck. Methods A retrospective review was carried out on 34 patients with ACC of the head and neck who underwent pretreatment 18F-FDG PET imaging from June 2005 through July 2009. All patients underwent surgery with curative intent, and 26 of them received adjuvant radiotherapy (RT). Results When subjects were stratified into 2 groups according to a cutoff value for SUVmax of 4.15, the risk of distant metastasis was significantly high in patients with high SUVmax (p = .014). Multivariate analysis showed that high SUVmax and histologic grade 3 were independent poor prognostic factors for distant metastasis-free and disease-free survival. Conclusion Pretreatment SUVmax of the primary tumor is an independent prognostic factor in patients with ACC of the head and neck. © 2015 Wiley Periodicals, Inc. Head Neck, 2014

The current study was aimed to investigate the clinical value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodule (TN) with inconclusive fine-needle aspiration biopsy (FNAB) results. The current study enrolled 200 patients who showed F-18 FDG incidentaloma and were performed FNAB. The intratumoral heterogeneity of F-18 FDG uptake was represented as the heterogeneity factor (HF), defined as the derivative (dV/dT) of a volume-threshold function for a primary tumor. The diagnostic and predictive values of HF and F-18 FDG PET/CT parameters were evaluated for characterization of inconclusive FNAB results. Among F-18 FDG PET/CT parameters, SUVmax, MTV, and TLG of malignant group were statistically higher than those of Bethesda category of suspicious malignant group. However, HF values were not statistically different between the groups of Bethesda categories (Kruskal–Wallis statistics, 9.924; p = 0.0774). In ROC analysis, when HF > 2.751 was used as cut-off value, the sensitivity and specificity for prediction of malignant TN were 100 % (95 % CI 69.2–100 %) and 60 % (95 % CI 42.1–76.1 %), respectively. The AUC was 0.826 (95 % CI 0.684–0.922) and standard error was 0.0648 (p

We describe detailed clinical, biochemical, neuroimaging and neuropathological features in adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP), encompassing hereditary diffuse leukoencephalopathy with axonal spheroids (HDLS) and pigmentary orthochromatic leukodystrophy (POLD), linked to colony-stimulating factor 1 receptor (CSF1R) mutations in four Korean cases. Clinical, biochemical, neuroimaging and neuropathological findings were obtained by direct evaluation and from previous medical records. The genetic analysis of the CSF1R gene was done in two autopsy-confirmed ALSP cases and two cases where ALSP was suspected based on the clinical and neuroimaging characteristics. We identified two known mutations: c.2342C>T (p.A781V) in one autopsy-proven HDLS and clinically ALSP-suspected case and c.2345G>A (p.R782H) in another autopsy-proven POLD case. We also found a novel mutation (c.2296A>G; p.M766V) in a patient presenting with hand tremor, stuttering and hesitant speech, and abnormal behavior whose father died from a possible diagnosis of spinocerebellar ataxia. To the best of our knowledge, this is the first documented ALSP-linked CSF1R mutation in Korea and supports the suggestion that HDLS and POLD, with pathological characteristics that are somewhat different but which are caused by CSF1R mutations, are the same spectrum of disease, ALSP.

Background: The purpose of this study was to evaluate the prognostic value of the maximum standard uptake value (SUVmax) measured by 18-F fluoro-2-deoxy-d-glucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) in newly diagnosed small cell lung cancer (SCLC) patients. Methods: We reviewed the medical records of newly diagnosed SCLC patients who were given a histological diagnosis from June 2008 to June 2014. 82 patients who satisfied the inclusion criteria were enrolled for final analysis (male n = 75, female n = 7). The relationship between SUVmax and overall survival (OS) and progression-free survival (PFS) was evaluated. Results: Median follow-up was 25.0 months (range 11.6-55.5 months). The median OS was 11.2 months (range 1.6-55.5 months), and the median PFS was 6.1 months (range 0.9-55.5 months). Survival analysis showed no statistical differences in OS and PFS between high and low SUVmax groups. Conclusion: This study does not support the use of SUVmax of pretreatment F-18 FDG PET/CT scans as a prognostic tool for patients with SCLC.

Genetic mutations have been found to be associated with thyroid cancer. Previous studies have been focused on the relation between genetic mutations and thyroid cancer. We sought to evaluate the prognostic value of the three most common genetic mutations (BRAF, RAS, and RET) in patients with thyroid cancer.Sources from MEDLINE (inception to December 2013) and EMBASE (inception to December 2013) were searched. Studies of thyroid cancer with results of genetic mutations and studies that reported survival data were included and two authors performed the data extraction independently. Any discrepancies were resolved by a consensus.Fourteen studies assessing BRAF mutations, 6 RAS mutations, 4 RET mutations, and 1 with analysis of both BRAF and RAS mutations were included in this meta-analysis. Patients with papillary thyroid cancer with BRAF mutations showed a 1.59-fold higher risk of events or a 2.66-fold higher risk of death than patients with papillary thyroid cancer without a BRAF mutation. Also, patients with RAS mutations showed a 2.90-fold higher risk of death by thyroid cancer than patients without a RAS mutation. In addition, patients with medullary thyroid cancer with RET mutations showed a 5.82-fold higher risk of death by the disease than without a RET mutation.Genetic mutations should be considered as a poor prognostic marker in thyroid cancer and may lead to better management of individual patients. However, the use of genetic mutations as prognostic markers should not be generalized, but individualized in the specific clinic setting.

Purpose: We compared the prognostic ability of the maximum standardized uptake value (SUVmax) and various biological marker expressions to predict recurrence in patients with surgically resected cervical cancer. Methods: A retrospective review identified 60 patients with cervical cancer who received [18F]fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) at the time of the diagnosis of cancer. The SUVmax, expressions of carbonic anhydrase-IX (CA-IX), glucose transporter 1 (GLUT-1), and vascular endothelial growth factor (VEGF), and known prognostic factors were investigated. Results: The median follow-up time was 22.2 months (range 3.4-43.1 months). Using univariate analyses, the stage (stage II, p = 0.0066), SUVmax (> 6, p = 0.027), parametrial involvement (p < 0.0001), and positivity for CA-IX (p = 0.0191) were associated with recurrences of cervical cancer. With the Cox proportional hazard regression model, the SUVmax was a potent predictor for disease-free survival (DFS). Conclusion: Although CA-IX expression was related to DFS in the current study, the potent predictor for DFS was SUVmax. Therefore, SUVmax is of greater prognostic value than biological marker expression in patients with surgically resected cervical cancer.

A few studies about lymphoscintigraphy in breast cancer patients have reported a correlation between decreased sentinel lymph node (LN) uptake and increased risk of axillary involvement with the hypothesis of blocked lymphatic passage of radiotracers by metastatic burden. This study is designed to investigate whether the visible internal mammary LN of lymphoscintigraphy (IM-LPS) is related to axillary LN metastasis, rather than identifying sentinel LN in the internal mammary area.We retrospectively reviewed medical records of 401 breast cancer patients who underwent sentinel lymphoscintigraphy using Tc-99m phytate and subsequent axillary LN dissection. The IM-LPS was divided into positive or negative groups, and axillary lymphoscintigraphy (A-LPS) was visually graded into four groups according to the method suggested by Lee et al. (1) To evaluate the relation of positive IM-LPS and A-LPS pattern with axillary LN metastasis, multivariate logistic regression analysis was done with covariates of Memorial Sloan-Kettering Cancer Center model.Positive IM-LPS was found in 32 patients. On the univariate logistic regression analysis, positive IM-LPS (p=0.01) and A-LPS pattern (p0.05) successfully predicted the axillary LN status. On the multivariate logistic regression model, positive IM-LPS (OR 2.6362; 95% CI 1.0382-6.6938; p=0.04) and group II A-LPS (OR 1.9773; 95% CI 1.1336-3.4491; p=0.01) remained statistically significant variables for the predictor of axillary LN metastasis.This study suggests that IM-LPS and A-LPS pattern might be useful to show the burden of axillary LN metastasis in breast cancer patients, as an indicator of altered lymphatic pathway.

Objective:The current review aimed to investigate the performance of the diagnostic accuracy of 18F- fludeoxyglucose positron emission tomography/CT (PET/CT) in detecting peritoneal carcinomatosis (PC) through a systematic review and meta-analysis. Methods:The MEDLINE via PubMed and EMBASE from the earliest available date of indexing to 31 March 2017, were searched for studies evaluating the diagnostic performance of 18F-FDG PET/CT in detecting PC. We evaluated the pooled sensitivities and specificities across included studies, calculated positive and negative likelihood ratios (LR+ and LR−), and plotted summary receiver operating characteristic curves. Deek’s funnel plot asymmetry tests were used to assess the possible underlying publication bias. Results:The current meta-analysis demonstrated no significant publication bias (p = 0.21). Across 14 studies (671 patients), the overall sensitivity of 18F-FDG PET/CT was 0.87 [95% CI (0.77−0.93)] with heterogeneity (χ2 = 94.2, p = 0.00) and a pooled specificit...

We aimed to evaluate the association between plasma epidermal growth factor (EGF) and the availability of dopamine transporter (DAT) measured from 123I-FP-CIT single-photon emission computed tomography in healthy controls in this study. Volume of interest template was applied to measure specific binding ratios (SBRs) of caudate nucleus, putamen, and striatum representing DAT availability as follows; SBR = (target– cerebellum)/cerebellum. Plasma EGF was negatively correlated with the availabilities of both caudate nucleus (r = −0.261, p = 0.019), and putamen (r = −0.341, p = 0.002). After dividing subjects according to Apo E genotyping, DAT availability of caudate nucleus of Apo e4 non-carriers (n = 60) showed the positive correlation with cerebrospinal fluid (CSF) α-synuclein (r = 0.264, p = 0.042). Plasma EGF was negatively correlated with DAT availabilities of Apo e4 non-carriers. Further studies are needed to clarify underlying mechanisms of this phenomenon.

BACKGROUND/AIM We aimed to explore the prognostic value of metabolic heterogeneity of 18F-FDG uptake in chemoradiotherapy-treated pharyngeal cancer patients. PATIENTS AND METHODS This study included 52 consecutive patients with pharyngeal cancer who underwent 18F-FDG PET/CT before definitive chemoradiotherapy. The heterogeneity factor (HF) was defined as the derivative (dV/dT) of a volume-threshold function for primary tumors and metastatic lymph nodes. The relationships between clinical parameters and HFs of primary tumors (pHF) and metastatic lymph nodes (nHF) were analyzed. RESULTS The pHF (range=∓1.367 - -0.027; median=-0.152) was significantly correlated with the maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis. Induction chemotherapy response was not correlated with HF, whereas response to radiotherapy was significantly better in patients with high pHF (low heterogeneity). Consistently, the 2-year locoregional recurrence-free survival was significantly better in patients with high pHF (82.9% for pHF>-0.152 vs. 30.5% for pHF

The aim of this study was to evaluate the usefulness of the metabolic tumor volume (MTV) measured by F-18 Fluorodeoxyglucose positron emission tomography (FDG PET-CT) in predicting recurrence free survival (RFS) in patients with esophageal cancer. Forty-five patients with squamous cell carcinoma, who had undergone whole-body F-18 FDG PET-CT scans before surgical resection, were included in this study. All patients were treated with Ivor-Lewis esophagectomy. The MTV was quantified within the primary tumor using the 50% threshold of the maximum standardized uptake value (SUV Overall median follow up period was 17.87 months (range: 1.07-63.27 months). The median survival between treatment completion and recurrence was 15.5 months (range: 1.37-72.43 months). Recurrence was found in eight patients. On univariate analysis, MTV Volume based parameter of F-18 FDG PET-CT may have a role in providing prognostic information in esophageal cancer patients who received esophagectomy.

We assessed the diagnostic usefulness of Tc-99m methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) for the evaluation of solitary pulmonary nodule (SPN).Thirty-five patients (17 malignant and 18 benign) were recruited. Double phase Tc-99m MIBI SPECT was performed 10 min and then 2 h after an injection of 925 MBq of Tc-99m MIBI. Visual interpretation grades of the Tc-99m MIBI scan were used for the determination of SPN characteristics. Receiver-operator curve analyses were performed for the optimal cut-off values of visual and quantitative indices for differentiation of benign and malignant SPN.The optimal visual grades were grade 4 and 5. When 3+ was used as the cut-off value for the detection of malignant SPN, the sensitivity and specificity of Tc-99m SPECT were 47.1% and 88.9%, respectively. The area under curve (AUC) was 0.758. The optimal planar lesions to non-lesion (L/N) ratios were 2.3 for the early image and 1.6 for the delayed image. The optimal SPECT L/N ratios were 3.1 for the early and 1.6 for the delayed image. The SPECT early L/N was superior to other quantitative indices and visual analysis.This study shows that Tc-99m MIBI SPECT is a useful non-invasive method for the evaluation of SPN.

Olfactory dysfunction in Parkinson’s disease is usually prodromal to other symptoms. In this study, we aimed to explore the association of olfactory function with the availabilities of striatal dopamine transporter (DAT) in healthy subjects. Data used in the preparation of this article were obtained from Parkinson’s Progression Markers Initiative database ( www.ppmi-info.org/data ). The study population consisted of healthy controls with screening 123I-FP-CIT single photon emission tomography (SPECT). University of Pennsylvania Smell Identification Test (UPSIT) was assessed to evaluate the olfactory function. Results: Totally, 181 healthy subjects (117 male, 64 female) with 123I-FP-CIT SPECT data were included in this study. Specific binding ratios (SBRs) of the caudate nucleus (rho = -0.4217, p < 0.0001), putamen (rho = -0.2292, p = 0.0019), and striatum (rho=-0.3425, p < 0.0001) showed a reduction with ageing. SBRs of the caudate nucleus, putamen, and striatum were positively correlated with UPSIT (rho = 0.3716, p < 0.0001; rho = 0.3655, p < 0.0001; rho = 0.3880, p < 0.0001). After controlling for age by partial correlation, SBRs of the caudate nucleus, putamen, and striatum showed an influence on UPSIT (rho = 0.3288, p < 0.0001; rho = 0.3374, p < 0.0001; rho = 0.3511, p < 0.0001). Olfactory function is associated with the availability of striatal DAT independent of age in healthy subjects. • Olfactory dysfunction in Parkinson’s disease is prodromal to other symptoms. • The availability of dopamine transporter showed a reduction with ageing. • Olfactory function is associated with the availability of dopamine transporter.

We aimed to explore the role of the diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) or positron emission tomography/computed tomography (PET/CT) for prediction of malignant potential of gastrointestinal stromal tumor (GIST) through a systematic review and meta-analysis.The MEDLINE, Embase, and Cochrane Library database, from the earliest available date of indexing through May 31, 2017, were searched for studies evaluating the diagnostic performance of F-18 FDG PET or PET/CT for prediction of malignant potential of GIST. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves.Across seven studies (188 patients), the pooled sensitivity for F-18 FDG PET or PET/CT was 0.88 (95% confidence interval [CI]: 0.80-0.94) without heterogeneity (χF-18 FDG PET or PET/CT demonstrated good sensitivity and specificity for the prediction of malignant potential of GIST. At present, the literature regarding the use of F-18 FDG PET or PET/CT for the prediction of malignant potential of GIST remains still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of F-18 FDG PET or PET/CT prediction of malignant potential of GIST.

Obesity, an increasingly common problem in modern societies, results from energy intake chronically exceeding energy expenditure. This imbalance of energy can be triggered by the internal state of the caloric equation (homeostasis) and non-homeostatic factors, such as social, cultural, psychological, environmental factors or food itself. Nowadays, positron emission tomography (PET) radiopharmaceuticals have been examined to understand the cerebral control of food intake in humans. Using 15O–H2 PET, changes in regional cerebral blood flow (rCBF) coupled to neuronal activity were reported in states of fasting, satiation after feeding, and sensory stimulation. In addition, rCBF in obese subjects showed a greater increase in insula, the primary gustatory cortex. 18F–fluorodeoxyglucose PET showed higher metabolic activity in postcentral gyrus of the parietal cortex and lower in prefrontal cortex and anterior cingulate cortex in obese subjects. In addition, dopamine receptor (DR) PET demonstrated lower DR availability in obese subjects, which might lead to overeating to compensate. Brain PET has been utilized to reveal the connectivity between obesity and brain. This could improve understanding of obesity and help develop a new treatment for obesity.

Evidence suggests that psoriasis might be associated with metabolic syndrome and an increased risk for cardiovascular disease.To determine whether ustekinumab reduces systemic and vascular inflammation associated with metabolic syndrome and cardiovascular disease, measured usingPatients with psoriasis and healthy controls underwent baselineAfter a Psoriasis Area and Severity Index of 75 was achieved with ustekinumab treatment, standardized uptake values were reduced in the liver, spleen, and 5 parts of the aorta (P .05).Our study does not provide outcome data concerning cardiovascular events or metabolic syndrome; it only shows surrogate markers in a limited (Korean) population.Ustekinumab treatment was significantly associated with decreased systemic and vascular inflammation related to metabolic syndrome and cardiovascular disease among patients with psoriasis.

Purpose: The purpose of this study was to evaluate the response of retinoic acid (RA) in radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC). Methods: Systematic searches of MEDLINE (from inception to December 2016) and of EMBASE (from inception to December 2016) were performed for English-language publications on thyroid cancer treated with RA. Studies were classified according to the response criteria used: (1) 123I or 131I whole body scintigraphy (WBS), (2) serum thyroglobulin (Tg) level, (3) the response evaluation criteria in solid tumors (RECIST) version 1.0, and (4) World Health Organization (WHO) criteria. Results: Disease response rates as determined by WBS ranged widely between 6.2% and 46.1% with a pooled disease response rate of 27.6% (95% confidence interval: 21.7-34.0%). Response rates as determined by Tg level ranged from 56.6% to 83.3% (pooled response rate 61.3% (51.0-70.9%)), RECIST response rates from 0% to 45.5% (pooled response rate 17.0% (1.4-44.5%)), and according to WHO criteria, the pooled response rate was 30.8% (12.7-52.7%). Conclusions: A minority of patients with RAI-refractory DTC respond to RA treatment.

Background The prognostic value of the tumor burden characterized by the metabolic tumor volume (MTV) remains under investigation in nasopharyngeal carcinoma (NPC). The purpose of this study was to evaluate the prognostic value of the maximum standardized uptake value (SUVmax) and MTV according to metabolic volume threshold as measured by positron emission tomography (PET)/computed tomography (CT), and other clinical factors, in patients with NPC. Methods This study was a retrospective chart review. We evaluated the association of SUVmax, MTV2.5, MTV3.0, and other clinical factors with overall survival (OS) using Kaplan-Meier and Cox regression models. (MTV2.5 and MTV3.0 are the volume of hypermetabolic tissue within the regions of gross tumor volumes with a SUV value greater than the threshold values of 2.5 and 3.0, respectively.) Results Higher MTV2.5 of 31.45 cm3 and MTV3.0 of 23.01 cm3 were associated with an increased risk of death (hazard ratio [HR] = 5.028; p = 0.029), although no significant relationship was found between SUVmax and OS. Interestingly, MTV3.0 was associated with OS in both the differentiated and undifferentiated groups, although MTV2.5 was only associated with OS in the undifferentiated group. Among the clinical parameters, only radiotherapy was associated with longer OS (HR = 12.124; p < 0.001). Conclusion The MTV and radiotherapy could be prognostic values associated with OS. Particularly, MTV2.5 and MTV3.0 might be valuable metabolic parameters for predicting long-term survival in patients with NPC. Furthermore, MTV3.0 may be more useful because it can be applied irrespective of pathologic subtype.

We conducted a comprehensive systematic review of the literature on volumetric parameters and a meta-analysis of the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with head and neck cancer (HNC). Methods: A systematic search of MEDLINE and EMBASE was performed using the key words PET, head and neck, and volume. Inclusion criteria were 18 F-FDG PET used as an initial imaging tool; studies limited to HNC; patients who had not undergone surgery, chemotherapy, or radiotherapy before PET scans; and studies reporting survival data. Event-free survival and overall survival were considered markers of outcome. The impact of MTV or TLG on survival was measured by the effect size hazard ratio (HR). Data from each study were analyzed using Review Manager. Results: Thirteen studies comprising 1,180 patients were included in this study. The combined HR for adverse events was 3.06 (2.33–4.01, P , 0.00001) with MTV and 3.10 (2.27–4.24, P , 0.00001) with TLG, meaning that tumors with high volumetric parameters were associated with progression or recurrence. Regarding overall survival, the pooled HR was 3.51 (2.62–4.72, P , 0.00001) with MTV and 3.14 (2.24–4.40, P , 0.00001) with TLG. There was no evidence of significant statistical heterogeneity at an I2 of 0%. Conclusion: MTV and TLG are prognostic predictors of outcome in patients with HNC. Despite clinically heterogeneous HNC and the various methods adopted between studies, we can confirm that patients with a high MTV or TLG have a higher risk of adverse events or death.