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Considering the difficulty in detecting primary breast cancers using whole-body positron emission tomography (WBPET) owing to its limited spatial resolution, we aimed to evaluate the detectability of breast cancer by ring-type dedicated breast PET (DbPET) on the World Health Organization (WHO) histological classification in comparison with WBPET.A total of 938 patients with breast cancer underwent WBPET and ring-type DbPET, and 1021 lesions were histologically assessed based on the WHO classification of tumors of the breast. The findings of WBPET and DbPET were retrospectively evaluated and compared.The size-related sensitivity of DbPET was superior to that of WBPET for subcentimetric tumors (81.9% vs. 52.4%, P 0.001). The histological distribution was as follows: 11 lobular carcinoma in situ, 158 ductal carcinoma in situ, 738 infiltrating duct carcinoma not otherwise specified (NOS), 12 lobular carcinoma NOS, 40 mucinous adenocarcinoma, 13 tubular carcinoma, 36 invasive breast carcinoma others, and 13 papillary neoplasms. WBPET had low sensitivity for lobular carcinoma in situ, ductal carcinoma in situ, lobular carcinoma NOS, mucinous adenocarcinoma, and tubular carcinoma. DbPET showed improved sensitivity for all the above except lobular and tubular carcinoma. The maximum standardized uptake values (SUVmax) of DbPET were significantly higher than those of WBPET for histological types, excluding lobular carcinoma in situ. The SUVmax of papillary neoplasms was high regardless of low-grade histology and Ki-67 labeling index.DBPET was found to have high sensitivity and SUVmax values for all histologic types that showed low sensitivity of detection on WBPET, except lobular carcinoma in situ.

BACKGROUND AND PURPOSE To compare and characterize metabolic features of high- and low-grade glioma tumors using 68 Ga-PSMA-617 and 18 F-FDG positron emission tomography/computed tomography (PET/CT). METHODS Thirty patients who underwent both 68 Ga-PSMA-617 and 18 F-FDG PET/CT over 2 consecutive days and then underwent surgical treatment were retrospectively identified. All tumors were diagnosed histologically. This report includes 16 high-grade glioma (HGG) and 14 low-grade glioma (LGG) tumors. Standard uptake value (SUV) and target to nontarget (T/NT) were quantitatively investigated through the entire tumor region. Statistical analyses were performed using area under the curve (AUC) and comparison of two means. RESULTS SUVmax and SUVmean were the most effective (AUC, 0.96 and 0.94 for PSMA PET; AUC, 0.79 and 0.74 for FDG PET, respectively) for differentiating HGGs from LGGs. These methods distinguished between HGG and LGG effectively (PSMA PET: SUVmax , 5.766 ± 3.945 vs. 0.7364 ± 0.5295, p < 0.0001; SUVmean , 1.666 ± 1.680 and 0.1514 ± 0.1534, p < 0.0001, respectively) (FDG PET: SUVmax , 11.67 ± 3.639 and 9.118 ± 6.612; SUVmean , 5.648 ± 2.114 and 4.435 ± 2.872; p = 0.0083, 0.0262, respectively). The Youden index for SUVmax and SUVmean of 68 Ga-PSMA-617 and 18 F-FDG were 0.82 and 0.79 and 0.54 and 0.61, separately. T/NTmax was helpful for visual inspection of 68 Ga-PSMA-617-PET images (T/NTmax : 1.291 ± 0.9553 in grade II, 5.25 ± 2.435 in grade III, and 13.61 ± 13.84 in grade IV). T/NTmax differed significantly between LGG and HGG and between subtypes of LGG. CONCLUSION PET/CT with 68 Ga-PSMA-617 and 18 F-FDG may help distinguish between HGG and LGG, and 68 Ga-PSMA-617 PET/CT is superior to18 F-FDG in differentiating HGG and LGG.

Although each 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) has been used to diagnose cardiac sarcoidosis (CS), active CS is still misdiagnosed. Active CS, diagnosed by PET alone, was defined as focal or focal on diffuse FDG uptake pattern. In fusion PET/CMR imaging, using a regional analysis with AHA 17-segment model, the patients were categorized into four groups: (1) PET−/LGE−, (2) PET+/LGE−, (3) PET+/LGE+, and (4) PET−/LGE+. PET+/LGE+ was defined as active CS. 74 Patients with suspected CS were enrolled. Between PET alone and fusion PET/CMR imaging, 20 cases had mismatch evaluations of active CS, and most had diffuse or focal on diffuse FDG uptake pattern on PET alone imaging. 40 Patients fulfilled the 2016 the Japanese Circulation Society diagnostic criteria for CS. The interobserver diagnostic agreement was excellent (κ statistics 0.89) and the overall accuracy for diagnosing CS was 87.8% in fusion PET/CMR imaging, which were superior to those in PET alone imaging (0.57 and 82.4%, respectively). In a sub-analysis of diffuse and focal on diffuse patterns, the agreement (κ statistics 0.86) and overall accuracy (81.8%) in fusion PET/CMR imaging were still better. Fusion PET/CMR imaging with regional analysis offered reliable and accurate diagnosis of CS, covering low diagnostic area by FDG-PET alone.

Whole-body 18F-fluorodeoxyglucose positron emission tomography (PET) has been used extensively in the last decade for the primary staging and restaging and to assess response to therapy in these patients. We aim to discuss the diagnostic performance of PET/computed tomography in the initial staging of breast carcinoma including the locally advanced disease and to illustrate its role in restaging the disease and in the assessment of response to therapy, particularly after the neoadjuvant chemotherapy. Causes of common pitfalls during image interpretations will be also discussed.

Serum thymus and activation regulated chemokine (TARC) levels reflect classical Hodgkin lymphoma (cHL) disease activity and correspond with treatment response. We compared mid-treatment interim TARC (iTARC) with interim 18 F-fluorodeoxyglucose positron-emission tomography (iPET) imaging to predict modified progression-free survival (mPFS) in a group of 95 patients with cHL. High iTARC levels were found in nine and positive iPET in 17 patients. The positive predictive value (PPV) of iTARC for a 5-year mPFS event was 88% compared to 47% for iPET. The negative predictive value was comparable at 86% for iTARC and 85% for iPET. Serum iTARC levels more accurately reflect treatment response with a higher PPV compared to iPET.

Immune-checkpoint inhibitors (ICI) have profoundly improved the prognosis of cancer patients but are associated with life-threatening myocarditis (incidence≤1%).The diagnosis of ICI-myocarditis remains challenging necessitating the need for novel diagnostic strategies.This single center cohort included 61 consecutive patients referred to our cardio-oncology unit for a suspicion of ICI-myocarditis with a positive troponin, between March 2019 and March 2021. In the 31 patients with suspected ICI-myocarditis with available FDG-PET, the median delay between admission and the first available FDG-PET performed was 12 days [interquartile-range:9-30]. Patients received ICI (ICI-monotherapy: 24/31, 77% and ICI-combination therapy: 7/31, 23%), mainly for lung cancer (n=10), melanoma (n=5), and kidney cancer (n=3). FDG-PET was performed using a standardized protocol involving dietary measures prior to PET, including fasting of at least 6h and a fat enriched diet without carbohydrates for 24h. FDG-PET platforms included Biograph-mCT-Flow Siemens (n=9/34, 26%) or Discovery-MI-5-Ring General Electric (n=25/34, 74%) devices and analysed using Singo.via Workstation (Siemens) by a nuclear medicine physician blinded to patients’ medical records. Interpretation of FDG-PET was based on the following classification: 1/No FDG uptake, 2/Diffuse FDG uptake, 3/Focal FDG uptake, 4/Focal on diffuse FDG uptake.An abnormal cardiac fixation on FDG-PET suggestive of myocarditis was observed in only 2/21 (9.5%) patients with otherwise definite ICI-myocarditis (1 diffuse, 1 focal), not different in proportion versus 1/7 (14.3%, 1 focal) patient without ICI-myocarditis (p>0.99). The sensitivity, specificity, positive predictive and negative predictive values (with their 95% confidence-interval) of FDG-PET for ICI-myocarditis was 9.5% (1.2-30.4%), 85.7% (42.1-99.6%), 66% (17.5-95%), 24% (18.5-30.6%), respectively. Only 2/14(14.2%) FDG-PET were positive despite being performed at a time in which ICI-myocarditis was fully active with troponin levels over ten-times the normal values versus 0/6(0%,p>0.99) for FDG-PET performed when troponin levels were abnormal but below ten-times the upper limit. Similarly, there was no difference in FDG-PET positivity rate for exams performed within 14 days (1/7, 14.3%; plus 3 inconclusive exams) versus those performed after 14 days (1/14, 7.2%; no inconclusive exams; p>0.99) of hospital admission.Altogether, our study suggests that FDG-PET has a limited diagnostic value for the diagnosis of ICI-Myocarditis.

18F-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG-PET/CT) is a functional imaging technique which is an established tool in oncology, and has also demonstrated a role in the field of inflammatory diseases, such as large vessel vasculitis (LVV). In the last few years, it is known that atherosclerotic lesions with inflammation, detected by FDG-PET, are high-risk structural features and more likely to lead to subsequent progression of atherosclerosis with more clinical complications.

Renal cell carcinomas (RCCs) commonly metastasize to the lungs and bones and rarely to the parathyroid, maxillary sinus, and adrenals. It is indeed very rare to have these all these metastases occurring simultaneously in an individual. We share a case of 67-year-old woman provisionally treated for parathyroid carcinoma but subsequently found to actually have metastatic RCC to the left maxillary sinus, parathyroid, lungs, and adrenals on 18F-fluorodeoxyglucose positron emission tomography–computed tomography.

We present a case of a 42-year-old Japanese man with ocular and pulmonary sarcoidosis who eventually led to a diagnosis with cardiac sarcoidosis (CS) through endomyocardial biopsy (EMB), despite negative findings on both late gadolinium enhancement with cardiac magnetic resonance (LGE-CMR) imaging and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). Cardiac sarcoidosis (CS) develops in only 5% of patients with systemic sarcoidosis. Previous studies have reported that CS was found in up to 50% of autopsy series with fatal sarcoidosis, implying that CS is frequently underdiagnosed with potentially life-threatening consequences. Therefore, the diagnostic accuracy and prognostic value of CS are important. Currently, LGE-CMR and FDG-PET play an important role in establishing a diagnosis of CS with high sensitivity. In the presented case, regardless of serial examinations with LGE-CMR and FDG-PET, confirmed diagnosis of CS could not be achieved; ultimately, a definitive diagnosis of CS was obtained through EMB. To the best of our knowledge, this is the first reported case showing the diagnosis of CS despite negative findings on serial LGE-CMR and FDG-PET examinations.

Objective This study aims to evaluate the potential role of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in detecting high-grade meningiomas and predicting the prognosis of patients after meningioma surgery. Patients and methods A total of 124 patients met the final inclusion criterion. Tumor to gray ratio (TGR) was compared with Ki-67 labeling index, and its correlations with pre-operative neurological function and treatment status were also evaluated. Receiver-operating characteristic (ROC) curve was drawn to determine a cut-off value which could discriminate meningioma of different grades. Prognostic factors including TGR were analyzed using Kaplan-Meier survival curve and cox proportional model. Results The TGR of higher World Health Organization (WHO) grade meningioma was significantly higher than that in lower grade (p < 0.001), and it was correlated with the Ki-67 labeling index (p < 0.001, r = 0.1545). The TGR of 1.30 was the best cutoff value for the detection of high grade (WHO grade II&III) meningioma from low grade (WHO grade I) according to ROC analysis, with a sensitivity of 61.5%, the specificity of 86.7%, and accuracy of 81.5%. The TGR (p < 0.001), treatment status (p = 0.035), tumor grade (p < 0.001) and Ki-67 labeling index (p < 0.001) were significantly associated with progression-free survival (PFS). Cox proportional hazards model demonstrated that TGR (p = 0.013) was an independent prognostic factor for PFS. Conclusion A high uptake of FDG was correlated with a more proliferative biological behavior and is a risk factor for tumor recurrence.

The kinetics of autoradiolytic degradation of the radiopharmaceutical drug 2-[18F]fluorodeoxyglucose ([18F]FDG) in an air-saturated normal saline solution with initial activity concentrations of 1 and 2 GBq/mL has been studied. It has been established that the only radioactive product of radiation-induced transformations of [18F]FDG is [18F]fluoride, whose contribution in the total activity of the radiopharmaceutical increases with storage. It has been shown that an increase in the initial activity concentration of the radiopharmaceutical or a decrease in the concentration of ethanol in it leads to the enhancement of autoradiolytic degradation of [18F]FDG. However, an increase in the storage temperature of the solutions from 25 to 40°C does not affect the rate of radiation-induced dehalogenation of [18F]FDG.

18F fluorodeoxyglucose (FDG) is widely used for PET CT examinations; however, positron-emitting florin generates relatively high gamma radiation (511 keV) raising occupational as well as public safety concerns. This study aimed to measure the rate of radiation emitted from patients that underwent 18FDG PET/CT examination for oncological conditions, approximately 2 hours after the procedure, before and after urination. A total of 100 patients who underwent 18F-FDG PET/CT examination were included in this study. Following imaging, external radiation exposure rate was measured using proportional counter probe at 1-m distance, approximately 2 hours after the completion of imaging procedure, before and after urination. Factors effecting resulting exposure from patients were examined. The mean post-urination activity ranged between 0.2 and 6.3 μSv/h (median, 1.8 μSv/h). Presence of metastasis, tumor type and gender did not have any effect on mean post-urination activity (P>0.05 for all comparisons). Older age, greater BMI and higher administered dose were associated with higher post-urination activity (P

A 79-year-old man with elevated blood glucose was started on insulin therapy. IgG4 was as high as 1,830 mg/dL, and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) confirmed diffuse pancreatic enlargement and accumulation of FDG. Based on the above, autoimmune pancreatitis (AIP) was diagnosed, but steroid treatment was not performed. IgG4 later declined, and FDG accumulation in the pancreas disappeared on FDG-PET/CT at the age of 83 years. AIP was thought to have gradually remitted spontaneously over time. FDG-PET/CT is useful for evaluating AIP activity.

BackgroundThe maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is presumed to visualize not only tumor cells but also active immune cells in the tumor microenvironment based on their glycolysis activity. This study aimed to investigate the relationship between SUVmax on FDG PET/CT and tumor-infiltrating lymphocyte (TIL) subsets.MethodsFifty-four patients with invasive triple-negative breast cancer (TNBC) underwent FDG PET/CT before neoadjuvant chemotherapy, and pre-treatment biopsy specimens were pathologically evaluated. The expression status of CD8, forkhead box P3 (FOXP3), programmed cell death-1 (PD-1), and programmed cell death-ligand 1 (PD-L1) were assessed by immunohistochemistry. The relationship between TIL subsets and SUVmax or pathological complete response (pCR) was investigated.ResultsTILs, CD8, FOXP3, PD-1, and PD-L1 were high in 15 (27.8%), 15 (27.8%), 39 (72.2%), 18 (33.3%), and 26 (48.2%) patients, respectively. SUVmax was significantly correlated with tumor size, Ki-67 labeling index, and CD8/FOXP3 ratio (P = 0.003, P = 0.043, and P = 0.017, respectively). In multiple linear regression analysis, tumor size and CD8/FOXP3 ratio predicted SUVmax (P < 0.001 and P = 0.045, respectively). Seventeen patients (31.5%) achieved a pCR. TILs, CD8/FOXP3 ratio, PD-1, and PD-L1 were significantly correlated with the pCR rate. In multivariate analysis, the CD8/FOXP3 ratio was the only independent predictive factor for pCR (P = 0.010).ConclusionSUVmax on FDG PET/CT was related to tumor biological factors and the immune microenvironment after adjusting for confounding factors in TNBC. FDG uptake was influenced by the CD8/FOXP3 ratio, which predicts pCR after neoadjuvant chemotherapy.

Background and Aims Acute T-cell mediated rejection (TCMR) is associated with the recruitment of mononuclear leukocytes into the renal transplant, which corresponds to the core of the conventional Banff classification. The boosted metabolism of these inflammatory cells can be assessed by positron emission tomography (PET) quantifying the renal uptake of 18F-fluorodeoxyglucose (18FDG). The correlation of biopsy-based Banff versus PET-based scores of acute inflammation in the renal transplant is unknown. Method From January 2013 to December 2019, we prospectively performed 114 18FDG-PET/CT in 105 adult KTR who underwent per cause transplant biopsy for suspected TCMR. Biopsy-proven polyoma-BK nephropathies (n=7) and uninterpretable PET images (n=2) were excluded. PET/CT was performed 194±19 minutes after administration of 243±35 MBq of 18FDG, before any immunosuppression change. The mSUVs were measured in both upper and lower poles of the renal allograft. The acute Banff score was conventionally defined as the sum (from 0 to 15) of g (glomerulitis), ptc (peritubular capillaritis), t (tubulitis), i (inflammation in non-scarred cortex) and v (endarteritis). The Banff “total i” score (from 0 to 3) corresponds to the total cortical inflammation, including scarred and non-scarred cortex. Regression of mSUV against the acute Banff score was performed, and Pearson correlation coefficients were calculated. The distribution of mSUV between “total i” groups was assessed by the non-parametric Kruskal-Wallis test followed by Dunn’s post hoc test. Results The mean age of the cohort was 51.5±14.3 years, with M/F ratio of 67/38. The prevalence of biopsy-proven TCMR and borderline was 20.9% and 16.2%, respectively. The mean mSUV of the 105-case cohort was 1.82±0.45. The highest value of acute Banff score was 12, while 55.2% of biopsies were scored as 0. The distribution of “Total i” score was: 0 (58.8%); 1 (20.6%); 2 (8.8%); 3 (11.8%). Regression showed a significant correlation between mSUV and acute Banff score (p Conclusion 18FDG-PET/CT may help noninvasively assess the degree of allograft inflammation in KTR with suspected TCMR.

BACKGROUND: The aim of this study was to investigate the value of visual assessment of (18)F-fluorodeoxyglucose ((18)F-FDG) metabolic spatial distribution (V-FMSD) in the diagnosis of indeterminate pulmonary nodules and masses with high (18)F-FDG uptake. METHODS: A total of 301 patients with indeterminate pulmonary nodules or masses who underwent (18)F-FDG positron emission tomography/computed tomography (PET/CT) imaging were retrospectively studied. The characteristics of (18)F-FDG metabolic spatial distribution (FMSD) in the proximal and distal regions of the lesions were visually analyzed using a 5-point scoring system. The sensitivity, specificity, accuracy, and area under receiver operating characteristic curve (AUC) were compared between V-FMSD and conventional PET/CT methods for the diagnosis of hypermetabolic indeterminate pulmonary nodules and masses. RESULTS: The V-FMSD results showed that 180 (92.8%) malignant lesions had a score of ≥3 and 78 (72.9%) benign lesions had a score of ≤2. This indicated that the FMSD in the proximal region of malignant lesions was significantly higher than that of the distal region, and the FMSD in the proximal region of benign lesions was significantly lower than that of the distal region. V-FMSD had a specificity of 72.9%, which was markedly higher than those of the maximum standard uptake value (SUV(max); 0%, P

Because enhancement on computed tomography (CT) and MR reflects blood-brain barrier (BBB) changes, molecular imaging with PET-based techniques is needed to assess brain tumor activity, especially in tumors with intact or partially intact BBB. 18F-fluorodeoxyglucose (FDG)-PET has been validated in tumor detection/delineation, recurrence, and prognostication. Although FDG remains the most widely used PET tracer in the evaluation of brain tumors, various other tracers, including amino acid indicators, have been studied extensively. Breakdown of the BBB plays a major role in visualizing brain tumors by radiolabeled amino acid tracers; therefore, this approach is suboptimal for assessing disease activity beyond CT and MR.

The present study aimed to evaluate the use of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for detection of high-fat and high-salt diet-induced inflammatory lesions of the arterial vessel walls in Wistar rats. A total of 20 healthy, 8-week-old, male Wistar rats were randomly assigned to the high-fat diet group and the normal diet group. After 16 and 24 weeks of feeding, Wistar rats in the normal diet group and the high-fat diet group (five rats in each group) were injected with 18F-FDG through the tail vein at a dose of 1 mCi/kg after fasting for 12 h. After 1 h, the rats were anesthetized with 2% isoflurane, followed by micro-PET imaging with a 10-min image capture duration and immunohistochemical staining. The standardized uptake values (SUVs) of 18F-FDG were significantly higher in the iliac artery in the high-fat diet group compared with those in the normal diet group at 16 weeks (1.53±0.08 vs. 1.04±0.03; P

Funding Acknowledgements Type of funding sources: None. Background 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is commonly used for the diagnosis of infective endocarditis (IE), but its prognostic value remains unknown. Objectives This study sought to assess the prognostic value of 18F-FDG PET/CT in prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE). Methods This study prospectively included 173 consecutive patients (109 PVE and 64 NVE) with definite left-sided IE who had an 18F-FDG PET/CT and were followed-up for 1 year. The primary endpoint was a composite of major cardiac events: death, recurrence of IE, acute cardiac failure, nonscheduled hospitalization for cardiovascular indication, and new embolic event. Results 18F-FDG PET/CT was positive in 100 (58%) patients, 83% (n = 90 of 109) in the PVE, and 16% (n = 10 of 64) in the NVE group. At a mean follow-up of 225 days (interquartile range: 199 to 251 days), the primary endpoint occurred in 94 (54%) patients: 63 (58%) in the PVE group and 31 (48%) in the NVE group. In the PVE group, positive 18F-FDG PET/CT was significantly associated with a higher rate of primary endpoint (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.1 to 6.7; p = 0.04). Moderate to intense 18F-FDG valvular uptake was also associated with worse outcome (HR: 2.3; 95% CI: 1.3 to 4.5; p = 0.03) and to new embolic events in PVE (HR: 7.5; 95% CI: 1.24 to 45.2; p = 0.03) and in NVE (HR: 8.8; 95% CI: 1.1 to 69.5; p = 0.02). In the NVE group, 18F-FDG PET/CT was not associated with occurrence of the primary endpoint CONCLUSIONS: In addition to its good diagnostic performance, 18F-FDG PET/CT is predictive of major cardiac events in PVE and new embolic events within the first year following IE. Primary Endpoint Occurrence: Univariate and Multivariate Analysis in PVE Univariate HR (95% CI) p Value Multivariate HR (95% CI) p Value Renal insufficiency at admission 2.16 (1.00-4.68) 0.05 CRP >100 mg/l 2.46 (1.04-5.89) 0.02 1.90 (1.10-3.40) 0.03 Staphylococcus aureus 2.70 (1.10-6.55) 0.03 Severe valvular regurgitation 2.55 (1.01-6.41) 0.05 1.20 (0.70-2.10) 0.68 Echographic complications 1.15 (0.54-2.46) 0.72 Vegetation length >10 mm 2.53 (1.19-4.60) 0.03 Positive 18F-FDG PET/CT 3.74 (1.30-10.80) 0.02 2.70 (1.10-6.70) 0.04 Moderate to intense 18FDG valvular uptake 2.70 (1.20-6.30) 0.02 2.30 (1.30-4.50) 0.03 Abstract Figure.

Introduction: IgG4-related diseases is an autoimmune disease newly recognized in recent years, it is rarely seen in clinical practice, the main clinical features of IgG4-RKD include acute or chronic renal insufficiency, proteinuria, elevated serum Ig G4, histopathological manifestations were tubulointerstitial nephritis, mainly characterized by a large amount of IgG4 positive plasma cell infiltration in the tubulointerstitial, it responded well to glucocorticoid therapy. Renal parenchymal damage could be seen on imaging. However, PET/CT imaging has been less reported, here we reported a case of IgG4-related kidney disease with PET/CT imaging.Case presentation: A 50-year-old female presented with chills and fever for more than 2 months, she came to the urology department of our hospital for further diagnosis and treatment due to the right kidney occupation revealed by CT examination in local hospital. MRI plain scan plus diffusion imaging suggested multiple lesions in the right kidney, multiple nodular abnormally hypermetabolism foci in the right kidney were seen on PET/CT imaging, and the negative findings in the other parts of the body, therefore, a primary malignant tumor of the kidney was considered. Laboratory tests revealed elevated Levels of C-reactive protein, erythrocyte sedimentation rate, and IgG4 of immunoglobulin, histological pathology of right kidney puncture indicated inflammation and infection with surgical indications, she underwent radical right nephrectomy with laparoscopic under general anesthesia and was discharged 1 week after the right kidney operation, her clinical symptom disappeared and kept in good health during follow-up.Conclusions: IgG4-related nephritis could manifest multiple or solitary hypermetabolism foci in unilateral kidney on PET/CT imaging, while the rest of the systemic PET/CT imaging manifestation was negative, which may be related to the infiltration of lymphocytes, plasma cells and inflammatory cells at the lesion site. The cause of abnormal accumulation of FDG in lesion site was unclear, and the true mechanism needs to be further clarified.

Background: Cardiac magnetic resonance imaging with late gadolinium enhancement (LGE) and 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) are widely used modalities for the diagnosis of cardiac sarcoidosis. The aim of this study was to examine the prognostic value of simultaneous hybrid 18 F-FDG PET/MRI in cardiac sarcoidosis. Methods: Forty-three consecutive patients with suspected cardiac sarcoidosis underwent cardiac FDG PET/MRI. The patients were categorized based on the presence or absence of LGE and/or FDG uptake in the myocardium. The end points were defined as composite of all-cause death, sustained ventricular tachyarrhythmia, hospitalization due to decompensated heart failure and a decline of left ventricular ejection fraction more than 10%. Results: During the median follow-up of 3.7 ± 1.3 years, there were 16 (33%) adverse events. Accumulated event rate was higher in the LGE positive group than in the LGE negative group (log-rank, P < 0.001, Figure A) Additionally, the FDG positive group showed higher adverse event rate than the FDG negative group (P < 0.001, Figure B). Furthermore, adverse event rate was highest in the both PET- and LGE-positive group among 4 groups (P < 0.001, Figure C). In the Cox proportional hazard analysis adjusted for other potential confounding factors, the presence of LGE and the presence of FDG uptake were independent predictors of adverse events (LGE: HR 11.1, 95% CI 1.3-92.4, P = 0.013; FDG: HR 4.4, 95% CI 1.4-13.2, P = 0.007) in cardiac sarcoidosis. Conclusion: Simultaneous cardiac PET/MRI with FDG identifies patients at higher risk for adverse events in patients with cardiac sarcoidosis.

Gadolinium chelates are widely used in cardiovascular magnetic resonance imaging (MRI) as passive intravascular and extracellular space markers. Manganese, a biologically active paramagnetic calcium analogue, provides novel intracellular myocardial tissue characterisation. We previously showed manganese-enhanced MRI (MEMRI) more accurately quantifies myocardial infarction than gadolinium delayed-enhancement MRI (DEMRI). Here, we evaluated the potential of MEMRI to assess myocardial viability compared to gold-standard 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) viability. Coronary artery ligation surgery was performed in male Sprague-Dawley rats (n = 13) followed by dual MEMRI and 18F-FDG PET imaging at 10–12 weeks. MEMRI was achieved with unchelated (EVP1001-1) or chelated (mangafodipir) manganese. T1 mapping MRI was followed by 18F-FDG micro-PET, with tissue taken for histological correlation. MEMRI and PET demonstrated good agreement with histology but native T1 underestimated infarct size. Quantification of viability by MEMRI, PET and MTC were similar, irrespective of manganese agent. MEMRI showed superior agreement with PET than native T1. MEMRI showed excellent agreement with PET and MTC viability. Myocardial MEMRI T1 correlated with 18F-FDG standard uptake values and influx constant but not native T1. Our findings indicate that MEMRI identifies and quantifies myocardial viability and has major potential for clinical application in myocardial disease and regenerative therapies.

Objectives This study sought to assess the diagnostic accuracy of cardiac computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) with positron emission tomography/computed tomography (PET/CT) in defining the nature of cardiac masses. Background The diagnostic accuracy of cardiac CT and 18F-FDG PET/CT in identifying the nature of cardiac masses has been analyzed to date only in small samples. Methods Of 223 patients with echocardiographically diagnosed cardiac masses, a cohort of 60 cases who underwent cardiac CT and 18F-FDG PET/CT was selected. All masses had histological confirmation, except for a minority of thrombotic formations. For each mass, 8 morphological CT signs, standardized uptake value (SUVmax, SUVmean), metabolic tumor volume, and total lesion glycolysis in 18F-FDG PET were used as diagnostic markers. Results Irregular tumor margins, pericardial effusion, invasion, solid nature, mass diameter, CT contrast uptake, and pre-contrast characteristics were strongly associated with the malignant nature of masses. The coexistence of at least 5 CT signs perfectly identified malignant masses, whereas the detection of 3 or 4 CT signs did not accurately discriminate the masses’ nature. The mean SUVmax, SUVmean, metabolic tumor volume, and total lesion glycolysis values were significantly higher in malignant than in benign masses. The diagnostic accuracy of SUV, metabolic tumor volume, and total lesion glycolysis 18F-FDG PET/CT parameters was excellent in detecting malignant masses. Among patients with 3 or 4 pathological CT signs, the presence of at least 1 abnormal 18F-FDG PET/CT parameter significantly increased the identification of malignancies. Conclusions Cardiac CT is a powerful tool to diagnose cardiac masses as the number of abnormal signs was found to correlate with the lesions’ nature. Similarly, 18F-FDG PET/CT accurately identified malignant masses and contributed with additional valuable information in diagnostic uncertainties after cardiac CT. These imaging tools should be performed in specific clinical settings such as involvement of great vessels or for disease-staging purposes.

Introduction The prevalence of incidental 18 F-fluorodeoxyglucose (FDG)-avid findings on positron emission tomography-computed tomography (PET/CT) has been extensively described. Few studies, however, have assessed the prevalence and significance of non-FDG-avid findings; pathology that is identified on review of the low-dose, non-contrast CT. The aim of this study was to determine the overall prevalence of non FDG-avid incidental findings on PET/CT and the prevalence of 'clinically significant' non FDG-avid pathology. Methods Five hundred consecutive whole body PET/CT studies performed in 2016 at a university affiliated tertiary hospital were retrospectively reviewed by two radiologists experienced in reporting PET/CT. Findings were categorized according to potential clinical relevance, and a targeted follow-up of clinically significant incidental findings was performed. Results Incidental findings were encountered in 463 of 500 (92.6%) patients. In 226 patients, these findings had been detected on previous imaging studies, with unknown incidental findings present in 237 of 500 (47.4%) patients. 113 of 500 (22.6%) patients had non-avid incidental findings of potentially major clinical significance, and in 35 patients (7.0%) these findings were considered previously unknown. The most common non-avid findings of potentially major significance were pulmonary nodules (6 mm or larger), moderate or large size pleural effusions, and vascular aneurysms. Unknown incidental findings of potentially major clinical significance were significantly higher in patients imaged for melanoma staging (P= 0.004). Conclusion The prevalence of incidental findings of clinical significance that do not accumulate FDG in PET/CT is not insignificant. Routine systematic review of the low-dose CT is required to avoid missing potentially clinically important findings, in particular pleural effusions, vascular aneurysms and metastatic pulmonary nodules.

Objectives In addition to traditional risk factors, excess cardiovascular disease (CVD) in rheumatoid arthritis (RA) is attributed to enhanced vascular and/or systemic inflammation. In several small studies using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to directly assess vascular inflammation, FDG uptake was higher in RA patients than controls. Using a substantially larger RA sample, we sought to identify RA-disease characteristics independently associated with vascular FDG uptake. Methods RA patients underwent cardiac FDG-PET/CT, with aortic inflammation assessed by quantification of FDG uptake in the ascending aorta, calculated as the mean and maximum (max) standardized-uptake-value (SUV) of the entire ascending aorta, and of its most diseased segment (SUV MDS). Univariable and multivariable regression models were constructed to model the associations of patient characteristics with aortic FDG uptake. Results Ninety-one RA patients were scanned. In multivariable models, in addition to the independent associations of hypertension and body-mass-index with increased aortic FDG uptake, the prevalence of rheumatoid nodules correlated with the SUV-mean and SUV MDS-mean measurements, while anti-CCP antibodies inversely correlated with these measures and with the SUV-max and SUV MDS-max (p

Cyclothymic temperament possesses a central dimension that includes rapid fluctuations in mood and emotional instability, and it is regarded as a prodromal state of bipolar disorder. The aim of the present study is to explore the neural correlates of cyclothymic temperament. We used the data of 55 healthy participants in our previous study and analyzed the association between cyclothymic temperament scores rated by the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A) and the uptake of [18F]-FDG measured by positron emission tomography (PET). A whole brain analysis revealed a cluster of [18F]-FDG uptake significantly and positively associated with cyclothymic temperament scores, located in the right superior parietal lobule (SPL). Even after adjustment for relevant factors, there remained a significant cluster of [18F]-FDG uptake with cyclothymic temperament scores in the right SPL. In ROI analyses, there were similar significant peaks in the right SPL in association with cyclothymic temperament scores. These findings suggest that the right superior parietal lobule may be one of the neural correlates of cyclothymic temperament.

According to the international societies’ recommendations, the 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) technique should not be used as the method of choice in brain tumour diagnosis. Therefore, the brain region can be omitted during standard [18F]FDG PET/CT scanning. We performed comprehensive literature research and analysed results from 14,222 brain and torso [18F]FDG PET/CT studies collected in 2010–2020. We found 131 clinically silent primary and metastatic brain tumours and 24 benign lesions. We concluded that the brain and torso [18F]FDG PET/CT study provides valuable data that may support therapeutic management by detecting clinically silent primary and metastatic brain tumours.

18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been suggested as a reliable imaging technique for monitoring of disease activity in patients with adult-onset Still's disease (AOSD). Therefore, we investigated the clinical significance of 18F-FDG PET/CT in Korean AOSD patients.Thirteen AOSD patients were included in the study. The PET/CT images were evaluated with visual and semiquantitative method using standardized uptake values (SUVs).The presence of increased 18F-FDG uptake was noted in 90% of clinically active AOSD patients. 18F-FDG uptake was located in the lymph node, spleen, and bone marrow. Visual grade and SUV intensity of lymph node was significantly correlated with the systemic score of AOSD. Visual grade of spleen was significantly correlated with the systemic score, erythrocyte sedimentation rate (ESR), and ferritin. Additionally, visual grade and SUV intensity of bone marrow was significantly correlated with the systemic score, ESR, leukocyte, and neutrophil.Visual grade and SUV intensity of lymph node, spleen, and bone marrow on 18F-FDG PET/CT scan showed significant correlations with known disease activity markers. The data suggest that 18F-FDG PET/CT scan may be a useful imaging technique for evaluation of disease activity in AOSD patients.

Background The role of 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in the evaluation of anaplastic large-cell lymphoma (ALCL) first presenting in the skin is not well established, while computed tomography (CT) is used as a standard procedure. Objectives The aim of this study was to evaluate the use of FDG-PET versus CT at initial staging of ALCL first presenting in the skin. Materials & methods Eleven cases of ALCL first presenting in the skin who underwent both FDG-PET and CT were retrospectively analysed. There were six males and five females, with a mean age of 59.7 years. Results of FDG-PET were compared with those of CT. Biopsy results of lesions served as a reference for the accuracy of PET and CT in the evaluation of local and metastatic lesions. Results In seven cases (64%), imaging revealed extracutaneous ALCL. FDG-PET results were concordant with CT results in five cases (45%); in four of these cases, FDG-PET was negative, consistent with CT, and one case had cutaneous and extracutaneous lesions detectable on both CT and FDG-PET. FDG-PET and CT were discordant in six cases (55%). Among these six cases, FDG-PET revealed extracutaneous lesions undetected on CT which consequently influenced the therapeutic decision in five cases (45%). Conclusion The sensitivity of CT and FDG-PET was 18% and 64%, respectively.

The purpose of this study is to compare the value of screening for synchronous multiple primary cancers in other organs by esophagogastroduodenoscopy (EGD) or 18F-fluorodeoxyglucose positron-emission tomography (PET-CT) in patients newly diagnosed with oral cancer. We retrospectively examined consecutive Japanese patients who were diagnosed with oral squamous cell carcinoma (OSCC) and were screened for synchronous multiple primary cancers in other organs by EGD and/or PET-CT between January 2010 and December 2015 at our institution. The study included 190 patients (106 males and 84 females) from 36 to 93 years of age (median age 68.8 years). The patients were screened by EGD, PET-CT, or both before beginning treatment for OSCC. Of 190 Japanese patients with OSCC, 15 had multiple primary cancers: 13 patients had double cancer and two had triple cancers. The sites of the 17 multiple primary cancers were gastric (6), esophageal (4), and lung (3), and ovarian, colon, liver, and thyroid (1 each). All of the gastric and esophageal cancers were found by EGD and were not detected by PET-CT. For three patients, the detection of multiple cancers affected the treatment modality or order of treatment selected for the OSCC. In two cases, the oral cancer and multiple primary cancer(s) in another organ were resected simultaneously by joint surgical teams. PET-CT for oral cancer patients is an effective supporting diagnostic tool. However, the ability of PET-CT has some limitations. Especially for early detection of the upper gastrointestinal cancers, it is necessary to be supplemented by EGD.

The assessment of both the pattern and activity of myocardial injury has important implications for the clinical management of patients with cardiovascular disease. Comprehensive evaluation of these has previously been challenging using a single imaging modality. Cardiac magnetic resonance (CMR)

Background Unexpected focal colorectal 18 F-fluorodeoxyglucose uptake has become a common clinical dilemma. The aim of this study was to identify the clinical significance of incidentally detected colorectal lesions on PET/CT scans by comparing positive PET/CT findings with endoscopic and histopathological analysis. Methods A retrospective analysis of a colonoscopy database was reviewed. All patients that underwent colonoscopy secondary to focal incidental uptake on PET/CT were evaluated. PET/CT findings were correlated with endoscopic and histopathological results. Results 84 patients underwent colonoscopy secondary to incidental focal colorectal uptake on PET/CT. A total of 63 patients had an endoscopic and histological confirmation of the area of abnormality, for a positive predictive value of 75%. Newly diagnosed colorectal carcinoma was discovered in 13 patients (15.4%) and forty-four patients (52.3%) were discovered to have a premalignant lesion. Conclusion Incidental focal colorectal uptake of 18 F-fluorodeoxyglucose is associated with a substantial risk of underlying neoplastic colorectal lesions. Early identification of these lesions may alter patient management and treatment plans.

Introduction: Schnitzler syndrome is an auto-inflammatory disease defined by chronic urticarial eruption and monoclonal gammopathy. 18F fluorodeoxyglucose positron emission tomography/compu...