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ABSTRACT: PURPOSE: We prospectively evaluated the regional cerebral metabolic rate of glucose (CMRglu) before and after ventricular shunt placement in idiopathic normal-pressure hydrocephalus (iNPH) patients, to investigate whether some brain regions are more involved than others; we also correlated the individual variations of CMRglu with the clinical scale score assessment after shunting. METHODS: Twenty iNPH patients (12 men; mean age 73 ± 9 years) underwent clinical scale score assessment and F-FDG PET-CT before and 1 week after shunting. RESULTS: Before shunting, CMRglu values were similar in right and left brain regions, as well as after shunting. After shunting, 17 of 20 iNPH patients were clinically improved; all scale scores decreased, and CMRglu significantly increased in all regions (P < 10). In 3 of 20 iNPH patients, the symptoms persisted, the scale scores did not change, and CMRglu increased only in 3 regions: left frontal, left putamen, and right thalamus. Before shunting, no difference in global CMRglu between clinically improved (n = 17) and not improved (n = 3) iNPH patients was found. After shunting, a significant (P = 0.01) correlation between individual variations of CMRglu and clinical assessment was found. CONCLUSIONS: These findings confirm that iNPH is a disease involving all cerebral regions almost in the same way, and shunt procedure has a similar effect on regional cerebral metabolism almost in the same way. Individual variations of CMRglu are more important than absolute values and correlate with clinical status after shunting. Clinical improvement depends not only on the capability to restore the cerebrospinal fluid dynamic, but also on the ability of cerebral parenchyma to recover the metabolic function.
Clinical nuclear medicine 05/2013; · 3.92 Impact Factor
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ABSTRACT: A 40-year-old female patient with suspected multifocal extra-adrenal paraganglioma, on the basis of biochemical, genetic, and conventional imaging data, underwent F-FDG, F-DOPA and Ga DOTANOC PET/CT. FDOPA- and FDG-PET/CT detected a multifocal mediastinal and cervical paraganglioma. Ga-DOTANOC PET/CT detected 2 additional lesions compared to the other PET/CT methods. In our case, somatostatin receptor PET/CT with Ga-DOTANOC correctly assessed the extent of the disease in a patient with multifocal paraganglioma.
Clinical nuclear medicine 03/2013; · 3.92 Impact Factor
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ABSTRACT: We report the case of a pulmonary neuroendocrine tumor (NET) incidentally detected by F choline PET/CT performed during restaging in a 68-year-old patient affected by prostate cancer. To clarify the nature of the pulmonary lesion, the patient underwent a CT-guided biopsy which revealed the presence of a pulmonary NET. A subsequent Ga-DOTANOC PET/CT demonstrated the somatostatin receptor expression in the pulmonary lesion. The patient underwent a right lung lobectomy; at pathology, a well-differentiated NET was confirmed. Our case highlights that pulmonary NETs should be considered in the differential diagnosis of pulmonary lesions showing uptake of radiolabeled choline.
Clinical nuclear medicine 02/2013; · 3.92 Impact Factor
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ABSTRACT: A 31-year-old woman presenting with acute abdomen underwent an emergency Hartmann's procedure for fecal peritonitis due to perforated adenocarcinoma of the left colon. Shortly after a 7-month course of adjuvant chemotherapy, follow-up contrast-enhanced CT showed multiple peritoneal and hepatic nodules, showing focal intense and homogeneous FDG uptake on FDG-PET/CT, highly suspected for recurrence of disease. Excisional biopsy of the nodules revealed foreign body granulomas made up of alimentary materials surrounded by a fibrous wall. We report a unique case of a false-positive finding secondary to food residues mimicking metastatic disease on FDG-PET in a patient with colon cancer.
Japanese journal of radiology 02/2013; · 0.65 Impact Factor
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ABSTRACT: A 65-year-old woman with suspected insulinoma on the basis of clinical, biochemical, and conventional imaging data underwent F-dihydroxyphenylalanine (DOPA) PET/CT and Ga-DOTANOC PET/CT. F-DOPA PET/CT did not show any focal uptake in the pancreas, whereas Ga-DOTANOC PET/CT showed a focal area of intense uptake in the pancreatic tail. The patient underwent surgery and an insulinoma of about 20 mm in diameter was detected in the pancreatic tail. F-DOPA PET may fail in localizing insulin secreting tumors in adults; in these cases, the use of Ga-somatostatin analogs may lead to the correct diagnosis.
Clinical nuclear medicine 01/2013; · 3.92 Impact Factor
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ABSTRACT: We report a rare case of thymic Hodgkin lymphoma that occurred in an elderly patient and detected by F-FDG PET/CT. A 77-year-old woman with fever of unknown origin underwent F-FDG PET/CT scanning, which showed an area of increased radiopharmaceutical uptake in a mediastinal mass corresponding to a thymic lesion at CT scan. On the basis of the PET/CT findings, the patient was referred to surgery with the clinical suspicious of a thymoma. Histological examination demonstrated the presence of a primary thymic Hodgkin lymphoma instead.
Clinical nuclear medicine 01/2013; · 3.92 Impact Factor
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ABSTRACT: We report a case of a nodular nongranulomatous vasculitis of the lung detected by F-FDG PET/CT. A 51-year-old woman with fever of unknown origin underwent F-FDG PET/CT, which showed multiple and bilateral pulmonary nodules at CT scan with increased radiopharmaceutical uptake in the largest one (20 mm in diameter). On the basis of the PET/CT findings, the patient was referred for excisional biopsy of the largest pulmonary nodules suspicious for neoplastic disease. Histological examination demonstrated the presence of an obliterative vasculitis with interstitial pulmonary perivascular inflammation.
Clinical nuclear medicine 01/2013; · 3.92 Impact Factor
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ABSTRACT: Background. The aim of the article is to systematically review published data about the comparison between posi-tron emission tomography (PET) or PET/computed tomography (PET/CT) using Fluorine-18-Fluorodeoxyglucose (FDG) and whole-body magnetic resonance imaging (WB-MRI) in patients with different tumours. systematic review. Several articles evaluated mixed tumours with both diagnostic methods. Concerning the spe-cific tumour types, more evidence exists for lymphomas, bone tumours, head and neck tumours and lung tumours, whereas there is less evidence for other tumour types. Conclusions. Overall, based on the literature findings, WB-MRI seems to be a valid alternative method compared to PET/CT in oncology. Further larger prospective studies and in particular cost-effectiveness analysis comparing these two whole-body imaging techniques are needed to better assess the role of WB-MRI compared to FDG-PET or PET/ CT in specific tumour types.
Radiology and Oncology 01/2013; · 0.91 Impact Factor
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ABSTRACT: The aim of this study was to systematically review and meta-analyze published data on the diagnostic accuracy of positron emission tomography (PET) using fluorine-18-dihydroxyphenylalanine ([18F]DOPA) in patients with neuroendocrine tumors (NETs). A comprehensive computer literature search of the PubMed/MEDLINE, Embase and Scopus databases was conducted to identify studies on the use of [18F]DOPA PET or PET/computed tomography (PET/CT) in patients with proven or suspected NETs. Pooled sensitivity and specificity of [18F]DOPA PET and PET/CT on a per patient-based analysis were calculated. The area under the ROC curve was calculated to measure the accuracy of [18F]DOPA PET or PET/CT. Eight articles on gastroenteropancreatic and thoracic NETs, 13 on pheochromocytoma/paraganglioma (Pheo/PGL) and eight on recurrent medullary thyroid carcinoma (MTC) were included in our meta-analysis. The pooled sensitivity and specificity of [18F]DOPA PET or PET/CT in patients with thoracic and gastroenteropancreatic NETs were 77% (95% CI 71–82) and 95% (95% CI 87–98), respectively. The area under the ROC curve was 0.94. The pooled sensitivity and specificity of [18F]DOPA PET or PET/CT in patients with Pheo/PGL were 92% (95% CI 88–95) and 92% (95% CI 85–97), respectively. The area under the ROC curve was 0.95. The pooled sensitivity of [18F]DOPA PET or PET/CT in patients with recurrent MTC was 62% (95% CI 54–69). Heterogeneity was found between the studies with regard to the sensitivity of [18F]DOPA PET or PET/CT. Evidence-based data show that [18F]DOPA PET and PET/CT are accurate methods in
patients with proven or suspected NETs. Large multicenter studies are necessary to substantiate the diagnostic accuracy of [18F]DOPA PET and PET/CT in this setting.
Clinical and Translational Imaging. 01/2013;
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ABSTRACT: Radioiodinated metaiodobenzylguanidine (MIbG) was developed in the late 1970's, at the Michigan University Medical center, for imaging of the adrenal medulla and its diseases. Soon after, MIbG was shown to depict a wide range of tumors of neural crest origin other than pheochromocytomas/paragangliomas (Pheo/PGl) with the result that its use rapidly spread to many countries. After more than 30 years of clinical application, MIbG continues to be the most widespread radiopharmaceutical for the functional imaging of Pheo/PGl in spite of the emergent role of PET agents for detection of these tumors. In this paper we review the evolu-tion in the use of MIbG over more than 30 years of experimental and clinical applications, with particular focus on the uptake mechanisms, pharmacokinetics, biodistribution and drug interaction as well as on clinical studies in Pheo/PGl also in comparison to other gamma-emitters tracers and PET radiopharmaceuticals.
Hormones 01/2013; 12(1):58-68.
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ABSTRACT: We report an unusual case of a solid-pseudopapillary pancreatic tumor (SPPT) with aggressive behavior that occurred in a 16-year-old male patient. F fluorodeoxyglucose PET/CT showed increased radiopharmaceutical uptake in a solid mass of the body of the pancreas, in several liver lesions, and in multiple peritoneal implants, corresponding to an SPPT with liver and peritoneal metastases, respectively. Based on PET/CT findings, the patient was referred to chemotherapy. In this unusual case of pediatric SPPT with aggressive behavior, F fluorodeoxyglucose PET/CT has been useful in staging the disease and in treatment planning.
Clinical nuclear medicine 01/2013; 38(1):e35-7. · 3.92 Impact Factor
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Journal of Nuclear Cardiology 12/2012; · 2.67 Impact Factor
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ABSTRACT: PURPOSE: To compare myocardial sympathetic imaging using (123) I-Metaiodobenzylguanidine (MIBG) scintigraphy and striatal dopaminergic imaging using (123) I-Ioflupane (FP-CIT) single photon emission computed tomography (SPECT) in patients with suspected Lewy body diseases (LBD). METHODS: Ninety-nine patients who performed both methods within 2 months for differential diagnosis between Parkinson's disease (PD) and other parkinsonism (n= 68) or between dementia with Lewy bodies (DLB) and other dementia (n= 31) were enrolled. Sensitivity, specificity, accuracy, positive and negative predictive values of both methods were calculated. RESULTS: For (123) I-MIBG scintigraphy, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 83%, 79%, 82%, 86%, and 76%, respectively. For (123) I-FP-CIT SPECT, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 93%, 41%, 73%, 71%, and 80%, respectively. There was a statistically significant difference between these two methods in patients without LBD, but not in patients with LBD. CONCLUSIONS: LBD usually present both myocardial sympathetic and striatal dopaminergic impairments. (123) I-FP-CIT SPECT presents high sensitivity in the diagnosis of LBD; (123) I-MIBG scintigraphy may have a complementary role in differential diagnosis between PD and other parkinsonism. These scintigraphic methods showed similar diagnostic accuracy in differential diagnosis between DLB and other dementia.
Journal of neuroimaging: official journal of the American Society of Neuroimaging 11/2012; · 1.72 Impact Factor
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ABSTRACT: A 40-year-old man was admitted to our hospital for surgical treatment of aortic insufficiency and coronary ostial stenosis. Histopathology and serological tests revealed a syphilitic aortitis. F-FDG PET/CT was performed to assess the extent of aortitis, showing increased radiopharmaceutical uptake along the ascending aortic wall. A repeated FDG PET/CT after antibiotic therapy showed a markedly reduced uptake in the aortic wall, suggesting resolution of the infection according to clinical and serological data. This case highlights the usefulness of FDG PET/CT for the assessment of disease extent and treatment response in patients with syphilitic aortitis.
Clinical nuclear medicine 11/2012; · 3.92 Impact Factor
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ABSTRACT: To systematically review the literature data on the role of Fluorine-18-fluorodeoxyglucose positron emission tomography and positron emission tomography/computed tomography (FDG-PET and PET/CT) in patients with retroperitoneal fibrosis (RF), PubMed/MEDLINE, Embase and Scopus databases were searched for articles that evaluated the usefulness of FDG-PET and PET/CT in patients with RF from inception to March 31, 2012. Review articles or editorials, articles not in the field of interest of this review, case reports and preclinical studies were excluded. Only studies including FDG-PET or PET/CT scans performed in at least three patients with RF were included. Ten studies comprising a total of 101 patients with RF were found. The main findings of the included studies are described. FDG-PET and PET/CT are feasible and suitable imaging methods for evaluating patients with RF. These functional imaging techniques seem to be useful both in the diagnosis (mainly in the assessment of activity and extent of the disease) and in evaluating the treatment response in patients with RF. Given the heterogeneity among the various studies for PET analysis and diagnostic criteria, a standardization of the technique is required in order to achieve reproducible and inter-observer independent results. Moreover, further studies are needed to substantiate the role of FDG-PET and PET/CT in patients with RF.
Rheumatology International 11/2012; · 1.88 Impact Factor
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ABSTRACT: PURPOSE: Psychiatric symptoms frequently occur in patients with movement disorders. They are not a mere reaction to chronic disability, but most likely due to a combination of psychosocial factors and biochemical dysfunction underlying the movement disorder. We assessed dopamine transporter (DAT) availability by means of (123)I-FP-CIT SPECT, and motor and psychiatric features in patients with Parkinson's disease, primary dystonia and essential tremor, exploring the association between SPECT findings and symptom severity. METHODS: Enrolled in the study were 21 patients with Parkinson's disease, 14 patients with primary dystonia and 15 patients with essential tremor. The severity of depression symptoms was assessed using the Hamilton depression rating scale, anxiety levels using the Hamilton anxiety rating scale and hedonic tone impairment using the Snaith-Hamilton pleasure scale. Specific (123)I-FP-CIT binding in the caudate and putamen was calculated based on ROI analysis. The control group included 17 healthy subjects. RESULTS: As expected, DAT availability was significantly decreased in patients with Parkinson's disease, whereas in essential tremor and dystonia patients it did not differ from that observed in the control group. In Parkinson's disease patients, an inverse correlation between severity of depression symptoms and DAT availability in the left caudate was found (r = -0.63, p = 0.002). In essential tremor patients, levels of anxiety symptoms were inversely correlated with DAT availability in the left caudate (r = -0.69, p = 0.004). In dystonia patients, the severities of both anxiety and depression symptoms were inversely associated with DAT availability in the left putamen (r = -0.71, p = 0.004, and r = -0.75, p = 0.002, respectively). There were no correlations between psychometric scores and (123)I-FP-CIT uptake ratios in healthy subjects. CONCLUSION: We found association between presynaptic dopaminergic function and affective symptoms in different movement disorders. Interestingly, the inverse correlation was present in each group of patients, supporting the fascinating perspective that common subcortical substrates may be involved in both anxiety and depression dimensions and movement disorders.
European Journal of Nuclear Medicine 09/2012; · 4.53 Impact Factor
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ABSTRACT: We performed a meta-analysis on published data on the diagnostic performance of fluorine-18 dihydroxyphenylalanine ((18)F-DOPA) positron emission tomography (PET) in diagnosing and localizing focal congenital hyperinsulinism (CHI).
A comprehensive computer literature search of studies published up to 31 January 2012 regarding (18)F-DOPA PET or PET/CT in patients with CHI was performed. Pooled sensitivity and specificity, area under the ROC curve and diagnostic odds ratio (DOR) of (18)F-DOPA PET or PET/CT in diagnosing focal CHI were calculated. The localization accuracy of focal CHI was also estimated. Seven studies comprising 195 CHI patients were included.
The pooled sensitivity and specificity of (18)F-DOPA PET or PET/CT in differentiating between focal and diffuse CHI were 89% (95% confidence interval [CI]:81-95%) and 98% (95% CI:89-100%), respectively. The DOR was 74.5 (95% CI:18-307). The area under the ROC curve was 0.95. The pooled accuracy of these functional imaging methods in localizing focal CHI was 80% (95% CI:71-88%).
In CHI patients, (18)F-DOPA PET or PET/CT demonstrated high sensitivity and specificity in differentiating between focal and diffuse CHI. (18)F-DOPA PET or PET/CT are accurate methods of localizing focal CHI. Nevertheless, possible sources of false-negative results for focal CHI should be kept in mind.
Pediatric Radiology 08/2012; 42(11):1372-9. · 1.67 Impact Factor
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ABSTRACT: The aim of this study was to perform a meta-analysis of published data about the diagnostic performance of (18)F-dihydroxyphenylalanine (DOPA) positron emission tomography (PET) or PET/computed tomography (CT) in detecting recurrent medullary thyroid carcinoma (MTC).
A comprehensive literature search of studies indexed in the PubMed/MEDLINE, Scopus, and Embase databases through January 2012 and regarding (18)F-DOPA PET or PET/CT in patients with suspected recurrent MTC was carried out. Pooled detection rates (DR) in per patient and per lesion analyses were calculated. A subanalysis considering serum levels of calcitonin and carcinoembryonic antigen, device used, and carbidopa pretreatment was also performed.
Eight studies including 146 patients with suspected recurrent MTC were included. The DRs of (18)F-DOPA PET and PET/CT in per patient and per lesion analyses were 66% and 71%, respectively. DRs significantly increased in patients with serum calcitonin ≥1000 ng/L (86%) and calcitonin doubling times <24 months (86%).
Fluorine-18-DOPA PET and PET/CT may be useful functional imaging methods in detecting recurrent MTC. The DR of recurrent MTC using these imaging methods increases in patients with higher calcitonin levels and lower calcitonin doubling times.
Academic radiology 07/2012; 19(10):1290-9. · 2.09 Impact Factor
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ABSTRACT: The diagnostic performance of positron emission tomography using (11)C-methionine (MET-PET) in detecting parathyroid adenoma has been investigated by several studies with conflicting results. Aim of our study is to meta-analyze published data about this topic. A comprehensive computer literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through May 2012 and regarding the diagnostic performance of MET-PET in patients with parathyroid adenoma was carried out. No language restriction was used. Only articles in which at least five patients with parathyroid adenoma underwent MET-PET were included in the meta-analysis. Pooled sensitivity and detection rate (DR) on a per patient-based analysis were calculated to assess the diagnostic performance of MET-PET. Nine studies comprising 258 patients with suspected parathyroid adenoma were included in this meta-analysis. Pooled sensitivity and DR values of MET-PET in patients with suspected parathyroid adenoma were 81 % (95 % confidence interval [95 %CI] 74-86 %) and 70 % (95 %CI 62-77 %), respectively, on a per patient-based analysis. The included studies were heterogeneous in their estimate of sensitivity and DR. Our meta-analysis demonstrates that MET-PET is a sensitive and reliable tool in patients with suspected parathyroid adenoma. Thus, this imaging method could be helpful in patients with diagnosis of primary hyperparathyroidism when conventional imaging techniques are negative or inconclusive in localizing parathyroid adenoma.
Endocrine 07/2012; · 1.42 Impact Factor
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ABSTRACT: To evaluate the metabolic changes on ¹⁸F-fluoro-2-deoxyglucose positron emission tomography integrated with computed tomography (¹⁸ F-FDG PET-CT) performed before, during and after concurrent chemo-radiotherapy in patients with locally advanced non-small cell lung cancer (NSCLC); to correlate the metabolic response with the delivered radiation dose and with the clinical outcome.
Twenty-five NSCLC patients candidates for concurrent chemo-radiotherapy underwent ¹⁸F-FDG PET-CT before treatment (pre-RT PET-CT), during the third week (during-RT PET-CT) of chemo-radiotherapy, and 4 weeks from the end of chemo-radiotherapy (post-RT PET-CT). The parameters evaluated were: the maximum standardized uptake value (SUVmax) of the primary tumor, the SUVmax of the lymph nodes, and the Metabolic Tumor Volume (MTV).
SUVmax of the tumor and MTV significantly (p=0.0001, p=0.002, respectively) decreased earlier during the third week of chemo-radiotherapy, with a further reduction 4 weeks from the end of treatment (p<0.0000, p<0.0002, respectively). SUVmax of lymph nodes showed a trend towards a reduction during chemo-radiotherapy (p=0.06) and decreased significantly (p=0.0006) at the end of treatment. There was a significant correlation (r=0.53, p=0.001) between SUVmax of the tumor measured at during-RT PET-CT and the total dose of radiotherapy reached at the moment of the scan. Disease progression free survival was significantly (p=0.01) longer in patients with complete metabolic response measured at post-RT PET-CT.
In patients with locally advanced NSCLC, ¹⁸F-FDG PET-CT performed during and after treatment allows early metabolic modifications to be detected, and for this SUVmax is the more sensitive parameter. Further studies are needed to investigate the correlation between the metabolic modifications during therapy and the clinical outcome in order to optimize the therapeutic strategy. Since the metabolic activity during chemo-radiotherapy correlates with the cumulative dose of fractionated radiotherapy delivered at the moment of the scan, special attention should be paid to methodological aspects, such as the radiation dose reached at the time of PET.
Radiation Oncology 07/2012; 7:106. · 2.32 Impact Factor
