[Show abstract][Hide abstract] ABSTRACT: We describe a rare case of primary pulmonary synovial sarcoma (PPSS) that occurred in a pediatric patient and evaluated by 18F-FDG PET/CT. A 14-year-old male patient underwent 18F-FDG PET/CT for metabolic characterization of a left pulmonary mass which showed increased 18F-FDG uptake (SUVmax = 4.5). Based on this PET/CT finding, the patient underwent a CTguided biopsy which demonstrated the presence of a PPSS. Other sites of disease were excluded. 18F-FDG PET/CT may be useful for staging pediatric patients with PPSS.
Clinical nuclear medicine 02/2014; 39(2):e166-8. · 3.92 Impact Factor
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] ABSTRACT: Objective. To meta-analyze published data about prevalence and malignancy risk of focal colorectal incidentalo-mas (FCIs) detected by Fluorine-18-Fluorodeoxyglucose positron emission tomography or positron emission tomogra-phy/computed tomography (18 F-FDG-PET or PET/CT).
Methods. A comprehensive computer literature search of studies published through July 31 st 2012 regarding FCIs detected by 18 F-FDG-PET or PET/CT was performed. Pooled prevalence of patients with FCIs and risk of malignant or premalignant FCIs after colonoscopy or histopathology verification were calculated. Furthermore, separate calcula-tions for geographic areas were performed. Finally, average standardized uptake values (SUV) in malignant, prema-lignant and benign FCIs were reported.
Results. Thirty-two studies comprising 89,061 patients evaluated by 18 F-FDG-PET or PET/CT were included. The pooled prevalence of FCIs detected by 18 F-FDG-PET or PET/CT was 3.6% (95% confidence interval [95% CI]: 2.6-4.7%). Overall, 1,044 FCIs detected by 18 F-FDG-PET or PET/CT underwent colonoscopy or histopathology evaluation. Pooled risk of malignant or premalignant lesions was 68% (95% CI: 60-75%). Risk of malignant and premalignant FCIs in Asia-Oceania was lower compared to that of Europe and America. A significant overlap in average SUV was found between ma-lignant, premalignant and benign FCIs. Conclusions. FCIs are observed in a not negligible number of patients who undergo 18 F-FDG-PET or PET/CT studies with a high risk of malignant or premalignant lesions. SUV is not reliable as a tool to differentiate between malignant, premalignant and benign FCIs. Further investigation is warranted whenever FCIs are detected by 18 F-FDG-PET or PET/CT.
Radiology and Oncology 01/2013; · 1.67 Impact Factor
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The aim of our preliminary study was to evaluate the potential role of (18)F-FDG PET-CT in monitoring response to reduced-intensity conditioning (RIC) transplant in a small series of chronic lymphocytic leukemia (CLL) patients and to compare the results with those obtained by standard criteria. METHODS: We retrospectively analyzed 9 consecutive refractory/relapsed CLL patients, who underwent RIC transplant from March 2004 until May 2009. PET-CT was planned at 6-8 months after transplant to assess response and at a mean of 6 months during follow-up. The mean long-term follow-up period was 38 months (range 12-74 months, median 29 months). RESULTS: The first PET-CT showed abnormal (18)F-FDG uptake in five patients, while by standard criteria eight patients showed persistent disease. At the end of follow-up (mean 38 months), all four patients with previously negative scan were still PET negative and in complete remission by standard criteria. All five patients with previously positive scan were still PET positive: one patient died for disease progression and four are alive with disease. CONCLUSIONS: Our preliminary data, although in a small series of CLL patients, suggest that the metabolic findings revealed at first PET-CT after transplant seem to predict the patient outcome and to assess the metabolic disease status earlier than clinical evaluation by standard criteria. PET-CT performed during follow-up may be useful to early detect disease progression.
Annals of Nuclear Medicine 08/2012; · 1.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: F-fluoro-deoxy-glucose (18F-FDG) positron emission tomography integrated/combined with computed tomography (PET-CT) provides the best diagnostic results in the metabolic characterization of undetermined solid pulmonary nodules. The diagnostic performance of 18F-FDG is similar for nodules measuring at least 1 cm and for larger masses, but few data exist for nodules smaller than 1 cm. CASE PRESENTATION: We report five cases of oncologic patients showing focal lung 18F-FDG uptake on PET-CT in nodules smaller than 1 cm. We also discuss the most common causes of 18F-FDG false-positive and false-negative results in the pulmonary parenchyma. In patient 1, contrast-enhanced CT performed 10 days before PET-CT did not show any abnormality in the site of uptake; in patient 2, high-resolution CT performed 1 month after PET showed a bronchiole filled with dense material interpreted as a mucoid impaction; in patient 3, contrast-enhanced CT performed 15 days before PET-CT did not identify any nodules; in patients 4 and 5, contrast-enhanced CT revealed a nodule smaller than 1 cm which could not be characterized. The 18F-FDG uptake at follow-up confirmed the malignant nature of pulmonary nodules smaller than 1 cm which were undetectable, misinterpreted, not recognized or undetermined at contrast-enhanced CT. CONCLUSION: In all five oncologic patients, 18F-FDG was able to metabolically characterize as malignant those nodules smaller than 1 cm, underlining that: 18F-FDG uptake is not only a function of tumor size but it is strongly related to the tumor biology; functional alterations may precede morphologic abnormalities. In the oncologic population, especially in higher-risk patients, PET can be performed even when the nodules are smaller than 1 cm, because it might give an earlier characterization and, sometimes, could guide in the identification of alterations missed on CT.
World Journal of Surgical Oncology 04/2012; 10(1):71. · 1.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The diagnosis of spondylodiscitis can be difficult, because the patients history, subjective symptoms and physical findings are often inconclusive, particularly in the early stages.
To perform an overview on the role of nuclear medicine procedures with single photon emission tomography (SPET) and positron emission tomography (PET) tracers in the diagnosis of spondylodiscitis.
A literature review about bone scintigraphy, Gallium-67-citrate scintigraphy, labeled leukocytes scintigraphy and PET was performed. Main findings of the literature were reported.
Bone scintigraphy is a sensitive and widely available nuclear medicine technique, but it is characterized by low specificity. Gallium-67-citrate scintigraphy is often used as a complement to bone scintigraphy to enhance the specificity of the study and to detect extra-osseous sites of infection. Labeled leukocytes scintigraphy is not a useful method in the diagnosis of spondylodiscitis. Fluorine-18-fluorodeoxyglucose positron emission tomography is a sensitive method and could potentially be useful in the diagnosis of spondylodiscitis and in the evaluation of treatment response. Nevertheless, scientific literature about this topic is still limited.
Overall, nuclear medicine procedures play a useful role in the diagnosis of spondylodiscitis identifying functional abnormalities which precede morphological changes. Therefore, nuclear medicine procedures may complement or integrate morphological imaging findings in patients with suspected spondylodiscitis.
European review for medical and pharmacological sciences 04/2012; 16 Suppl 2:20-5. · 0.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 64-year-old man was referred to our center for metabolic characterization of 2 bilateral pulmonary lesions, incidentally detected at computed tomography (CT). F-FDG PET/CT scan showed a weak radiopharmaceutical uptake in both pulmonary lesions. A subsequent Ga-DOTANOC PET/CT showed intense radiopharmaceutical uptake in both pulmonary lesions. Subsequently, the patient underwent histopathological examinations of both lesions, which showed a synchronous well-differentiated pulmonary neuroendocrine carcinoma (typical carcinoid tumor). This case reports a rare occurrence of synchronous pulmonary carcinoid, highlighting the role of different PET tracers for metabolic characterization of pulmonary nodules.
Clinical nuclear medicine 04/2012; 37(4):e91-4. · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction: The purpose of this article is to examine the emerging role of whole-body positron
emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in patients with sarcoidosis.
Materials and methods: We reviewed the literature on the use of FDG-PET in patients with
sarcoidosis to identify how this technique is being applied in clinical practice.
Results and discussion: Our review shows that: 1) sarcoidosis is commonly associated with
increased FDG uptake. Therefore, positive findings should be interpreted with caution when
FDG-PET is being used to distinguish benign from malignant abnormalities; 2) FDG-PET seems to
be a very useful molecular imaging method for staging sarcoidosis, identification of occult sites of
involvement, guiding biopsy procedures, and monitoring patients’ responses to treatment; and 3)
in patients with sarcoidosis, the diagnostic accuracy of FDG-PET is superior to that of 67Ga
[Show abstract][Hide abstract] ABSTRACT: Aim. To systematically review the role of positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (FDG) in patients with neurofibromatosis type 1 (NF1). Methods. A comprehensive literature search of published studies regarding FDG-PET and PET/CT in patients with NF1 was performed. No beginning date limit and language restriction were used; the search was updated until December 2011. Only those studies or subsets in studies including whole-body FDG-PET or PET/CT scans performed in patients with NF1 were included. Results. We identified 12 studies including 352 NF1 patients. Qualitative evaluation was performed in about half of the studies and semiquantitative analysis, mainly based on different values of SUV cutoff, in the others. Most of the studies evaluated the role of FDG-PET for differentiating benign from malignant peripheral nerve sheath tumors (MPNSTs). Malignant lesions were detected with a sensitivity ranging between 100% and 89%, but with lower specificity, ranging between 100% and 72%. Moreover, FDG-PET seems to be an important imaging modality for predicting the progression to MPNST and the outcome in patients with MPNST. Two studies evaluated the role of FDG-PET in pediatric patients with NF1. Conclusions. FDG-PET and PET/CT are useful methods to identify malignant change in neurogenic tumors in NF1 and to discriminate malignant from benign neurogenic lesions.
Radiology research and practice. 01/2012; 2012:431029.
[Show abstract][Hide abstract] ABSTRACT: This study was designed to systematically review the emerging role of whole-body positron emission tomography (PET) with 18F-Fluorodeoxyglucose (FDG) in patients with sarcoidosis.
A comprehensive literature search of published studies through December 2010 in PubMed/MEDLINE and Embase databases regarding whole-body FDG-PET and PET/CT in patients with sarcoidosis was performed.
Ultimately, we identified nine studies comprising a total of 379 patients with sarcoidosis. Main findings of the included studies are presented.
from this systematic review we can summarize that: (1) positive FDG-PET findings should be interpreted with caution in differentiating sarcoidosis from other inflammatory diseases and malignant abnormalities; (2) FDG-PET seems to be a very useful molecular imaging method in assessing disease activity, in staging and identifying occult sites, and in monitoring treatment response in patients with sarcoidosis; (3) FDG-PET shows a better diagnostic accuracy compared to 67Ga scintigraphy in patients with sarcoidosis, because of a better sensitivity of FDG-PET (mainly due to the high quality of FDG-PET images with superior contrast and spatial resolution compared to 67Ga scintigraphy) in addition to several practical advantages (less radiation exposure, shorter time between injection and imaging).
Sarcoidosis, vasculitis, and diffuse lung diseases: official journal of WASOG / World Association of Sarcoidosis and Other Granulomatous Disorders 10/2011; 28(2):87-94. · 1.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: (1) To investigate the diagnostic value of some O-(2-[F]fluoroethyl)-L-tyrosine (F-18 FET) indices derived from the dynamic acquisition to differentiate low-grade gliomas from high-grade; (2) to analyze the course of tumor time-activity curves (TACs); and (3) to calculate the individual probability of a high-grade glioma using the logistic regression.
Seventeen low-grade (WHO I-II) and 15 high-grade (WHO III-IV) gliomas were studied with dynamic F-18 FET PET. Regions of interests were drawn over the tumor and contralateral brain, and TACs were analyzed. We considered early standardized uptake value (SUV), middle SUV, late SUV, early-to-middle SUV tumor ratio, early-to-late SUV tumor ratio; time to peak (Tpeak), in minutes, from the beginning of the dynamic acquisition up to the maximum SUV of the tumor; and SoD (sum of the frame-to-frame differences). To assess the individual probability of high-grade, logistic regression was also used.
High-grade gliomas showed significantly (P < 0.0001) higher values when compared with low-grade gliomas in early SUV, early-to-middle ratio, early-to-late ratio, Tpeak, and SoD. For the grading of gliomas, the best indices were early-to-middle ratio and Tpeak providing a diagnostic accuracy of 94%. TACs analysis provided an 87% diagnostic accuracy. For individual high-grade diagnosis, the logistic regression provided 93% sensitivity, 100% specificity, and 97% accuracy.
Early-to-middle SUV tumor ratio and Tpeak were the best indices for assessing the grading of gliomas. Since early-to-middle ratio derives from the first 35 minutes of the dynamic acquisition, the PET study could last half an hour instead of 1 hour. By logistic regression, it is possible to assess the individual probability of high-grade, useful for prognosis and treatment.
Clinical nuclear medicine 10/2011; 36(10):841-7. · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was designed to review the emerging role of fluorine 18 fluorodeoxyglucose (¹⁸F-FDG)-positron emission tomography (PET) CT/computed tomography (PET/CT) in patients with mycobacteriosis.
A comprehensive literature search of published studies through October 2010 in PubMed/MEDLINE database regarding ¹⁸F-FDG-PET and PET/CT in patients with mycobacteriosis was performed.
Ultimately, we identified 16 studies comprising a total of 220 patients with mycobacteriosis. Main findings of the included studies are presented.
(1) Mycobacteriosis commonly causes increased ¹⁸F-FDG uptake; therefore, positive ¹⁸F-FDG-PET results should be interpreted with caution in differentiating benign from malignant abnormalities. (2) ¹⁸F-FDG-PET and PET/CT are potentially useful in detecting sites of Mycobacterium infection. (3) Dual-phase ¹⁸F-FDG-PET is not useful for the differential diagnosis between malignant lesions and sites of Mycobacterium infection. (4) ¹⁸F-FDG-PET and PET/CT are useful for the evaluation of disease activity and in monitoring response to therapy in patients with mycobacteriosis. (5) Dual-tracer PET and PET/CT are potentially useful for presumptive diagnosis of solitary pulmonary nodules.