Hellenic journal of nuclear medicine最新文献

Objective: Neurolymphomatosis (NL) is a rare but serious manifestation defined as invasion of peripheral nervous system by malignant lymphocytes. Thus, this study investigated fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) and clinicopathological characteristics of NL in lymphoma patients.

Subjects and methods: Clinicopathological and ¹⁸F-FDG PET/CT findings and treatment regimens were retrospectively investigated in 20 lymphoma patients with NL, and analyzed their correlation with progression-free survival (PFS) and overall survival (OS).

Results: These 20 lymphoma patients (11 males, 9 females; median age, 49 years) included 10 primary and 10 secondary NL patients. Non-Hodgkin's lymphoma (NHL) was noted in 19 patients, B-cell NHL was associated with 18 cases, and diffuse large B-cell lymphoma was the most common. Notably, 18 patients were aggressive lymphoma while 2 were indolent lymphoma. The affected neural structures included nerve roots (n=17), peripheral nerves (n=3), cranial nerves (n=3), and neural plexus (n=2). Fluorine-18-FDG was avid in all cases, and the median maximum standardized uptake value (SUVmax) of neural and all lesions was 12.2 (range, 3.3-25.6) and 15.0 (range, 4.4-34.2), respectively. The median PFS and OS of all patients were 9.3 and 14.3 months. The 12-month OS rate of 18 patients with aggressive lymphoma receiving intrathecal chemotherapy/autologous stem cell transplants (IT chem/ASCT) was significantly higher than who did not (64.8% vs 15.9%).

Conclusion: The majority of NL occurred in patients with aggressive lymphoma, of which B-cell NHL were the predominant subtypes. Fluorine-18-FDG PET/CT imaging of NL was mainly characterized by intense glucose accumulation alongside peripheral nerves, and IT chem/ASCT was suggested to improve the outcomes of NL.

Objective: This study was conducted to investigate the utility of standardized uptake value (SUV) derived from bone single photon emission tomography/computed tomography (SPECT/CT) for diagnosing bone metastasis.

Subjects and methods: One hundred forty-seven patients with malignant cancer (breast or prostate cancer), joint disorders, primary skeletal disease, or cartilaginous bone neoplasms who underwent skeletal quantitative SPECT/CT were retrospectively investigated. Acquired data were classified as normal fourth lumbar vertebra, skeletal degenerative changes, or bone metastasis. Receiver operating characteristic (ROC) curves were used to determine the optimum cut-off value for SUVmax to distinguish among these diagnoses.

Results: Mean SUVmax values for the normal L4 bone (n=101), skeletal degenerative changes (n=47) and bone metastasis (n=64) groups were 4.47±1.66 (range 1.01-11.25), 6.99±2.58 (2.21-14.6), and 25.4±15.7 (3.88-98.87), respectively. Compared to the other two groups, SUVmax for the bone metastasis group was significantly higher (P<0.001). In the normal bone group, sensitivity, specificity and accuracy for discriminating bone metastasis were 96.3%, 95.1%, and 95.7% respectively, with a best SUVmax cut-off value of 7.40. For the skeletal degenerative changes group sensitivity, specificity and accuracy were 87.5%, 93.6%, and 90.4% respectively, with a best SUVmax cut-off value of 11.26.

Conclusion: Quantitative bone SPECT/CT may be useful for bone metastasis diagnosis.

Objective: The aim of this study is to investigate the roles of pre- and post- treatment quantitative fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) and their rate of change in predicting pathological complete response (pCR) in patients with local and locally advanced invasive breast cancer receiving neoadjuvant chemotherapy (NAC).

Subjects and methods: Ninety-eight patients who received NAC after being diagnosed with local and locally advanced invasive breast cancer between January 2017 and September 2021 were retrospectively included in our study. Molecular subtypes of all patients were determined. Maximum SUV, MTV, TLG, percent change in SUVmax (ΔSUVmax), ΔMTV, and ΔTLG obtained from PET/CT scans performed before and after NAC were calculated. The cut-off, AUC, sensitivity, and specificity values of these parameters in predicting pCR were calculated using receiver operating characteristic (ROC) curves.

Results: ΔTMTV (cut-off 94.01%, AUC: 0.846), ΔTTLG (cut-off 97.36%, AUC: 0.870), B2MTV (cut-off<1.75, AUC: 0.764), B2TLG (cut-off<2.11, AUC: 0.764), B2SUVmax (cut-off<1.58, AUC: 0.767), ΔBMTV (cut-off 93.67%, AUC: 0.851), ΔBTLG (cut-off 97.22%, AUC: 0.870), ΔBSUVmax (cut-off 84.99%, AUC: 0.846) calculated using ROC curves were found to significantly predict pCR with high sensitivity and specificity.

Conclusion: We concluded that metabolic and volumetric PET/CT parameters, the rates of their change, and metabolic response during NAC may be important variables in predicting pCR in patients with breast cancer.

Technetium-99m (^99mTc)-labeled pyrophosphate (PYP) and 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) are currently the most established imaging agents for the diagnosis of cardiac amyloidosis, being able to distinguish light chain (AL) from transthyretin (TTR) type of the disease. We present a pattern of increased uptake in all soft tissues, sparing the organs that are usually most affected.

A 52-year old woman with fever of unknown origin underwent fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) scan for further evaluation. A clinical history of cervical cancer (CIS) operated 20 years ago was documented. Two foci in the right lobe of the slightly enlarged liver presented increased ¹⁸F-FDG uptake. Visceral brucellosis was diagnosed via blood culture. The patient received anti-brucella therapy and recovered rapidly, the liver lesions diminished on control CT.

Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is an exceedingly rare neoplastic disease with a predisposition in immune-compromised individuals, especially in patients with prior transplantation, human immunodeficiency virus infection, or congenital immunodeficiency. Here, we present imaging findings of EBV-SMT in multiphasic contrast-enhanced computed tomography (CT) and fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/CT in a two-and-a-half-year-old boy with prior heart transplantation.

Objective: The aim of this study was to assess the diagnostic value of gallium-68-prostate specific membrane antigen (⁶⁸Ga-PSMA) positron emission tomography/computed tomography (PET/CT) in detecting metastases in prostate cancer (PCa) patients.

Materials and methods: A comprehensive literature search of studies published before August 2021 in PubMed, Embase and Cochrane Library databases was conducted.The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Studies investigating the diagnostic value of ⁶⁸Ga-PSMA PET/CT were selected for qualitative and quantitative analysis.

Results: Twenty-five articles using ⁶⁸Ga-PSMA PET/CT for detecting metastases in PCa patients were selected for qualitative analysis, 16 of which were selected for meta-analysis. The sensitivities of ⁶⁸Ga-PSMA PET/CT in detecting lymph node metastases ranged from 33.3% to 96.08%, with high specificities ranged from 82% to 100%. Gallium-68-PSMA PET/CT demonstrated outstanding diagnostic performance in PCa patients with bone metastases. Only two articles about ⁶⁸Ga-PSMA PET/CT for lung metastases showed that the detection value was limited. It was difficult to distinguish lung metastases in PCa patients from benign lesions or primary lung cancer. There was only one article about ⁶⁸Ga-PSMA PET/CT for liver metastases, which showed that about 77.7% of metastatic lesions will be ⁶⁸Ga-PSMA-positive and 22.3% will be false negatives. Due to the lack of articles on PCa visceral metastases, we only conducted a meta-analysis on lymph node metastases and bone metastases. In our meta-analysis, the per-patient pooled sensitivity, specificity, positive likelihood ratio (LR⁺), negative likelihood ratio (LR^-), diagnostic odds ratio (DOR), and the area under the ROC curve (AUC) of lymph node metastases were 0.61, 0.96, 14.4, 0.41, 35, and 0.95, respectively. The per-lesion pooled sensitivity, specificity, LR⁺, LR^-, DOR, and AUC of V were 0.74, 0.99, 76.0, 0.26, 289 and 0.99, respectively. The per-patient pooled sensitivity, specificity, LR⁺, LR^-, DOR, and AUC of bone metastases were 0.97, 1.00, 1100.1, 0.03, 37490 and 0.98, respectively.

Conclusion: Gallium-68-PSMA PET/CT demonstrated outstanding diagnostic performance for bone metastases in PCa patients. The majority of lymph node metastases, lung metastases, and liver metastases overexpressed PSMA, which could be directly detected. However, a considerable number of lesions were false negatives.

Objective: To evaluate the compatibility between ventilation/perfusion (V/Q) single photon emission computed tomography (SPECT) scintigraphy and computed tomography pulmonary angiography (CTPA) in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH).

Subject and methods: Twenty cases of CTEPH, out of 98 patients with pre-diagnosis of pulmonary hypertension (PH), who was diagnosed with CTEPH with a multidisciplinary approach and a council decision, were included in the study retrospectively. The diagnostic performances of V/Q SPECT and CTPA, which are used as noninvasive methods in diagnosing CTEPH, and the compatibility between them were calculated statistically.

Results: Of 20 patients diagnosed with CTEPH, 12 were female, and 8 were male; the mean age was 59.1 (range: 36-79). The sensitivity of V/Q SPECT scintigraphy of imaging methods used to diagnose CTEPH was 90%, CTPA was 80%, specificities were 88% and 92%, respectively, and accuracy was 88% in both cases methods. According to the reference standard, the kappa value for V/Q scintigraphy was calculated as 0.765 and 0.678 for CTPA. These values were statistically significant (P<0.01), and there was a substantial concordance between them.

Conclusion: There is significant compatibility between V/Q SPECT scintigraphy and CTPA in diagnosing CTEPH, whose differential diagnosis is essential because of its high cure potential due to PH causes.