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De Jong, W. K., H. F. Van der Heijden, J. Pruim, W. J. Oyen, and H. J. Groen. "Prognostic value of different standard uptake values (SUV) of primary tumor measured with FDG-PET in resectable non-small cell lung cancer." Journal of Clinical Oncology 24, no. 18_suppl (2006): 7214. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.7214.
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7214 Background: The SUV is a measure for the preferential uptake of a radiopharmaceutical in a tumor compared with a homogenous distribution in a body. SUV can be based on the maximum value (SUVmax) or on the mean value in a region outlined by isodensity contours, e.g., 70% and 50%. The prognostic value of the different SUVs in non-small cell lung cancer (NSCLC) is not clear. We evaluated the prognostic value of SUVmax, SUV 70% and SUV 50% in patients (pts) with resectable NSCLC. Methods: All consecutive pts who underwent an attenuation corrected whole body FDG-PET scan were selected. All data were reconstructed iteratively. Only pts with stage I through IIIA NSCLC were included. By adjusting the isocontour in the region of interest, the SUVmax, SUV 70% and SUV 50% of the primary tumor were calculated. Cox regression analysis was used to calculate the relation between the different SUVs and survival. Results: Eighty-four pts (67 males, median age 64 years, range 38–86) were included. Histology was squamous cell carcinoma (n = 43), adenocarcinoma (n = 27), large cell carcinoma (n = 13), and 1 patient with bronchoalveolar carcinoma. Nineteen pts had stage IA, 28 stage IB, 4 stage IIA, 19 stage IIB, and 14 stage IIIA. Median (range) SUVmax, SUV 70%, and SUV 50% were 6.9 (1.6–32.5), 5.5 (1.0–23.2), and 4.5 (0.9–21.9), respectively. Analysis of residuals of SUVmax as a continuous variable suggests no cut-off point and no indication of time-dependency. By univariate analysis, all pts with a SUV higher than the median value had a worse survival than pts with a SUV lower than median (Hazard ratio’s for SUVmax, SUV70% and SUV 50% were 2.3 (p = 0.024), 2.5 (p = 0.015), and 2.7 (p = 0.010), respectively). Conclusions: SUVmax, SUV 70% and SUV 50% measured with FDG-PET have a similar prognostic impact. No cut-off point for SUVmax has been observed. No significant financial relationships to disclose.
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Walker, Matthew D., Katherine Dinelle, Rick Kornelsen, et al. "[11C]PBR28 PET Imaging is Sensitive to Neuroinflammation in the Aged Rat." Journal of Cerebral Blood Flow & Metabolism 35, no. 8 (2015): 1331–38. http://dx.doi.org/10.1038/jcbfm.2015.54.
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Neuroinflammation in the aging rat brain was investigated using [11C]PBR28 microPET (positron emission tomography) imaging. Normal rats were studied alongside LRRK2 p.G2019S transgenic rats; this mutation increases the risk of Parkinson's disease in humans. Seventy [11C]PBR28 PET scans were acquired. Arterial blood sampling enabled tracer kinetic modeling and estimation of VT. In vitro autoradiography was also performed. PBR28 uptake increased with age, without differences between nontransgenic and transgenic rats. In 12 months of aging (4 to 16 months), standard uptake value (SUV) increased by 56% from 0.44 to 0.69 g/mL, whereas VT increased by 91% from 30 to 57 mL/cm3. Standard uptake value and VT were strongly correlated (r = 0.52, 95% confidence interval (CI) = 0.31 to 0.69, n = 37). The plasma free fraction, fp, was 0.21 ± 0.03 (mean ± standard deviation, n = 53). In vitro binding increased by 19% in 16 months of aging (4 to 20 months). The SUV was less variable across rats than VT; coefficients of variation were 13% ( n = 27) and 29% ( n = 12). The intraclass correlation coefficient for SUV was 0.53, but was effectively zero for VT. These data show that [11C]PBR28 brain uptake increases with age, implying increased microglial activation in the aged brain.
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Rohani, Mohd Fazrin Mohd, Siti Nurshahirah Mohd Yonan, Nashrulhaq Tagiling, Wan Mohd Nazlee Wan Zainon, Yusri Udin, and Norazlina Mat Nawi. "Standardized Uptake Value from Semiquantitative Bone Single-Photon Emission Computed Tomography/Computed Tomography in Normal Thoracic and Lumbar Vertebrae of Breast Cancer Patients." Asian Spine Journal 14, no. 5 (2020): 629–38. http://dx.doi.org/10.31616/asj.2019.0308.
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Study DesignRetrospective study.PurposeThis study aims to semiquantitatively evaluate the standardized uptake value (SUV) of 99mTc-methylene diphosphonate (MDP) radionuclide tracer in the normal vertebrae of breast cancer patients using an integrated single-photon emission computed tomography (SPECT)/computed tomography (CT) scanner.Overview of LiteratureMolecular imaging techniques using gamma cameras and stand-alone SPECT have traditionally been utilized to evaluate metastatic bone diseases. However, these methods lack quantitative analysis capabilities, impeding accurate uptake characterization.MethodsA total of 30 randomly selected female breast cancer patients were enrolled in this study. The SUV mean (SUVmean) and SUV maximum (SUVmax) values for 286 normal vertebrae at the thoracic and lumbar levels were calculated based on the patients’ body weight (BW), body surface area (BSA), and lean body mass (LBM). Additionally, 106 degenerative joint disease (DJD) lesions of the spine were also characterized, and both their BW SUVmean and SUVmax values were obtained. A receiver operating characteristic (ROC) curve analysis was then performed to determine the cutoff value of SUV for differentiating DJD from normal vertebrae.ResultsThe mean±standard deviations for the SUVmean and SUVmax in the normal vertebrae displayed a relatively wide variability: 3.92±0.27 and 6.51±0.72 for BW, 1.05±0.07 and 1.75±0.17 for BSA, and 2.70±0.19 and 4.50±0.44 for LBM, respectively. Generally, the SUVmean had a lower coefficient of variation than the SUVmax. For DJD, the mean±standard deviation for the BW SUVmean and SUVmax was 5.26±3.24 and 7.50±4.34, respectively. Based on the ROC curve, no optimal cutoff value was found to differentiate DJD from normal vertebrae.ConclusionsIn this study, the SUV of 99mTc-MDP was successfully determined using SPECT/CT. This research provides an approach that could potentially aid in the clinical quantification of radionuclide uptake in normal vertebrae for the management of breast cancer patients.
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Luo, J. "SU-FF-I-78: Estimate Standard Uptake Value (SUV) in F18 FDG PET Tumor Imaging." Medical Physics 33, no. 6Part4 (2006): 2014–15. http://dx.doi.org/10.1118/1.2240758.
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Castellucci, P., P. S. Duarte, and A. Alavi. "DETECTION OF BONE METASTASIS WITH FDG-PET USING STANDARD UPTAKE VALUE (SUV) AND VISUAL ANALYSIS." Clinical Nuclear Medicine 24, no. 6 (1999): 469. http://dx.doi.org/10.1097/00003072-199906000-00032.
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Poyraz, Necdet, Cihan Şimşek, Celalettin Korkmaz, and Buğra Kaya. "Functional imaging in non-small cell lung carcinoma: Correlation between standardized uptake values and apparent diffusion coefficient values." International Journal Of Medical Science And Clinical Invention 5, no. 4 (2018): 3721–26. http://dx.doi.org/10.18535/ijmsci/v5i4.01.
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Objective: To investigate the relationship between apparent diffusion coefficient (ADC) values and standard uptake value (SUV) in patients with non-small cell lung cancer (NSCLC).
 Methods: PET/CT and diffusion-weighted magnetic resonance imaging (DW MRI) were performed in 73 consecutive patients with histologically verified NSCLC. Analysing the PET/CT data calculation of the maximum and mean SUV was performed. The mean and minimum ADC values were measured directly on the parametric ADC maps.
 Results: Significant inverse correlations were found between ADCmean and SUVmean (r = - 0.53; p < 0.001) as well as ADCmin and SUVmax (r = - 0.71; p < 0.001).
 Conclusions: The significant negative correlations between ADC and SUV suggest an association between tumor cellularity and metabolic activity in NSCLC.
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Groot Jebbink, Erik, Leo H. van Den Ham, Beau B. J. van Woudenberg, et al. "Physiological Appearance of Hybrid FDG–Positron Emission Tomography/Computed Tomography Imaging Following Uncomplicated Endovascular Aneurysm Sealing Using the Nellix Endoprosthesis." Journal of Endovascular Therapy 27, no. 3 (2020): 509–15. http://dx.doi.org/10.1177/1526602820913888.
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Purpose: To investigate the physiological uptake of hybrid fluorine-18-fluorodeoxyglucose (FDG)–positron emission tomography/computed tomography (PET/CT) before and after an uncomplicated endovascular aneurysm sealing (EVAS) procedure as a possible tool to diagnose EVAS graft infection and differentiate from postimplantation syndrome. Materials and Methods: Eight consecutive male patients (median age 78 years) scheduled for elective EVAS were included in the prospective study ( ClinicalTrials.gov identifier NCT02349100). FDG-PET/CT scans were performed in all patients before the procedure and 6 weeks after EVAS. The abdominal aorta was analyzed in 4 regions: suprarenal, infrarenal neck, aneurysm sac, and iliac. The following parameters were obtained for each region: standard uptake value (SUV), tissue to background ratio (TBR), and visual examination of FDG uptake to ascertain its distribution. Demographic data were obtained from medical files and scored based on reporting standards. Results: Visual examination showed no difference between pre- and postprocedure FDG uptake, which was homogenous. In the suprarenal region no significant pre- and postprocedure differences were observed for the SUV and TBR parameters. The infrarenal neck region showed a significant decrease in the SUV and no significant decrease in the TBR. The aneurysm sac and iliac regions both showed a significant decrease in SUV and TBR between the pre- and postprocedure scans. Conclusion: Physiological FDG uptake after EVAS was stable or decreased with regard to the preprocedure measurements. Future research is needed to assess the applicability and cutoff values of FDG-PET/CT scanning to detect endograft infection after EVAS.
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Deng, Shengming, Zhifang Wu, Yiwei Wu, et al. "Meta-Analysis of the Correlation between Apparent Diffusion Coefficient and Standardized Uptake Value in Malignant Disease." Contrast Media & Molecular Imaging 2017 (2017): 1–16. http://dx.doi.org/10.1155/2017/4729547.
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The objective of this meta-analysis is to explore the correlation between the apparent diffusion coefficient (ADC) on diffusion-weighted MR and the standard uptake value (SUV) of 18F-FDG on PET/CT in patients with cancer. Databases such as PubMed (MEDLINE included), EMBASE, and Cochrane Database of Systematic Review were searched for relevant original articles that explored the correlation between SUV and ADC in English. After applying Fisher’s r-to-z transformation, correlation coefficient (r) values were extracted from each study and 95% confidence intervals (CIs) were calculated. Sensitivity and subgroup analyses based on tumor type were performed to investigate the potential heterogeneity. Forty-nine studies were eligible for the meta-analysis, comprising 1927 patients. Pooled r for all studies was −0.35 (95% CI: −0.42–0.28) and exhibited a notable heterogeneity (I2 = 78.4%; P < 0.01). In terms of the cancer type subgroup analysis, combined correlation coefficients of ADC/SUV range from −0.12 (lymphoma, n = 5) to −0.59 (pancreatic cancer, n = 2). We concluded that there is an average negative correlation between ADC and SUV in patients with cancer. Higher correlations were found in the brain tumor, cervix carcinoma, and pancreas cancer. However, a larger, prospective study is warranted to validate these findings in different cancer types.
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Favier, L., A. Berriolo-Riedinger, B. Coudert, et al. "Predicative value of [18F]-FDG PET scan for pathological complete response to neoadjuvant chemotherapy in breast cancer." Journal of Clinical Oncology 25, no. 18_suppl (2007): 505. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.505.
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505 Background: To evaluate, in breast cancer patients treated by neoadjuvant chemotherapy, the early predictive value of the FDG uptake decrease for the assessment of the pathological complete response (pCR). Methods: Forty seven women with non metastatic with conventional imaging, non inflammatory, large or locally advanced breast cancer were included. Pathological tumour regression determined on surgical resection specimens served as the gold standard for the assessment of the neoadjuvant chemotherapy response. According to the Sataloff classification, patients were classified in two groups: patients with a pathological complete response (pCR) and patients with a pathological non complete response (non pCR). FDG uptake of breast lesions was evaluated before and after the first course of neoadjuvant chemotherapy, using Standard Uptake Value maximum (SUV) corrected by body surface area and glycaemia. Relations between baseline [18F]-FDG uptake and clinical, histopathological and biological parameters were assessed by Mann-Whitney test. Predictive value of the FDG decrease for the assessment of the pCR was studied with logistic regression analysis. Results: An elevated baseline SUV was found independently associated with a high mitotic activity (p<0.002), tumour grading (p<0.004), high score of nuclear pleomorphism (p= 0.03) and positive hormonal receptor status (p<0.005). After completion of chemotherapy, 11 (23%) of the 47 breast tumours examined at surgery showed a pCR while 36 (77%) showed a non pCR. The relative decrease (ΔSUV) after the first course of neoadjuvant chemotherapy was significantly greater in the pCR group than in the non pCR group (p< 10-4). A SUV decrease of 85.4% ± 21.9% in pCR patients versus 22.6% ± 36.6% in non pCR patients was found. ΔSUV<-60% predicted pCR with an accuracy of 87%. With multivariate logistic regression analyses, ΔSUV<-60% was the only predictive factor of the pCR Conclusions: In breast cancer patients treated by neoadjuvant chemotherapy, the FDG uptake decrease, after only one course of treatment, is an early and powerful predictor of the pCR. No significant financial relationships to disclose.
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Lerman, Hedva, Shikma Bar-On, Limor Helpman, Einat Even-Sapir, and Dan Grisaru. "ATL." International Journal of Gynecologic Cancer 22, no. 7 (2012): 1187–91. http://dx.doi.org/10.1097/igc.0b013e31825bedc7.
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ObjectivePositron emission tomography/computed tomography (PET/CT) is an important tool in oncology for assessment of disease extent and recurrence. Recognition of benign fluorodeoxyglucose (FDG) uptake promotes correct interpretation of imaging data. This study assesses the appearance of benign uterine leiomyomas (ULs) on PET/CT and evaluates possible hormonal influences.Patients and MethodsThis was a retrospective study performed in a tertiary referral cancer center in Israel. One hundred fifty-two women with nongynecologic malignancies were referred for PET/CT scans, with incidental UL on imaging. Information on menopausal status and menstrual phase and on the use of oral contraceptives, hormone replacement therapy, and selective estrogen receptor modulators (SERM) was collected. Fluorodeoxyglucose uptake measured as standard uptake value (SUV) was obtained for UL, normal myometrium, and gluteus muscle. Changes associated with menopausal status, menstrual cycle phase, and the use of oral contraceptives, hormone replacement therapy, and SERM were assessed.ResultsThe mean ± SD SUV in UL for the entire cohort was 1.39 ± 0.65 and was higher than in myometrium (1.24 ± 0.33) and gluteus muscle (0.48 ± 0.36). Fluorodeoxyglucose uptake was similar in UL and in myometrium during the preovulatory (1.42 ± 0.31 vs 1.23 ± 0.34) and postovulatory (1.23 ± 0.34 vs1.38 ± 0. 4) periods. During ovulation, SUV was significantly higher in UL (1.62 ± 0.39) than in normal myometrium (1.12 ± 0.15; P = 0.01). Uterine leiomyoma FDG uptake in premenopausal women (1.47 ± 0.32) was higher than in postmenopausal women (1.29 ± 0.41; P < 0.02). The UL/gluteus SUV ratio in patients on hormone replacement therapy (2.53 ± 0.23) was significantly higher than in untreated patients (1.27 ± 0.92; P = 0.05). Lower uptake was recorded in patients on SERM (SUV, 1.1 ± 0.24) than in untreated patients (SUV, 1.41 ± 0.36; P < 0.01).ConclusionFluorine 18 FDG uptake in UL may be estrogen dependent. Endogenous estrogen and hormone replacement therapy increase FDG uptake, whereas withdrawal of estrogen by menopause or SERM decreases uptake.
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Mulani, N. "The Standard Uptake Value (SUV) Is It Necessary for Diagnosing Malignant Tissue by F-18-FDG PET?" Clinical Positron Imaging 1, no. 4 (1998): 243. http://dx.doi.org/10.1016/s1095-0397(98)00033-8.
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Brendle, Cornelia, Jürgen Kupferschläger, Konstantin Nikolaou, Christian la Fougère, Sergios Gatidis, and Christina Pfannenberg. "Is the standard uptake value (SUV) appropriate for quantification in clinical PET imaging? – Variability induced by different SUV measurements and varying reconstruction methods." European Journal of Radiology 84, no. 1 (2015): 158–62. http://dx.doi.org/10.1016/j.ejrad.2014.10.018.
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Schwarz-Dose, Jörg, Michael Untch, Reinhold Tiling, et al. "Monitoring Primary Systemic Therapy of Large and Locally Advanced Breast Cancer by Using Sequential Positron Emission Tomography Imaging With [18F]Fluorodeoxyglucose." Journal of Clinical Oncology 27, no. 4 (2009): 535–41. http://dx.doi.org/10.1200/jco.2008.17.2650.
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Purpose To evaluate positron emission tomography (PET) using [18F]fluorodeoxyglucose (FDG) for prediction of histopathologic response early during primary systemic therapy of large or locally advanced breast cancer. Patients and Methods In a prospective multicenter trial, 272 FDG-PET scans were performed in 104 patients at baseline (n = 104) and after the first (n = 87) and second cycle (n = 81) of chemotherapy. The level and relative changes in standardized uptake value (SUV) of FDG uptake were assessed regarding their ability to predict histopathologic response. All patients underwent surgery after chemotherapy, and histopathologic response defined as minimal residual disease or gross residual disease served as the reference standard. Results Seventeen (16%) of 104 patients were histopathologic responders and 87 were (84%) nonresponders. All patients for whom baseline SUV was less than 3.0 (n = 24) did not achieve a histopathologic response. SUV decreased by 51% ± 18% after the first cycle of chemotherapy in histopathologic responders (n = 15), compared with 37% ± 21% in nonresponders (n = 54; P = .01). A threshold of 45% decrease in SUV correctly identified 11 of 15 responders, and histopathologic nonresponders were identified with a negative predictive value of 90%. Similar results were found after the second cycle when using a threshold of 55% relative decrease in SUV. Conclusion FDG-PET allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after each cycle of chemotherapy. Moreover, relative changes in SUV after the first and second cycle are a strong predictor of response. Thus, FDG-PET may be helpful for individual treatment stratification in breast cancer patients.
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Durand, E., and F. Besson. "How is the standard uptake value (SUV) linked to the influx constant in Sokoloff's model for 18F-FDG?" Médecine Nucléaire 39, no. 1 (2015): 11–17. http://dx.doi.org/10.1016/j.mednuc.2015.01.002.
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John, C. S., R. Madabushi, C. Farah, C. Lubas, and G. Williams. "Can [F-18]FDG PET imaging predict early response to chemotherapy in breast cancer patients?" Journal of Clinical Oncology 27, no. 15_suppl (2009): e14577-e14577. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e14577.
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e14577 Background: The purpose of this study was to perform a meta-analysis of literature data and see if [F-18]FDG and PET imaging can be used to predict the early response to chemotherapy based upon the measure of standard uptake value (SUV) or drug uptake ratio (DUR; a measure of glycolytic index) in breast cancer patients. This intervention may identify the responders for continued therapy or identify the non- responders for change of therapy. Methods: A literature search determined the number of studies that used PET-FDG imaging to monitor the response of various chemotherapies in breast cancer patients. A total of nine studies have been reviewed that used SUV/DUR as a measure of glycolytic activity of the primary tumors. The percent decrease of SUV over baseline was determined for chemotherapy cycle 1 and for subsequent cycles. A paired t-test was performed to see the statistical significance of the SUV decrease. Results: Five (n=158) studies presented the data in % mean reduction in SUV and four (n=59) studies presented SUV values for the individual patient. The average decrease in SUV in responders were 29% and 51% after first and second cycle, respectively. The non responders did not show significant change in SUV as compared to responders. Conclusion: The preliminary data mining and analysis strongly implies that PET imaging using [F-18]FDG may be used to monitor the progress of chemotherapy in breast cancer patients. This study was supported by a grant from OWH, FDA. The results do not represent official FDA position. No significant financial relationships to disclose.
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Cheng, Ching-Yuan, Kwo-Whei Lee, Chiang-Hsuan Lee, et al. "Time Sensitivity Factor of Single Pulmonary Nodule: A New Cancer Characteristic Metabolic Parameter byF18-FDG PET." BioMed Research International 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/830135.
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Objective. To calculate the time sensitivity factor (S) for discriminating the solitary pulmonary nodule (SPN) by FDG PET at different time points.Methods. The multiple time-point FDG PET images from 41 patients for evaluating SPN seen on chest X-ray or CT were prospectively analyzed to calculate and evaluateSagainst the gold standard of tissue histology (n=38) or long term clinicoradiographic follow-up (n=3). The maximal standardized uptake values (SUV) at the 3 hourly time points were measured. TheSwas calculated usingS=d{ln(SUV)}/d{ln(t)}at 3 different time intervals. ROC analysis of theSparameters was performed to evaluate the optimal cut-off value and their accuracy in classifying the SPN.Results. The SUV in malignant SPN was higher than the corresponding value in benign lesions at all 3 hourly time points (P<0.003). TheSparameters using 3 different time intervals all significantly separated the two groups (P<0.0005) with an optimal cut-off point near the theoretical value of zero with a high sensitivity of 100% and specificity of 86%.Conclusion. TheScan be calculated for SPNs using multiple time-point FDG PET, providing a tumor characteristic metabolic parameter with high discrimination power using a simple positive value representing malignancy.
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Baksh, Kathryn, and Khaldoun Almhanna. "Correlation between standardized uptake value in pre- and post-neoadjuvant chemoradiotherapy and tumor regression grade in patients with locally advanced esophageal cancer." Journal of Clinical Oncology 32, no. 3_suppl (2014): 150. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.150.
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150 Background: A multimodality approach with neoadjuvant chemotherapy and radiation is the standard of care in the United States in the treatment of patients with locally advanced esophageal cancer. It is well established that neoadjuvant chemoradiotherapy (CRT) in these patients can facilitate downstaging, correlating with pathologic response, and improving overall survival. Our clinical practice involves the use of positron emission tomography (PET) to assist with staging in patients prior to undergoing neoadjuvant CRT and surgery. While there has been evidence showing correlation between tumor regression grade (TRG) and increased overall survival in these patients, the relationship between standardized uptake values on PET scans and TRG has not been discerned. The purpose of this study was to determine whether pre and post-chemoradiotherapy SUV on PET scans correlate with TRG in esophageal cancer patients receiving neoadjuvant chemoradiotherapy. Methods: A retrospective review of 56 patients with stage II-III esophageal cancer treated with neo-adjuvant CRT followed by surgery was performed. Pre- and post- treatment PET scans were reviewed. Maximum SUV at the site of the primary tumor was recorded. Upon completion of surgery, tumor regression grade was determined by a specialized pathologist. Spearman correlation was used to compare pre, post, and change in max SUV, to the 4 level TRG variables. Results: The median follow-up was 24 months. No significant correlation was found between pre-treatment or post treatment SUV and TRG with p value of 0.73 and 0.94 respectively. There was no significant correlation between decreased FDG uptake following CRT and TRG with p value of 0.82. Consistent with previous data, TRG predicted the therapeutic efficacy and prognosis for patients with locally advanced esophageal carcinoma treated by neoadjuvant chemotherapy. Conclusions: Our results are preliminary and retrospective in nature. A larger sample is needed to confirm these findings. Decreased FDG uptake in sequential PET scans strongly correlates with tumor response, but is not accurate enough to predict pathological response.
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Abdelhakeem, Ahmed, Xuemei Wang, Rebecca E. Waters, et al. "Localized diffuse-type gastric adenocarcinoma: Influence of baseline positron emission tomography on survival and therapy response." Journal of Clinical Oncology 39, no. 3_suppl (2021): 176. http://dx.doi.org/10.1200/jco.2021.39.3_suppl.176.
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176 Background: Diffuse type of gastric adenocarcinoma (dGAC) confers a poor but variable prognosis compared to intestinal type of GAC. The value of baseline uptake of FDG-PET in localized dGAC is unclear and ~40% are not FDG-PET avid. We analyzed outcomes based on the avidity (high with SUV > 3.5 or low with SUV ≤3.5) of the primary on baseline FDG-PET. Methods: We retrospectively selected 111 localized dGAC cases who had baseline FDG-PET for staging. We compared the FDG-PET avidity with overall survival (OS) and response to preoperative therapy. Standard statistical methods were utilized. Results: The mean age was 59.4 years and with many female patients (47.7%). All patients had dGAC. The high-SUV group (58 [52.3%] patients) and the low-SUV group (53 [47.7%] patients) were equally divided. While the median OS for all patients was 49.5 months (95% CI: 38.5 – 98.8 months), it was 98.0 months for the low-SUV group and 36.0 months for the high-SUV ( p value = 0.003). While the median PFS for all patients was 38.2 months (95%CI: 27.7 – 97.6 months), it was 98.0 months for the low-SUV group was and 27.0 months for the high-SUV group ( p value = 0.005). Clinical responses before surgery were more common in the low-SUV group but there were only 4 patients with pathologic complete response in the entire cohort. Conclusions: Our unique data suggest that localized dGAC patients with low SUV fare better than those with high SUV meaning highly metabolic GACs consuming glucose confer poor prognosis and overall all dGACs seem resistant to therapy.
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Pietrantonio, Filippo, Maria Di Bartolomeo, Chiara Bampo, et al. "Role of FDG-PET as predictive biomarker of pathologic complete response (pCR) in locally advanced rectal cancer (LARC) treated with capecitabine-based neoadjuvant chemoradiation (NACR)." Journal of Clinical Oncology 30, no. 15_suppl (2012): e21118-e21118. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e21118.
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e21118 Background: A favourable outcome is associated with pCR in LARC treated with NACR; pCR prediction through functional imaging may help the prospective evaluation of management strategies alternative to standard surgery. The aim of this prospective study was to identify whether FDG-PET activity and early/late response predicted independently pCR. Methods: Patients with histologically diagnosed cT3-4 and/or N+ primary rectal cancer were treated homogeneously with NACR (simultaneous boost technique radiotherapy 54 Gy on GTV/24 fractions plus capecitabine 1650 mg/mq/day) and total mesorectal excision 7-8 weeks later. FDG-PET uptake, expressed as maximum standardized uptake value, was obtained at baseline (SUV-1), at interim (2 weeks after treatment start: SUV-2) and 6 weeks after NARC completion (SUV-3) and was calculated as percentage difference (Δ-SUV). The role of SUV-1, SUV-2, SUV-3, Δ-SUV(1-2) and Δ-SUV(1-3) for pCR prediction was assessed using logistic regression analysis; ROC analysis was performed to identify the optimal thresholds. Results: The study enrolled 30 pts (median age 59 yrs; 12M:18F) treated from January 2009 to November 2011 at Istituto Nazionale Tumori of Milan. All underwent FDG-PET at baseline and post-NACR and 80% consented to an interim assessment; one patient was excluded due to surgery refusal. pCR rate was 28%. Among all parameters, only post-NACR SUV (mean 4 +/- 1.7 for pCR vs 8.7 +/-5.8 for non-pCR; P=0.001 by Mann-Whitney test) showed significant association with pCR at univariate analysis (P=0.03). At multivariate analysis including baseline SUV, post-NACR SUV, Δ-SUV, age (≤ or >65 yrs), sex (F or M) and pre-treatment stage (N- or N+/cT3 or cT4), only female sex and post-NACR SUV predicted independently pCR (both P=0.01). With ROC analysis, a post-NACR SUV threshold <5.5 had 88% sensitivity and 81% specificity, with 83% overall accuracy. Conclusions: The SUV cut-off of 5.5, explained by inflammatory modifications, could limit the applicability in clinical practice assuming values ≤2.5 for negativity. However, FDG-PET SUV post-NACR may serve as useful predictive biomarker in LARC.
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Pini, Sara, Francesca Di Fabio, Bruno Iacopino, et al. "Prognostic value of baseline 18F-FDG-PET (PET) in anal cancer (AC) patients (pts): A Bologna Multidisciplinary Rectal Cancer Group analysis (BMRCG-AC01)." Journal of Clinical Oncology 31, no. 15_suppl (2013): e15154-e15154. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e15154.
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e15154 Background: The incidence of AC has increased. In locally advanced disease treatment is curative radio-chemotherapy (RCT) followed by brachytherapy boost (BRT) or external beam radiotherapy (EBR). The aim of this analysis is to evaluate prognostic factors in predicting disease recurrence. Methods: We retrospectively evaluated pts with diagnosis of T2-3-4, N-/+ AC. External RT was delivered up to a dose of 4,500 cGy in 25 fr and CT consisted in 5-fluorouracil CI day 1-4 and Mitomicin-C bolus day 1 in the first and fifth weeks of radiotherapy as per Nigroregimen. BRT or EBR were performed at the end of RCT. A PET scan was performed at diagnosis before starting treatment. The standard uptake value (SUV) was determined from the most active tumor site. Results: Between March 2006 and August 2012, 50 pts with AC accessed the BMRCG. In this analysis we considered 29 pts evaluated by PET. The pt characteristics were: 8(27.6%) men, 21(72.4%) women; median age 63 (42-89) years; 17(58.6%) squamous cell carcinoma (scc), 12(41.4%) basaloid carcinoma (bc); 6(20.7%) cT2N0, 5(17.2%) cT3N0, 7(24.1%) cT3N+, 2(6.9%) cT4N0, 9(31.1%) cT4N+. Twenty-six (90%) pts received full-dose standard protocol RCT and subsequent radiotherapy boost. After a median follow-up of 25 months we observed 4 (13.8%) recurrences: 3 local and 1 lung metastasis. No disease-related death occurred. Stage at diagnosis (T2-3N0 vs T3N+T4N+/-) and tumor histotype (scc vs bc) did not relate to DFS (p=0.67 and p=0.86 respectively). ROC analysis identified a SUV cut-off of 12.5 at the baseline PET related to recurrence. In 15(51.7%) pts the baseline SUV was ≤12.5 (low SUV) and in 14 (48.3%) it was >12.5 (high SUV). Pts with high SUV had significantly worse DFS than those with low SUV (p=0.02). Multivariate Cox regression did not confirm any SUV prognostic value (p=0.95). Conclusions: These results suggest that high SUV could predict relapse in AC pts treated with curative RCT. The small number of pts rules out any definitive conclusion; a controlled trial should be conducted to explore the prognostic role of SUV to define good prognosis pts for “tailored” treatment and reduce therapy-related toxicities.
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Yu, J., D. Han, Xiaojun Zhong, et al. "The optimal threshold of 18F-FLT PET and 18F-FDG PET to estimate the length of gross tumor volume in patients with squamous cell carcinoma of the thoracic esophagus verified by pathological examination." Journal of Clinical Oncology 27, no. 15_suppl (2009): e15665-e15665. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e15665.
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e15665 Background: To determine the optimal method of using 3-deoxy-3-18F-fluorothymidine (FLT) positron emission tomography (PET) to estimate gross tumor length in esophageal carcinoma, and compared with that of 18F- fluorodeoxyglucose(FDG) PET. Methods: Twenty patients with esophageal squamous cell carcinoma treated with radical surgery were enrolled and detected by FLT PET, eighteen of them underwent FDG PET scan. Gross tumor volumes (GTVs) were delineated using seven different methods with FLT PET: visual interpretation, standardized uptake value (SUV) 1.3, SUV 1.4, SUV 1.5, and 20% of maximum standard uptake value (SUVmax), 25% SUVmax,30% SUVmax, on FLT PET imaging, and three different methods with FDG PET: visual interpretation, SUV 2.5, and 40%SUVmax on FDG PET imaging. The length of tumors on FLT PET scan were measured and recorded as LFLTvis, LFLT1.3, LFLT1.4, LFLT1.5, LFLT20%, LFLT25%, and LFLT30%, and FDG PET scan were measured and recorded as LFDGvis, LFDG2.5, and LFDG40%, respectively, and compared with the length of gross tumor in the resected specimen measured by pathological examination (LPath). Results: The mean (±SD) LPath was 5.16±2.19cm. The mean LFLTvis, LFLT1.3, LFLT1.4, LFLT1.5, LFLT20%, LFLT25%, and LFLT30%were 5.17±2.40cm, 5.55±2.43cm, 5.17±2.41cm, 4.95±2.44cm, 5.82±2.23cm, 5.32±2.31cm, and 5.04±2.28cm, respectively. Compared with the LPath, the P value were 0.971, 0.045, 0.972, 0.255, 0.066, 0.644, and 0.714, respectively. The correlation coefficients were 0.952, 0.944, 0.959, 0.948, 0.763, 0.783, and 0.800, respectively. The mean LFDGvis, LFDG2.5, and LFDG40% were 5.41±2.27cm, 5.38±2.25cm, and 4.02±1.57cm, respectively. Compared with the LPath, the P value were 0.098, 0.085 and 0.000, respectively. The correlation coefficients were 0.984, 0.990 and 0.932, respectively. On FLT PET, LFLT1.4, and on FDG PET, L FDG2.5 seem more approximate to LPath. The difference between LFLT1.4 and LFDG2.5 was not significantly (P=0.442), the correlation coefficients was 0.960. Conclusions: An SUV cutoff of 1.4 on FLT PET, and an SUV cutoff of 2.5 on FDG PET, provided the closest estimation of GTV length in this study No significant financial relationships to disclose.
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Lin, Qiuyu, Qianle Qi, Sen Hou, et al. "Application of Pet-CT Fusion Deep Learning Imaging in Precise Radiotherapy of Thyroid Cancer." Journal of Healthcare Engineering 2021 (August 5, 2021): 1–10. http://dx.doi.org/10.1155/2021/2456429.
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This article explores the value of wall F-FDG PET/Cr imaging in the diagnosis of thyroid cancer, studies its ability to distinguish benign and malignant thyroid lesions, and seeks ways to improve the accuracy of diagnosis. The normal control group selected 40 patients who came to our center for physical examination. In the normal control group, the average value of the standard uptake value of both sides of the thyroid was used as the SUV of the thyroid gland and the highest SUV value of the patient's lesion (SUV max) represented the SUV of the lesion. After injection of imaging agent 18F-FD1G, routine imaging was performed at 1h, time-lapse imaging was performed at 2.5 h, and the changes with conventional imaging were compared to infer the benign and malignant lesions. We used SPSS software to carry out statistical analysis, respectively, carrying out analysis of variance, paired t-test, independent sample t-test, and linear correlation analysis. In the thyroid cancer group, 87.5% of the delayed imaging SUV was higher than the conventional imaging SUV, while 83.33% of the benign disease group had a lower SUV than the conventional imaging SUV. 18F-FDG PET/CT imaging has higher sensitivity and specificity for the diagnosis of recurrence or metastasis in patients with Tg positive. However, it has lower sensitivity and specificity for the diagnosis of 131I-Dx-WBS negative DTC and 18F-FDG PET/CT. The specificity increases with the increase of serum Tg level. The above results confirm that 18F-FDG PET/CT imaging is of great significance for the diagnosis of recurrence or metastasis in patients; with PET/CT imaging, the results changed 16.13% of the Tg-positive and 131I-Dx-WBS negative DTC patients' later treatment decision. The decision-making and curative effect evaluation have certain value.
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Purim, O., N. Goldberg, Y. Kundel, et al. "Early prediction of pathological complete response (pCR) of rectal cancer after 1 week of preoperative radiochemotherapy (RCT) using positron emission computererized tomography (PET-CT) imaging." Journal of Clinical Oncology 29, no. 4_suppl (2011): 572. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.572.
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572 Background: Preoperative radiochemotherapy (RCT) is the standard treatment of locally advanced rectal cancer (LARC), obtaining pathological complete response (pCR) in 15%-30% of cases. Post-RCT reduction of 18F-fluorodeoxyglucose (FDG) uptake within the tumor compared with the baseline, i.e. the tumor's metabolic response, correlates with pCR. However, an earlier prediction of pCR could enable tailored modifications of the treatment. We hence evaluated the correlation between the metabolic response after only one week of RCT for LARC and the actual pCR at the post-RCT surgery. Methods: Patients (pts) were eligible for this prospective study if they had LARC, defined as T3-4NX or TxN+ tumors by pre-treatment PET-CT and endoscopic ultrasound. Pts received standard RCT regimen, consisting of 50.4Gy radiotherapy concurrently with a fluoropyrimidine-based chemotherapy, followed by surgery. Pts underwent baseline FDG-PET-CT imaging within 2 weeks prior to the initiation of RCT and a second one on day 8 of RCT. Maximum standardized uptake value (SUV-max) was measured in both scans and changes in FDG- uptake were recorded. Man-Whitney test was used to evaluate differences in the SUV-max between baseline and day 8 in pts obtaining pCR and those who did not. Results: Twenty pts participated in the study. Half were males and the median age was 64 years. Ten pts had T3N0 tumors and 10 had T3N+ disease. Radical surgery was done in 19 pts and local excision in one. Considering the entire group, there was a borderline-significant difference between the metabolic response of pts with pCR and those without pCR (Chi-square = 3.429, p = 0.064). Yet, the changes in FGD-uptake were able to identify pts who achieved pCR and those who did not: only pts with a decrease of more than 33% in SUV-max had pCR while none of the pts who had less than 8.9% decrease in SUV-max had pCR. Conclusions: A decrease in SUV-max between baseline-PET-CT scans and scans done after only one week of RCT for LARC may be able to predict the achievement of pCR in the post-RCT surgical specimen. Validation in a larger independent cohort is planned. No significant financial relationships to disclose.
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Otsuka, Hideki, Akiko Kubo, Michael Graham, and Hiromu Nishitani. "The relationship between standard uptake value (SUV) and Hounsfield Unit (HU) of oral contrast agent for FDG-PET/CT study." Journal of Medical Investigation 51, no. 3,4 (2004): 226–29. http://dx.doi.org/10.2152/jmi.51.226.
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Gallamini, Andrea, Luigi Rigacci, Francesco Merli, et al. "Predictive Value of 18F-Fluorodeoxyglucose Positron Emission Tomography (FDG PET) Performed after Two Cycles of Standard Chemotherapy (CT) on Treatment Outcome in Hodgkin Disease." Blood 104, no. 11 (2004): 310. http://dx.doi.org/10.1182/blood.v104.11.310.310.
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Abstract Objectives: Several prognostic models based on simple clinical variables have been proposed for Hodgkin’s Disease (HD); however, when applied in a prospective way, they showed unsatisfactory predictive value and scarce reproducibility. The prognostic role of early evaluation of treatment response by TC or Gallium scan has been proved in the past. We report here the preliminary results of a clinical trial on the prognostic role of FDG PET scan performed very early during treatment in advanced stage HD patients (pts), treated by conventional, standard-dose, CT. Matherials and methods: Starting from january 2002, 55 new HD pts were consecutively enrolled into the trial; 42 completed the program and are valuable for the analysis. Pts characteristics were: mean age 34.9 years (16-79), advanced disease (stages IIB-IVB) in 24, and stage IIA in 18. Bulky and extra-nodal disease were recorded in in 12 and 11 pts, respectively. Histopathology was: NS in 36, LP in 3, MC in 2 and LD in 1. All pts were staged at baseline with TC scan, bone marrow trephine biopsy and FDG PET scan (PET-0); they were re-staged after 2 CT courses and at the end of the treatment, including radiotherapy, by TC scan and PET scan (TC-2, PET-2 and TC-8, PET-8, respectively). Standardized Uptake Value (SUV) was calculated in all FDG PET scans. PET-0 and PET-8 were considerate positive when the SUV value was ≥ 3 and PET-2 when the SUV ratio PET-2/PET 0 was &gt; 33%. CT was ABVD in 36 pts, escalated BEACOPP in 5 and MOPP/EBV/CAD in 1. In 19/42 additional radiotherapy was given. The mean interval between the end of the 2nd CT course and PET-2 was 11.5 days (6-32); the interval between the end of the therapy (either CT or radiotherapy) and PET-8 was never shorter than 50 days. Results: The mean follow-up from the final restaging was 328.7 days (11-690). Mean SUV value of PET-0 was 12.04. At the end of the program 38 pts were in CR and 4 in progression; one relapsed 13 months after CR entry. TC-2 showed PR in 37 pts and CR in 5. By contrast, PET-2 was positive in only 5 pts: two of them, with a mean SUV-2/SUV-0 ratio of 26.5% (20-33), showed a progressive reduction of SUV in subsequent PET scans, up to a complete negativity: both are in continuous CR. Two out of three pts with a mean SUV reduction to 61% (49-85) of the basal values progressed after the 5th and the 8th CT course, respectively; the third relapsed in CR one year after CT completion. 34/37 (92%) pts with a negative PET-2 showed a PET-8 persistently negative and remained in CR; 2 progressed during CT and one relapsed 12 months after the end of the therapy. Upon assuming that a PET-2 is positive when the ratio of SUV-2/SUV-0 is &gt;33%, the Predictive Positive Value (PPV) of a PET-2 was 100% and the Predictive Negative Value (PNV) was 92%. The sensitivity of PET-2 was 50%, the specificity was 100% and the overall accuracy 93%. Conclusions: The FDG PET scan performed very early during therapy predicts the treatment outcome in most pts. (39/42: 93%), with a PPV value of 100% and a PNV value of 92%. However, since most relapses of HD occur within 24 months from diagnosis, definite conclusions will be drawn after a minimum follow-up of two years.
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Schmalenbach, M., M. Jungehülsing, P. Theissen, et al. "18F-FDG PET for detecting recurrent head and neck cancer, local lymph node involvement and distant metastases." Nuklearmedizin 43, no. 03 (2004): 91–101. http://dx.doi.org/10.1055/s-0038-1625597.
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Summary Aim: Assessment of the clinical value of 18F-FDG-PET for detection of recurrent head and neck cancer, local lymph node involvement and distant metastases comparing a qualitative visual with a semiquantitative analysis (SUV values). Patients, methods: Retrospective evaluation of 73 18F-FDG PET studies in 55 patients by use of a four-step qualitative visual grading system and calculation of standard uptake values in pathological lesions. Calculation of SUV values in normal regions for generating a map of physiological 18F-FDG distribution. Correlation to histopathological findings and clinical follow-up. Results: 1. Qualitative visual analysis of 18F-FDG PET studies: a) local recurrence sensitivity 79%, specificity 97%, positive predictive value 95%, negative predictive value 85%, and diagnostic accuracy 89%; b) local metastatic lymph nodes 100%, 95%, 85%, 100%, 96%; c) distant metastases 100%, 98%, 86%, 100%, 98%, respectively. 2. Semiquantitative analysis had only little incremental, non-significant value in comparison to qualitative visual analysis for the detection of a local recurrence in two patients: a) local recurrence: sensitivity 83%, specificity 100%, positive predictive value 100%, negative predictive value 88%, and diagnostic accuracy 93%; b) local metastatic lymph nodes or c) distant metastases did not change in comparison to qualitative visual analysis. Conclusion: 18F-FDG PET is an effective tool for re-staging of patients with suspected recurrence after therapy for head and neck cancer.
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Sukari, A., O. Wong, M. Balasubramaniam, and D. Decker. "The pre-treatment PET scans SUV inversely correlates with overall survival (OS) of high grade NHL." Journal of Clinical Oncology 24, no. 18_suppl (2006): 17543. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.17543.
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17543 Background: Parling-Lynch (Blood 2003; Abs, 102(11):4805). report a high discriminative power of maximum standard uptake value (SUV) in differentiating high and low grade lymphoma. This study examines the relationship between the pre-treatment (18)F-2-deoxy-2-fluoro-D-glucose Positron emission tomography (18-FDG PET) scans, SUV, overall survival (OS) and disease free survival (DFS) in high grade non-Hodgkin’s lymphoma (NHL). Methods: 33 patients with pathological diagnosis of aggressive NHL but without other malignancies were included; the patients had a pre treatment 18-FDG PET scan with calculated SUV. NHL was classified using WHO classification, IPI score was calculated using International Non-Hodgkin’s Lymphoma Prognostic Factors Project criteria. Cox Proportional Hazards Regression analysis was used to assess the effect of SUV and the grouped IPI Score on both overall survival and disease-free survival. Results: 29 patients have diffuse large B-cell lymphoma (DLBCL), 2 have Mantle cell lymphoma (MCL) and 2 have peripheral T-cell lymphoma (PTCL). Over a median follow up of 2.6 years (0.6–4.6), OS and DFS were 76% and 82%, respectively. Median SUV was 18.6 (1.6–55.9). Patients with higher SUV have higher risks of dying after adjusting for their IPI Score (p-value = 0.0038). Specifically, each additional unit of SUV is associated with a 9.8% increase in the hazard of death. Patients with higher IPI Score have higher risks of dying after adjusting for their SUV (p-value = 0.0017). Specifically, each additional level of IPI Score is associated with a 274.9% increase in the hazard of death. SUV is not a significant predictor of disease-free survival once IPI Score is already known/adjusted for (p-value = 0.0731). Patients with higher IPI Score have higher risks of relapse after adjusting for their SUV (p-value = 0.023). Conclusions: Pre-treatment PET scan SUV significantly affects overall survival in high grade NHL. Our data indicate statistically non significant correlation between SUV and DFS. These findings could be secondary to small study sample or short median follow up. No significant financial relationships to disclose.
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de Vries, Bart M., Tessa Timmers, Emma E. Wolters, et al. "Non-invasive Standardised Uptake Value for Verification of the Use of Previously Validated Reference Region for [18F]Flortaucipir and [18F]Florbetapir Brain PET Studies." Molecular Imaging and Biology 23, no. 4 (2021): 550–59. http://dx.doi.org/10.1007/s11307-020-01572-y.
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Abstract Purpose The simplified reference tissue model (SRTM) is commonly applied for the quantification of brain positron emission tomography (PET) studies, particularly because it avoids arterial cannulation. SRTM requires a validated reference region which is obtained by baseline-blocking or displacement studies. Once a reference region is validated, the use should be verified for each new subject. This verification normally requires volume of distribution (VT) of a reference region. However, performing dynamic scanning and arterial sampling is not always possible, specifically in elderly subjects and in advanced disease stages. The aim of this study was to investigate the use of non-invasive standardised uptake value (SUV) approaches, in comparison to VT, as a verification of the previously validated grey matter cerebellum reference region for [18F]flortaucipir and [18F]florbetapir PET imaging in Alzheimer’s disease (AD) patients and controls. Procedures Dynamic 130-min [18F]flortaucipir PET scans obtained from nineteen subjects (10 AD patients) and 90-min [18F]florbetapir dynamic scans obtained from fourteen subjects (8 AD patients) were included. Regional VT’s were estimated for both tracers and were considered the standard verification of the previously validated reference region. Non-invasive SUVs corrected for body weight (SUVBW), lean body mass (SUL), and body surface area (SUVBSA) were obtained by using later time intervals of the dynamic scans. Simulations were also performed to assess the effect of flow and specific binding (BPND) on the SUVs. Results A low SUV corresponded well with a low VT for both [18F]flortaucipir and [18F]florbetapir. Simulation confirmed that SUVs were only slightly affected by flow changes and that increases in SUV were predominantly determined by the presence of specific binding. Conclusions In situations where dynamic scanning and arterial sampling is not possible, a low SUV(80–100 min) for [18F]flortaucipir and a low SUV(50–70 min) for [18F]florbetapir may be used as indication for absence of specific binding in the grey matter cerebellum reference region.
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Aldyab, Mahmoud, and Mohammed Shiekhmohammed. "Observations of PET Scan Levels of Standard Uptake Values (SUV) in Low Grade Follicular Lymphoma (LGFL) with High Proliferation Index (HPI)." Blood 136, Supplement 1 (2020): 14. http://dx.doi.org/10.1182/blood-2020-140358.
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Introduction: Low grade follicular lymphoma (LGFL) with high proliferation index (HPI) behave more like high grade follicular lymphoma (HGFL) and therefore, may require different therapeutic options. Currently they're only identified histologically. We studied the PET scan observations of this subset of follicular lymphoma (FL) which occupy a clinical grey zone between LGFL and HGFL to determine whether these lymphomas can be distinguished based on PET scan SUV. Methods: One hundred and twenty-four FL cases at the pathology department at Albany Medical Center between years 2013-2019 were collected. The grade, evaluated based upon the WHO criteria for grading of FL, and KI67 index were recorded. PET scan reports of these cases were reviewed. Cases with no PET scan report, or where the PET scan report did not match the date criteria or site of the biopsy (Bx) were excluded. Of the 87 cases that were included 67 cases were of low grade and 20 cases were of high grade. Among the low grade cases, 23 cases had a high proliferation index (KI67&gt;40%). 53 cases were excisional Bx and 34 Core Bx. The male to female ratio was: 46:40, and the age ranged from 35-92 with a mean of 63.59. Results: KI67 and SUV means were compared using an independent sample t test and the analysis (table 1) shows that although PET SUV may differentiate HGFL from LGFL, it does not differentiate HGFL from LGFL with HPI when using KI67≥40 % or KI67≥30% as cutoff points. However, the statistical significance noted in SUV between HGFL and LGFL with HPI when using KI67≥20% as a cut off point, is probably due to the grade of lymphoma, given the loss of significance (p&gt;0.05) when LGFL with KI67≥20% is compared to LGFL with KI67≤20%. Conclusion: Our findings indicate that LGFL with HPI cannot be reliably identified on PET scan alone. Histology remains the gold standard for identifying low grade follicular lymphoma with high proliferation index. Disclosures No relevant conflicts of interest to declare.
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Kim, D., J. Robertson, M. Barnes, et al. "Standard Uptake Value (SUV) Measurement from CT/PET Scans following Stereotactic Body Radiotherapy Correlates with the Biologically Equivalent Dose (BED) Delivered." International Journal of Radiation Oncology*Biology*Physics 75, no. 3 (2009): S140—S141. http://dx.doi.org/10.1016/j.ijrobp.2009.07.334.
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Grant, Nazaneen, Richard J. Wong, Dennis H. Kraus, Heiko Schoder, and Ryan C. Branski. "Positron-Emission Tomography Enhancement after Vocal Fold Injection Medialization." Ear, Nose & Throat Journal 96, no. 6 (2017): 218–24. http://dx.doi.org/10.1177/014556131709600621.
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The potential for the misinterpretation of positron-emission tomography (PET) scans in the context of a possible malignancy has been confirmed in a case report showing increased 18F-fluorodeoxyglucose (FDG) uptake after unilateral vocal fold augmentation medialization. We sought to expand these findings by investigating FDG uptake in a larger cohort of patients via a retrospective chart review. We examined the records of 15 adults—8 men and 7 women—who had undergone vocal fold augmentation for unilateral vocal fold paralysis and at least one subsequent PET scan. The differences in PET standard uptake value (SUV) between the injected and noninjected vocal folds were assessed via the Wilcoxon signed-rank test. A Spearman rank correlation coef-ficient was then used to estimate the relationship between differences in PET uptake and the length of time between the injection and the follow-up PET scan. The mean SUV of the injected vocal folds was 3.70, and the mean in the noninjected folds was 2.97. The difference did not achieve statistical significance (p = 0.34). In addition, the rank correlation coefficient with regard to the association between the difference in PET uptake and the duration between injection and PET was −0.24, suggesting an inverse relationship. However, the correlation coefficient did not differ significantly from zero (p = 0.34). We conclude that PET uptake after vocal fold augmentation medialization is variable and that it can increase substantially. This information should be considered in the context of the diagnostic accuracy of malignancy on PET.
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Döbert, N., O. Rieker, W. Kneist, et al. "18F-Deoxyglucose PET for the staging of oesophageal cancer." Nuklearmedizin 42, no. 03 (2003): 90–93. http://dx.doi.org/10.1055/s-0038-1625303.
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SummaryAim: Evaluation of the influence of histopathologic sub-types and grading of primaries of oesophageal cancer, relative to their size and location, on the uptake of 18F-deoxyglucose (FDG) as measured by positron emission tomography (PET). Methods: 50 consecutive patients were evaluated. There were four drop-outs due to previous surgical and/or chemotherapeutical treatments and thus in 46 patients (28 squamous cell carcinomas and 18 adenocarcinomas) a pretherapeutic PET evalution of the primary including a standard uptake value (SUV) was obtained. In 42 cases data on tumour grading were available also. Results: Squamous cell carcinomas (SCC) were in 7/13/8 cases located in the proximal, medial and distal part of the oesophagus, respectively the grading was Gx in 3, G 2 in 12, G2-3 in 7, and G3 in 6 cases. The SUVmax showed a mean of 6.5 ± 2.8 (range 1.7-13.5). Adenocarcinomas (ACA) were located in the medial oesophagus in two cases and otherwise in its distal parts. Grading was Gx in one, G2 in 4, G2-3 in 3, G3 in 3, G3-4 in 3, and G4 in one case. The mean SUVmax was 5.2 ± 3.2 (range 1-13.6) and this was not significantly different from the SCC. Concerning the tumour grading there was a slight, statistically not relevant trend towards higher SUVmax in more dedifferentiated cancer. Discussion: SCC and ACA of the oesophagus show no relevant differences in the FDG-uptake. While there was a significant variability of tumour uptake in the overall study group, a correlation of SUV and tumour grading was not found.
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Li, Ling, Feng-Ming (Spring) Kong, Nan Bi, et al. "Total lesion glycolysis (TLG) at baseline FDG-PET/CT compared with maximum standard uptake value (SUVmax) to predict survival in non-small cell lung cancer (NSCLC)." Journal of Clinical Oncology 31, no. 15_suppl (2013): 7579. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.7579.
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7579 Background: SUVmaxat baseline FDG-PET has been reported as a significant prognostic factor while recent studies suggest that metabolic tumor volume (MTV) may be more important factor in patients with NSCLC. We hypothesized that TLG is a better prognostic factor than either SUVmax or MTV alone for overall survival (OS) and progression free survival (PFS) in NSCLC because it integrates both volumetric and biologic activity. Methods: The study population included a prospectively recruited cohort of stage I-III NSCLC patients treated with chemoradiation. FDG PET/CT scans were performed within 2 weeks from treatment start. The SUV in the tumor was normalized to that of the background level in the middle of ascending aorta to minimize the confounding effect from inter-scan variation in SUV measurement. MTV was delineated by auto-threshold at 1.5 times background level in the aorta followed by knowledge based manual editing. Mean and maximum SUV normalized to the background level were computed. TLG was calculated as the product of lesion SUVmean and MTV. Results: A total of 96 patients with minimum follow-up of 1 year were eligible. The median follow-up among survivors was 30 months. Univariate analysis demonstrated that MTV and TLG were significant factors for both OS and PFS (all P<0.05). There was a significant correlation between SUVmean and PFS (P=0.013), but there was no significant association between SUVmean and OS. SUVmax was not a significant factor for either OS or PFS (all P>0.05). Under multivariate Cox regression analysis, MTV (HR= 2.62, P= 0.003) and NSUVmean (HR=0.351, P=0.003) were significantly associated with PFS; but only TLG was significantly associated with OS (HR=2.14, P=0.006)adjusted by of TNM stage and other clinical factors. Conclusions: These results support our hypothesis that metabolic tumor volume and biologic average glucose metabolic activity of this volume are more important prognostic factors for overall prognosis than SUVmax in NSCLC patients treated with chemoradiation. Should this be validated by independent studies, future clinical trial should take this into consideration for individualized care.
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Combemale, Patrick, Thomas Mognetti, Laurence Allanore, et al. "Interest of tumor to liver ratio 18F-FDG uptake in positron emission tomography for detection of neurofibrosarcoma in neurofibromatosis 1 patients." Journal of Clinical Oncology 30, no. 15_suppl (2012): 10049. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.10049.
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10049 Background: Malignant peripheral nerve sheath tumors (MPNSTs) are difficult to detect in neurofibromatosis 1 (NF1) individuals. The 18F FDG positron emission tomoscintigraphy (FDG PET) is a useful tool. The Standard Uptake Value (SUV) is the gold standard but it is subject to individual variation among patients and medical centers. So we assessed the interest of FDG PET based on a specific tumor to liver uptake ratio (T/L) instead of SUV to find a reproducible and constant cut-off for detecting malignant tumors. Methods: From 2000 to 2010, we conduct a multi centric study: all patients with NF1 and presenting clinical signs of MPNST suspicion (increased tumor size, induration or pain) underwent a FDG PET. Preliminary study estimated a T/L ratio of 1.5 as cut-off for malignity. Based on semi-quantitative analysis of FDG PET images, patients were compared with this cut-off value. Results: 98 patients with 125 tumors were included. FDG PET evaluation identified 42/125 suspected lesions with T/L > 1.5; among these 30 MPNST and 12 benign lesions were found. 83/125 tumors were classified as non-suspicious and 82 were actually benign according to histology or long term follow up. The 1.5 T/L cut off corresponds to 99 % Negative Predictive Value (NPV) and 71% Positive (PPV). The positive likelihood ratio (LR) was thus equal to 7, 69 and the Negative LR to 0, with 97% sensitivity and 87% specificity. When T/L ratio is < 1.5, MPNST is eliminated with 99% NPV, thus avoiding useless surgery. When T/L ratio is above 1.5, there is a strong suspicion of malignancy. But there is a risk of false positivity, which requires discussion before any therapeutic decision. On the over hand we found no significant correlation between SUVmax and malignancy. Conclusions: This study confirms the FDG PET in the detection of NF1-associated MPNST. The tumor/liver ratio with a cut off 1.5 has a very sensitive and specific value to sort out malignant from benign tumors and thus provides adequate surgery. More this semi-quantitative analysis method is just as easy as SUV, more sensitive and more reproducible.
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Bakhshayesh Karam, Mehrdad, Abtin Doroudinia, Farzaneh Joukar, et al. "Hypermetabolic Thyroid Incidentaloma on Positron Emission Tomography: Review of Laboratory, Radiologic, and Pathologic Characteristics." Journal of Thyroid Research 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/7176934.
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Introduction. Incidental hypermetabolic thyroid lesions on Positron Emission Tomography have significant clinical value and may harbor malignancy. In this study we evaluated laboratory, radiologic, and pathologic characteristics of incidental hypermetabolic thyroid lesions. Materials and Methods. We evaluated 18 patients prospectively with various malignancies and hypermetabolic thyroid incidentaloma. The thyroid function tests, ultrasound assessment, and guided FNA biopsy were performed on all cases. Results. We included 9 male and 9 female patients with mean age of 51 years. Most common malignancy was colon cancer. Metabolic activity quantification using maximum standard uptake value demonstrated range between 1.4 and 65.4 with mean value of 9.4. We found highest metabolic activity in patients with lung adenocarcinoma, B-cell lymphoma, and colon adenocarcinoma. On ultrasound exam most thyroid lesions were of solid, hypoechoic, noncalcified nature with either normal or peripheral increased vascularity. FNA biopsy report was benign in 15 cases and malignant or highly suggestive for malignancy in 3 other cases. Two of the three malignant cases demonstrated metabolic activity higher than average SUV max. Conclusion. Most thyroid hypermetabolic incidentalomas are benign lesions, while higher values of SUV max are in favor of malignancy. This mandates further evaluation of incidentally found thyroid hypermetabolic lesions on routine PET/CT scans.
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Gennari, Alessandra, Dino Amadori, Etienne Brain, et al. "Early prediction of efficacy of endocrine therapy in breast cancer (BC): Pilot study and validation with 18F fluoroestradiol (18F-FES) PET/CT." Journal of Clinical Oncology 31, no. 15_suppl (2013): TPS649. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.tps649.
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TPS649 Background: Almost 70% of early BC are endocrine responsive, as defined by estrogen receptor (ER) expression; however roughly 30% of ER+ BC patients will relapse despite adjuvant ET. Moreover, 10 to 20% of BC metastases lose ER expression. The upfront administration of ET in ER+ women with MBC is recommended by major guidelines. However, the early identification of endocrine resistance might improve systemic treatment options, sparing unnecessary toxicities and inactive drugs. 18F-FES, an oestradiol analogue labeled with 18F, may allow to test the performance of ERs, by testing their in vivo linkage ability. In MBC, 18F-FES uptake has been proposed to be a better predictor of response to ET than ER expression itself. The aim of the ET-FES study is to validate the predictive value of 18F-FES uptake at PET/CT scan in metastatic ER+ patients. Methods: This is aphase II, multicentric european comparative study of first line ET vs CT in ER+ MBC with low 18F- FES uptake. The primary endpoint is disease control rate (DCR). Correlative studies include: 1. Optimization of 18F-FES production; 2. Association between gene alterations in ESR1/ESR2 genes and 18F- FES uptake; 3. Development of a predictive score of endocrine responsiveness based on 18F-FES SUV value and clinical and biological information. All patients with ER+ MBC candidate to first line ET will receive a 18F-FES CT/PET at baseline, in addition to standard staging. Patients with 18F-FES uptake (SUV) > 2 will receive ET. Patients with 18F-FES SUV < 2 will be randomized to ET until disease progression (control arm) or CT (single agents) until PD. A total of 220 patients with ER+ MBC will be enrolled. Of these, approximately 50% (n=110) will show a 18F-FES SUV < 2 and will be randomized to ET or CT. The study will have 85% power to detect an absolute 20% difference in the DCR between arms after 3 months of therapy, assuming a 5% two-sided alpha level and a 10% drop-out rate. Current status: The ET-FES study was approved for funding by the ist Join TRANSCAN European call. 18F-FES production is currently on final development (GMP), and the clinical protocol is being finalized for EC approval in the different EU countries. Clinical trial information: 2013-000287-29.
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Grisanti, Salvatore, Angelina Filice, Vittoria Basile, et al. "Treatment With 90Y/177Lu-DOTATOC in Patients With Metastatic Adrenocortical Carcinoma Expressing Somatostatin Receptors." Journal of Clinical Endocrinology & Metabolism 105, no. 3 (2019): e1-e5. http://dx.doi.org/10.1210/clinem/dgz091.
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Abstract Context We investigated the role of Gallium 68 dodecanetetraacetic acid Tyr3-octreotide (68Ga-DOTATOC) positron emission tomography/computed tomography (PET/CT) in detecting somatostatin receptors (SSTRs) in 19 patients with metastatic adrenocortical carcinoma (ACC) and explored the activity of yttrium-90/lutetium-177 (90Y/177Lu-DOTATOC) peptide receptor radionuclide therapy (PRRT). Case description and methods 68Ga uptake in metastatic sites was scored in terms of intensity and anatomical uptake distribution of standard uptake value (SUV). Tissue expression of SSTR2A and SSTR5 was also evaluated by immunohistochemistry (IHC) on primary tumors. Eight (42%) patients displayed radiometabolic uptake of any-grade intensity with focal and limited distribution. Two (11%) patients displayed strong uptake in multiple lesions and were treated with PRRT. Both obtained an overall disease control lasting 4 and 12 months, respectively. Conclusions ACC can express SSTRs as detected by IHC and 68Ga-DOTATOC PET. SSTRs-based PRRT may represent a potential treatment opportunity for a minority of patients with advanced ACC. This treatment modality deserves further investigation.
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Lee, Kim, and Kim. "Improved Quantification of 18F-FDG PET during 131I-Rituximab Therapy on Mouse Lymphoma Models after 131I Prompt Emission Correction." Diagnostics 9, no. 4 (2019): 144. http://dx.doi.org/10.3390/diagnostics9040144.
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18F-FDG Positron Emission Tomography (PET) is used to monitor tumor response to 131I-therapy, but is confounded by prompt emissions (284, 364, 637, and 723 keV) from 131I, particularly in animal PET imaging. We propose a method for correcting this emission in 18F-FDG PET. The 131I prompt emission effect was assessed within various energy windows and various activities. We applied a single gamma correction method to a phantom and in vivo mouse model. The 131I prompt emission fraction was 12% when 300 µCi of 131I and 100 µCi of FDG were administered, and increased exponentially with escalating 131I activity for all energy windows. The difference in spill-over ratio was reduced to <5% after 131I prompt emission correction. In the mouse model, the standard uptake value (SUV) did not differ significantly between FDG PET only (gold standard) and FDG PET after 131I prompt emission-correction, whereas it was overestimated by 38% before correction. Contrast was improved by 18% after 131I prompt emission correction. We first found that count contamination on 18F-FDG follow-up scans due to 131I spilled-over count after 131I rituximab tumor targeted therapy. Our developed 131I prompt emission-correction method increased accuracy during measurement of standard uptake values on 18F-FDG PET.
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Dong, Feng, Lin Li, Yanzhu Bian, et al. "Standardized Uptake Value Using Thyroid Quantitative SPECT/CT for the Diagnosis and Evaluation of Graves’ Disease: A Prospective Multicenter Study." BioMed Research International 2019 (January 30, 2019): 1–8. http://dx.doi.org/10.1155/2019/7589853.
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The clinical applications of the quantitative single photon emission computed tomography (SPECT)/computed tomography (CT) are being expanded to a variety of fields of nuclear medicine. However, clinical application of quantitative SPECT/CT for the evaluation of Graves’ disease (GD) still needs further investigation. Our aim was to investigate the feasibility of standard uptake value (SUV) of the thyroid for the clinical diagnosis and evaluation of GD. In this prospective multicenter study, 116 patients diagnosed with GD (Graves group) and 74 healthy volunteers (control group) were enrolled from 8 different hospitals. All patients underwent technetium pertechnetate (TcO99m4-) SPECT/CT imaging with Q.Metrix quantitative software and 24-hour thyroid radioactive iodine uptake (24h-RAIU) test. The SUVmax and SUVmean in Graves group were significantly higher than those of control group (P<0.01). Cut-off values of SUVmax and SUVmean to predict GD were 231.425 and 116.66 by ROC curves, respectively. The SUVmax and SUVmean in Graves patients were significantly related to serum thyroxine level with correlation coefficient of 0.493 and 0.512 for FT3and 0.449 and 0.464 for FT4, respectively (allP<0.01). Additionally, the SUVmax and SUVmean in GD positively correlated with 24h-RAIU with a coefficient of 0.832 and 0.830, respectively (P<0.01). The volumes determined by Q.Metrix (35.65 ± 20.56ml) of 72 subjects also positively correlated with that from ultrasound (36.67 ± 21.00ml) with a coefficient of 0.927 (P<0.01). SUV measurements derived from thyroid SPECT/CT may be useful for the clinical diagnosis and evaluation of GD.
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Masumoto, Norio, Takayuki Kadoya, Makoto Fujiwara, et al. "Dedicated breast PET to improve clinical diagnosis of breast cancer: Initial evaluation." Journal of Clinical Oncology 35, no. 15_suppl (2017): e12097-e12097. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e12097.
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e12097 Background: Unlike whole body (WB) 18F-fluorodeoxyglucose (FDG) PET, dedicated breast PET (DBPET) enables detailed high-resolution images within the breast and quantitative assessment using SUV. We aimed to determine whether DBPET can detect ductal carcinoma in situ (DCIS) and predict the malignancy and neoplastic progress of invasive breast cancer. Methods: We investigated 155 consecutive patients with breast cancer who underwent concurrent DB– and WB– PET (Elmammo®) between January and November 2016. All DB– and WB– PET images were quantified based on standard uptake values (SUV). We also assessed 12 patients with ring-like uptake (RU) without central FDG accumulation in invasive breast cancers on DBPET images. Results: The SUV (means ± SD) determined from DB– and WB– PET images of breast cancer were 8.2 ± 7.7 and 3.1 ± 3.3 respectively. We detected DCIS in DB- and WB– PET images from 22 (84.7%) and 15 (57.6%) of 26 among the 155 patients, respectively (p = 0.003). The SUV on WB– PET images was significantly higher for NG3 than for NG1-2 (p = 0.004), and for high (≥ 20%) than low ( < 20%) Ki67 (p = 0.003), and significantly lower for Luminal A than Luminal B, HER2 and triple-negative cancer (p < 0.05 for all three). The SUV for NG (p = 0.002), Ki67 (p = 0.001) and the luminal (p < 0.05) type also significantly differed in DBPET images. RU without central FDG accumulation was evident in DbPET images of 12 patients, all of whom had Ki67 ≥ 20 (p = 0.0001), two had NG1-2 and 10 had NG3 (p = 0.005), one had clinical T1, 11 had T2 (p = 0.0004), five had clinical N0 and seven had N1 (p = 0.03). RU was associated with high-grade malignancy and neoplastic progress. Conclusions: The detection rate of DBPET was excellent for DCIS. The RU on DBPET offers predictive value for high-grade malignancy and the neoplastic progress of invasive breast cancer. Thus, DBPET might help to determine therapeutic strategies.
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Camacho, Juan C., Nima Kokabi, David M. Schuster, and Hyun Sik Kim. "PERCIST criteria to predict survival at 3 months following intra-arterial resin-based yttrium-90 (Y-90) radioembolization therapy of unresectable intrahepatic cholangiocarcinoma refractory to standard chemotherapy: A proof of concept study." Journal of Clinical Oncology 31, no. 15_suppl (2013): e15141-e15141. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e15141.
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e15141 Background: To investigate the prognostic value of PET Response Criteria in Solid Tumors (PERCIST) on predicting survival in patients with unresectable intrahepatic cholangiocarcinoma (ICC) after resin-basedYttrium-90 (Y-90) radioembolization. Methods: IRB approved prospective correlative study in ICC patients refractory to standard chemotherapy who had 18F-FDG PET-CT before and after Y-90 therapy. Measurable tumor was defined as a lesion ≥ 1 cm in diameter and maximum standardized uptake ((max) SUV) ≥ 2.5. (Max) SUV was measured in targeted and non-targeted lesions after local therapy (overall response). PERCIST criteria defined complete response (CR) as no FDG uptake within target lesion, and partial response (PR) as reduction of 30% in FDG (max) SUV peak in measurable lesions. Objective response included PR/CR. PET imaging was acquired pre-treatment, 1-3-and-6 months following Y90. Survival analyses were carried out with Kaplan–Meier and Log-Rank proportional models using SPSS software v20 (IBM, Armonk, NY) with significance set at <0.05. Results: 9 consecutive patients were enrolled (56% men, mean age 58). Median overall survival from Y90 was 21.7 months. Average max SUV pretreatment was 10.02 and after Y90, 6.03. At 1-month after Y90, target PERCIST criteria showed CR= 1 (11.1%), PR=1 (11.1%), SD=7 (33.3%) and PD=0 (0.0%). Following 3-month after Y90, target response was CR= 2 (22.2%), PR=3 (33.3%), SD=3 (33.3%) and PD=1 (11.1%). No correlation between survival and either target or overall PERCIST criteria response on 1-month follow-up scan was seen(p=0.260). Statistically significant prolonged overall survival was observed for patients with objective targeted response based on PERCIST criteria at 3-month scan (P=0.022). In addition, objective overall PERCIST response at 3-month showed significant correlation with overall survival (p= 0.011). Conclusions: In patients with unresectable ICC refractory to standard chemotherapy, PERCIST criteria at 3-months following Y-90 therapy predict overall survival.
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Wong, R. J., D. T. Lin, H. Schöder, et al. "Diagnostic and Prognostic Value of [18F]Fluorodeoxyglucose Positron Emission Tomography for Recurrent Head and Neck Squamous Cell Carcinoma." Journal of Clinical Oncology 20, no. 20 (2002): 4199–208. http://dx.doi.org/10.1200/jco.2002.02.590.
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PURPOSE: Patients with recurrent head and neck squamous cell carcinoma (HNSCC) present a diagnostic and therapeutic challenge. We evaluated the diagnostic accuracy and prognostic value of [18F]fluorodeoxyglucose positron emission tomography (PET) in this patient population. PATIENTS AND METHODS: We performed a retrospective review of 143 patients with previously treated HNSCC who underwent 181 PET scans at our institution from May 1996 through April 2001 to detect recurrent disease. Disease recurrence within 6 months was used as the gold standard for assessing true disease status at PET. RESULTS: With equivocal sites considered positive, the sensitivity and specificity of PET for detecting recurrence overall were 96% and 72%, respectively. PET was highly sensitive and specific at regional and distant sites. At local sites, sensitivity was high, but specificity was lower because of false-positive findings. One fifth of all false-positive PET scans occurred at sites of known inflammation or infection. The area under the curve for a receiver operator characteristic curve on the basis of standardized uptake value (SUV) was 0.882 ± 0.025. PET interpretation, SUV, and physical examination were independent predictors of relapse-free and overall survival in a time-dependent, multivariate proportional hazards model. An increase in SUV by one unit increased the relative risk (RR) of relapse by 11% and the RR of death by 14%. A positive PET interpretation increased the RR of relapse by four-fold and the RR of death by seven-fold. CONCLUSION: PET was a highly sensitive method of detecting recurrent HNSCC and provided important prognostic information for relapse-free and overall survival.
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Holalkere, Nagaraj, Ephraim P. Hochberg, Ronald Takvorian, et al. "Intensity of FDG Uptake on PET Scan Varies by Histologic Subtype of Hodgkin Lymphoma." Blood 110, no. 11 (2007): 4393. http://dx.doi.org/10.1182/blood.v110.11.4393.4393.
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Abstract FDG-PET scanning has demonstrated utility in the staging and prognostication of Hodgkin lymphoma, but PET characteristics of discrete histologic subsets of Hodgkin lymphoma have never been reported. Further, while studies in this disease have focused on classical Hodgkin lymphoma, the PET features of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) have not been addressed to date. NLPHL represents less than 5% of all cases of Hodgkin lymphoma and has distinct clinicopathologic features, natural history, and treatment from classical subtypes. Diagnosis may be difficult as it exists in a “gray zone” between Hodgkin and non-Hodgkin lymphomas (NHL), and shares immunophenotypic and histologic features with the T-cell rich variant of diffuse large B-cell lymphoma. Clinically, NLPHL follows a natural history more akin to indolent B-cell NHLs than to classical Hodgkin lymphomas. We retrospectively identified 7 cases of NLPHL diagnosed at our institution since 2003 with available PET staging data. Consistent with prior series of this disease, the majority of patients were male (6:1) and the median age was 32 years. All 7 patients presented with limited stage disease (3 stage I, 4 stage II) and without “B” symptoms. All 7 cases demonstrated increased FDG avidity on PET scanning. The mean Standard Uptake Value (SUV) max was 6.1 (range 1.1–8.8), and mean SUV mean was 5.6 (range 1.0–8.3). We compared these results to recently diagnosed patients with nodular sclerosis and mixed cellularity subtypes of classical Hodgkin lymphoma. Among 13 patients with nodular sclerosis Hodgkin lymphoma (NSHL), the mean SUV max was 10.1 (range 4.8–15.8), while among the 7 patients with mixed cellularity histology (MCHL), the mean SUV max was 5.6 (range 4.0–9.8). Patients with NLPHL had significantly decreased SUV max compared to NSHL patients (p=0.022), but were similar to patients with MCHL (Figure 1). Mixed cellularity histology similarly demonstrated significantly decreased SUV max compared to patients with nodular sclerosing disease (p=0.005). PET intensity therefore highlights differences between classical subtypes of Hodgkin lymphoma, as well as between classical and non-classical variants. When compared to published PET SUV data in aggressive B-cell lymphomas, the maximal SUVs we observe in NLPHL fall well below those reported in aggressive B-cell lymphomas, which may aid in the diagnosis of these occasionally similar appearing neoplasms. We conclude that PET scans identify differences in FDG avidity across classical and non-classical Hodgkin lymphoma subtypes, likely reflecting underlying biological differences. We also demonstrate for the first time that despite its indolent behavior, NLPHL is a uniformly FDG-avid neoplasm, and so PET scans may have a role in the staging and surveillance of this uncommon disease variant. Figure Figure
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Ceresoli, G. L., C. Pinto, G. Selvaggi, et al. "6556 POSTER Prognostic role of standard uptake value (SUV) on positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) in malignant pleural mesothelioma (MPM)." European Journal of Cancer Supplements 5, no. 4 (2007): 374–75. http://dx.doi.org/10.1016/s1359-6349(07)71384-8.
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Chandana, S. R., S. Movva, M. Arora, and T. Singh. "Utility of PET imaging in predicting the aggressiveness and histopathology of lymphoma." Journal of Clinical Oncology 25, no. 18_suppl (2007): 8085. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.8085.
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8085 Background: F (18)-fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in the staging and restaging of non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). Few studies have investigated whether the intensity of tumor FDG uptake, measured by standard uptake value (SUV), a semiquantitative measure, could differentiate between indolent and aggressive disease. The clinical utility of SUV in determining the aggressiveness of NHL and HD and in differentiating histopathological subtypes was investigated in the present study. Methods: FDG-PET studies and histopathology of patients with NHL and HD were evaluated retrospectively. Inclusion criteria include PET before any therapy or on relapse of the disease, no diagnosis of diabetes mellitus or other types of cancer and time interval of < 90 days between PET and biopsy. After reviewing the PET scans, the SUV of biopsy site were measured by drawing regions of interest. Mean ± SD of SUV was calculated for HD and various histopathological subgroups of NHL. Results: Fifty-five patients (mean age 58.1 ± 17.2 years, 30 males, 25 females, 13 patients with HD, 42 with NHL, among which 24 with aggressive and 18 with indolent NHL) were included. The mean SUV was 9.9 ± 7.8 for aggressive NHL, 4.1 ± 2.6 for indolent NHL and 11.5 ± 7.3 for HD. Mean SUV was statistically different between aggressive and indolent NHL (p < 0.001) and HD and indolent NHL (p < 0.001), but not between aggressive NHL and HD (p = 0.4). The SUV for the aggressive NHL can be subdivided further as follows: anaplastic (n =3, 15.1 ± 1.7), diffuse large cell (n=19, 9.6 ± 5.3) and follicular grade III (n=2, 8.1 ± 2.2). Indolent NHL included: mantle cell (n=1, 4.3), marginal zone (n=1, 6.3), small cleaved (n=12, 4.2 ± 3.5), low grade follicular (n=4, 3.2 ± 1.4) and small lymphocytic NHL (n=1, 2.3). Conclusions: Our study suggests that FDG- PET can distinguish aggressive from indolent lymphomas. There was a considerable overlap between HD and aggressive NHL.A SUV of seven or less indicates indolent lymphoma. PET could potentially differentiate between different histopathological subgroups of lymphomas. Future studies with greater sample size are warranted. No significant financial relationships to disclose.
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Boonyawan, Keeratikarn, Sasipilai Naivikul, Putipun Puataweepong, Wichana Chamroonrat, Thiti Swangsilpa, and Rawee Ruangkanchanasetr. "Comparison of Tumor Target Volume on Four-Dimensional Computed Tomography and 18F-FDG PET/CT in Lung Cancer." Journal of Health Science and Medical Research 36, no. 3 (2018): 223. http://dx.doi.org/10.31584/jhsmr.2018.36.3.18.
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Objective: The correlation between 18F-fluorodexyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and four-dimensional computed tomography (4DCT) based-tumor volumes is unclear. This prospective study was conducted to determine the optimal threshold of PET/CT for gross tumor volume (GTV) delineation using 4DCT as the standard reference for locally advanced lung cancer patients.Material and Methods: Ten patients with histologically proven primary lung cancer who underwent radiotherapy fromJune 2017 to March 2018 in Ramathibodi Hospital were enrolled in the study. The 4DCT simulation and 18F-FDG PET/CT simulation were performed on the same position and same date. Eight standard uptake value (SUV) thresholds of SUV 1.5.0-2.0 and 15.0-35.0% of maximum SUV were selected for contouring in order to be compared with 4DCT based tumor volumes. The comparison methods used were the mean percentage volume change, dice similarity coefficient (DSC), and 3D-centroid shift of the targets between 18F-FDG PET/CT-based gross tumor volume (GTVPET) and internal gross tumor volume (IGTV) from 4DCT.Results: The largest and smallest volume of primary tumors were 422.6 cm3 and 5.9 cm3. GTVPET contoured using SUV 1.5 (GTVPET1.5) approximated closely to IGTV in all the parameters, including volume change, DSC, and 3D-centroid shift. The best median percentage volume change, median DSC, and median centroid shift between IGTV and GTVPET1.5 were 5.55, 0.745 and 0.37, respectively.Conclusion: GTVPET contoured by 18F-FDG PET at SUV1.5 corresponded most closely to the IGTV in all parameters. Further study with a larger sample size and clinical outcome analysis is needed.
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Allegra, E., M. G. Cristofaro, L. G. Cascini, N. Lombardo, O. Tamburrini, and A. Garozzo. "18FDG Uptake in Sinonasal Inverted Papilloma Detected by Positron Emission Tomography/Computed Tomography." Scientific World Journal 2012 (2012): 1–4. http://dx.doi.org/10.1100/2012/943412.
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Inverted papilloma (IP) is a benign but locally aggressive sinonasal tumour. Aggressive surgical treatment has thus been traditionally recommended because of the risk of transformation in squamous carcinoma. CT and MRI are used to evaluate bone destruction and soft-tissue extension before surgery but may be ineffective to differentiate an inverted papilloma from squamous cell carcinoma. In recent years, F-18 Fluorodeoxyglucose positron emission tomography (18FDG-PET) is widely used as diffuse imaging procedure for diagnosis and followup of malignancy affecting the head and neck district. To evaluate the utility of18FDG-PET/CT in the diagnosis of patients with suspicious lesions for IP, twelve patients with suspicious sinonasal inverted papilloma were selected for this study.18FDG-PET/CT imaging was performed, and standard uptake value (SUV) was calculated for each patient. was considered as the maximum value measured in the visualized lesions. Seven of the twelve cases exhibited uptake of18FFDG with an ranging from 1 to 8.1. Histopathologic diagnosis after surgery confirmed the diagnosis of IP in five cases; all these cases had an . The five cases, which exhibited absence of18FDG uptake, had a histological diagnosis of absence of IP.
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Huang, Jiayi, John L. Chunta, Mitual Amin, et al. "Early Treatment Response Monitoring Using 2-Deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography Imaging during Fractionated Radiotherapy of Head Neck Cancer Xenografts." BioMed Research International 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/598052.
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Background.To determine the optimal timing and analytic method of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (PET) imaging during fractionated radiotherapy (RT) to predict tumor control.Methods.Ten head neck squamous cell carcinoma xenografts derived from the UT-14-SCC cell line were irradiated with 50 Gy at 2 Gy per day over 5 weeks. Dynamic PET scans were acquired over 70 minutes at baseline (week 0) and weekly for seven weeks. PET data were analyzed using standard uptake value (SUV), retention index (RI), sensitivity factor (SF), and kinetic index (Ki).Results.Four xenografts had local failure (LF) and 6 had local control. Eighty scans from week 0 to week 7 were analyzed. RI and SF after 10 Gy appeared to be the optimal predictors for LF. In contrast, SUV and Ki during RT were not significant predictors for LF.Conclusion.RI and SF of PET obtained after the first week of fractionated RT were the optimal methods and timing to predict tumor control.
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Lee, Seokmo, Yunseon Choi, Geumju Park, et al. "18F-FDG PET/CT Parameters for Predicting Prognosis in Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy." Technology in Cancer Research & Treatment 20 (January 1, 2021): 153303382110246. http://dx.doi.org/10.1177/15330338211024655.
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Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower ( P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV ( P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS ( P = 0.002) and OS ( P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS ( P = 0.009) and OS ( P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS ( P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.
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Lee, D., S. Kim, H. Kim, et al. "Early prediction of response in patients with advanced/metastatic non-small cell lung cancer during chemotherapy with FDG-PET-CT." Journal of Clinical Oncology 24, no. 18_suppl (2006): 13154. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.13154.
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13154 Background: To evaluate the use of 18-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) for prediction of response and survival early during the course of treatment in patients with advanced/metastatic NSCLC. Methods: Between May 2004 and November 2005, 31 patients (gender, 23M, 8F; stage, 2IIIB/29IV, histology, 6 squamous cell ca, 22 adenoca, 3 NOS; age median 57 (30–73 y)) with histopathologically proven NSCLC stage IIIB/IV were enrolled into this study. PET-CT was performed prior to and after one cycle of treatment. Early changes of primary tumor FDG-uptake measured by standardized uptake values (SUV) were correlated with best response to therapy as assessed by CT scan according to WHO response criteria. Results: Patients underwent standard treatment with gemcitabine/vinorelbine (15), gemcitabine/cisplatin (1) gemcitabine/vinorelbine/cisplatin (1), irinotecan/cisplatin (9) or gefitinib (5). In the 25 patients evaluable for response, other 6 patients ongoing, 9 patients achieved a partial response (36%), 5 showed stable diseases and 11 were progressive. Using a cut-off value of 20% reduction of FDG-uptake as a criterion for a response in PET-CT, subsequent best response was predicted with a sensitivity of 88.9% and a specificity of 87.5%. The positive predictive value of a metabolic response was 80.0% and the negative predictive value 93.3%, respectively. There was a significant correlation between the decrease of tumor metabolic activity and subsequent best response (p< 0.001). The median time to progression for PET-CT responder was 10.1 months when compared with that of non-responders with 2.6 months (log-rank p=0.009). Conclusions: Using FDG-PET best response to standard treatment and patient outcome can be predicted very early and therefore, the use of PET-CT may allow to reduce side effects and costs of ineffective therapy in non-responding patients No significant financial relationships to disclose.