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Focal incidental colorectal fluorodeoxyglucose uptake:Should it be spotlighted?

World Journal of Clinical Cases 2024年第15期12卷 2466-2474页

作者： Haejun Lee Kyung-Hoon Hwang Department of Nuclear Medicine Gachon University College of MedicineGil Medical CenterIncheon 21565South Korea

Fluorine-18 fluorodeoxyglucose(F-18 FDG)positron emission tomography/computed tomography(PET/CT)has emerged as a cornerstone in cancer evaluation imaging,with a well-established history spanning several years.This imaging modality,encompassing the examination of the body from the base of the skull to the upper thighs,comprehensively covers the chest and abdominopelvic regions in a singular scan,allowing for a holistic assessment of nearly the entire body,including areas of marginal interest.The inherent advantage of this expansive scan range lies in its potential to unveil unexpected incidental abnormal hypermetabolic areas.The identification of incidental focal FDG uptake within colorectal regions during PET/CT scans is not an uncommon occurrence,albeit fraught with challenges associated with non-specific FDG uptake.The presence of benign colorectal lesions or physiological uptake poses a particular obstacle,as these may manifest with FDG uptake levels that mimic malignancy.Consequently,physicians are confronted with a diagnostic dilemma when encountering abnormal FDG uptake in unexpected colorectal areas.Existing studies have presented divergent results concerning these uptakes.Standardized uptake value and its derivatives have served as pivotal metrics in quantifying FDG uptake in PET images.In this article,we aim to succinctly explore the distinctive characteristics of FDG,delve into imaging findings,and elucidate the clinical significance of incidental focal colorectal uptake.This discussion aims to contribute valuable insights into the nuanced interpretation of such findings,fostering a comprehensive understanding.

关键词： Focal Incidental Colorectal fluorodeoxyglucose Positron emission tomography Hypermetabolism

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Unexpected focal fluorodeoxyglucose uptake in main organs;pass through or pass by?

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World Journal of Clinical Cases 2024年第11期12卷 1885-1899页

作者： Haejun Lee Kyung-Hoon Hwang Department of Nuclear Medicine Gachon University College of MedicineGil Medical CenterIncheon 21565South Korea

Since the inception of fluorine-18 fluorodeoxyglucose(F-18 FDG),positron emission tomography/computed tomography(PET/CT)utilizing F-18 FDG has become widely accepted as a valuable imaging modality in the field of oncology,with global prevalence in clinical practice.Given that a single Torso PET/CT scan encompasses the anatomical region from the skull base to the upper thigh,the detection of incidental abnormal focal hypermetabolism in areas of limited clinical interest is both feasible and not uncommon.Numerous investigations have been undertaken to delineate the distinctive features of these findings,yet the outcomes have proven inconclusive.The incongruent results of these studies present a challenge for physicians,leaving them uncertain about the appropriate course of action.This article provides a succinct overview of the characteristics of fluorodeoxyglucose,followed by a comprehensive discussion of the imaging findings and clinical significance associated with incidental focal abnormal F-18 FDG activity in several representative organs.In conclusion,while the prevalence of unrecognized malignancy varies across organs,malignancies account for a substantial proportion,ranging from approximately one-third to over half,of incidental focal uptake.In light of these rates,physicians are urged to exercise vigilance in not disregarding unexpected uptake,facilitating more assured clinical decisions,and advocating for further active evaluation.

关键词： Incidental Focal Incidentaloma fluorodeoxyglucose Positron emission tomography Hypermetabolism

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fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging of uterine leiomyosarcomas： 2 cases report

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Chinese Medical Journal 2011年第14期124卷 2237-2240页

作者： ZHANG Hui-juan ZHAN Feng-hua LI Yaojun SUN Hao-ran BAI Ren-ju GAO Shuo Reproductive Medicine Center General Hospital of Tianjin Medical University Tianjin 300052China Department of Anesthesiology Tianjin Children's Hospital Tianjin 300074 China Department of RadiologyGeneral Hospital of Tianjin Medical University Tianjin 300052China PET/CT CenterGeneral Hospital of Tianjin Medical University Tianjin 300052Chin a

Uterine leiomyosarcoma is an uncommon malignant neoplasm of smooth muscle origination and is associated with a poor prognosis. We report two cases of uterine leiomyosarcoma that presented with pulmonary metastases.2-deoxy-2-（18F）fluorodeoxyglucose （FDG） positron emission tomography （PET）/computed tomography （CT） was performed to identify the primary carcinoma and found the focus located in the uterus. The follow-up magnetic resonance imaging （MRI） confirmed the diagnosis was uterine leiomyosarcoma.

关键词： fluorodeoxyglucose positron emission tomography computed tomography magnetic resonance imaging uterine leiomyosarcoma

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Emerging role of ^(18)F-fluorodeoxyglucose positron emission tomography for guiding management of hepatocellular carcinoma

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World Journal of Gastroenterology 2019年第11期25卷 1289-1306页

作者： Sang Mi Lee Hong Soo Kim Sangheun Lee Jeong Won Lee Department of Nuclear Medicine Soonchunhyang University Cheonan Hospital Department of Internal Medicine Soonchunhyang University Cheonan Hospital Division of Hepatology Department of Internal medicineCatholic Kwandong University College of MedicineInternational St.Mary’s Hospital Institute for Health and Life Science Catholic Kwandong University College of MedicineInternational St.Mary’s Hospital Department of Nuclear Medicine Catholic Kwandong University College of MedicineInternational St.Mary’s Hospital

Hepatocellular carcinoma(HCC) is one of major causes of cancer mortality worldwide. For decades, ^(18)F-fluorodeoxyglucose(FDG) positron emission tomography(PET) has been widely used for staging, predicting prognosis, and detecting cancer recurrence in various types of malignant diseases. Due to low sensitivity of FDG PET for detecting intrahepatic HCC lesions, the clinical value of FDG PET in HCC patients has been limited. However, recent studies with diverse analytic methods have shown that FDG PET has promising role in aiding management of HCC patients. In this review, we will discuss the clinical role of FDG PET for staging, predicting prognosis, and evaluating treatment response in HCC. Further, we will focus on recent clinical studies regarding implication of volumetric FDG PET parameters, the significance of FDG uptake in HCC for selecting treatment and predicting treatment response, and the use of radiomics of FDG PET in HCC.

关键词： Hepatocellular carcinoma fluorodeoxyglucose F18 Positron emission tomography Staging Prognosis

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F-18 fluorodeoxyglucose positron emission tomography/computed tomography image of gastric mucormycosis mimicking advanced gastric cancer: A case report

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World Journal of Clinical Cases 2019年第10期7卷 1155-1160页

作者： Bong-Il Song Department of Nuclear Medicine Dongsan Medical CenterKeimyung University School of Medicine

BACKGROUND Mucormycosis is a very rare fungal infection,and its prognosis is poor.Most common sites of infection are the sinuses,lung,or skin,and gastric involvement is uncommon.The standard antifungal therapy is the treatment of choice for gastric mucormycosis.However,the symptoms of gastric mucormycosis are varied and the early diagnosis is not easy.CASE SUMMARY I report a 53-year-old alcoholic man,who was admitted due to epigastric pain.The upper gastrointestinal endoscopy revealed a huge ulcer lesion in the stomach,which was suspected to be gastric cancer.F-18 fluorodeoxyglucose positron emission tomography/computed tomography(F-18 FDG PET/CT)showed diffusely intense FDG uptake at the ulcer lesion of the stomach,and several enlarged hypermetabolic lymph nodes were noted at the left gastric chain.Although,endoscopy and F-18 FDG PET/CT findings suggested advanced gastric cancer with regional lymph node metastases,there was no cancer cells in the biopsy results and multiple fungal hyphae were noted in the periodic acid-Schiff stained image.CONCLUSION He was diagnosed with gastric mucormycosis and successfully underwent amphotericin B and posaconazole treatment.

关键词： F-18 fluorodeoxyglucose Positron emission tomography Mucormycosis Amphotericin B Gastric cancer Case report

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Nomogram using F-18 fluorodeoxyglucose positron emission tomography/computed tomography for preoperative prediction of lymph node metastasis in gastric cancer

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World Journal of Gastrointestinal Oncology 2020年第4期12卷 447-456页

作者： Bong-Il Song Department of Nuclear Medicine Keimyung University Dongsan HospitalKeimyung University School of MedicineDaegu 42601South Korea

BACKGROUND Lymph node(LN)metastasis is an important prognostic factor in patients with gastric cancer(GC).However,the evaluation of LN metastasis status in the preoperative setting is not accurate.Therefore,precise preoperative prediction of LN metastasis status is crucial for optimal treatment in patients with GC.AIM To develop a preoperative nomogram for LN metastasis using F-18 fluorodeoxyglucose(F-18 FDG)positron emission tomography/computed tomography(PET/CT)and preoperative laboratory test findings in GC.METHODS In this study,the data of 566 GC patients who underwent preoperative F-18 FDG PET/CT and subsequent surgical resection were analyzed.The LN metastasis prediction model was developed in the training cohort and validated in the internal validation cohort.Routine preoperative laboratory tests,including albumin and carbohydrate antigen(CA)19-9 were performed in all patients.Univariate and multivariable logistic regression was performed to validate the preoperative predictive indicators for LN metastasis.RESULTS Of the 566 patients,232(41%)had confirmed histopathologic LN metastasis.Univariate logistic regression revealed that the tumor location,blood hemoglobin,serum albumin levels,neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,CA 19-9,maximum standardized uptake value(SUVmax)of the primary tumor(T_SUVmax),and SUVmax of LN(N_SUVmax)were significantly associated with LN metastasis.In multivariate analysis,T_SUVmax(OR=1.08;95%CI:1.02–1.15;P=0.011)and N_SUVmax(OR=1.49;95%CI:1.19–1.97;P=0.002)were found to be significant predictive factors for LNmetastasis.The LN metastasis prediction model using T_SUVmax,N_SUVmax,serum albumin,and CA 19-9 yielded an area under the curve(AUC)of 0.733(95%CI:0.683–0.784,P=0.025)in the training cohort and AUC of 0.756(95%CI:0.678–0.833,P<0.001)in the test cohort.CONCLUSION T_SUVmax and N_SUVmax measured by preoperative F-18 FDG PET/CT are independent predictive factors for LN metastasis in GC.

关键词： Gastric cancer Lymph node metastasis Positron emission tomography/computed tomography fluorodeoxyglucose Prognostication Standardized uptake value

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Positron emission tomography imaging for the assessment of mild traumatic brain injury and chronic traumatic encephalopathy:recent advances in radiotracers

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Neural Regeneration Research 2022年第1期17卷 74-81页

作者： Chu-Xin Huang Yan-Hui Li Wei Lu Si-Hong Huang Meng-Jun Li Li-Zhi Xiao Jun Liu Department of Radiology the Second Xiangya Hospital of Central South UniversityChangshaHunan ProvinceChina Department of Neurology the Second Xiangya Hospital of Central South UniversityChangshaHunan ProvinceChina PET-CT Center the Second Xiangya Hospital of Central South UniversityChangshaHunan ProvinceChina

A chronic phase following repetitive mild traumatic brain injury can present as chronic traumatic encephalopathy in some cases,which requires a neuropathological examination to make a definitive diagnosis.Positron emission tomography(PET)is a molecular imaging modality that has high sensitivity for detecting even very small molecular changes,and can be used to quantitatively measure a range of molecular biological processes in the brain using different radioactive tracers.Functional changes have also been reported in patients with different forms of traumatic brain injury,especially mild traumatic brain injury and subsequent chronic traumatic encephalopathy.Thus,PET provides a novel approach for the further evaluation of mild traumatic brain injury at molecular levels.In this review,we discuss the recent advances in PET imaging with different radiotracers,including radioligands for PET imaging of glucose metabolism,tau,amyloid-beta,γ-aminobutyric acid type A receptors,and neuroinflammation,in the identification of altered neurological function.These novel radiolabeled ligands are likely to have widespread clinical application,and may be helpful for the treatment of mild traumatic brain injury.Moreover,PET functional imaging with different ligands can be used in the future to perform largescale and sequential studies exploring the time-dependent changes that occur in mild traumatic brain injury.

关键词： amyloid-β chronic traumatic encephalopathy flumazenil fluorodeoxyglucose mild traumatic brain injury positron emission tomography tau protein traumatic brain injury

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Findings of <sup>18</sup>F-fluorodeoxyglucose Positron-Emission Tomography in Methotrexate-Related Lymphoproliferative Disorder

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Open Journal of Radiology 2014年第4期4卷 293-300页

作者： Atsushi K. Kono Kazuhiro Kitajima Hiroshi Mmatsuoka Kyoko Otani Tomoo Itoh Kazuro Sugimura Department of Radiology Kobe University Hospital Kobe Japan Department of Radiology Kobe University Graduate School of Medicine Kobe Japan Division of Medical Oncology/Hematology Department of Medicine Kobe University Graduate School of Medicine Kobe Japan Department of Diagnostic Pathology Kobe University Hospital Kobe Japan

Introduction: The use of methotrexate (MTX) for rheumatoid arthritis (RA) is increasing. However, the immune suppression state leads to the occurrence of lymphoproliferative disorder (MTX-LPD). The purpose of this study was to describe the findings of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in MTX-LPD patients, and compare it with non-MTX-related malignant lymphoma (ML). Materials and Methods: We retrospectively reviewed 11 MTX-LPD patients (9 female, mean age 68.3 years) and 21 ML patients (7 female, mean age 60.6 years) with a histopathological diagnosis. FDG-PET imaging was performed using a standard oncology procedure. We assessed the disease distribution based on FDG-PET images and measured the maximum standardized up take values (SUVmax) for each region. Results: Mean values of SUVmax in MTX-LPD and ML were 14.6 and 17.2, respectively (p = 0.49). In MTX-LPD, 55 lesions met the Cotswold classification, consisting of 37 nodal and 18 extranodal lesions. In ML, 82 lesions were found, consisting of 68 nodal and 14 extranodal lesions. MTX-LPD showed a higher incident of the involvement in extranodal lesions throughout the whole body (p < 0.001). Conclusion: Because this disease occurs widely throughout the whole body, we need to pay attention to the less frequent sites as well when performing PET imaging in patients with MTX-LPD.

关键词： fluorodeoxyglucose (FDG) F 18 Lymphoma Methotrexate Positron-Emission Tomography (PET) Rheumatoid Arthritis

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Fluorine-18 fluorodeoxyglucose Positron Emission Tomography for Osteochondromas Utilizing a Triple-Time Point Protocol

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Open Journal of Medical Imaging 2011年第2期1卷 15-20页

作者： Chris Sambaziotis Andrew Lovy Renee M. Moadel Murthy Chamarthy Joseph Glaser Srividya Jaini Esperanza Villanueva-Siles David S. Geller 不详

Purpose: The purpose of this study was to assess solitary osteochondroma and hereditary multiple osteochondral exostoses (HMOCE) utilizing FDG PET and a triple time point protocol. Methods: Seven patients were consented and recruited for PET evaluation of presumed benign osteochondroma. Following injection of 15 mCi of FDG, the lesion(s) of interest was imaged with PET-CT at 45 minutes post injection, whole body at 50 minutes post, and lesion of interest at 95 minutes post injection. A maximum standardized uptake value (SUVmax) was obtained for the lesion(s) of interest at each time point, and an SUVΔ was calculated for each lesion of interest from the first time point to the third time point. Results: 16 lesions from 7 patients were included in the study. Mean SUVmax for all 3 time points was 1.04 with a standard deviation of 0.50 (range 0.3 - 2.2). The mean SUV was 0.096 with a range of 0 - 0.4. Among the 3 patients with histologically confirmed osteochondromas, mean SUVmax was 0.67, with standard deviation of 0.23 and range of 0.3 to 1.0. The mean SUVΔ13 was 0.081 (range 0 - 0.4), mean SUVΔ12 was 0.10 (0 - 0.3), and mean SUVΔ23 was 0.11 (range 0 - 0.4) (p = 0.74). Conclusion: Benign lesions were found to not have progressively increasing uptake on multiple time point FDG PET. Until chondrosarcomas are evaluated using triple time point 18FDG PET, its applicability in the evaluation of osteochondroma versus malignant change remains uncertain.

关键词： Positron Emission Tomography Osteochondroma Chondrosarcoma Fluorine-18 fluorodeoxyglucose

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fluorodeoxyglucose uptake in absence of CT abnormality on PET-CT: What is it?

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World Journal of Radiology 2013年第12期5卷 460-467页

作者： Yiyan Liu Nuclear Medicine Service Department of RadiologyNew Jersey Medical School

The purpose of this article is to provide a pictorial review of the findings and interpretative pitfalls about focal fluorodeoxyglucose(FDG)uptake in the absence of corresponding computer tomography(CT)lesion or abnormality on an integrated positron emission tomography(PET)-CT.The integrated CT images in the PET-CT scanner allow correct co-registration and fused imaging of anatomical and functional data.On FDG PET-CT imaging,a real pathologic process often demonstrates abnormal uptake associated with a visible corresponding CT lesion or abnormality.When focal uptake is seen on PET imaging but no corresponding anatomic abnormality is visualized on the integrated CT,one should always be aware of possible mis-registration or mismatch of the PET and CT images due to the patient’s respiratory or body motion.While most of the hot spots in the absence of corresponding anatomic abnormalities are artefactual or secondary to benign etiologies,some may represent small sized or early staged neoplasm or metastases,especially in the gastrointestinal tract and skeletons.Caution should be exercised to simply diagnose a pathology based on the presence of the uptake only,or exclude the disease based on the absence of anatomic abnormality.

关键词： fluorodeoxyglucose uptake Positron emission tomography-computer tomography ARTEF actual uptake Mis-registration Positron emission tomography interpretation

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