Bone scan has long been considered to be an important diagnostic test in searching for bone metastases. However, considerable difficulty is encountered in the vertebral region due to the complexity of structures and the fact that other benign lesions, especially degenerative changes, are very common there. Single-photon emission tomography (SPET) has been reported to be useful in the differentiation of benign from malignant conditions. Here we report our experience with bone SPET in the diagnosis of vertebral metastases. This is a retrospective study of technetium-99m methylene diphosphonate (MDP) bone scans in 174 consecutive patients who were referred for the investigation of back pain in our department. MDP planar and SPET images were obtained. Of teh 174 patients, 98 had a known history of malignant tumours. The diagnosis of vertebral metastasis was made on the basis of the patients' clinical histories and the findings with other imaging techniques such as magnetic resonance imaging, computed tomography or follow-up bone scan. We found that the presence of pedicle involvement as seen on SPET was an accurate diagnostic criterion of vertebral metastasis. SPET had a sensitivity of 87%, a specificity of 91%, a positive predictive value of 82%, a negative predictive value of 94% and an accuracy of 90%. On the other hand, planar study had a sensitivity of 74%, a specificity of 81%, a positive predictive value of 64%, a negative predictive value of 88% and an accuracy of 79% in diagnosing vertebral metastasis. Except with regard to the negative predictive value, SPET performed statistically better than planar imaging. Only 9/147 (6.4%) lesions involving the vertebral body alone and 3/49 (6.1%) lesions involving facet joints alone were subsequently found to be metastases. We conclude that bone SPET is an accurate diagnostic test for the detection of vertebral metastases and is superior to planar imaging in this respect.
Introduction:We aimed to analyse the effect of coronavirus disease 2019 vaccination on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging findings in cancer patients. Methods: A total of 165 oncology patients who underwent FDG PET/CT between 1 May 2021 and 30 September 2021 after their first or second COVID-19 vaccination with were included in this retrospective study. The occurrence and pattern of FDG uptake at the injection site (usually deltoid), ipsilateral axillary and other regional lymph nodes, were measured. Results: Overall, the incidence of FDG-avid ipsilateral regional nodal uptake was 26.7% (44/165), with a median maximal standardised uptake value of 3.2 (range, 1.7-13.8). Vaccine-associated hypermetabolic lymphadenopathy (VAHL) was found in 11.4% (5/44) of the subjects beyond 6 weeks after vaccination. VAHL was more common in patients receiving BioNTech-Fosun mRNA vaccine (compared with patients receiving the Sinovac CoronaVac inactivated vaccine), and in women (p < 0.05). Conclusion: VAHL is common and can be observed beyond 6 weeks after vaccination. It was seen more frequently in women and in patients receiving the mRNA-based vaccine. Proper vaccination history documentation, locating the vaccination site contralateral to the primary cancer, and appropriate scheduling of FDG PET/CT are advisable for correct image interpretation.
18 F-fluorodeoxyglucose positron emission tomography-computed tomography is commonly used for the staging of non-small-cell lung carcinoma. However, few studies have investigated the correlation between the maximum standardised uptake value (SUV max) of the primary tumour and the disease staging according to histology. The current retrospective study evaluated this relationship using statistical analyses. The findings suggest that higher SUV max is positively correlated with more advanced staging. This study demonstrates the importance of SUV max interpretation on the radiological staging of non-small-cell lung carcinoma.
Introduction: Lung cancer has the highest incidence and mortality among malignancies in many countries. 18 F-Fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) is commonly indicated for the preoperative nodal staging of non-small-cell lung carcinoma. While maximum standardised uptake value (SUV max ), visual scoring systems and nodal diameter have been proposed to distinguish benign from malignant nodes, studies comparing the different measurements have been limited. Correct nodal staging is crucial in determining if treatment intent is curative or palliative. This study aimed to evaluate the accuracies of nodal staging in 18 F-FDG PET/CT based on different methods. Methods: A total of 467 mediastinal/extramediastinal lymph nodes from 97 patients, who underwent staging 18 F-FDG PET/CT at our centre for non-small-cell lung carcinoma, were retrospectively reviewed. The nodes were evaluated based on SUV max , five-point visual interpretation score, and diameter. Their sensitivities, specificities and accuracies were compared with histology using receiver operating characteristics curves and areas under the curves (AUCs). Subgroup analyses based on T staging, histology, epidermal growth factor receptor (EGFR) status, lymph node locations, and tumour SUV max were also investigated. Results:The diagnostic performance of visual score (at optimal cut-off of 3) yielded the highest specificity (0.932), accuracy (0.916), positive predictive value (0.623), and negative predictive value (0.972), results of which were similar to SUV max of 2.5 and better than nodal diameter of 10 mm. Subgroup analyses showed that visual interpretation achieved satisfactory AUCs in different T stages, histologies, EGFR statuses, locations of lymph nodes, and tumour SUVs max . Conclusion:The five-point visual interpretation is a convenient diagnostic tool with performance better than nodal diameter, and similar to that of SUV max .
Introduction Brain metastases may manifest as hypermetabolism or hypometabolism compared with normal brain activity on 18fluorine-fluorodeoxyglucose PET (18F-FDG PET). We aim to undertake a systematic review and meta-analysis to determine the diagnostic accuracy of FDG PET for detecting brain metastases from different extracranial primary cancers. Methods PubMed and EMBASE were searched systematically. Study selection and quality assessment were performed independently by two authors. Meta-analysis was performed using a bivariate random-effects model. Subgroup analysis and meta-regression would be performed if heterogeneity was found. Results A total of 2227 patients from 11 studies were included in the review and analysis. Using the bivariate random-effects model, summary patient-based sensitivity and specificity for all 11 studies were estimated to be 0.440 [95% confidence interval (CI)] 0.295–0.597) and 0.997 (95% CI, 0.977–1.000). In view of significant between-study heterogeneity (I 2 = 74.0% for sensitivity and I 2 = 67.3% for specificity), subgroup analyses were performed. Meta-regression showed significantly higher patient-based summary sensitivity for the three better-quality studies (a total of 1037 patients) with satisfactory index test (counting both hypermetabolism and hypometabolism as positive index test) and satisfactory reference standards (other imaging and clinical follow-up) compared with other included studies [0.735 (95% CI, 0.601–0.836) vs 0.304 (95% CI, 0.223–0.400), P value = 0.000]. Conclusion Our systematic review and meta-analysis showed that FDG PET has overall limited sensitivity and excellent specificity in the detection of brain metastases from extracranial primary cancers. Importantly, subgroup analyses showed that the sensitivity can be significantly improved by raising awareness of asymmetrical hypometabolism. Further studies are warranted to assess the benefits of including the brain in FDG PET studies for all or certain groups of oncological patients.
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