It is known that following a traumatic fracture or surgical intervention, bone scintigraphy reveals positive results for an extended period of time, posing a challenge when evaluating patients for possible malignancy or superimposed osteomyelitis. Previous reports indicate that acute fractures can also result in increased fluorine-18 fluorodeoxyglucose (FDG) accumulation and therefore cause difficulties when patients are evaluated for other indications by FDG-PET. The purpose of this study was to assess the pattern and time course of abnormal FDG uptake following traumatic or surgical fracture. A total of 1,517 consecutive patients who underwent whole-body FDG-PET imaging were retrospectively studied. A history of fractures or orthopedic intervention was obtained from an interview prior to scanning. The FDG-PET results were compared with the results of other imaging studies, including bone scans, radiographs, CT, and MRI, as well as surgical pathology reports. Thirty-seven patients with a known date of traumatic or surgical fracture were identified. Among these, 14 had fractures or surgery within 3 months prior to FDG-PET, while 23 had fractures or surgical intervention greater than 3 months prior to FDG-PET. FDG-PET showed no abnormally increased uptake at the known fracture or surgical sites in 30 of these patients. Notably, in the 23 patients with fractures more than 3 months old, all but one showed no abnormally increased uptake. Furthermore, the positive FDG uptake in this exception was a result of complicating osteomyelitis. In the 14 patients with a history of fracture less than 3 months old, only six had abnormally increased FDG uptake. Following traumatic or surgical fractures, FDG uptake is expected to be normal within 3 months unless the process is complicated by infection or malignancy.

FDG PET is a highly effective imaging method to exclude osteomyelitis when a negative scan result is obtained. However, positive results can be caused not only by true osteomyelitis but also by inflammation in the bone or surrounding soft tissues as a result of other causes. Overall, FDG PET may prove to be the preferred study in the management of patients with possible chronic osteomyelitis.

The routine use of FDG PET to characterize lung lesions significantly increases the probability of detecting unexpected extrathoracic disease. In these patients, the incidental finding of colon cancer had an important effect on their treatment and may prove to be very cost-effective.

Liver metastasis is a common consequence of colorectal carcinoma. Early and accurate detection of liver metastasis is crucial for a decision about partial hepatectomy, which is considered a standard and potentially curative therapy in such a setting. The presence of extrahepatic metastases will exclude surgical resection as a therapeutic option. Positron emission tomography with fluorine-18-deoxyglucose (FDG-PET) has been successful in detecting and staging a variety of malignancies. The purpose of this study was to assess the utility of FDG-PET in the accurate detection of liver and distal metastases from colorectal cancer. The results of 80 PET and computed tomography (CT) scans were compared with surgical pathology and clinical outcome. FDG-PET detected liver metastases in 28 patients, with a sensitivity of 100%. CT detected metastasis in 20 patients, giving a sensitivity of 71.4%. In addition, in one patient with negative CT findings, PET detected a focus of hypermetabolism in the region adjacent to liver, which was proven to be a second focus of primary colon carcinoma. In six patients with liver metastases, PET correctly detected extrahepatic lesions, while CT only detected hepatic lesions. In conclusion, FDG-PET is an excellent imaging modality for the detection and staging of liver metastases in patients with colorectal carcinomas.

ABSTRACT

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Purpose Patients with stage III non-small-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT) in low- and middle-income countries (LMIC) continue to have a poor prognosis. It is known that FDG PET/CT improves staging, treatment selection and target volume delineation (TVD), and although its use has grown rapidly, it is still not widely available in LMIC. CRT is often used as sequential treatment, but is known to be more effective when given concurrently. The aim of the PERTAIN study was to assess the impact of introducing FDG PET/CT-guided concurrent CRT, supported by training and quality control (QC), on the overall survival (OS) and progression-free survival (PFS) of patients with stage III NSCLC. Methods The study included patients with stage III NSCLC from nine medical centres in seven countries. A retrospective cohort was managed according to local practices between January 2010 and July 2014, which involved only optional diagnostic FDG PET/CT for staging (not for TVD), followed by sequential or concurrent CRT. A prospective cohort between August 2015 and October 2018 was treated according to the study protocol including FDG PET/CT in treatment position for staging and multimodal TVD followed by concurrent CRT by specialists trained in protocol-specific TVD and with TVD QC. Kaplan–Meier analysis was used to assess OS and PFS in the retrospective and prospective cohorts. Results Guidelines for FDG PET/CT image acquisition and TVD were developed and published. All specialists involved in the PERTAIN study received training between June 2014 and May 2016. The PET/CT scanners used received EARL accreditation. In November 2018 a planned interim analysis was performed including 230 patients in the retrospective cohort with a median follow-up of 14 months and 128 patients in the prospective cohort, of whom 69 had a follow-up of at least 1 year. Using the Kaplan–Meier method, OS was significantly longer in the prospective cohort than in the retrospective cohort (23 vs. 14 months, p = 0.012). In addition, median PFS was significantly longer in the prospective cohort than in the retrospective cohort (17 vs. 11 months, p = 0.012). Conclusion In the PERTAIN study, the preliminary results indicate that introducing FDG PET/CT-guided concurrent CRT for patients with stage III NSCLC in LMIC resulted in a significant improvement in OS and PFS. The final study results based on complete data are expected in 2020. Electronic supplementary material The online version of this article (10.1007/s00259-019-04421-5) contains supplementary material, which is available to authorized users.

The results suggest that transient ischemic dilation assessed using the stress/rest sestamibi protocol may be useful to separate patients with extensive myocardial ischemia from those without ischemia.