18F-FDG and 18F-FLT PET/CT imaging in the characterization of mediastinal lymph nodes

Rayamajhi, Sampanna Jung; Mittal, Bhagwant Rai; Maturu, Venkata Nagarjuna; Agarwal, Ritesh; Bal, Amanjit; Dey, Pranab; Shukla, Jaya; Gupta, Dheeraj

doi:10.1007/s12149-015-1047-6

Cited by 36 publications

(20 citation statements)

References 32 publications

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“…Yamamoto et al . 26 indicated that the diagnostic ability of FLT PET was lower than FDG PET, the sensitivity, specificity, PPV, NPV and accuracy of FLT PET and FDG PET for lymph node staging were 57%, 93%, 67%, 89%, 85 and 57%, 78%, 36%, 91%, 74%, respectively. For 4DST, the results of clinical study suggested that the sensitivity for detecting LNMs was high (82%), but its low specificity (72%) was a limitation (P < 0.001) 27 .…”

Section: Discussionmentioning

confidence: 96%

“…Therefore, the researchers focused their attention on the development of new diagnostic methods and new tracers of PET for detecting LNMs in patients with NSCLC. 11 C-choline 25 , 18 F-fluorothymidine( 18 F-FLT) 26 , 4′-[methyl- 11 C]-thiothymidine(4DST) 27 , 18 F-Alfatide are all PET tracers used to visualize various malignancies and LNMs.…”

Section: Discussionmentioning

confidence: 99%

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A Pilot Study of 18F-Alfatide PET/CT Imaging for Detecting Lymph Node Metastases in Patients with Non-Small Cell Lung Cancer

Zhou

Gao

Huang

et al. 2017

Sci Rep

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Angiogenesis plays a key role in tumor development and αvβ3 integrin are overexpressed on the endothelial cell surface of newly forming vessels. 18F-Alfatide has favorable properties for αvβ3 integrin targeting and showed potential for imaging angiogenesis with Positron Emission Tomography (PET)/computed tomography (CT). In this study, 13 patients with non-small cell lung cancer (NSCLC) who underwent 18F-Alfatide PET/CT before surgery were enrolled. The uptake of all dissected lymph nodes (LNs) of 18F-Alfatide were assessed visually and analyzed with a maximum and mean standard uptake value (SUVmax, SUVmean) and SUV ratios. LN metastases were pathologically confirmed and 20 of 196 LNs were malignant. All malignant LNs were successfully visualized on 18F-Alfatide PET/CT in patients and the sensitivity, specificity and accuracy was 100.0%, 94.9% and 95.4%, respectively. SUVmax, SUVmean and SUV ratios in malignant LNs were significantly higher than in benign LNs for NSCLC patients (P < 0.001). The same result was observed in patients with adenocarcinoma and squamous cell carcinoma (P < 0.001). The 18F-Alfatide parameter shows high sensitivity (83.9–100%), specificity (78.6–96.7%) and accuracy (81.7–96.9%) according to thresholds calculated from receiver operating characteristic curve. Our results suggest that 18F-Alfatide PET/CT is valuable in the diagnosis of metastatic LNs for NSCLC patients.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

A Pilot Study of 18F-Alfatide PET/CT Imaging for Detecting Lymph Node Metastases in Patients with Non-Small Cell Lung Cancer

Zhou

Gao

Huang

et al. 2017

Sci Rep

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“…It is important to recognize FDG-avid lesions that are benign, which in this study were most commonly benign FDG-avid mediastinal lymph nodes from inflammatory etiologies [9], FDG-avid physiologic adnexal cysts in premenopausal women [10], and physiologic rectal sphincter FDG avidity. Not all malignancies will be appreciably FDG-avid, and may be detected on the CT component of the FDG PET/CT [11, 12].…”

Section: Discussionmentioning

confidence: 99%

Value of second-opinion review of outside institution PET-CT examinations

Ulaner

Mannelli

Dunphy

2017

Nuclear Medicine Communications

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Objective Determine if second opinion reviews of PET/CT examinations by subspecialists alters reporting of malignant findings. Methods This IRB-approved study compared 240 FDG PET/CT consecutively dictated reports by two nuclear medicine subspecialists against the original outside institution reports. Subspecialist reviews documented if malignant findings on the outside report were malignant, and noted additional malignant findings not described on the outside report. Final diagnosis of malignancy or benignity was determined by pathology when available, otherwise by imaging follow-up. Results 22 findings (in 20 reports) called suspicious/malignant on the outside reports were deemed benign by subspecialist review. A final diagnosis was available for 20 of 22 findings by pathology (3) or follow-up imaging (17). The subspecialist review was accurate in 20 of 20 (100%) cases where a final diagnosis was available. The subspecialist review called 11 findings (in 11 reports) suspicious/malignant that were not described or deemed benign on the outside reports. Definitive diagnosis was available for 10 of 11 findings by pathology (7) or follow-up imaging (3). The second opinion report was accurate in 7 of 10 (70%) cases where a final diagnosis was available. Conclusions In 31 of 240 (13%) FDG PET/CT examinations performed at an outside institution, subspecialist review resulted in at least one discordant opinion of malignancy. For 28 discrepant cases where a final diagnosis was available, the subspecialist review defined malignancy or benignity correctly in 25 of 28 (89%) cases. This provides evidence for cost and effort invested in performing second opinion reviews of PET/CT studies.

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“…Indeed, it is known that false-positive 18 F-FDG PET results occur in a considerable proportion of treated DLBCL patients (10,27). Moreover, as recently reported (28), it is quite impossible to characterize mediastinal lymphadenopathy as benign (e.g., as tuberculosis or sarcoidosis) or malignant on the basis of 18 F-FDG or 18 F-FLT PET, even though they reflect different aspects of biology (i.e., metabolism and proliferation, respectively). The potential capacity of 18 F-fludarabine to distinguish tumor burden from inflammatory tissue is also crucial for predicting viable lymphoma in residual masses after completion of therapy.…”

Section: Discussionmentioning

confidence: 91%

¹⁸F-Fludarabine PET for Lymphoma Imaging: First-in-Humans Study on DLBCL and CLL Patients

Chantepie¹,

Hovhannisyan²,

Guillouet³

et al. 2018

J Nucl Med

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This was the first-in-humans clinical study of F-fludarabine, which is a radiopharmaceutical for PET imaging in lymphoma, for which many issues remain controversial with the standard radiotracerF-FDG. F-fludarabine PET or PET/CT was performed on 10 patients: 5 with diffuse large B-cell lymphoma (DLBCL) and 5 with chronic lymphocytic leukemia. The tumor uptake, biodistribution, and radiation dosimetry ofF-fludarabine were evaluated. Six successive partial-body PET scans were acquired for 250 min after an intravenous 4 MBq/kg bolus of F-fludarabine. SUVs were recorded for each involved lymph node territory and for several extranodal sites, with particular reference to the liver. To assess the time-related uptake profile ofF-fludarabine, PET images were analyzed by delineating volumes of interest over the uptake sites on the optimal scan for visual observation and were projected onto all coregistered scans of the same subject. Physical examination, laboratory studies, and contrast-enhanced CT were performed on all patients. For the DLBCL group, F-FDG PET was also considered. In DLBCL patients, increased F-fludarabine uptake was observed in sites considered abnormal by CT orF-FDG, with SUVs significantly higher in involved lesions than in physiologic nontarget sites. Nonetheless, the comparison of F-fludarabine andF-FDG PET showed discrepancies in 2 patients. In chronic lymphocytic leukemia patients, the uptake of F-fludarabine coincided with sites expected to be involved (including splenic invasion) according to conventional clinical and CT staging and was significant in hematopoietic bone marrow. No uptake was observed, whatever the disease group, in cardiac muscle or brain. The mean effective dose from a mean injectedF-fludarabine activity of 305 ± 76 MBq was 3.07 ± 0.81 mSv. F-fludarabine PET might well be a promising tool for lymphoproliferative diseases. The radiation dose of this radiopharmaceutical is below that ofF-FDG. The specificity of this PET probe for lymphoid cells, its absence of accumulation in reactive tissues, and its feasibility for detection of bone marrow infiltration might play an innovative role in lymphoma imaging.

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18F-FDG and 18F-FLT PET/CT imaging in the characterization of mediastinal lymph nodes

Cited by 36 publications

References 32 publications

A Pilot Study of 18F-Alfatide PET/CT Imaging for Detecting Lymph Node Metastases in Patients with Non-Small Cell Lung Cancer

A Pilot Study of 18F-Alfatide PET/CT Imaging for Detecting Lymph Node Metastases in Patients with Non-Small Cell Lung Cancer

Value of second-opinion review of outside institution PET-CT examinations

¹⁸F-Fludarabine PET for Lymphoma Imaging: First-in-Humans Study on DLBCL and CLL Patients

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18F-FDG and 18F-FLT PET/CT imaging in the characterization of mediastinal lymph nodes

Cited by 36 publications

References 32 publications

A Pilot Study of 18F-Alfatide PET/CT Imaging for Detecting Lymph Node Metastases in Patients with Non-Small Cell Lung Cancer

A Pilot Study of 18F-Alfatide PET/CT Imaging for Detecting Lymph Node Metastases in Patients with Non-Small Cell Lung Cancer

Value of second-opinion review of outside institution PET-CT examinations

18F-Fludarabine PET for Lymphoma Imaging: First-in-Humans Study on DLBCL and CLL Patients

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¹⁸F-Fludarabine PET for Lymphoma Imaging: First-in-Humans Study on DLBCL and CLL Patients