Potential clinical utility of dual time point FDG-PET for distinguishing benign from malignant lesions: implications for oncological imaging

Viedma, S. Sanz; Torigian, Drew A.; Parsons, Molly; Basu, Sandip; Alavi, Abass

doi:10.1016/s0212-6982(09)71360-6

Cited by 33 publications

(9 citation statements)

References 19 publications

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“…Another very important issue is the fact that several tumors exhibit a maximum FDG uptake well beyond 60 min after FDG administration while surrounding normal tissues show a decline in FDG uptake with time [48–50]. Therefore, lesion-to-background contrast can be considerably increased at delayed PET imaging [48–50], thereby increasing detectability of the unknown primary tumor.…”

Section: Challenges and Future Considerationsmentioning

confidence: 99%

FDG PET/CT in carcinoma of unknown primary

Kwee

Basu

Cheng

et al. 2009

Eur J Nucl Med Mol Imaging

116

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Carcinoma of unknown primary (CUP) is a heterogeneous group of metastatic malignancies in which a primary tumor could not be detected despite thorough diagnostic evaluation. Because of its high sensitivity for the detection of lesions, combined 18F-fluoro-2-deoxyglucose positron emission tomography (FDG PET)/computed tomography (CT) may be an excellent alternative to CT alone and conventional magnetic resonance imaging in detecting the unknown primary tumor. This article will review the use, diagnostic performance, and utility of FDG PET/CT in CUP and will discuss challenges and future considerations in the diagnostic management of CUP.

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Section: Challenges and Future Considerationsmentioning

confidence: 99%

FDG PET/CT in carcinoma of unknown primary

Kwee

Basu

Cheng

et al. 2009

Eur J Nucl Med Mol Imaging

116

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“…Fig. 1 Hypothetical time course of uptake of 18 FDG measured as the standard uptake value (SUV, y-axis) over time (x-axis) in minutes [3]. By 120 min, there is a marked discrepancy in the uptake of 18 FDG between malignant lesions and those due to inflammation.…”

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confidence: 99%

“…This discrimination is related to the differences in the activity of the enzyme glucose-6-phosphatase (G6PD) in inflammatory compared to malignant nodules. Malignant cells have low enzyme activity and so continue to accumulate 18 FDG over time, resulting in continued uptake on delayed imaging; the opposite occurs in inflammation, where there are relatively high levels of activity of G6PD [3] (Fig. 1).…”

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confidence: 99%

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Dual-Time-Point FDG PET/CT to Distinguish Coccidioidal Pulmonary Nodules from Those Due to Malignancy

Pasha

Walsh

Ampel

2015

Lung

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It has been estimated that there are approximately 150,000 coccidioidal infections every year in the United States. The vast majority of these are acquired in coccidioidal endemic regions, including the San Joaquin Valley of California, the south central portion of Arizona, and some areas of Nevada, Utah, and Texas. A frequent outcome of pulmonary coccidioidomycosis is the development of a pulmonary nodule. Currently, there are no reliable noninvasive methods that can distinguish a coccidioidal pulmonary nodule from one due to other causes, including a malignancy. This frequently results in the need to perform a biopsy with its attendant risks.Recently, Reyes and colleagues published the results of a retrospective study demonstrating the utility of assessment of the uptake of 18 fluorodeoxyglucose ( 18 FDG) by positron emission tomography with computed axial tomography (FDG PET/CT) at a single time point in differentiating coccidioidal lung nodules from those due to malignancy, but only when the uptake of 18 FDG was very high [1]. Dual-time-point imaging (DTPI) employing FDG PET/CT is a promising next step forward in differentiating benign from malignant lesions [2]. This discrimination is related to the differences in the activity of the enzyme glucose-6-phosphatase (G6PD) in inflammatory compared to malignant nodules. Malignant cells have low enzyme activity and so continue to accumulate 18 FDG over time, resulting in continued uptake on delayed imaging; the opposite occurs in inflammation, where there are relatively high levels of activity of G6PD [3] (Fig. 1).Two studies of DTPI FDG PET/CT have already demonstrated positive results in differentiating benign from malignant lesions [4,5], but these did not include cases of coccidioidomycosis. A prospective study of DTPI FDG PET/CT among subjects with pulmonary nodules in the coccidioidal endemic could result in the development of a non-invasive method for distinguishing coccidioidal from malignant lesions and lead to a low-risk diagnostic test for this common clinical problem in the coccidioidal endemic region. Fig. 1 Hypothetical time course of uptake of 18 FDG measured as the standard uptake value (SUV, y-axis) over time (x-axis) in minutes [3]. By 120 min, there is a marked discrepancy in the uptake of 18 FDG between malignant lesions and those due to inflammation. Published with permission of the author and the publisher. Originally published in [3].

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“…20,21 Both techniques are promising in increasing specificity and/or sensitivity of 18 F-FDG PET/CT scan based on the hypothesis that malignant lesions increase 18 F-FDG uptake overtime, whereas normal tissues decrease the uptake. However, there has been limited evidence that confirms the benefit of these techniques.…”

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confidence: 99%