Rim^(18)F-fluorodeoxyglucose uptake of hepatic cavernous hemangioma on positron emission tomography/computed tomography:A case report

BACKGROUND Peripheral FDG accumulation in a hepatic hemangioma presenting in a patient with prolonged fever is rare.Therefore,clinicians should pay close attention to patients with hepatic mass.CASE SUMMARY A 54-year-old woman with a 4-wk history of daily fevers was admitted to our hospital.A whole body^(18)-Fluordesoxyglucose(PET-FDG)positron emission tomography/computed tomography(PET/CT)was performed to elucidate the source of the fever.However,whole body^(18)-FDG PET/CT raised the suspicion of a malignant lesion because of peripheral FDG accumulation(SUVmax 3.5 g/mL)higher than that of the normal liver parenchyma(SUVmax 1.6 g/mL)surrounding a hypoactive area,and no other abnormalities were showed.Subsequently,the patient underwent liver mass resection.Histopathology showed a hepatic cavernous hemangioma with fatty infiltration around the lesion.The fever disappeared four days after surgery and the patient did not present any complications during follow-up.CONCLUSION Fatty infiltration in the peripheral parts of hepatic cavernous hemangioma may lead to subacute inflammation which further activate the Kupffer cells.This may cause prolonged fever and peripheral rim FDG accumulation on PET/CT.

Technetium-99m-methylene diphosphonate single photon emission computed tomography/computed tomography combined with prostate-specific antigen/free prostate-specific antigen ratio for bone metastasis of prostate cancer

BACKGROUND Prostate cancer(PC)is one of the most common malignant tumors in men,and bone metastasis is one of its common complications,which seriously affects the quality of life and prognosis of patients.AIM To investigate the diagnostic value of technetium-99m-methylene diphosphonate(99mTc-MDP)single photon emission computed tomography(SPECT)/CT imaging combined with the serum prostate-specific antigen(PSA)/free PSA ratio for PC bone metastasis(PCBM).METHODS One hundred patients with PC who visited the Hospital of Chengdu University of Traditional Chinese Medicine from January 2020 to January 2022 were recruited as the experimental(Exp)group,while 30 patients with benign prostatic lesions(BPLs)were recruited as the control(Ctrl)group.All patients underwent 99mTc-MDP SPECT/CT imaging and serum PSA/fPSA testing.The SPECT/CT imaging results and serum PSA/fPSA ratios of patients were analyzed to evaluate their diagnostic values for PCBM.RESULTS The difference in general information of the patients was not obvious,showing comparability.The two methods showed no visible differences in negative predictive value and sensitivity for patients with PCBM,but had great differences in positive predictive value and specificity(P<0.05).The PSA/fPSA ratio of patients with PC in the Exp group was lower than those with BPLs,and patients with PCBM had a much lower PSA/fPSA ratio than those without PC(P<0.05).The results confirmed that the combined use of 99mTc-MDP SPECT/CT imaging and serum PSA/fPSA ratio achieved a detection rate of 95%for PCBM.CONCLUSION The combination of 99mTc-MDP SPECT/CT and PSA/fPSA ratio is accurate and reliable for the diagnosis of PCBM,which provides an important reference for clinical practice.

Pancreatic neuroendocrine tumor detected by technetium-99m methoxy-2-isobutylisonitrile single photon emission computed tomography/computed tomography:A case report

BACKGROUND Pancreatic neuroendocrine tumors(NETs)account for about 1%–2%of pancreatic tumors and about 8%of all NETs.Computed tomography(CT),magnetic resonance imaging,and endoscopic ultrasound are common imaging modalities for the diagnosis of pancreatic NETs.Furthermore,somatostatin receptor imaging is of great value for diagnosing pancreatic NETs.Herein,we report the efficacy of technetium-99m methoxy-2-isobutylisonitrile(99mTc-MIBI)single photon emission CT(SPECT)/CT for detecting pancreatic NETs.CASE SUMMARY A 57-year-old woman presented to our hospital with a 1-d history of persistent upper abdominal distending pain.The distending pain in the upper abdomen was aggravated after eating,with nausea and retching.Routine blood test results showed a high neutrophil percentage,low leukomonocyte and monocyte percentages,and low leukomonocyte and eosinophil counts.Amylase,liver and kidney function,and tumor markers alpha-fetoprotein,carcinoembryonic antigen,and cancer antigen(CA)125,CA72-4,CA19-9,and CA153 were normal.Abdominal CT showed a mass,with multiple calcifications between the pancreas and the spleen.The boundary between the mass and the pancreas and spleen was poorly defined.Contrast-enhanced CT revealed that the upper abdominal mass was unevenly and gradually enhanced.99mTc-MIBI SPECT/CT revealed that a focal radioactive concentration,with mild radioactive concentration extending into the upper abdominal mass,was present at the pancreatic body and tail.The 99mTc-MIBI SPECT/CT manifestations were consistent with the final pathological diagnosis of pancreatic NET.CONCLUSION 99mTc-MIBI SPECT/CT appears to be a valuable tool for detecting pancreatic NETs.

Evaluation of response to gemcitabine plus cisplatin-based chemotherapy using positron emission computed tomography for metastatic bladder cancer

BACKGROUND The purpose of the present study was to examine retrospectively the contribution of 18Fluorodeoxyglucose positron emission tomography computed tomography(18FDG-PET/CT)to the evaluation of response to first-line gemcitabine plus cispla-tin-based chemotherapy in patients with metastatic bladder cancer.AIM To evaluate the response to Gemcitabine plus Cisplatin-based chemotherapy using 18FDG-PET/CT imaging in patients with metastatic bladder cancer.METHODS Between July 2007 and April 2019,79 patients underwent 18FDG-PET/CT imaging with the diagnosis of Metastatic Bladder Carcinoma(M-BCa).A total of 42 pa-tients(38 male,4 female)were included in the study,and all had been admi-nistered Gemcitabine plus Cisplatin-based chemotherapy.After completion of the therapy,the patients underwent a repeat 18FDG-PET/CT scan and the results were compared with the PET/CT findings before chemotherapy according to European Organisation for the Research and treatment of cancer criteria.Mean age was 66.1 years and standard deviation was 10.7 years(range:41–84 years).RESULTS Of the patients,seven(16.6%)were in complete remission,17(40.5%)were in partial remission,six(14.3%)had a stable disease,and 12(28.6%)had a pro-gressive disease.The overall response rate was 57.1 percent.CONCLUSION 18FDG-PET/CT can be considered as a successful imaging tool in evaluating response to first-line chemotherapy for metastatic bladder cancer.Anatomical and functional data obtained from PET/CT scans may be useful in the planning of secondline and thirdline chemotherapy.

Impact of random and scattered coincidences from outside of field of view on positron emission tomography/computed tomography imaging with different reconstruction protocols

Image quality in positron emission tomography(PET)is affected by random and scattered coincidences and reconstruction protocols.In this study,we investigated the effects of scattered and random coincidences from outside the field of view(FOV)on PET image quality for different reconstruction protocols.Imaging was performed on the Discovery 690 PET/CT scanner,using experimental configurations including the NEMA phantom(a body phantom,with six spheres of different sizes)with a signal background ratio of 4:1.The NEMA phantom(phantom I)was scanned separately in a one-bed position.To simulate the effect of random and scatter coincidences from outside the FOV,six cylindrical phantoms with various diameters were added to the NEMA phantom(phantom II).The 18 emission datasets with mean intervals of 15 min were acquired(3 min/scan).The emission data were reconstructed using different techniques.The image quality parameters were evaluated by both phantoms.Variations in the signal-to-noise ratio(SNR)in a 28-mm(10-mm)sphere of phantom II were 37.9%(86.5%)for ordered-subset expectation maximization(OSEM-only),36.8%(81.5%)for point spread function(PSF),32.7%(80.7%)for time of flight(TOF),and 31.5%(77.8%)for OSEM+PSF+TOF,respectively,indicating that OSEM+PSF+TOF reconstruction had the lowest noise levels and lowest coefficient of variation(COV)values.Random and scatter coincidences from outside the FOV induced lower SNR,lower contrast,and higher COV values,indicating image deterioration and significantly impacting smaller sphere sizes.Amongst reconstruction protocols,OSEM+PSF+TOF and OSEM+PSF showed higher contrast values for sphere sizes of 22,28,and 37 mm and higher contrast recovery coefficient values for smaller sphere sizes of 10 and 13 mm.

Rare finding of primary aortoduodenal fistula on single-photon emission computed tomography/computed tomography of gastrointestinal bleeding: A case report

BACKGROUND Primary aortoduodenal fistula is a rare cause of gastrointestinal(GI)bleeding consisting of abnormal channels between the aorta and GI tract without previous vascular intervention that results in massive intraluminal hemorrhage.CASE SUMMARY A 67-year-old man was hospitalized for coffee ground vomiting,tarry stools,and colic abdominal pain.He was repeatedly admitted for active GI bleeding and hypovolemic shock.Intermittent and spontaneously stopped bleeders were undetectable on multiple GI endoscopy,angiography,computed tomography angiography(CTA),capsule endoscopy,and ^(99)mTc-labeled red blood cell(RBC)scans.The patient received supportive treatment and was discharged without signs of rebleeding.Thereafter,he was re-admitted for bleeder identification.Repeated CTA after a bleed revealed a small aortic aneurysm at the renal level contacting the fourth portion of the duodenum.A ^(99)mTc-labeled RBC singlephoton emission CT(SPECT)/CT scan performed during bleeding symptoms revealed active bleeding at the duodenal level.According to his clinical symptoms(intermittent massive GI bleeding with hypovolemic shock,dizziness,dark red stool,and bloody vomitus)and the abdominal CTA and ^(99)mTc-labeled RBC SPECT/CT results,we suspected a small aneurysm and an aortoduodenal fistula.Subsequent duodenal excision and duodenojejunal anastomosis were performed.A 7-mm saccular aneurysm arising from the anterior wall of the abdominal aorta near the left renal artery was identified.Percutaneous intravascular stenting of the abdominal aorta was performed and his symptoms improved.CONCLUSION Our findings suggest that ^(99)mTc-labeled RBC SPECT/CT scanning can aid the diagnosis of a rare cause of active GI bleeding.

Appearance of aseptic vascular grafts after endovascular aortic repair on[(18)F]fluorodeoxyglucose positron emission tomography/computed tomography

BACKGROUND Diagnosis of prosthetic vascular graft infection with[(18)F]fluorodeoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)allows for early detection of functional changes associated with infection,based on increased glucose utilization by activated macrophages and granulocytes.Aseptic vascular grafts,like all foreign bodies,can stimulate an inflammatory response,which can present as increased activity on 18F-FDG PET/CT.Consequently,distinguishing aseptic inflammation from graft infection,though important,can be difficult.In the case of endovascular aneurysm repair(EVAR),a minimally invasive procedure involving the transfemoral insertion of an endoprosthetic stent graft,the normal postoperative appearance of these grafts on 18F-FDG PET/CT can vary over time,potentially confounding study interpretation.AIM To investigate the visual,semiquantitative,and temporal characteristics of aseptic vascular grafts in patients status post EVAR.METHODS In this observational retrospective cohort study,patients with history of EVAR who underwent 18F-FDG PET/CT for indications other than infection were identified retrospectively.All patients were asymptomatic for graft infection-no abdominal pain,fever of unknown origin,sepsis,or leukocytosis-at the time of imaging and for≥2 mo after each PET/CT.Imaging studies such as CT for each patient were also reviewed,and any patients with suspected or confirmed vascular graft infection were excluded.One hundred two scans performed on 43 patients(34 males;9 females;age=77±8 years at the time of the final PET/CT)were retrospectively reviewed.All 43 patients had an abdominal aortic(AA)vascular graft,40 patients had a right iliac(RI)limb graft,and 41 patients had a left iliac(LI)limb graft.Twentytwo patients had 1 PET/CT and 21 patients had from 2 to 9 PET/CTs.Grafts were imaged between 2 mo to 168 mo(about 14 years)post placement.Eight grafts were imaged within 6 mo of placement,including three that were imaged within three months of placement.The mean interval between graft placement and PET/CT for all 102 scans was 51±39 mo.PET/CT data was reconstructed with region-of-interest analysis of proximal,mid and distal portions of the grafts and background ascending aorta.Maximum standardized uptake value(SUVmax)was recorded for each region.SUVmax-to-background uptake ratios(URs)were calculated.Visual assessment was performed using a 2-pattern grading scale:Diffuse(homogeneous uptake less than liver uptake)and focal(one or more areas of focal uptake in any part of the graft).Statistical analysis was performed.RESULTS In total,there were 306 AA grafts,285 LI grafts,282 RI grafts,and 306 ascending aorta background SUVmax measurements.For all 102 scans,mean SUVmax values for AA grafts were 2.8-3.0 along proximal,mid,and distal segments.Mean SUVmax values for LI grafts and RI grafts were 2.7-2.8.Mean SUVmax values for background were 2.5±0.5.Mean URs were 1.1-1.2.Visual analysis of the scans reflected results of quantitative analysis.On visual inspection,98%revealed diffuse,homogeneous 18F-FDG uptake less than liver.Graft URs and visual pattern categories were significantly associated for AA graft URs(F-ratio=21.5,P<0.001),LI graft URs(F-ratio=20.4,P<0.001),and RI graft URs(F-ratio=30.4,P<0.001).Thus,visual patterns of 18F-FDG uptake corresponded statistically significantly to semiquantitative URs.The age of grafts showing focal patterns was greater than grafts showing diffuse patterns,87±89 vs 50±37 mo,respectively(P=0.02).URs were significantly associated with graft age for AA grafts(r=0.19,P=0.001).URs were also significantly associated with graft age for LI grafts(r=0.25,P<0.0001),and RI grafts(r=0.31,P<0.001).Quartiles of similar numbers of graft(n=25-27)grouped by graft age indicated that URs were significantly higher for 4th quartile vs 2nd quartile URs(F-ratio=19.5,P<0.001).When evaluating URs,graft SUVmax values within 10%-20%of the ascending aorta SUVmax is evident in aseptic grafts,except for grafts in the oldest quartiles.In this study,grafts in the oldest quartiles(>7 years post EVAR)showed SUVmax up to 30%higher than the ascending aorta SUVmax.CONCLUSION Characteristics of an aseptic vascular stent graft in the aorta and iliac vessels on 18F-FDG PET/CT include graft SUVmax values within 10%-20%of the ascending aorta background SUVmax.The SUVmax of older aseptic grafts can be as much as 30%above background.The visual uptake pattern of diffuse,homogeneous uptake less than liver was seen in 98%of aseptic vascular grafts,making this pattern particularly reassuring for clinicians.

^(18)F-Fluorodeoxyglucose positron emission tomography/computed tomography comparison of gastric lymphoma and gastric carcinoma

AIM To compare ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT) features in gastric lymphoma and gastric carcinoma.METHODS Patients with newly diagnosed gastric lymphoma or gastric carcinoma who underwent ^(18)F-FDG PET/CT prior to treatment were included in this study. We reviewed and analyzed the PET/CT features of gastric wall lesions,including FDG avidity,pattern(focal/diffuse),and intensity [maximal standard uptake value:(SUVmax)]. The correlation of SUVmax with gastricclinicopathological variables was investigated by χ~2 test,and receiver-operating characteristic(ROC) curve analysis was performed to determine the differential diagnostic value of SUVmax-associated parameters in gastric lymphoma and gastric carcinoma. RESULTS Fifty-two patients with gastric lymphoma and 73 with gastric carcinoma were included in this study. Abnormal gastric FDG accumulation was found in 49 patients(94.23%) with gastric lymphoma and 65 patients(89.04%) with gastric carcinoma. Gastric lymphoma patients predominantly presented with type Ⅰ and type Ⅱ lesions,whereas gastric carcinoma patients mainly had type Ⅲ lesions. The SUVmax(13.39 ± 9.24 vs 8.35 ± 5.80,P < 0.001) and SUVmax/THKmax(maximal thickness)(7.96 ± 4.02 vs 4.88 ± 3.32,P < 0.001) were both higher in patients with gastric lymphoma compared with gastric carcinoma. ROC curve analysis suggested a better performance of SUVmax/THKmax in the evaluation of gastric lesions between gastric lymphoma and gastric carcinoma in comparison with that of SUVmax alone.CONCLUSION PET/CT features differ between gastric lymphoma and carcinoma,which can improve PET/CT evaluation of gastric wall lesions and help differentiate gastric lymphoma from gastric carcinoma.

Endocrine radionuclide scintigraphy with fusion single photon emission computed tomography/computed tomography

AIM: To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT) hybrid imaging for diagnosis of various endocrine disorders.METHODS: We performed MEDLINE and Pub Med searches using the terms: "SPECT/CT"; "functional anatomic mapping"; "transmission emission tomography"; "parathyroid adenoma"; "thyroid cancer"; "neuroendocrine tumor"; "adrenal"; "pheochromocytoma"; "paraganglioma"; in order to identify relevant articles published in English during the years 2003 to 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts(case reports, reviews, meta-analyses and abstracts) concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.RESULTS: The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging, with seamless fusion of three-dimensional volume datasets. The usefulness of combining functional information to depict the biodistribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin, with anatomy derived from CT, has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function. The literature describes benefits of SPECT/CT for ^(99m)Tc-sestamibi parathyroid scintigraphy and ^(99m)Tc-pertechnetate thyroid scintigraphy, ^(123)I- or ^(131)I-radioiodine for staging of differentiated thyroid carcinoma, ^(111)In- and ^(99m)Tclabeled somatostatin receptor analogues for detection of neuroendocrine tumors, ^(131)I-norcholesterol(NP-59) scans for assessment of adrenal cortical hyperfunction, and ^(123)I- or ^(131)I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.CONCLUSION: SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT, translating to improved diagnostic accuracy and meaningful impact on patient care.

Significance of functional hepatic resection rate calculated using 3D CT/^(99m)Tc-galactosyl human serum albumin singlephoton emission computed tomography fusion imaging

AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/99mTc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and 99mTc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/99mTc-GSA SPECT fusion images.RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.

Hepatic clearance measured with ^(99m)Tc-GSA single-photon emission computed tomography to estimate liver fibrosis

AIM: To evaluate the clinical utility of hepatic clearance(HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin(99mTc-GSA) single-photon emission computed tomography(SPECT) to estimate the degree of liver fibrosis.METHODS:Seventy-eight consecutive patients who underwent initial hepatectomy due to hepatocellular carcinoma were enrolled in this study.Indocyanine green clearance(ICG R15),quantitative indices estimated by 99mTc-GSA[the receptor index(LHL15 and HH15)and HC via SPECT analysis],and conventional liver function tests were performed before hepatectomy.Correlations among the quantitative indices for liver functional reserve,conventional liver function tests,andthe degree of liver fibrosis were evaluated.RESULTS:The degree of liver fibrosis was correlated with ICG R15,HH15,LHL15,and HC.HC showed the best correlation with conventional liver function tests.According to multivariate analysis,HC and LHL15 were significant independent predictors of severe fibrosis.HC was the most valuable index for predicting severe fibrosis.CONCLUSION:HC measured with 99mTc-GSA SPECT is a reliable index for assessing liver fibrosis before hepatectomy.

Whole Body Positron Emission Tomography/Computed Tomography （PET/CT） in the Evaluation of Ophthalmic Tumors

The clinical value of whole body positron emission tomography/computed tomography （PET/CT） as an imaging tool in diagnosis of ophthalmic tumors was investigated. The retrospective observational case series were performed on the patients with suspected ophthalmic tumors who underwent whole body PET/CT. The golden standard of diagnosis was the final pathological diagnosis or the results of long-term follow-up for patients without surgery/ biopsy. PET/CT findings were compared with the golden standard. The sensitivity, specificity, accuracy an^t positive likelihood ratio of PET/CT in the detection of ophthalmic tumors were calculated. The clinical application of PET/CT in different types of ophthalmic tumors was evaluated. The results showed that 30 patients （18 males and 12 females） with a mean age of 43.0 years （range 4-63 years） were collected. The mean sizes of orbital tumors and intraocular tumors were 26.8 mmxl7.8 mm and 11.2 minx6.1 mm, respectively. The overall sensitivity, specificity, accuracy and positive likelihood ratio of whole body PET/CT in ophthalmic tumors were 76.5%, 71.4%, 75.0% and 2.67, and were 62.5%, 100% and 70.0% in intraocular tumors, and those were 100%, 60.0% and 84.6% in orbital tumors, respectively. PET/CT findings were applied to help make appropriate treatment options in 27 out of 30 patients （90.0%）, and 12 （40.0%） patients changed the treatment strategy. False negative results in 4 cases and false positive results in 2 cases were observed in this series. It was suggested that PET/CT was an effective imaging modality in detecting, diagnosing and developing therapeutic schedule for patients with ophthalmic tumors. It was more sensitive and accurate for detecting orbital tumors than for detecting intraocular tumors.

Incidental focal colorectal ^(18)F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography

AIM: To assess the clinical significance of incidental focal colorectal 18 F-fluorodeoxyglucose ( 18 F-FDG) uptake on 18 F-FDG-positron emission tomography/computed tomography (PET/CT). METHODS: The records of all the cases which had undergone colonoscopy after PET/CT within a two weeks interval were reviewed. Adenomas were considered advanced when they were villous, ≥ 10 mm in size, or had high-grade dysplasia. Colorectal cancers and advanced adenomas are collectively referred to as advanced colorectal neoplasms. Receiver-operating characteristic curve analysis was used to determine thesignificant predictive maximum standardized uptake value (SUVmax) cutoff value for advanced colorectal neoplasms and cancer. RESULTS: Ninety-five colorectal lesions matched the site of incidental focal colorectal 18 F-FDG uptake on PET/CT and 146 did not. Colonoscopy showed advanced colorectal neoplasms corresponding to the site of 18 F-FDG uptake in 49 of the 95 (51.5%) lesions with incidental uptake. Of the lesions without incidental uptake, only 6 of 146 (4.1%) had advanced colorectal neoplasms on colonoscopy, indicating a statistically significant difference between the two groups (P < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of incidental focal 18 F-FDG uptake in identifying advanced colorectal neoplasms were 89.1%, 75.3%, 51.6%, 95.9%, and 78.4%, respectively. In detecting only CRC, these values were 89.2%, 69.6%, 34.7%, 97.3%, and 72.6%, respectively. The significant SUVmax cutoff value for advanced colorectal neoplasms (area under the curve 0.755, P < 0.001) was 4.35, with a sensitivity, specificity, PPV, NPV, and accuracy of 75.5%, 65.2%, 69.8%, 71.4% and 70.5%, respectively. For CRC, 5.05 was the significant SUVmax cutoff value (area under the curve 0.817, P < 0.001), with a sensitivity, specificity, PPV, NPV, and accuracy of 84.8%, 71.0%, 80.9%, 89.8%, and 75.8%, respectively. CONCLUSION: The presence of incidental focal colorectal 18 F-FDG uptake on PET/CT with a SUVmax ≥ 4.35 increases the likelihood of an advanced colorectal neoplasm.

Tumor characteristics of ductal carcinoma in situ of breast visualized on [F-18] fluorodeoxyglucose-positron emission tomography/computed tomography: Results from a retrospective study

AIM To clarify clinicopathological features of ductal carcinoma in situ(DCIS) visualized on [F-18] fluorodeoxyglucosepositron emission tomography/computed tomography(FDG-PET/CT).METHODS This study retrospectively reviewed 52 consecutive tumors in 50 patients with pathologically proven pure DCIS who underwent [F-18] FDG-PET/CT before surgery. [F-18] FDG-PET/CT was performed after biopsy in all patients. The mean interval from biopsy to [F-18] FDGPET/CT was 29.2 d. [F-18] FDG uptake by visual analysis and maximum standardized uptake value(SUVmax) was compared with clinicopathological characteristics.RESULTS[F-18] FDG uptake was visualized in 28 lesions(53.8%) and the mean and standard deviation of SUVmax was 1.63 and 0.90. On univariate analysis, visual analysis and the SUVmax were associated with symptomatic presentation(P = 0.012 and 0.002, respectively), palpability(P = 0.030 and 0.024, respectively), use of core-needle biopsy(CNB)(P = 0.023 and 0.012, respectively), ultrasound-guided biopsy(P = 0.040 and 0.006, respectively), enhancing lesion ≥ 20 mm on magnetic resonance imaging(MRI)(P = 0.001 and 0.010, respectively), tumor size ≥ 20 mm on histopathology(P = 0.002 and 0.008, respectively). However, [F-18] FDG uptake parameters were not significantly associated with age, presence of calcification on mammography, mass formation on MRI, presence of comedo necrosis, hormone status(estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2), and nuclear grade. The factors significantly associated with visual analysis and SUVmax were symptomatic presentation(P = 0.019 and 0.001, respectively), use of CNB(P = 0.001 and 0.031, respectively), and enhancing lesion ≥ 20 mm on MRI(P = 0.001 and 0.049, respectively) on multivariate analysis.CONCLUSION Although DCIS of breast is generally non-avid tumor, symptomatic and large tumors(≥ 20 mm) tend to be visualized on [F-18] FDG-PET/CT.

Cerebral functional imaging of Waiguan (SJ 5) acupoint specificity using single-photon emission computed tomography

The action of needling in acupoint therapy has to first be regulated and integrated by the brain, and then it affects the target organ and manifests its therapeutic effects, which is dependent on the specificity of the acupoints. The authors put forward the hypothesis of the ＂acupoint-related brain＂. Single-photon emission computed tomography was used to explore the activation of brain regions following true needling in true acupoint Waiguan （SJ 5）, sham needling in true acupoint Waiguan, true needling in a sham point, and sham needling in a sham point. The relative specificity of Waiguan in normal persons was analyzed by observing changes in regional cerebral blood flow. Compared with the sham needling in true acupoint group and sham needling in the sham point group, acupuncture at Waiguan can activate brain regions controlling movement. Compared with true needling in the sham point group, acupuncture at Waiguan can also activate brain regions controlling movement. The results suggest that the specificity of needling at an acupoint is related to certain activated cerebral functional regions, which are associated with the clinical application of the acupoint.

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

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.

Positron emission tomography/computed tomography with ^(18)F-fluorodeoxyglucose identifies tumor growth or thrombosis in the portal vein with hepatocellular carcinoma

Patients suffering from hepatocellular carcinoma (HCC) with tumor thrombus in the portal vein generally have a poor prognosis. Portal vein tumor thrombus must be distinguished from portal vein blood thrombus, and this identification plays a very important role in management of HCC. Conventional imaging modalities have limitations in discrimination of portal vein tumor thrombus. The application of positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) for discrimination between tumor extension and blood thrombus has been reported in few cases of HCC, while portal tumor thrombosis and portal vein clot identified by 18F-FDG PET/CT in HCC patients has not been reported so far. We present two HCC cases, one with portal vein tumor thrombus and one thrombosis who were identified with 18F-FDG PET/CT. This report illustrates the complimentary value of combining the morphological and functional imaging in achieving a correct diagnosis in such clinical situations.

Evaluation of recurrence in gastric carcinoma: Comparison of contrast-enhanced computed tomography and positron emission tomography/computed tomography

AIM To compare the value of contrast-enhanced abdominal computed tomography(CT) and fluorodeoxyglucose(FDG) positron emission tomography/computed tomography(PET/CT) for detecting gastric carcinoma recurrence.METHODS We retrospectively examined data from 2475 patients who underwent both contrast-enhanced abdominal CT and FDG PET/CT for the surveillance of gastric carcinoma curative resection. Patients had an interval of less than 1 mo between their CT and PET/CT scans. Sixty patients who had recurrence were enrolled. Among 1896 patients who did not have recurrence, 60 were selected by simple random sampling. All CT and PET/CT images were reviewed retrospectively by two reviewers blinded to all clinical and pathologic information except curative resection due to gastric carcinoma. RESULTS The pathological stage of the recurrence group was statistically significantly higher than that of the control group(P < 0.001). In the 60 patients who had recurrence, there were 79 recurrent lesions. Fortyfour patients had only one location of recurrence, 13 patients had two locations, and 3 patients had three. In the detection of patient-based overall recurrence, no statistically significant differences existed between the two modalities(P = 0.096). However, for peritoneal carcinomatosis, CT had a statistically significantly higher sensitivity compared to PET/CT(96% vs 50%, P = 0.001). Adenocarcinoma was the most common type of gastric carcinoma. On the pathology-based analysis, CT also had a statistically significantly higher sensitivity compared to PET/CT(98% vs 80%, P = 0.035).CONCLUSION Contrast-enhanced CT was superior to PET/CT in the detection of peritoneal carcinomatosis and pathologic type of adenocarcinoma.

2-deoxy-2-(^(18)F)fluoro-D-glucose positron emission tomography/computed tomography imaging in paediatric oncology

Positron emission tomography(PET) is a minimally in-vasive technique which has been well validated for the diagnosis, staging, monitoring of response to therapy, and disease surveillance of adult oncology patients. Tra-ditionally the value of PET and PET/computed tomogra-phy(CT) hybrid imaging has been less clearly defined for paediatric oncology. However recent evidence has emerged regarding the diagnostic utility of these mo-dalities, and they are becoming increasingly important tools in the evaluation and monitoring of children with known or suspected malignant disease. Important indi-cations for 2-deoxy-2-(18F)fluoro-D-glucose(FDG) PET in paediatric oncology include lymphoma, brain tumours, sarcoma, neuroblastoma, Langerhans cell histiocytosis, urogenital tumours and neurofibromatosis type Ⅰ. This article aims to review current evidence for the use of FDG PET and PET/CT in these indications. Attention will also be given to technical and logistical issues, the description of common imaging pitfalls, and dosimetric concerns as they relate to paediatric oncology.

Comparisons between glucose analogue 2-deoxy-2-(^(18)F)fluoro-D-glucose and ^(18)F-sodium fluoride positron emission tomography/computed tomography in breast cancer patients with bone lesions

AIM: To compare 2-deoxy-2-(18F)fluoro-D-glucose(18F-FDG) and 18F-sodium (18F-NaF) positron emission tomography/computed tomography (PET/CT) accuracy in breast cancer patients with clinically/radiologically suspected or known bone metastases.METHODS: A total of 45 consecutive patients with breast cancer and the presence or clinical/biochemical or radiological suspicion of bone metastatic disease underwent 18F-FDG and 18F-fluoride PET/CT. Imaging results were compared with histopathology when available, or clinical and radiological follow-up of at least 1 year. For each technique we calculated: Sensitivity (Se), specificity (Sp), overall accuracy, positive and negative predictive values, error rate, and Youden’s index. McNemar’s χ2 test was used to test the difference in sensitivity and specificity between the two diagnostic methods. All analyses were computed on a patient basis, and then on a lesion basis, with consideration ofthe density of independent lesions on the co-registered CT (sclerotic, lytic, mixed, no-lesions) and the divergent site of disease (skull, spine, ribs, extremities, pelvis). The impact of adding 18F-NaF PET/CT to the work-up of patients was also measured in terms of change in their management due to 18F-NaF PET/CT findings.RESULTS: The two imaging methods of 18F-FDG and 18F-fluoride PET/CT were significantly different at the patient-based analysis: Accuracy was 86.7% and 84.4%, respectively (McNemar’s χ2 = 6.23, df = 1, P = 0.01). Overall, 244 bone lesions were detected in our analysis. The overall accuracy of the two methods was significantly different at lesion-based analysis (McNemar’s χ2 = 93.4, df = 1, P < 0.0001). In the lesion density-based and site-based analysis, 18F-FDG PET/CT provided more accurate results in the detection of CT-negative metastasis (P < 0.002) and vertebral localizations (P < 0.002); 18F-NaF PET/CT was more accurate in detecting sclerotic (P < 0.005) and rib lesions (P < 0.04). 18F-NaF PET/CT led to a change of management in 3 of the 45 patients (6.6%) by revealing findings that were not detected at 18F-FDG PET/CT.CONCLUSION: 18F-FDG PET/CT is a reliable imaging tool in the detection of bone metastasis in most cases, with a diagnostic accuracy that is slightly, but significantly, superior to that of 18F-NaF PET/CT in the general population of breast cancer patients. However, the extremely high sensitivity of 18F-fluoride PET/CT can exploit its diagnostic potential in specific clinical settings (i.e., small CT-evident sclerotic lesions, high clinical suspicious of relapse, and negative 18F-FDG PET and conventional imaging).