Objective To investigate the value of 18F-FDG PET-CT in the diagnosis of adrenal metastasis.Methods 88 patients (107 adrenal lesions) with adrenal metastasis and benign tumor underwent 18F-FDG PET-CT,all adrenal lesions' short diameter,CT value and 18F-FDG maximum standardized uptake values (SUVmax) were measured.The t test,chi-square test and Pearson correlation test were used for data analysis.Meanwhile,receiver operating characteristic (ROC) curve was used to determine the ability of CT value and SUV~x to differentiate the adrenal metastasis and benign tumor.Results There were 73 adrenal metastases and 34 adrenal benign tumors of 107 adrenal lesions.The short diameter of adrenal metastasis was (2.17±1.14) cm,benign tumor was (1.76±1.00) cm,there was no statistical significant difference between the two groups (t =1.817,P =0.072).The CT value of adrenal metastasis and benign tumor were (29.65±10.29) Hu and (14.83±14.42) Hu (t =5.389,P =0.000),respectively.The SUVmax of adrenal metastasis was 9.28±5.33,while benign tumor was 2.81±1.14,statistical significant difference was found between the two groups (t =9.890,P =0.000).For adrenal metastasis,a significant positive correlation was found between short diameter and SUV~ (r =0.620,P =0.000),and it was also found between CT value and SUVmax (r =0.561,P =0.000).Among all patients with adrenal metastasis,32 (58.2 ％) patients' lesions were found in the left adrenal gland,and 5 (9.1％) in the right side (x2 =29.689,P =0.000).ROC curve analysis showed that using lesion' s SUVmax ＞ 4.1 and CT value ＞ 20 Hu as diagnostic criteria,the sensitivity,specificity,accuracy,PPV and NPV were 91.3 ％ (63/69),94.7 ％ (36/38),92.5 ％ (99/107),96.9 ％ (63/65) and 85.7 ％ (36/42),respectively.Conclusion 18F-FDG PET-CT has high sensitivity,specificity and accuracy in diagnosis of adrenal metastasis,and the adrenal lesion' s SUVmax ＞ 4.1 and CT value ＞ 20 Hu is a better diagnostic criteria.

Purpose To analyze the 18F-FDG PET/CT features of small intestinal malignant neoplasm, and to discuss the diagnosis value. Materials and Methods Forty-seven patients who were highly suspected with small intestinal tumors underwent 18F-FDG PET/CT whole body scan were retrospectively analyzed, the results of PET/CT examinations and the findings of biopsy and surgical pathology were compared. The maximum of intestinal wall thickness (IWTmax) and maximum of standardized uptake value (SUVmax) were calculated to analyze the relationship of them under different pathological conditions. Results Six out of the 47 small intestinal tumors were benign, the other 41 were malignant tumors among which 19 were malignant lymphoma and 17 were adenocarcinoma. The sensitivity, specificity, accuracy rate, positive predictive value and negative predictive value of 18F-FDG PET/CT in the diagnosis of small intestinal malignant neoplasm were 92.7%, 83.3%, 91.5%, 97.4% and 62.5%, respectively. Compared with those of benign tumors, the SUVmax and IWTmax of malignant intestinal tumors were significantly higher (t=5.596 and 2.376, P<0.05). The SUVmax in small bowel adenocarcinoma was significantly lower than that in malignant lymphoma (t=2.419, P<0.05);the IWTmax. between the two kinds of tumors showed no difference (t=0.369, P>0.05). The SUVmax and IWTmax of small intestinal malignant lymphoma had no correlation (r=0.293, P>0.05), whilst there was significant correlation between the IWTmax and SUVmax in small intestinal adenocarcinoma (r=0.542, P<0.05). Conclusion The SUVmax and IWTmax of malignant intestinal tumors are higher than those of benign intestinal tumors; 18F-FDG PET/CT imaging is rather reliable in differentiating small intestinal malignant tumors from benign ones. Intestinal malignant lymphoma shows a higher uptake of 18F-FDG than intestinal adencarcinoma, but the intestinal wall thickness of the two kinds shows no difference.

Objective To evaluate the imaging characteristics of 18 F-FDG PET/CT in patients with Castleman's disease (CD).Methods Twelve patients (male 7,female 5,mean age:(51.2±19.3)years) with pathologically confirmed CD and 18F-FDG PET/CT were retrospectively enrolled.A lesion with SUVmax greater than that of normal liver tissue was defined as positive.Lesion size (short diameter) was measured.Correlation between size and SUVmax was analyzed by Pearson correlation analysis.SUVmax of different clinical and pathological types was compared using Mann-Whitney rank sum test.Results Among 12patients,7 patients had localized CD (LCD) involving a single group of lymph nodes and 5 patients had multicentric CD (MCD) involving more than one group of lymph nodes with some having lung and spleen infiltration.A total of 129 positive lesions were found (7 of LCD,122 of MCD) and the average SUVmax was 4.20±1.84 (range:2.50 to 10.70).There was no significant correlation between SUVmax and lesion size (r =0.189,P＞0.05).There was no significant difference in SUVmax between LCD and MCD (4.23±1.77 vs 4.19±1.86; Z=-0.108,P＞0.05) ; but there was significant difference in SUVmax between the patients with and without clinical manifestations (4.56±2.06 vs 3.41±0.87; Z=-2.443,P＜0.05).No significant difference was found between SUVmax of hyaline vascular CD and plasma cell CD (3.63±0.89 vs 4.26±1.91; Z=-0.519,P＞0.05).Conclusions CD shows primarily lymph node involvement with increased 18F-FDG uptake.However,the degree of FDG uptake does not correlate with clinical presentation or pathological types.

Objective To investigate the predictive value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) calculated from 18F-FDG PET-CT results for postoperative recurrence and prognosis in patients with resectable pancreatic cancer. Methods From may 2009 to December 2015, 30 patients with pancreatic cancer who underwent curative resection after PET-CT examination were enrolled, and the clinic pathological data and 18F-FDG PET-CT data were retrospectively analyzed. The prognostic value of SUVmax, SUVmean, MTV, TLG and other prognosis factors were analyzed. Results In 30 patients with pancreatic cancer, preoperative 18F-FDG PET-CT detected all primary lesion (10 0%). 29 patients were recurrence or metastasis, and 26 patients were died with median of 17.8 months (2.6-39.6 months) follow-up. The median progression-free survival (PFS) time was 6.5 months and the median overall survival (OS) time was 11.6 months. The multivariate analysis revealed the histological differentiation and MTV were the independent influencing factors for PFS (both P<0.05). The lymph node metastasis, MTV and TLG were the independent influencing factors for OS (all P<0.05). Conclusion The MTV and TLG of PET-CT may be predicting the recurrence and survival of patients with pancreatic cancer after curative resection, suggesting that it can be used to guide the individual treatment.

Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG) PET/CT examination to predict the prognosis of patients after colorectal cancer operation.Methods The retrospective cross-sectional study was adopted.The clinicopathological data of 80 patients with colorectal cancer who were admitted to the First Hospital of Nanjing Medical University from March 2007 to October 2015 were collected.Eighty patients received first preoperative 18 F-FDG PET/CT examination and underwent operations under decisions of patients and their families,and then adjuvant chemotherapy were performed according to the patients' condition.Observation indicators included:(1) preoperative imaging examination,(2) situations of treatment and follow-up,(3) analysis of prognostic factors.The patients were followed up by outpatient examination and telephone interview once every 3 months within postoperative 1 year,once every half a year within postoperative 2 years and then once a year up to May 2016.The follow-up included tumor recurrence or progression and survival of patients.Tumor-free survival time was from postoperative day 1 to tumor recurrence or progression and death or end of follow-up.Overall survival time was from postoperative day 1 to death or end of follow-up.Measurement data with skewed distribution were represented as M (Qn) and M (range).The optimal cutoff point of tumor-free survival of maximum standardized uptake value (SUVmax),mean standardized uptake value (SUV),metabolism of volume (MTV) and total lesion of glycolysis (TLG) were investigated using the ROC curve analysis,and calculating area under the curve (AUC).The median was used as a cutoff point if there was smaller AUC.The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis,and COX proportional hazards model for multivariate analysis.Results (1) Results of preoperative imaging examination:results of PET/CT in patients with colorectal cancer showed there were circumscribed thickening of bowel wall,intestinal cavity strictures,fuzzy fat space around the some lesions,enlarged lymph node and 18 F-FDG uptake increased abnormally.The SUV SUV MTV and TLG of 80 patients were 11.83(4.26,35.42),7.06(2.38,20.92),20.47 cm3 (1.29 cm3,161.50 cm3) and 138.58 (14.17,857.89),respectively.ROC curve showed that the AUC of SUV SUV MTV and TLG were 0.453,0.448,0.815 and 0.749 [95％ confidence interval (CI):0.307-0.600,P ＞0.05;0.303-0.594,P ＞ 0.05;0.717-0.913,P ＜ 0.05;0.635-0.863,P ＜ 0.05],respectively.The median SUVmax (11.83) and SUV (7.06) were used as the cutoff points due to smaller AUC of SUVmax and SUV.The cutoff point of MTV was 18.79 cm3 (sensitivity =86.2％ and specificity =68.3％),and the cutoff point of TLG was 142.05 (sensitivity =75.9％ and specificity =70.7％).(2) Situations of treatment and follow-up:among 80 patients,13 underwent the radical resection of colorectal cancer and resection of liver metastasis and 67 underwent radical resection of colorectal cancer.Sixty-two patients received postoperative chemotherapy,including 45 with chemotherapy regimens of capecitabine and 17 with fluorouracil.Eighty patients were followed up for 41.8 months (range,6.5-109.1 months).During the follow-up,29 patients had tumor recurrence or progression,and 19 patients were dead.The median tumor-free survival time,1-,3-and 5-year tumor-free survival rates in 80 patients were 19.5 months (range,2.0-109.1 months),73.7％,36.3％ and 18.8％,respectively.The median overall survival time,1-,3-and 5-year overall survival rates were 31.8 months (range,3.3-109.1 months),76.3％,37.5％ and 20.0％,respectively.(3) Analysis of prognostic factors:results of univariate analysis showed that tumor location,N staging,M staging,clinical staging,postoperative chemotherapy,MTV and TLG were relative factors affecting postoperative tumor-free survival rate (HR =3.469,5.325,5.295,8.605,2.630,7.388,5.155,95％ CI:1.522-7.906,2.256-12.568,2.405-11.657,2.969-24.937,1.063-6.504,2.550-21.403,2.178-12.204,P ＜ 0.05).The tumor location,tumor differentiation,N staging,M staging,clinical staging,MTV and TLG were relative factors affecting postoperative overall survival rate (HR =2.697,2.814,3.083,2.916,4.193,5.450,4.876,95％ CI:1.011-7.197,1.121-7.062,1.166-8.149,1.140-7.454,1.386-12.678,1.581-18.786,1.727-13.766,P ＜ 0.05).In multivariate analysis,stage Ⅲ-Ⅳ of clinical staging and TLG≥ 142.05 were independent risk factors affecting postoperative tumor-free survival rate (HR =9.879,3.569,95％ CI:1.854-22.836,1.127-11.306,P＜0.05).The stage M1,stage Ⅲ-Ⅳ of clinical staging and TLG≥ 142.05 were independent risk factors affecting postoperative overall survival rate (HR =4.522,9.315,10.120,95％ CI:1.223-16.717,1.338-24.864,2.385-12.947,P＜0.05).Conclusion TLG through 18 F-FDG PET/CT examination is an independent prognostic factor affecting postoperative tumor-free survival rate and overall survival rate in patients with colorectal cancer after curative resection,and it has certainly reference value for prognosis.

Objective To investigate the relationship between metabolic parameters of 18F-FDG PET-CT and cilinicopathological features of patients with lung squamous cell carcinoma. Methods The study comprised 118 patients with lung squamous cell carcinoma. All patients undergone 18F-FDG PET-CT before surgery. Maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) were measured, and total lesion glycolysis (TLG) was calculated. Relationship between metabolic parameters and clinicopathological factors was analyzed. Results SUVmax, MTV and TLG of 118 primary lesions were 11.93 (3.12-41.46), 27.71 cm3 (0.54-347.10 cm3) and 153.13 (1.65-2219.37), respectively. SUVmax was related to tumor differentiation degree and pleural invasion (χ2= 15.358, P= 0.000; Z= -2.875, P= 0.004); MTV was related to tumor differentiation degree, pleural invasion, vascular invasion and lymphatic metastasis (χ2= 13.341, P= 0.001; Z= -2.855, P= 0.004; Z= -2.683, P= 0.008; Z= -3.951, P= 0.000), TLG was also related to these clinicopathological factors (χ2= 15.609, P= 0.001;Z= -3.901, P= 0.002;Z= -2.311, P=0.021;Z= -3.721, P= 0.000). T stage and TNM stage had positive correlation with all metabolic parameters (r= 0.326, 0.794, 0.732;r= 0.358, 0.718, 0.668; all P< 0.05). And for N stage, SUVmax was no correlative (r=0.125, P=0.107), but MTV and TLG were positively correlative (r=0.399, 0.371, both P< 0.05). According the MTV or TLG and tumor size, patiens were divided into three groups: low-risk group, moderate-risk group and high-risk group. Significant differences were found among the three groups not even in MTV model, but also in TLG model (χ2= 20.800, P= 0.000; χ2= 20.069, P= 0.000). Conclusions Metabolic parameters of lung squamous cell carcinoma primary lesion have good correlation with clinicopathological factors, and can reflect partial characteristics of the tumor pathology in a certain extent. Furthermore, the probability of lymphatic metastasis could be predicted by MTV or TLG combined with tumor size.

Objective To assess the value of CT or PET-CT with fluorine-18-labeled fluorodeoxyglucose (FDG) for the diagnosis of pulmonary mucosa-associated lymphoid tissue (MALT) type lymphoma. Methods The CT or FDG PET-CT findings in 14 patients with pathologically proved pulmonary MALT lymphoma were retrospectively analyzed. Results Lung lesions were unilateral in 7 patients and bilateral in 7 patients. Lesions presented as a single mass in 3 patients, as a single consolidation in 3 patients, as a nodule in 1 patient, as multiple nodules in 1 patient, as multiple patchy consolidations in 4 patients, as a mass with multiple nodules and patchy consolidations in 1 patients, as diffuse interstitial change in 1 patients. Air bronchogram was found in 9 patients and CT angiogram sign in 5 patients. On PET-CT, lesions showed heterogeneous FDG uptake in 2 patients, maximum standard uptake value was higher than 2. 5. Conclusion Imaging characteristics of pulmonary MALT lymphoma are single or multiple nodules or consolidations with air bronchogram on CT, and heterogeneous high FDG uptake on PET-CT.

Objective To investigate the clinical value of 18F-FDG PET/CT in staging,therapeutic response evaluation,relapse early detection and prognostic prediction of follicular lymphoma (FL).Methods Twenty-eight patients (12 males,16 females; average age 57 (36-82) years) with pathologically confirmed FL from December 2005 to January 2013 were enrolled.All patients underwent 18F-FDG PET/CT before treatment.The SUVmax of different staging groups,different pathological grade groups (high:3a+3b; low:1+2) was compared.Seventeen of 28 patients underwent PET/CT after chemotherapy and received phone follow-up (10-88 months) to monitor the progress of treatment.Survival difference was analyzed.Mann-Whitney u test,Wilcoxon signed-rank test and Kaplan-Meier survival analysis were used for data analysis.Results (1) The initial clinical staging without 18F-FDG PET/CT based on Ann Arbor standard changed in 4 cases (up-staging in 3 cases,down-staging in 1 case) after the PET/CT scan.The 18F-FDG uptake (SUVmax) in patients of stage Ⅰ/Ⅱ and stage Ⅲ/Ⅳ was 10.1±3.2 and 11.5±4.9,respectively (Z=-0.619,P＞0.05).The SUVmax in patients of the low grade group (6.9±3.6,n=15) was significantly lower than that of the high grade group (12.4±5.6,n=13) (Z=-3.706,P＜0.01).(2) 17 patients underwent PET/CT scan both before and after chemotherapy,the pre-treatment SUVmax and post-treatment SUVmax were significantly different in CR+PR group (10.8±5.1 vs 3.4±2.3; Z=-2.312,P＜0.05),while there was no significant difference in SD+PD group (11.2±6.9 vs 7.8±3.3; Z=-1.153,P＞0.05).There was a significant difference in the median progress-free survival time between the CR+PR group and the SD+PD group (48 months vs 26 months; x2 =4.207,P＜0.05).Conclusion 18F-FDG PET/CT has an advantage in clinical staging,therapeutic evaluation,relapse monitoring and prognosis predicting of FL.

Objective To investigate the prognostic value of interim and post-therapy 18F-FDG PET/CT in patients with DLBCL.Methods A retrospective analysis was conducted in 110 patients (62males,48 females; median age 52 years) with newly diagnosed DLBCL.Forty-two patients underwent interim PET/CT after 4 cycles chemotherapy,44 patients underwent post-therapy PET/CT after 6-8 cycles of chemotherapy,and 24 patients underwent both interim PET/CT and post-therapy PET/CT.Interim and post-therapy PET/CT status (i.e.,positive or negative) were visually interpreted according to criteria of the International Harmonization Project.Three-year progression-free survival (PFS) and 3-year overall survival (OS) was compared between the subjects with positive or negative PET/CT results.x2 test and KaplanMeier analysis were used for data analysis.Results Interim 18F-FDG PET/CT results were positive in 28cases and negative in 38 cases.The median PFS and OS were 20 and 28 months in patients with positive scan results,those were 37 and 39 months in patients with negative results,respectively.Three-year PFS and 3-year OS rates were 17.9％(5/28) and 35.7％(10/28) in patients with positive interim PET/CT results,those were 52.6％ (20/38) and 55.3％ (21/38) in patients with negative results (x2 =8.285,P ＜0.01,x2=2.473,P＞0.05,respectively).Post-therapy 18F-FDG PET/CT results were positive in 20 cases and negative in 48 cases.Median PFS and OS were 21 and 26 months in patients with positive results,those were 54 and 57 months in patients with negative results.Three-year PFS and 3-year OS rates were 20.0％(4/20) and 25.0％ (5/20) in patients with positive results at post-therapy PET/CT,those were 77.1％(37/48) and 83.3％ (40/48) in patients with negative results (x2=19.215,21.462,both P＜0.01).Conclusions Post-therapy 18F-FDG PET/CT is useful to predict prognosis of patients with DLBCL.However,the value of interim PET/CT may be limited in terms of prognosis prediction.