Objective To compare the PET response criteria in solid tumors (PERCIST) and response evaluation criteria in solid tumors (RECIST) in the evaluation of therapeutic response in 49 non-small-cell lung cancer(NSCLC) patients.Methods Forty-nine NSCLC patients who received chemotherapy but no surgery were studied.Therapeutic responses were evaluated using 18 F-FDG PET and CT according to the RECIST and PERCIST methods.The PET-CT scans were obtained before chemotherapy and about 2 or 6 weeks after completion of chemotherapy.Firstly the reduction rates of tumor diameter and reduction rates of tumor standardized uptake value were compared with paired t-test.Then the response was classed into 4 levels according to RECIST and PERCIST:PD and PMD =1,SD and SMD =2,PR and PMR =3,CR and CMR =4.Pearson and Chi-square test was used to compare the proportion of four levels in RECIST and PERCIST.Finally one target lesion and two target lesions were compared for RECIST therapeutic evaluation in 33 cases with two target lesions.Results The diameter was (3.52 ± 1.65) cm before the therapy and (2.39 ± 1.43)cm after the therapy.The standardized uptake value was 8.78 ±4.18 vs.5.06 ±3.62 before and after therapy for the first target lesions in 49 patients.The differences of reduction rates between tumor diameter and standardized uptake value were not significant because of selection bias (0.32 ± 0.27 vs.0.28 ±0.64,t =0.176,P ＞0.05).However,there was a significant difference when the reduction rate was compared only in 39 patients in which the standardized uptake values were reduced after therapy (0.39 ± 0.29 vs.0.52 ±0.28,t =-4.08,P ＜0.01).The results of classification were 1/13 for CR/CMR,25/16 for PR/PMR,22/15 for SD/SMD,1/5 for PD/PMD,and 33 cases had no consistent results from RECIST and PERCIST.There was a significant difference in response classification between RECIST and PERCIST (x2 =16.252,P ＜ 0.01).No significant difference was found between one target lesion and two target lesions for RECIST evaluation results in 33 cases (x2 =1.171,P ＞ 0.05),but results of response classification were changed in 5 cases.Conclusions PERCIST criteria may be more sensitive in NSCLC therapeutic evaluation comparing to RECIST criteria.There is a higher proportion with CMR and PMD in PERCIST,but its effect on the prognosis is not yet clear.The number of target lesions may affect the results of therapeutic evaluation with RECIST criteria.

Objective To evaluate the clinical value of 18F-FDG PET-CT imaging on monitoring recurrence, metastasis and therapeutic decision-making in small intestinal adenocarcinoma patients after radical surgery. Methods Twenty-two patients were enrolled, who underwent surgical operation before received PET-CT scan. PET-CT findings were retrospectively observed to compare with the results of follow-up [postoperative pathology and (or) long-term clinical follow-up]. The roles of PET-CT on therapeutic decision-making were then investigated. Results Among 22 patients, 14 cases were finally diagnosed as recurrence and (or) metastasis, the other 8 cases as disease-free survival after long-term follow-up. According to PET-CT, 13 cases were diagnosed as recurrence and (or) metastasis (including 12 true-positive and 1 false-positive), and 9 cases were negative (including 2 false-negative). The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET-CT were 85.7 % (12/14), 87.5 % (7/8), 86.4 %(19/22), 92.3%(12/13) and 77.8%(7/9), respectively. The therapeutic decisions were changed in 10 patients (10/22, 45.5 % ) based on PET-CT results. Conclusion 18F-FDG PET-CT has an important clinical value on the detection of recurrence and (or) metastasis of small intestinal adenocarcinoma, which is an ideal method of monitoring.

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.

Objective To summarize the imaging manifestations of 18F-FDG PET/CT in patients with secondary hemophagocytic lymphohistiocytosis (sHLH).Methods From January 2008 to June 2012,31 patients (18 males,13 females,average age:42 years) with sHLH were enrolled.All patients were divided into 3 groups:malignancy associated HLH (MAHLH) group (n =13),infection associated HLH (IAHLH) group (n =13) and rheumatosis associated HLH (RAHLH) group (n =5).They all underwent 18F-FDG PET/CT and SUVmax of lesions in each group was calculated.One-way analysis of variance and two-sample t test were used to analyze the SUVmax.Results Twenty-three patients were found splenomegaly with high FDG uptake,including 4 RAHLH patients,9 IAHLH patients and 10 MAHLH patients.The splenetic FDG uptake values (SUVmax) of RAHLH,IAHLH and MAHLH groups were 3.16±0.61,5.67±3.37 and 6.04±3.06,respectively (F=1.051,P＞0.05).The SUVmax of enlarged lymph nodes in IAHLH (n=8) and MAHLH groups (n =7) was 5.35± 1.69 and 10.14±5.24,respectively (t =-2.456,P＜0.05).Increased uptake in bone marrow was found in 17 patients,including 1 RAHLH patient,7 IAHLH patients and 9 MAHLH patients.The SUVmax of bone marrow in IAHLH and MAHLH patients was 5.31±2.05 and 6.36± 3.71 respectively (t=-0.670,P＞0.05).There were 10 cases of hepatomegaly,but only 4 of them had intense FDG uptake (SUVmax 4.9-10.2).The SUVmax of RAHLH,IAHLH and MAHLH groups was 3.02± 1.31,5.62±2.45 and 8.15±4.38,respectively (F=9.123,t=2.562,5.236,3.030,all P＜0.05).Conclusions RAHLH mostly showed splenomegaly with high FDG uptake,IAHLH and MAHLH both showed splenomegaly with lymph node and bone marrow invasion.The SUVmax of MAHLH was the highest.18F-FDG PET/CT imaging manifestations of sHLH may be helpful to improve the diagnostic accuracy.

Objective To investigate the prognostic value of interim and post-therapy 18fluorine-fluododeoxyglucose(18F-FDG) PET-CT in patients with T-cell lymphoma.Methods A retrospective analysis was conducted on data from 50 patients diagnosed with T-cell lymphoma(12 patients underwent interim PET-CT only,19 patients underwent interim and post-therapy PET-CT,and the rest 19 patients underwent only post-therapy PET-CT).Interim and post-therapy PET-CT(positive versus negative) were visually interpreted according to the criteria of the International Harmonization Project.The progression-free survival (PFS) and overall survival(OS) of two groups were calculated.We used the Fisher exact test and KaplanMeier testfor data analysis.Results Interim 18F-FDG PET-CT results were positive in 19 cases and negative in 12 cases.The median PFS and OS were 8 months and 16 months,in patients with positive results,versus 30 months and 36 months,in patients with negative results.The 1-year PFS and 3-year OS rates were 21.1％ (4/19) and 10.5％(2/19) in patients with positive results at interim PET/CT versus 100.0％(12/12) and 66.7％ (8/12) in patients with negative results(P＜0.01.Post-therapy 18F-FDG PET-CT results were positive in 16 cases and negative in 22 cases,the median PFS and OS were 10 months and 20 months in patients with positive results versus 32 months and 41 months in patients with negative results.The 1-year PFS and 3-year OS rates were 12.5％(2/16) and 12.5％(2/16),in patients with positive results at post-therapy PET-CT versus 95.5％(21/22) and 54.5％(12/22),in patients with negative results(P＜0.01).Conclusion Both interim PET-CT status and post-therapy PET-CT have significant value in monitoring response to therapy and predicting prognosis for patients with T-cell lymphoma.

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.

OBJECTIVETo investigate the prognostic value of interim and post-therapy PET-CT in patients with diffuse large B-cell lymphoma.

METHODSA retrospective analysis was conducted on data from 116 patients with newly diagnosed diffuse large B-cell lymphoma. 43 patients underwent interim PET-CT after 4 cycles of chemotherapy, 48 patients underwent post-therapy PET-CT after 6-8 cycles of chemotherapy, and 25 patients underwent both interim PET-CT and post-therapy PET-CT. The patients were divided into three groups: complete response group, partial response group and no response group. The therapeutic response was assessed by comparing with baseline PET-CT. PET-CT status was assessed for its ability to predict progression-free survival (PFS) and overall survival (OS). The 2-year PFS rate and 3-year OS rate were evaluated using chi-square test. PFS and OS were estimated according to the Kaplan-Meier method and survival curves were compared by log-rank test.

RESULTSInterim PET-CT: The interim PET-CT findings of 42 patients were judged as complete response, 15 were judged as partial response, and the rest 11 were judged as no response. The 2-year PFS rates of the complete response group, partial response group and no response group were 61.9%, 60.0%, and 18.2%, respectively, and the 3-year OS rates were 52.4%, 46.7% and 9.1%, respectively. There were no significant differences between the complete response group and partial response group in 2-year PFS rate and 3-year OS rate (P > 0.05 for both). But there was a significant difference between the partial response group and no response group (P < 0.05). The post-therapy PET-CT findings of 50 patients was judged as complete response, 11 as partial response, and the rest 12 were judged as no response. The 2-year PFS rate of the complete response group, partial response group and no response group were 82.0%, 45.5%, and 8.3%, respectively, and the 3-year OS rates were 88.0%, 54.5%, and 8.3%, respectively. There were significant differences between the complete response group and partial response group in 2-year PFS rate and 3-year OS rate (P < 0.05), and there was a significant difference between the partial response group and no response group (P < 0.05).

CONCLUSIONSCompared with the interim PET-CT, post-therapy PET-CT can accurately evaluate the prognosis of patients with DLBCL. Interim PET-CT cannot define the prognosis of the complete response and partial response patients.

Adult ; Disease-Free Survival ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; diagnostic imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Prognosis ; Radiography ; Remission Induction ; Retrospective Studies ; Treatment Outcome