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Prognostic Significance of Pre-operative FDG-PET in Colorectal Cancer Patients with Hepatic Metastasis.

Hyo Sang LEE ; Won Woo LEE ; Duck Woo KIM ; Sung Bum KANG ; Kyoung Ho LEE ; Keun Wook LEE ; Jee Hyun KIM ; Sang Eun KIM

Nuclear Medicine and Molecular Imaging.2009;43(5):429-435.

PURPOSE: The purpose of this study was to assess the prognostic value of preoperative FDG-PET in colorectal cancer (CRC) patients with hepatic metastasis (HM). MATERIALS AND METHODS: 24 CRC patients (M:F=14:10; age, 63+/-10 yrs) with HM who had undergone preoperative FDG PET were included. Cure-intent surgery was performed in all the patients and HMs were controlled using resection (n=13), radio-frequency ablation (RFA) (n=7), and resection plus RFA (n=4). Potential prognostic markers tested were maxSUV of primary tumor, maxSUV of HM, maxSUV ratio of HM over primary tumor (M/P ratio), histologic grade, CEA level, venous/lymphatic/nerve invasion, T stage, N stage, no. of HM, no. of lymph node metastasis, and treatment modality of HM. RESULTS: 14 CRC patients developed a recurrence with a median follow-up duration of 244 days, whereas 10 patients did not develop recurrence with a median follow-up duration of 504 days. M/P ratios but other potential prognostic markers were significantly higher in the recurrent patients (0.72+/-0.14) than recurrence-free patients (0.54+/-0.23) (p=0.038). M/P ratio only was found to predict recurrence by Cox multivariate analysis (hazard ratio 37.7, 95% confidence interval 2.01-706.1, p=0.016). The 11 patients with lower M/P ratio of <0.61 had significantly better disease-free survival rate than the 13 patients with higher M/P ratio (> or =0.61) (p=0.026). CONCLUSION: maxSUV ratio of HM over primary tumor (M/P ratio) may be useful for prognosis prediction of CRC patients with HM. Higher FDG uptake of HM than that of primary tumor may indicate a more advanced status in stage IV CRC.
Colorectal Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Positron-Emission Tomography ; Prognosis ; Recurrence

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Usefulness of F-18 FDG PET/CT in Adrenal Incidentaloma: Differential Diagnosis of Adrenal Metastasis in Oncologic Patients.

Hong Je LEE ; Bong Il SONG ; Sung Min KANG ; Shin Young JEONG ; Ji Hyoung SEO ; Sang Woo LEE ; Jeongsoo YOO ; Byeong Cheol AHN ; Jaetae LEE

Nuclear Medicine and Molecular Imaging.2009;43(5):421-428.

PURPOSE: We have evaluated characteristics of adrenal masses incidentally observed in nonenhanced F-18 FDG PET/CT of the oncologic patients and the diagnostic ability of F-18 FDG PET/CT to differentiate malignant from benign adrenal masses. MATERIALS AND METHODS: Between Mar 2005 and Aug 2008, 75 oncologic patients (46 men, 29 women; mean age, 60.8+/-10.2 years; range, 35-87 years) with 89 adrenal masses incidentally found in PET/CT were enrolled in this study. For quantitative analysis, size (cm), Hounsfield unit (HU), maximum standardized uptake value (SUVmax), SUVratio of all 89 adrenal masses were measured. SUVmax of the adrenal mass divided by SUVliver, which is SUVmax of the segment 8, was defined as SUVratio. The final diagnosis of adrenal masses was based on pathologic confirmation, radiologic evaluation (HU<0 : benign), and clinical decision. RESULTS: Size, HU, SUVmax, and SUVratio were all significantly different between benign and malignant adrenal masses.(P < 0.05) And, SUVratio was the most accurate parameter. A cut-off value of 1.0 for SUVratio provided 90.9% sensitivity and 75.6% specificity. In small adrenal masses (1.5 cm or less), only SUVratio had statistically significant difference between benign and malignant adrenal masses. Similarly a cut-off value of 1.0 for SUVratio provided 80.0% sensitivity and 86.4% specificity. CONCLUSION: F-18 FDG PET/CT can offer more accurate information with quantitative analysis in differentiating malignant from benign adrenal masses incidentally observed in oncologic patients, compared to nonenhanced CT.
Adrenal Gland Neoplasms ; Diagnosis, Differential ; Humans ; Male ; Neoplasm Metastasis ; Sensitivity and Specificity

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Usefulness of (18)F-FDG PET/CT in Locoregional Recurrence of Differentiated Thyroid Cancer: Comparison PET/CT to PET and Neck Ultrasonography for Biopsy-proven Lesions.

Kun Ho KIM ; Min Ho SHONG ; Young Duk SEO ; Seong Min KIM

Nuclear Medicine and Molecular Imaging.2009;43(5):411-420.

PURPOSE: The aim of this study was to investigate the usefulness of (18)F-FDG PET/CT with neck ultrasonography (neck US) in patients with recurrent, papillary thyroid cancer. MATERIAL AND METHODS: This retrospective study (December 2006 to April 2008) enrolled sixty-one patients (ninety-one lesions) who underwent high-dose (131)I-ablation therapy after total thyroidectomy, and evaluated recurred papillary thyroid cancer. All lesions were confirmed by histopathology and compared histopathologic findings to PET, PET/CT, and neck US findings. RESULTS: In sixty-one patients (57 women, 4 men; age range, 24-81 years, mean 49 years; 61 papillary carcinomas), the sensitivity, specificity, accuracy of (18)F-FDG PET/CT was 87.2%, 64.0%, 78.1% on a patient basis and 92.3%, 66.7%, 80.9% on a lesion basis, respectively. The sensitivity, specificity, accuracy of (18)F-FDG PET was 71.8% (p=0.03), 59.0% (p=1.00), 67.2% (p=0.03) on a patient basis and 78.8% (p<0.01), 64.1% (p=1.00), 72.5% (p=0.02) on a lesion basis, respectively. The sensitivity, specificity, accuracy of neck US was 71.1% (p=0.07), 52.2% (p=0.75), 63.9% (p=0.05) on a patient basis and 71.2% (p<0.01), 61.5% (p=1.00), 67.0% (p=0.06) on a lesion basis, respectively. Combined (18)F-FDG PET/CT with neck US improved the sensitivity, specificity, accuracy to 94.7% (p=0.50), 82.6% (p=0.13), 90.2% (p=0.03) on a patient basis and 96.2% (p=0.50), 89.7% (p<0.01), 93.4% (p<0.01) on a lesion basis, respectively. CONCLUSION: (18)F-FDG PET/CT demonstrated significantly higher sensitivity than neck US for the detection of recurred papillary thyroid cancer lesions. Furthermore, combined (18)F-FDG PET/CT with neck US showed more improved sensitivity, specificity, accuracy for diagnosis of recurrent papillary thyroid cancer.
Female ; Humans ; Neck ; Recurrence ; Retrospective Studies ; Sensitivity and Specificity ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

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Clinical Significance of Incidental Asymmetric Palatine Tonsillar Uptake on (18)F-FDG PET/CT.

Sun Young CHAE ; Sora BAEK ; Dae Hyuk MOON ; Jin Sook RYU ; Jae Seung KIM

Nuclear Medicine and Molecular Imaging.2009;43(5):402-410.

PURPOSE: The aim of this study was to determine the incidence and malignant rate of incidental asymmetric palatine tonsillar uptake (ATU) on (18)F-FDG PET/CT in various clinical indications and to evaluate the clinical and PET/CT findings suggesting malignancy. MATERIALS AND METHODS: We retrospectively reviewed a total of 2,901 patients (58.4+/-12.3 yrs, range 20~88 yrs, M:F=1,841:1,060) who underwent (18)F-FDG PET/CT during an 1-year period with various indications except primary tonsillar cancer and lymphoma evaluation. On (18)F-FDG PET/CT, metabolic abnormality of the palatine tonsil and cervical lymph node were visually assessed. ATU was defined as increased palatine tonsillar uptake with diffuse, focal, or irregular pattern compared to contralateral side. The incidence and malignant ratio of ATU were evaluated according to clinical and PET/CT findings. RESULTS: Of 2,901 cases, 290 (10.0%) showed ATU. The incidence of ATU showed seasonal variation and was high in the winter (12.1%). Of 209 cases with ATU confirmed pathologically and/or clinically, five (2.4%) were malignant lesions. ATU with irregular uptake pattern (2/2) and in cases referred for cervical lymph node metastasis of unknown origin (3/5) were frequently associated with malignant lesion (p<0.05). CONCLUSION: ATU was not infrequently observed on (18)F-FDG PET/CT, and the malignant risk of ATU was low. However, ATU with cervical lymph node metastasis or with irregular pattern on PET/CT would be further evaluated by the histopathologic examination.
Humans ; Incidence ; Lymph Nodes ; Lymphoma ; Neoplasm Metastasis ; Palatine Tonsil ; Retrospective Studies ; Seasons ; Tonsillar Neoplasms

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(18)F-FDG PET/CT in Patients with Initially Diagnosed Adenoid Cystic Carcinoma of the Head and Neck: Clinicoplathologic Correlation.

Ji Young LEE ; Joon Young CHOI ; Young Hyeh KO ; Chung Hwan BAEK ; Young Ik SON ; Suk Kyong CHO ; Miju CHEON ; Kyung Han LEE ; Byung Tae KIM

Nuclear Medicine and Molecular Imaging.2009;43(5):395-401.

PURPOSE: We evaluated (18)F-FDG PET/CT findings in initially diagnosed adenoid cystic carcinoma (ACC) of the head and neck in association with pathological subtype, staging, uptake comparison with squamous cell carcinoma (SqCC) and prognosis. MATERIALS AND METHODS: The subjects were 16 patients with initially diagnosed ACC of head and neck who underwent pretreatment (18)F-FDG PET/CT. Histological subtype (solid pattern vs. tubular/cribriform pattern), SUV(max) of size-matched SqCC of the head and neck as control group, disease-free survival (DFS) were compared with the SUV(max) of ACC of the head and neck. RESULTS: Of total 16 patients, 6 had solid pattern and the remaining 10 had tubular/cribriform pattern. The SUV(max) were significantly higher in solid pattern group than in tubular/cribriform pattern group (6.7+/-3.2 vs. 4.2+/-0.9, p=0.03). PET/CT found unexpected distant metastasis in 18.7% of patients (3/16) and changed the therapeutic plan in those patients. The SUV(max) of ACC was significantly lower than that of size-matched SqCC (5.1+/-2.4 vs. 13.6+/-6.0, p<0.001). DFS was not significantly different according to the histological subtype. In contrast, patients with high (18)F-FDG uptake (SUV(max) > or =6.0) had significantly shorter DFS than those with low (18)F-FDG uptake (SUV(max) <6.0). CONCLUSION: (18)F-FDG uptake of ACC of the head and neck is significantly associated with histological subtype and DFS. (18)F-FDG PET/CT may be useful for detecting unexpected metastasis. Since (18)F-FDG uptake of tubular/cribriform ACC compared with SqCC is relatively low, it is necessary to interpret PET images carefully in patients without alleged ACC.
Adenoids ; Carcinoma, Adenoid Cystic ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Head ; Humans ; Neck ; Neoplasm Metastasis ; Prognosis

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Comparison Study between Myocardial Velocity obtained from Gated Myocardial SPECT and Myocardial Functional indices with a Focus on Myocardial Perfusion.

Jung Min HA ; Shin Young JEONG ; Hee Seung BOM ; Byeong Il LEE

Nuclear Medicine and Molecular Imaging.2009;43(5):386-394.

PURPOSE: We aimed to assess the myocardial velocity on gated myocardial perfusion SPECT (gated MPS), to compare myocardial velocity between patients without coronary artery disease (CAD) and CAD patients and to assess the correlation of myocardial velocity and perfusion and wall thickening on CAD group. MATERIALS AND METHODS: Seventeen patients without CAD (M:F=9:8, mean age 61.8+/-11.1 yrs: group A) and thirty-nine patients with CAD (M:F=18:21, mean age 66.9+/-8.1 yrs: group B) had undergone one-day adenosine stress gated MPS. In twenty segment model, 12 segments (except apical and basal segments) of each patient were included. We obtained systolic and diastolic gate ratio in left ventricular volume curve by eight frames per cardiac cycle on gated MPS. Using the systolic and diastolic gate ratio and R-R time of each patient, we obtained systolic and diastolic time ratio. The myocardial velocity was defined as wall thickening over systolic or diastolic time. RESULTS: We presented normal range of myocardial velocities according segments and territories of coronary artery. The myocardial velocity of group B was significantly lower than group A (p=0.00). There was no significant difference between the myocardial velocity of group B with preserved EF and group A. The stress systolic velocity significantly correlated with regional myocardial perfusion in group B with preserved EF (p=0.00) as well as decreased EF (p=0.01). In group B, stress perfusion of segments which had decreased wall thickening and decreased myocardial velocity was significantly lower than segments which had decreased wall thickening and preserved myocardial velocity (p=0.01). CONCLUSION: The new functional index of velocity will be used as an useful of gated MPS
Adenosine ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Perfusion ; Reference Values ; Tomography, Emission-Computed, Single-Photon

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Assessment of Tumor Response to Therapy in Lymphoma Using (18)F-FDG PET: Diagnostic Performance of (18)F-FDG PET and Interval Likelihood Ratio.

Chang Guhn KIM ; Dae Weung KIM ; Moo Rim PARK

Nuclear Medicine and Molecular Imaging.2009;43(5):369-385.

In this paper, the authors intended to summarize briefly the features of lymphoma with regard to (18)F-FDG PET for assessment of tumor response to therapy, to describe why assessment of treatment response should be performed, to review what method so far has been used in monitoring treatment response, to discuss what limitations of morphologic imaging criteria for assessing tumor response are, in compared with (18)F-FDG PET, and to introduce recently proposed criteria for assessing tumor response in malignant lymphoma. And also the authors emphasize the need to understand the characteristics of diagnostic performance of (18)F-FDG PET in several clinical settings in order to interpret (18)F-FDG PET results appropriately, and to encourage the use of interval likelihood ratio to enhance clinical implications of test results which, in turns, allows referring physicians to understand the meaning of interpretation with easy. Until recently, treatment response has been assessed according to the morphologic criteria. Metabolic imaging with (18)F-FDG PET was adopted to have important role for treatment assessment in IWC+PET criteria proposed recently by IHP. To accomplish this role, we should perform and interpret (18)F-FDG PET according to IWC+PET criteria. It is important for referring physicians to understand the various limitations of (18)F-FDG PET and pitfalls in PET interpretation, and to understand that clinical information are needed by nuclear medicine physicians to optimize the interpretation of (18)F-FDG PET.
Lymphoma ; Nuclear Medicine ; Positron-Emission Tomography

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F-18 FDG Uptake in Respiratory Muscle Mimicking Metastasis in Patients with Gastric Cancer.

Seung Jin CHOI ; Jeong Ho KIM ; In Young HYUN

Nuclear Medicine and Molecular Imaging.2006;40(4):233-236.

A 67-year-old man with a history of chronic obstructive pulmonary disease (COPD) underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for staging of gastric cancer. The projection images of F-18 FDG PET/CT showed intensely increased F-18 FDG uptake in the anterior neck, chest wall, and upper abdomen. We suspected distant metastases of cervical lymph nodes, ribs, and peritoneum in gastric cancer. However, the transaxial images of F-18 FDG PET/CT showed abnormal F-18 FDG uptake in scalene muscles of anterior neck, intercostal muscles of chest wall, and diaphragm of upper abdomen. Patients with COPD use respiratory muscles extensively on the resting condition. These excessive physiologic use of respiratory muscles causes increased F-18 FDG uptake as a result of increased glucose metabolism. The F-18 FDG uptake in respiratory muscles of gastric cancer patient with COPD mimicked distant metastases in cervical lymph nodes, ribs, and peritoneum.
Abdomen ; Aged ; Diaphragm ; Electrons ; Glucose ; Humans ; Intercostal Muscles ; Lymph Nodes ; Metabolism ; Muscles ; Neck ; Neoplasm Metastasis* ; Peritoneum ; Positron-Emission Tomography and Computed Tomography ; Pulmonary Disease, Chronic Obstructive ; Respiratory Muscles* ; Ribs ; Stomach Neoplasms* ; Thoracic Wall

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Production of 18FF2 Gas for Electrophilic Substitution Reaction.

Byung Seok MOON ; Jae Hong KIM ; Kyo Chul LEE ; Gwang Il AN ; Gi Jeong CHEON ; Kwon Soo CHUN

Nuclear Medicine and Molecular Imaging.2006;40(4):228-232.

PURPOSE: Electrophilic 18F (T1/2=110 min) radionuclide in the form of [18F]F2 gas is of great significance for labeling radiopharmaceuticals for positron emission tomography (PET). However, its production in high yield and with high specific radioactivity is still a challenge to overcome several problems on targetry. The aim of the present study was to develop a method suitable for the routine production of [18F]F2 for the electrophilic substitution reaction. MATERIALS AND METHODS: The target was designed water-cooled aluminum target chamber system with a conical bore shape. Production of the elemental fluorine was carried out via the 18O(p,n)18F reaction using a two-step irradiation protocol. In the first irradiation, the target filled with highly enriched 18O2 was irradiated with protons for 18F production, which were adsorbed on the inner surface of target body. In the second irradiation, the mixed gas (1% [19F]F2/Ar) was loaded into the target chamber, following a short irradiation of proton for isotopic exchange between the carrier-fluorine and the radiofluorine absorbed in the target chamber. Optimization of production was performed as the function of irradiation time, the beam current and 18O2 loading pressure. RESULTS: Production runs was performed under the following optimum conditions: The 1st irradiation for the nuclear reaction (15.0 bar of 97 % enriched 18O2, 13.2 MeV protons, 30 micro A, 60-90 min irradiation), the recovery of enriched oxygen via cryogenic pumping; The 2nd irradiation for the recovery of absorbed radiofluorine (12.0 bar of 1% [19F]fluorine/argon gas, 13.2 MeV protons, 30 micro A, 20-30 min irradiation), the recovery of [18F]fluorine for synthesis. The yield of [18F]fluorine at EOB (end of bombardment) was achieved around 34+/-6.0 GBq (n>10). CONCLUSION: The production of 18F electrophilic agent via 18O(p,n)18F reaction was much under investigation. Especially, an aluminum gas target was very advantageous for routine production of [18F]fluorine. These results suggest the possibility to use [18F]F2 gas as a electrophilic substitution agent.
Aluminum ; Fluorine ; Oxygen ; Positron-Emission Tomography ; Protons ; Radioactivity ; Radiopharmaceuticals

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Synthesis and Preliminary Evaluation of 9-(4-18FFluoro-3-hydroxymethylbutyl) Guanine (18FFHBG) in HSV1-tk Gene Transduced Hepatoma Cell.

Byung Seok MOON ; Tae Sup LEE ; Myoung Keun LEE ; Kyo Chul LEE ; Gwang Il AN ; Kwon Soo CHUN ; Ok Doo AWH ; Dae Yoon CHI ; Chang Woon CHOI ; Sang Moo LIM ; Gi Jeong CHEON

Nuclear Medicine and Molecular Imaging.2006;40(4):218-227.

PURPOSE: The HSV1-tk reporter gene system is the most widely used system because of its advantage that direct monitoring is possible without the introduction of a separate reporter gene in case of HSV1-tk suicide gene therapy. In this study, we investigate the usefulness of the reporter probe (substrate), 9-(4-[18F]fluoro-3-hydroxymethylbutyl)guanine ([18F]FHBG) for non-invasive reporter gene imaging using PET in HSV1-tk expressing hepatoma model. MATERIALS AND METHODS: Radiolabeled FHBG was prepared in 8 steps from a commercially available triester. The labeling reaction was carried out by NCA nucleophilic substitution with K[18F]/K2.2.2. in acetonitrile using N2-monomethoxytrityl-9-[4-(tosyl)-3-monomethoxytritylmethylbutyl]guanine as a precursor, followed by deprotection with 1 N HCl. Preliminary biological properties of the probe were evaluated with MCA cells and MCA-tk cells transduced with HSV1-tk reporter gene. In vitro uptake and release-out studies of [18F]FHBG were performed, and was analyzed correlation between [18F]FHBG uptake ratio according to increasing numeric count of MCA-tk cells and degree of gene expression. MicroPET scan image was obtained with MCA and MCA-tk tumor bearing Balb/c-nude mouse model. RESULTS: [18F]FHBG was purified by reverse phase semi-HPLC system and collected at around 16-18 min. Radiochemical yield was about 20-25% (corrected for decay), radiochemical purity was >95% and specific activity was around >55.5 GBq/micro mol. Specific accumulation of [18F]FHBG was observed in HSV1-tk gene transduced MCA-tk cells but not in MCA cells, and consecutive 1 hour release-out results showed more than 86% of uptaked [18F]FHBG was retained inside of cells. The uptake of [18F]FHBG was showed a highly significant linear correlation (R2=0.995) with increasing percentage of MCA-tk numeric cell count. In microPET scan images, remarkable difference of accumulation was observed for the two type of tumors. CONCLUSION: [18F]FHBG appears to be a useful as non-invasive PET imaging substrate in HSV1-tk expressing hepatoma model.
Animals ; Carcinoma, Hepatocellular* ; Cell Count ; Gene Expression ; Genes, Reporter ; Genetic Therapy ; Guanine* ; Mice ; Suicide ; Thymidine Kinase

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