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The Effect of Intravenous Contrast on SUV Value in 18F-FDG PET/CT using Diagnostic High Energy CT.

Nuclear Medicine and Molecular Imaging.2006;40(3):169-176.

PURPOSE: According to the development of CT scanner in PET/CT system, the role of CT unit as a diagnostic tool has been more important. To improve the diagnostic ability of CT scanner, it is a key aspect that CT scanning has to be performed with high dose energy and intravenous (IV) contrast. So we investigated the effect of IV contrast media on the maximum SUV (maxSUV) of normal tissues and pathologic lesions using PET/CT scanner with high dose CT scanning. MATERIALS AND METHODS: The study enrolled 13 patients who required PET/CT evaluation. At first, the patients were performed whole body non-contrast CT (NCCT - 120 kVp, 130 mAs) scan. Then contrast enhanced CT (CECT) scan was performed immediately. Finally PET scan was followed. The PET emission data were reconstructed twice, once with the NCCT and again with the CECT. We measured the maxSUV of 10 different body regions that were considered as normal in all patients. Also pathologic lesions were investigated. RESULTS: There were not seen focal artifacts in PET images based on CT with IV contrast agent. Firstly, 130 normal regions in 13 patients were evaluated. The maxSUV was significantly different between two PET images (p<0.001). The maxSUV was 1.1+/-0.5 in PET images with CECT-corrected attenuation and 1.0+/-0.5 in PET images with NCCT-corrected attenuation. The limit of agreement was 0.1+/-0.3 in Bland-Altman analysis. Especially there were significant differences in 6 of 10 regions, apex and base of the right lung, ascending aorta, segment 6 and segment 8 of the liver and spleen (p<0.05). Secondly, 39 pathologic lesions were evaluated. The maxSUV was significantly different between two PET images (p<0.001). The maxSUV was 4.7+/-2.0 in PET images with CECT-corrected attenuation and 4.4+/-2.0 in PET images with NCCT-corrected attenuation. The limit of agreement was 0.4+/-0.8 in Bland-Altman analysis. CONCLUSION: Although there were increases of maxSUVs in the PET images based on CT with IV contrast agent, it was very narrow in the range of limit of agreement. So there was no significant effect to clinical interpretation for PET images that were corrected attenuation with high dose CT using IV contrast.
Aorta ; Artifacts ; Body Regions ; Contrast Media ; Fluorodeoxyglucose F18* ; Humans ; Liver ; Lung ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography* ; Spleen ; Tomography, X-Ray Computed

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The Usefulness of F-18 FDG PET to Discriminate between Malignant and benign Nodule in Idiopathic Pulmonary Fibrosis.

Bom Sahn KIM ; Won Jun KANG ; Dong Soo LEE ; June Key CHUNG ; Myung Chul LEE

Nuclear Medicine and Molecular Imaging.2006;40(3):163-168.

PURPOSE: Incidence of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) is known to be higher than that in general population. However, it is difficult to discriminate pulmonary nodule in patients with IPF, because underlying IPF can be expressed as lung nodules. We evaluated the diagnostic performance of FDG PET in discriminating lung nodule in patients with IPF. METHODS: We retrospectively reviewed 28 lung nodules in 16 subjects (age; 67.53+/-9.83, M:F=14:2). Two patients had previous history of malignant cancer (small cell lung cancer and subglottic cancer). The diagnostic criteria on chest CT were size, morphology and serial changes of size. FDG PET was visually interpreted, and maximal SUV was calculated for quantitative analysis. RESULTS: From 28 nodules, 18 nodules were interpreted as benign nodules, 10 nodules as malignant nodules by histopahthology or follow-up chest CT. The sensitivity and specificity of FDG PET were 100% and 94.4%, while those of CT were 70.0% and 44.4%, respectively. Malignant nodule was higher maxSUV than that of benign lung nodules (7.68+/-3.96 vs. 1.22+/-0.65, p<0.001). Inflammatory lesion in underlying IPF was significantly lower maxSUV than that of malignant nodules (1.80+/-0.43, p<0.001). The size of malignant and benign nodule were 23.95+/-10.15 mm and 10.83+/-5.23 mm (p<0.01). CONCLUSION: FDG PET showed superior diagnostic performance to chest CT in differentiating lung nodules in patients with underlying IPF. FDG PET could be used to evaluate suspicious malignant lung nodule detected by chest in patients with IPF.
Follow-Up Studies ; Humans ; Idiopathic Pulmonary Fibrosis* ; Incidence ; Lung ; Lung Neoplasms ; Retrospective Studies ; Sensitivity and Specificity ; Thorax ; Tomography, X-Ray Computed

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Diagnosis of Coronary Artery Disease using Myocardial Perfusion SPECT in Patients with Diabetes Mellitus: Analysis of Risk Factors.

Ji Hyoung SEO ; Seong Min KANG ; Jin Ho BAE ; Shin Young JEONG ; Sang Woo LEE ; Jeong Soo YOO ; Byeong Cheol AHN ; Jaetae LEE

Nuclear Medicine and Molecular Imaging.2006;40(3):155-162.

PURPOSE: Diabetes mellitus (DM) is a critical disease with higher rates of cardiovascular morbidity and mortality due to myocardial ischemia and infarction. There is growing interest in how to determine high-risk patients who are candidates for screening testing. This study was performed to evaluate the incidence of coronary artery disease (CAD) in diabetic patients detected by Tc-99m MIBI myocardial perfusion SPECT (MPS) and to assess risk factors of CAD and cardiac hard events. SUBJECTS AND METHODS: 203 diabetic patients (64 male, mean age 64.1+/-9.0 years) who underwent MPS were included between Jan 2000 and July 2004. Cardiac death and nonfatal myocardial infarction (MI) were considered as hard events, and coronary angioplasty and bypass surgery >60 days after testing were considered as soft events. The mean follow-up period was 36+/-18 months. Patients underwent exercise (n=6) or adenosine stress (n=197) myocardial perfusion SPECT. RESULTS: Perfusion defects on MPS were detected in 28.6% (58/203) of the patients. There was no cardiac death but 11 hard events were observed. The annual cardiac hard event rate was 1.1%. In univariate analysis of clinical factors, typical anginal pain, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were significantly associated with the ocurrence of hard events. Anginal pain, peripheral vascular disease, and resting ECG abnormality remained independent predictors of nonfatal MIs with multivariate analysis. Abnormal SPECT results were significantly associated with high prevalence of hard events but not independent predictors on uni- and multivariate analyses. CONCLUSION: Patients who were male, had longer diabetes duration (especially over 20 years), peripheral vascular disease, peripheral polyneuropathy, or resting ECG abnormality had higher incidence of CAD. Among clinical factors in diabetic patients, typical angina, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were strong predictors of hard events.
Adenosine ; Angioplasty ; Coronary Artery Disease* ; Coronary Vessels* ; Death ; Diabetes Mellitus* ; Diagnosis* ; Electrocardiography ; Follow-Up Studies ; Humans ; Incidence ; Infarction ; Male ; Mass Screening ; Mortality ; Multivariate Analysis ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion* ; Peripheral Vascular Diseases ; Polyneuropathies ; Prevalence ; Risk Factors* ; Tomography, Emission-Computed, Single-Photon*

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Effectiveness of Radionuclide Cisternography to Detect the Leakage Site of CSF in Spontaneous Intracranial Hypotension; Preliminary Report.

Seong Min KIM ; Jae Moon KIM

Nuclear Medicine and Molecular Imaging.2006;40(3):148-154.

PURPOSE: Although radionuclide cisternography (RNC) is an useful study to detect cerebrospinal fluid (CSF) leakage in the patient with spontaneous intracranial hypotension (SIH), it sometimes fails to demonstrate the site of CSF leakage. The aim of the study is to improve the detection of leakage site of CSF and to reduce time for the study in RNC using modified protocol (m-RNC). MATERIALS AND METHODS: The study consists of 8 studies of 7 patients (38+/-8 years, M:F=2:5) with SIH, who underwent m-RNC following administration of 185-222 MBq of 99mTc-DTPA into the lumbar subarachnoid space. Sequential images were obtained the whole spine with the head including urinary bladder at 10 minute, 30 minute, 1 hour, 2 hour, 4 hour and 6 hour. Radioactivity of extradural space and urinary bladder was evaluated. RESULTS: Leakage site of CSF was identified in all 8 cases by m-RNC. Leakage site was cervicothoracic junction (CTJ, n=3), CTJ with C1-2 (n=2), CTJ with thoracic spine, thoracolumbar spine and lumbar spine (each n=1). All cases presented leakage sites within 1 hour and multiple sites, where CTJ was included in 6 cases. Only one case presented additional site in 6 hour image. Early radioactivity within the urinary bladder was noted in 6 cases, but that was following after identification of the leakage site. CONCLUSION: Radionuclide cisternography is sensitive to detect the leakage site of CSF and is expected to improve the detection of CSF leakage site and reduce time for the study using modified protocol.
Cerebrospinal Fluid ; Head ; Humans ; Intracranial Hypotension* ; Radioactivity ; Spine ; Subarachnoid Space ; Urinary Bladder

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Role of F-18 FDG PET or PET/CT in the Evaluation of Gastric Cancer.

Mijin YUN

Nuclear Medicine and Molecular Imaging.2006;40(3):141-147.

PET detects only less than 50% of early gastric cancer and 62-98% of advanced gastric cancer. Therefore, mass screening programs are recommended for all adults over the age of 40 for early detection and early treatment of gastric cancer through endoscopy or various radiological tests. The most important step after being diagnosed with gastric cancer is accurate staging, which mainly evaluates tumor resectability to avoid unnecessary surgery. Important factors that affect tumor resectability are whether the tumor can be separated from adjacent organs or important blood vessels, the extent of lymph node metastasis, presence of peritoneal metastasis, or distant organ metastasis. To evaluate the extent of local tumor invasion, anatomical imaging that has superior spatial resolution is essential. There are a few studies on prognostic significance of FDG uptake with inconsistent results between them. In spite of lower sensitivities for lymph node staging, the specificities of CT and PET are very high, and the specificity for PET tends to be higher than that for CT. Limited data published so far show that PET seems less useful in the detection of lung and bone metastasis. In the evaluation of pleural or peritoneal metastasis, PET seems very specific but insensitive as well. When FDG uptake of the primary tumor is low, the distant metastasis is also known to show low FDG uptake reducing its detection. There are only a few data available in the evaluation of recurrence detection and treatment response using FDG PET.
Adult ; Blood Vessels ; Endoscopy ; Humans ; Lung ; Lymph Nodes ; Mass Screening ; Neoplasm Metastasis ; Positron-Emission Tomography and Computed Tomography* ; Recurrence ; Sensitivity and Specificity ; Stomach Neoplasms* ; Unnecessary Procedures

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Topographic Locomotive Analysis of (99m)Tc-HDP Uptake of Acute Rhabdomyolysis and Musculotendinous Unit Injury due to Excessive Swimming Exercise in Novice: A Case Report.

Yong Whee BAHK ; Ho Seung JEON

Nuclear Medicine and Molecular Imaging.2008;42(6):491-493.

No abstract available.
Rhabdomyolysis ; Swimming

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Significant Mismatch between FDG Uptake and Size after Chemotherapy in a Patient with Non-small Cell Lung Cancer.

Seong Young KWON ; Shin Young JEONG ; Young Soon SEO ; Jung Min HA ; Ari CHONG ; Jong Ryool OH ; Ho Chun SONG ; Jung Joon MIN ; Hee Seung BOM

Nuclear Medicine and Molecular Imaging.2008;42(6):488-490.

A 75-year-old man with non-small cell lung cancer (NSCLC) underwent F-18 fluorodeoxyglucose (FDG) PET/CT for staging. PET/CT showed distant metastases to intra-abdominal lymph nodes (LNs) as well as bilateral mediastinal LNs (stage IV). He underwent PET/CT (restaging PET/CT) 1 week after the completion of first-line chemotherapy (docetaxel + carboplatin). It showed markedly increased FDG uptake in primary tumor, whereas tumor size decreased significantly, compared to prior PET/CT. This lesion was aggravated on follow-up CT 3 months after the completion of chemotherapy. Although there are several reports that FDG PET has potential to evaluate early response to chemotherapy and prognosis, there are a few cases to show mismatch between FDG uptake and size on PET/CT. Thus we report a case of NSCLC showed increased FDG uptake of primary tumor while decreased tumor size on restaging PET/CT.
Aged ; Carcinoma, Non-Small-Cell Lung ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

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Dual Lingual Thyroid Mimicking Mono-ectopic Thyroid in the Anterior View of Tc-99m Sodium Pertechnetate Thyroid Scan.

Ari CHONG ; Shin Young JEONG ; Seong Young KWON ; Young Soon SEO ; Jung Min HA ; Jong Ryool OH ; Hee Seung BOM ; Ho Chun SONG ; Jung Joon MIN

Nuclear Medicine and Molecular Imaging.2008;42(6):485-487.

Ectopic thyroid is not common disease and double ectopic thyroid is rare. Until January of 2008, dual ectopic thyroid has been reported only 23 cases in international literatures. Tc-99m sodium pertechnetate scan is playing an important role in the diagnosis of ectopic thyroid. In most of the cases, dual lingual thyroid tissues could be detected as two radiotracer uptake foci. We report a case of dual lingual thyroid mimicking mono-lingual thyroid in the anterior view of thyroid scan. Lateral view helped in this case to detect the dual lingual thyroid. With lateral view, the anatomical position and relationship could be examined in more detail.
Lingual Thyroid ; Sodium ; Sodium Pertechnetate Tc 99m ; Thyroid Dysgenesis ; Thyroid Gland

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A Case of Incidentally Detected Nasopharyngeal Tuberculosis on F-18 FDG PET/CT.

Jai Hyuen LEE ; Jae Seung KIM

Nuclear Medicine and Molecular Imaging.2008;42(6):482-484.

It is well known that F-18 FDG PET/CT is a highly sensitive diagnostic modality for cancer patients. However, false positive cases resulting from benign disease such as tuberculosis in the endemic area often compromise the diagnostic accuracy of F-18 FDG PET/CT. Nasopharyngeal tuberculosis is a rare disease although extrapulmonary tuberculosis can involve any region in the body. We report one case of nasopharyngeal tuberculosis incidentally detected on F-18 FDG PET/CT.
Humans ; Rare Diseases ; Tuberculosis

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Defect of 18F-FDG Uptake Observed in Infarcted Myocardium Showing Reverse Redistribution on Rest / 24-Hour Delayed 201Tl Myocardial SPECT after Acute Myocardial Infarction.

Ho Young LEE ; Jin Chul PAENG ; So Won OH ; Ji Yeong KIM ; Woo Young CHUNG

Nuclear Medicine and Molecular Imaging.2008;42(6):478-481.

Reverse redistribution is frequently observed after revascularization in acute myocardial infarction, and usually regarded as a predictor of viable myocardium on stress/rest and 2- to 4-hour redistribution 201Tl SPECT. However, there is not enough report of reverse redistribution in case of 24-hour delayed SPECT, which is commonly used for viability assessment. In this report, a case of reverse redistribution on rest and 24-hour delayed 201Tl SPECT is reported with use of automatic segmental quantitative analysis. The myocardium of reverse redistribution was dysfunctional on gated SPECT, and diagnosed as non-viable on 18F-FDG PET.
Fluorodeoxyglucose F18 ; Myocardial Infarction ; Myocardium ; Tomography, Emission-Computed, Single-Photon

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