Imaging assessment FDG-avid lymphomas. Is Diagnostic CT a necessary adjunct to PET-CT?

Aim: Despite recent local introduction of evidence-based guidelines recommending PET-CT (low dose unenhanced CT) for staging and assessment of treatment response of predictably FDG-avid lymphoma sub-types, in our institution diagnostic CT with intravenous contrast enhancement is still often used in addition to PET-CT at the same time in the course of disease. This study evaluates whether diagnostic CT yields additional diagnostic information for lymphoma patients when performed at same time as PET-CT. Materials & Methods: We carried out a retrospective review of all lymphoma patients referred to our centre for PET-CT imaging over a six month period (February 2008 - July 2008). We determined whether these patients had undergone diagnostic CT at the same time. PET-CT images were classified into ‘staging’ scans and ‘post-treatment’ scans and PET-CT reports were compared with those of diagnostic CT to determine whether there were any differences in diagnostic yield between the two scans. Results: For the 98 PET-CT examinations identified, diagnostic CT had been carried out at the same time in 47 (48%). 22 of these examination pairs (PET-CT vs. diagnostic CT) were for staging, whilst 25 were post-treatment. For staging, there was no difference in diagnostic yield in 10/22 (45%), other than one (5%) incidental finding on PET-CT (uterine fibroids). PET-CT upstaged diagnostic CT in 10/22 (45%) cases and increased confidence in reporting splenic disease on 1/22 occasion (5%). Diagnostic CT upstaged PET-CT on no single occasion. Post-treatment, there was no difference in diagnostic yield in14/25 cases (56%) other than 3 (12%) incidental findings on CT (initial SVC compression, uterine fibroids and interstitial fibrosis). In 4/25 (16%) cases PET revealed evidence of active lymphoma missed by CT whereas; in a further 3/25 (12%) cases PET confirmed no active disease in diagnostic CT residual masses. In one case (4%) of peripheral T-cell Non Hodgkin’s Lymphoma, diagnostic CT demonstrated a possible new non-FDG avid intra-thoracic site of disease which was also seen on the CT component of the PET-CT. No incidental finding (8%) was considered likely to impact on lymphoma management. Conclusion: Our results support the view that FDG-PET-CT obviates the need for additional diagnostic CT in FDG-avid lymphoma. Diagnostic CT may have a remaining role in assessment of lymphoma sub-types that are not predictably FDG avid

F-fluorodeoxyglucose (FED)-PET-CT diagnosis of medium and large vessels vasculitis in an elderly woman with pyrexia of unknown origin (PUO): case history and cost effectiveness analysis

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Slow metabolic deterioration towards diabetes in islet cell antibody positive patients with autoimmune polyendocrine disease

We studied metabolic progression to IDDM in a cohort of adults who are ICA-positive and have associated autoimmune endocrine disease or circulating organ-specific autoantibodies (the Polyendocrine Study). Of the 186 individuals recruited 27 developed overt diabetes after a median follow-up of 4.5 years (range 0.4-12). Of these, eight patients did not require insulin treatment until at least 6 months after clinical diagnosis, with an interval of 1.8 years (1.2-5.7). An IVGTT was performed in 38 subjects and 23 had sequential studies. Of the initial 38 subjects six developed diabetes and only three showed a loss of FPIR to glucose (below the first percentile of a normal control group) before clinical onset of the disease. An additional three subjects showed a loss of the FPIR, and all still have normal glucose tolerance after median follow-up of 28 months (22-95). A whole or mixed pattern of islet cell staining was found in five of the six patients who developed diabetes and antibodies against an islet 37 k-antigen were detectable in four patients, all of whom required insulin soon after diagnosis. A beta-cell selective ICA staining pattern was seen in 14 of 17 subjects who did not develop diabetes and the mixed pattern in only three. None of this group had detectable 37k-antibodies. We conclude that metabolic deterioration is slow in polyendocrine patients, and that the IVGTT has less prognostic significance in this group than in first degree relatives of patients with IDDM. In contrast, the presence of the whole or mixed ICA staining pattern or of 37k-antibodies can identify a high risk of progression to IDDM within this polyendocrine population and may indicate the rate of metabolic deterioration. © 1994 Springer-Verlag.</p

Slow metabolic deterioration towards diabetes in islet cell antibody positive patients with autoimmune polyendocrine disease

We studied metabolic progression to IDDM in a cohort of adults who are ICA-positive and have associated autoimmune endocrine disease or circulating organ-specific autoantibodies (the Polyendocrine Study). Of the 186 individuals recruited 27 developed overt diabetes after a median follow-up of 4.5 years (range 0.4-12). Of these, eight patients did not require insulin treatment until at least 6 months after clinical diagnosis, with an interval of 1.8 years (1.2-5.7). An IVGTT was performed in 38 subjects and 23 had sequential studies. Of the initial 38 subjects six developed diabetes and only three showed a loss of FPIR to glucose (below the first percentile of a normal control group) before clinical onset of the disease. An additional three subjects showed a loss of the FPIR, and all still have normal glucose tolerance after median follow-up of 28 months (22-95). A whole or mixed pattern of islet cell staining was found in five of the six patients who developed diabetes and antibodies against an islet 37 k-antigen were detectable in four patients, all of whom required insulin soon after diagnosis. A beta-cell selective ICA staining pattern was seen in 14 of 17 subjects who did not develop diabetes and the mixed pattern in only three. None of this group had detectable 37k-antibodies. We conclude that metabolic deterioration is slow in polyendocrine patients, and that the IVGTT has less prognostic significance in this group than in first degree relatives of patients with IDDM. In contrast, the presence of the whole or mixed ICA staining pattern or of 37k-antibodies can identify a high risk of progression to IDDM within this polyendocrine population and may indicate the rate of metabolic deterioration. © 1994 Springer-Verlag.</p

Imaging biomarker roadmap for cancer studies.

Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing 'translational gaps' through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored 'roadmap'. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use

Imaging biomarker roadmap for cancer studies.

Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing 'translational gaps' through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored 'roadmap'. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use