Clinical Applications of FDG PET and PET/CT in Head and Neck Cancer

18F-FDG PET plays an increasing role in diagnosis and management planning of head and neck cancer. Hybrid PET/CT has promoted the field of molecular imaging in head and neck cancer. This modality is particular relevant in the head and neck region, given the complex anatomy and variable physiologic FDG uptake patterns. The vast majority of 18F-FDG PET and PET/CT applications in head and neck cancer related to head and neck squamous cell carcinoma. Clinical applications of 18F-FDG PET and PET/CT in head and neck cancer include diagnosis of distant metastases, identification of synchronous 2nd primaries, detection of carcinoma of unknown primary and detection of residual or recurrent disease. Emerging applications are precise delineation of the tumor volume for radiation treatment planning, monitoring treatment, and providing prognostic information. The clinical role of 18F-FDG PET/CT in N0 disease is limited which is in line with findings of other imaging modalities. MRI is usually used for T staging with an intense discussion concerning the preferable imaging modality for regional lymph node staging as PET/CT, MRI, and multi-slice spiral CT are all improving rapidly. Is this review, we summarize recent literature on 18F-FDG PET and PET/CT imaging of head and neck cancer

Synovial sarcoma presenting with huge mediastinal mass: a case report and review of literature

BACKGROUND: Synovial sarcoma presenting in the mediastinum is exceedingly rare. Furthermore, data addressing optimal therapy is limited. Herein we present a case where an attempt to downsize the tumor to a resectable state with chemotherapy was employed. CASE PRESENTATION: A 32 year female presented with massive pericardial effusion and unresectable huge mediastinal mass. Computed axial tomography scan - guided biopsy with adjunctive immunostains and molecular studies confirmed a diagnosis of synovial sarcoma. Following three cycles of combination Ifosfamide and doxorubicin chemotherapy, no response was demonstrated. The patient refused further therapy and had progression of her disease 4 months following the last cycle. CONCLUSION: Synovial sarcoma presenting with unresectable mediastinal mass carry a poor prognosis. Up to the best of our knowledge there are only four previous reports where primary chemotherapy was employed, unfortunately; none of these cases had subsequent complete surgical resection. Identification of the best treatment strategy for patients with unresectable disease is warranted. Our case can be of benefit to medical oncologists and thoracic surgeons who might be faced with this unique and exceedingly rare clinical scenario

Prominent 18F-FDG Uptake in the Adrenal Gland after Contralateral Adrenalectomy in a Known Case of Adrenocortical Oncocytic Carcinoma

Adrenocortical carcinoma (ACC) is a rare type of cancer that is associated with a high rate of recurrence and poor prognosis. The main diagnostic approaches to adrenocortical cancer include CT scan, MRI and the promising role of 18F-FDG PET/CT. The main therapeutic approaches include radical surgery of local disease and recurrences, as well as adjuvant mitotane therapy.The evaluation of adrenocortical carcinoma (ACC) could be difficult by using 18F-FDG PET/CT in view of the significant association between the 18F-FDG uptake and ACC. At the same time, not all adrenal glands with 18F-FDG uptake are considered to be malignant, so awareness of these various findings is substantial for ACC management, especially with limited data regarding the role of 18F-FDG PET/CT in ACC post-operative settings.This report discusses the case of a 47-year-old man with a history of left adrenocortical carcinoma who underwent adrenalectomy and received adjuvant mitotane therapy. 9 months after the surgery, a follow-up 18F-FDG PET/CT scan showed that the 18F-FDG uptake was prominent in the right adrenal gland without corresponding abnormal CT scan findings

Unmasking Coincident Hodgkin Lymphoma and Giant Cell Tumor: Insights from [18F] FDG PET/CT

Tenosynovial giant cell tumors represent a group of typically non-malignant tumors found within the joints and soft tissues. The occurrence of tenosynovial giant cell tumor alongside hematologic malignancies is an infrequent finding. Herein, we report a patient who presented with coinciding Hodgkin Lymphoma (HL) and tenosynovial giant cell tumor before chemotherapy initiation. The case was discovered during initial assessment using [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging for HL staging. An unrelated hypermetabolic mass within the left knee joint led to the discovery of this unusual case, which led to a CT-guided biopsy and tenosynovial giant cell tumor discovery. This was clearly demonstrated in interim and end-of-therapy PET/CT studies when all lymphomatous lesions had resolved but the tenosynovial giant cell tumor remained. This case serves as a reminder of the intricate nature of oncological pathology and emphasizes the need for thorough and vigilant diagnostic evaluation for optimal management plan

Clinical Impact of 18F-FDG PET/CT on the Management of Gynecologic Cancers: One Center Experience

Objective(s): We aim to investigate the clinical impact of 18F-FDG PET/CT in managing patients with gynecological malignancies and pelvic or extrapelvic lymph nodes that are of equivocal significance on conventional imaging.Methods: We retrospectively evaluated 18F-FDG PET/CT scans of patients with gynecologic tumors who were referred to King Hussein Cancer Center from January 2010 to August 2014. PET/CT results were compared with MRI and CT findings. We evaluated sensitivity and specificity of 18F-FDG PET/CT, its role in changing treatment planand its positive predictive value (PPV) and negative predictive value (NPV).Results: Ninety seven patients (mean age: 49 years) underwent 18F-FDG/PET in the study period (40 cervical, 37 endometrial and 20 ovarian cancers). PET/CT scan provided additional information in 23 patients; upstaging 4.1% (4 patients; 3 true positive) and down staging in 19.5% (19 patients; 15 true negative). As a result, treatment strategy was changed from curative to palliative in three patients, and modification of radiation field or additional curative therapy was implemented following exclusion of distant metastasis in 11 patients. Mean follow up time for the whole cohort was 35 months (range 6 - 60 months). NPV of 18F-FDG PET/CT in detecting extrapelvic lymphadenopathy was 83.3%.Conclusion: 18F-FDG PET/CT has high clinical impact in management of gynaecological cancers as it alters the treatment plan in a substantial number of patients who had equivocal findings on conventional imaging,as well as it offers excellent validity in lymph nodes staging

Artificial intelligence in Jordanian education: Assessing acceptance via perceived cybersecurity, novelty value, and perceived trust

The growing significance of Artificial Intelligence (AI) across different fields highlights the essential role of user acceptance, as the success of this technology largely depends on its adoption and practical use by individuals. This research aims to examine how perceived cybersecurity, novelty value, and perceived trust affect students' willingness to accept AI in educational settings. The study's theoretical basis is the AI Device Use Acceptance (AIDUA) model. Using structural equation modeling, the study tested hypothesized relationships using data from 526 students at Jordanian universities. The results showed that social influence is positively associated with performance expectancy, while perceived cybersecurity is positively related to both performance and effort expectancy. Novelty value is positively associated with performance expectancy but a negative one with effort expectancy. Additionally, effort and performance expectancy significantly influence perceived trust and the willingness to accept AI. Moreover, perceived trust has a notable positive effect on the willingness to accept AI in education. These findings provide valuable guidance for the creation and improvement of AI-driven educational systems in universities, contributing to the broader understanding of AI technology acceptance in the educational field

Initial clinical experience using 68Ga-FAPI-46 PET/CT for detecting various cancer types

OBJECTIVE: Numerous studies have shown that gallium-68-labeled fibroblast activation protein inhibitor (68Ga-FAPI) positron emission tomography/computed tomography (PET/CT) scans would yield high intra-tumoral tracer uptake and low uptake in normal tissues as background, thus allowing for excellent visualization of lesions in the cancer microenvironment. This study set out to compare the suitability of novel 68Ga-FAPI-46 PET versus routine fluorine-18-fluorodeoxyglucose (18F-FDG) PET and other few cases of 68Ga-DOTATATE/68Ga-Pentixafor PET/CT for the assessment of different types of cancer.SUBJECTS AND METHODS: A retrospective analysis of 11 patients (6 males, 5 females; average age: 53 years, range: 10-58 years) with histopathologically confirmed, well-differentiated adenocarcinoma, medullar thyroid cancer (MTC), papillary thyroid carcinoma (PTC), cervical, gastric, glioblastoma multiform (GBM), colon, Ewing's sarcoma, and breast cancer was performed. These patients underwent PET/CT scans using four different radiotracers (9 18F-FDG, 11 68Ga- FAPI, 3 68Ga-DOTATATE, and 1 68Ga-Pentixafor). The patients' PET/CT images were visually evaluated for cancer detection, and analyzed semi-quantitatively through image- derived metrics, such as target-to-background ratio (TBR) and maximum standardized uptake value (SUVmax), for recurrence and metastasis.RESULTS: The study of 11 patients revealed that 68Ga-FAPI-46 was more effective than other tracers for detecting metastases, with 55 vs. 49 metastases in the lymph nodes, 4 vs. 3 in the liver, and 4 vs. 3 in the bones detected in comparison to 18F-FDG. No significant differences were observed in 68Ga-DOTATATE and 68Ga-Pentixafor PET images. In addition, in five patients, the SUVmax and TBR values in 68Ga-FAPI-46 PET images were significantly higher than those in 18F-FDG PET images for lymph nodes and bone metastases. Although the SUVmax in 68Ga-FAPI-46 and 18F-FDG PET images for liver metastases was comparable, 68Ga-FAPI- 46 had a significantly higher TBR than 18F-FDG.CONCLUSION: Our findings suggest that FAPI PET/CT is not suitable for evaluating GBM and Ewing sarcoma but generally outperforms 18F-FDG PET/CT in various types of breast cancer, gastrointestinal, gynecological, PTC and MTC. However, larger trials are needed to validate these preliminary findings.</p

Theranostics in the Arab World; Achievements & Challenges

In nuclear medicine, theranostics (combining therapy and diagnostics in one platform) is made possible through the utilization of radiopharmaceuticals for both therapeutic and diagnostic purposes by targeting one specific tumor receptor or certain molecular pathway. To make radiopharmaceuticals biologically relevant compounds, receptor ligands must be labeled with radionuclides. The possible applications are multifold and include: in vivo visualization of tumor biology; diagnosis and tumor staging; therapy planning and treatment of specific tumors. The application of theranostics results in giving the right treatment to the right patient at the right time, which is expected to improve therapeutic efficacy and increase overall compliance to therapy. For example, theranostics can be used to determine the heterogeneity of cancer lesions, which is one of the most difficult aspects of therapeutic success, allow the identification of patients who will benefit from therapy, avoid unnecessary conventional therapies, and implement salvage treatments for those who need them. The use of theranostics has seen unprecedented value for cancer patients in the last decade. Several radiopharmaceuticals are currently in use in clinical practice (e.g., [68Ga/177Lu] DOTATATE), while dozens more are still in the preclinical stages. The goal of this review article is to cover the current and future status of nuclear theranostics, particularly in the Arab world, with a focus on expanding the discipline beyond neuroendocrine tumors, castration-resistant prostate cancers, and differentiated thyroid cancers. Furthermore, representatives from different Arab countries were invited to describe their recent understanding and contributions to drive innovation in this evolving field © 2022 University of Jordan,Deanship of Scientific Research. All rights reserved

The prognostic utility of 18F-FDG PET parameters in lymphoma patients under CAR-T-cell therapy : a systematic review and meta-analysis

DATA AVAILABITY STATEMENT: The data analyzed in this study is subject to the following licenses/restrictions: Datasets are available upon reasonable request from corresponding author. Requests to access these datasets should be directed to [email protected]: Chimeric antigen receptor (CAR) T-cell therapy has attracted considerable attention since its recent endorsement by the Food and Drug Administration, as it has emerged as a promising immunotherapeutic modality within the landscape of oncology. This study explores the prognostic utility of [18F] Fluorodeoxyglucose positron emission tomography ([18F]FDG PET) in lymphoma patients undergoing CAR T-cell therapy. Through meta-analysis, pooled hazard ratio (HR) values were calculated for specific PET metrics in this context. METHODS: PubMed, Scopus, and Ovid databases were explored to search for relevant topics. Dataset retrieval from inception until March 12, 2024, was carried out. The primary endpoints were impact of specific PET metrics on overall survival (OS) and progression-free survival (PFS) before and after treatment. Data from the studies were extracted for a meta-analysis using Stata 17.0. RESULTS: Out of 27 studies identified for systematic review, 15 met the criteria for meta-analysis. Baseline OS analysis showed that total metabolic tumor volume (TMTV) had the highest HR of 2.66 (95% CI: 1.52-4.66), followed by Total-body total lesion glycolysis (TTLG) at 2.45 (95% CI: 0.98-6.08), and maximum standardized uptake values (SUVmax) at 1.30 (95% CI: 0.77-2.19). TMTV and TTLG were statistically significant (p < 0.0001), whereas SUVmax was not (p = 0.33). For PFS, TMTV again showed the highest HR at 2.65 (95% CI: 1.63-4.30), with TTLG at 2.35 (95% CI: 1.40-3.93), and SUVmax at 1.48 (95% CI: 1.08-2.04), all statistically significant (p ≤ 0.01). The DSUVmax was a significant predictor for PFS with an HR of 2.05 (95% CI: 1.13-3.69, p = 0.015). CONCLUSION: [18F]FDG PET parameters are valuable prognostic tools for predicting outcome of lymphoma patients undergoing CAR T-cell therapy.https://www.frontiersin.org/journals/immunologyNuclear MedicineSDG-03:Good heatlh and well-beingSDG-09: Industry, innovation and infrastructur

Case report of epithelioid osteoblastoma of the mandible: findings on positron emission tomography/computed tomography and review of the literature

Epithelioid osteoblastoma is a clinically aggressive subtype of osteoblastoma that favors the mandible and the maxilla. Its histologic features lie on a spectrum between conventional osteoblastoma and low-grade osteosarcoma, thus making it difficult at times to confirm the diagnosis. It is known to have a high risk of recurrence after surgical resection, but it is a benign entity and does not have the propensity to metastasize. To our knowledge, there are no published reports on findings of epithelioid osteoblastoma on positron emission tomography/computed tomography (PET/CT). We report a case of a 25-year-old male patient with a diagnosis of epithelioid osteoblastoma of the mandible. The lesion exhibited significantly increased fluorodeoxyglucose uptake on PET/CT with a maximum standardized uptake value of 5.5. PET/CT is not specific in differentiating between malignant and benign bone lesions but may be necessary to rule out distant lesions when a confirmed diagnosis of epithelioid osteoblastoma cannot be obtained through histologic examination. © 2018 Elsevier Inc