18F-FDGPET/CT: diabetes and hyperglycaemia

BACKGROUND: Some patients who undergo 18F-FDG PET/CT for neoplastic or benign disease are also affected by diabetes or hyperglycaemia. We propose different preparation procedures in patients (pts) with hyperglycaemia (acute, temporary or chronic) or diabetes (type 1 or 2) at the time of the 18F-FDG injection, in order to improve the diagnostic scheduling of 18F-FDG PET/CT. MATERIAL AND METHODS: We evaluated a sample of 13,063 pts, examined in two different PET/CT centres, one with a stationary scanner (94.4%) and the other with a mobile device (5.6%). High blood sugar was present in 1,698 patients (13%) at the time of the 18F-FDG injection (hyperglycaemia was defined as fasting blood glucose > 11.1 mmol/l). We considered all 18F-FDG PET/CT tests performed over a period of 4 years (2006-2009). In the first 2 years (6,236 tests), scheduling was done directly by the administrative secretary. In the next two years, 6,827 pts underwent a preliminary visit to assess the test indications, medical history, and therapy as well as pre-test preparation. We evaluated different preparation protocols for hyperglycaemic or diabetic pts, especially those recommended in the guidelines of the European Association of Nuclear Medicine (EANM) and Society of Nuclear Medicine (SNM). RESULTS: In the four-year period, 713/13,063 patients (5.45%) were rescheduled; of these, 78.8% were rescheduled in the two years before the implementation of our preparation protocols and 21.2% in the next two years. Before the implementation of our preparation protocols, 562 patients (9%) presented occasional, acute or chronic hyperglycaemia (56.7%), or diabetes (43.3%), requiring postponement of the test to a later date. The test was not performed in 17 of 6,236 pts (0.27%) because of blood glucose levels above 11.1 mmol/l for several days, while in 16/6236 pts (0.26%) the 18F-FDG injection was performed despite high blood glucose levels, in view of the clinical urgency. After the implementation of the preparation protocols, 2.2% of pts were rescheduled because of occasional, acute or chronic hyperglycaemia (79%), or diabetes (21%); 0.1% of pts did not undergo the test because of chronic high blood glucose levels. Although the administration of insulin is recommended in the EANM and SNM guidelines, in our new preparation procedures experience it was not necessary, because we reduced the numbers of hyperglycaemic pts thanks to screening at the preliminary visit and a subsequent good preparation of the patient before scheduling. CONCLUSIONS: The application of our preparation protocols improves the on-time performance and diagnostic accuracy, and increases patients' compliance. Copyright © 2013 Via Medica

Heterogeneous response to target therapy in metastatic papillary renal cell carcinoma evaluated by morphologic and metabolic multimodality imaging

Papillary renal cell carcinoma (PRCC) accounts for about 15% to 20% of renal cell carcinoma and is histologically distinguished in type I and type II. The last one is associated with poorer prognosis. Treatment options for PRCC patients are surgery, immunotherapy, revolutionized by Nivolumab, and other target-therapy with an improvement in overall survival. Heterogenous response and a pseudo-progression may be observed in the initial phase of biological treatment that could induce premature discontinuation. Patient concerns: We present the case of a 44-year-old woman with left cervical palpable mass increased in size and without concomitant disease or previous surgery. Diagnosis: Neck ultrasonography, contrast-enhanced Computed Tomography, and 18F-FDG PET/CT were performed with the detection of lymph nodes involvement and a left renal lesion. Interventions: The patients underwent left radical nephrectomy and homolateral cervical and para-aortic lymphadenectomy, with histological diagnosis of PRCC, type II. After disease relapse, the inter-aortocaval lymph node was laparoscopically removed. Following the detection of further disease relapse in several lymph nodes and the lung, several lines of target-therapy were started; then disease progression and worsening of clinical and hematological status led us to start Nivolumab as last-line therapy. Outcomes: A heterogeneous response to therapies was documented with morphological and nuclear medicine imaging, however the concomitant deterioration of performance status and liver function led to discontinuation of Nivolumab; then the patient died, 30 months after diagnosis. Lessons: Here we describe the clinical case and radiological and nuclear medicine imaging investigations performed by our patient, highlighting that 18F-FDG PET/CT shows greater adequacy in assessing the response to therapy, avoiding premature drug discontinuation, and ensuring better management of a patient with advanced PRCC

Copper-64 Dichloride as Theranostic Agent for Glioblastoma Multiforme: A Preclinical Study

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults with a median survival time less than one year. To date, there are only a limited number of effective agents available for GBM therapy and this does not seem to add much survival advantage over the conventional approach based on surgery and radiotherapy. Therefore, the development of novel therapeutic approaches to GBM is essential and those based on radionuclide therapy could be of significant clinical impact. Experimental evidence has clearly demonstrated that cancer cells have a particularly high fractional content of copper inside the nucleus compared to normal cells. This behavior can be conveniently exploited both for diagnosis and for delivering therapeutic payloads (theranostic) of the radionuclide copper-64 into the nucleus of cancerous cells by intravenous administration of its simplest chemical form as dichloride salt [64Cu]CuCl To evaluate the potential theranostic role of [64Cu]CuClin GBM, the present work reports results from a preclinical study carried out in a xenografted GBM tumor mouse model. Biodistribution data of this new agent were collected using a small-animal PET tomograph. Subsequently, groups of tumor implanted nude mice were treated with [64Cu]CuClto simulate single-and multiple-dose therapy protocols, and results were analyzed to estimate therapeutic efficacy

18F-FDGPET/CT: diabetes and hyperglycaemia

BACKGROUND: Some patients who undergo 18F-FDG PET/CTfor neoplastic or benign disease are also affected by diabetes orhyperglycaemia. We propose different preparation procedures inpatients (pts) with hyperglycaemia (acute, temporary or chronic)or diabetes (type 1 or 2) at the time of the 18F-FDG injection, inorder to improve the diagnostic scheduling of 18F-FDG PET/CT.MATERIAL AND METHODS: We evaluated a sample of 13,063pts, examined in two different PET/CT centres, one with a stationaryscanner (94.4%) and the other with a mobile device (5.6%). High blood sugar was present in 1,698 patients (13%) at thetime of the 18F-FDG injection (hyperglycaemia was defined asfasting blood glucose > 11.1 mmol/l). We considered all 18F-FDG PET/CT tests performed over a periodof 4 years (2006–2009). In the first 2 years (6,236 tests), scheduling was done directly by the administrative secretary. In the next two years, 6,827 pts underwent a preliminary visitto assess the test indications, medical history, and therapy aswell as pre-test preparation. We evaluated different preparation protocols for hyperglycaemicor diabetic pts, especially those recommended in the guidelinesof the European Association of Nuclear Medicine (EANM) and Society of Nuclear Medicine (SNM).RESULTS: In the four-year period, 713/13,063 patients (5.45%)were rescheduled; of these, 78.8% were rescheduled in the twoyears before the implementation of our preparation protocolsand 21.2% in the next two years.Before the implementation of our preparation protocols, 562 patients (9%) presented occasional, acute or chronic hyperglycaemia (56.7%), or diabetes (43.3%), requiring postponement of the test to a later date. The test was not performed in 17 of 6,236 pts (0.27%) because of blood glucose levels above 11.1 mmol/l for several days, while in 16/6236 pts (0.26%) the18F-FDG injection was performed despite high blood glucoselevels, in view of the clinical urgency.After the implementation of the preparation protocols, 2.2% ofpts were rescheduled because of occasional, acute or chronic hyperglycaemia (79%), or diabetes (21%); 0.1% of pts did notundergo the test because of chronic high blood glucose levels. Although the administration of insulin is recommended in theEANM and SNM guidelines, in our new preparation proceduresexperience it was not necessary, because we reduced the numbers of hyperglycaemic pts thanks to screening at the preliminary visit and a subsequent good preparation of the patientbefore scheduling.CONCLUSIONS: The application of our preparation protocolsimproves the on-time performance and diagnostic accuracy,and increases patients’ compliance

18F-FDG PET/CT role in staging of gastric carcinomas: comparison with conventional contrast enhancement computed tomography

The purpose of the report was to evaluate the role of fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F-FDG PET/CT) in staging gastric cancer comparing it with contrast enhancement computed tomography (CECT).This retrospective study included 45 patients who underwent performed whole body CECT and F-FDG PET/CT before any treatment. We calculated CECT and F-FDG PET/CT sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) for gastric, lymphnode, and distant localizations; furthermore, we compared the 2 techniques by McNemar test. The role of F-FDG PET/CT semiquantitative parameters in relation to histotype, grading, and site of gastric lesions were evaluated by ANOVA test.Sensitivity, specificity, accuracy, PPV and NPV of CECT, and F-FDG PET/CT for gastric lesion were, respectively, 92.11%, 57.14%, 86.66%, 92.11%, 57.14% and 81.58%, 85.71%, 82.22%, 96.88%, 46.15%. No differences were identified between the 2 techniques about sensitivity and specificity. No statistical differences were observed between PET parameters and histotype, grading, and site of gastric lesion. The results of CECT and F-FDG PET/CT about lymphnode involvement were 70.83%, 61.90%, 66.66%, 68%, 65% and 58.33%, 95.24%, 75.55%, 93.33%, 66.67%. The results of CECT and F-FDG PET/CT about distant metastases were 80%, 62.86%, 66.66%, 38.10%, 91.67% and 60%, 88.57%, 82.22%, 60%, 88.57%. FDG PET/CT specificity was significantly higher both for lymphnode and distant metastases.The F-FDG PET/CT is a useful tool for the evaluation of gastric carcinoma to detect primary lesion, lymphnode, and distant metastases using 1 single image whole-body technique. Integration of CECT with F-FDG PET/CT permits a more valid staging in these patients

Comparison of the Diagnostic Value of MRI and Whole Body 18F-FDG PET/CT in Diagnosis of Spondylodiscitis

Spondylodiscitis is a spine infection for which a diagnosis by a magnetic resonance imaging (MRI) is considered the most appropriate imaging technique. The aim of this study was to compare the role of an F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT) and an MRI in this field. For 56 patients with suspected spondylodiscitis for whom MRI and F-18-FDG PET/CT were performed, we retrospectively analyzed the results. Cohen's kappa was applied to evaluate the agreement between the two techniques in all patients and in subgroups with a different number of spinal districts analyzed by the MRI. Sensitivity, specificity, and accuracy were also evaluated. The agreements of the F-18-FDG PET/CT and MRI in the evaluation of the entire population, whole-spine MRI, and two-districts MRI were moderate (kappa = 0.456, kappa = 0.432, and kappa = 0.429, respectively). In patients for whom one-district MRI was performed, F-18-FDG PET/CT and MRI were both positive and completely concordant (kappa = 1). We also separately evaluated patients with suspected spondylodiscitis caused by Mycobacterium tuberculosis for whom the MRI and F-18-FDG PET/CT were always concordant excepting in 2 of the 18 (11%) patients. Sensitivity, specificity, and accuracy of the MRI and F-18-FDG PET/CT were 100%, 60%, 97%, and 92%, 100%, and 94%, respectively. Our results confirmed the F-18-FDG PET/CT diagnostic value in the diagnosis of spondylodiscitis is comparable to that of MRI for the entire spine evaluation. This could be considered a complementary technique or a valid alternative to MRI

Vasculitis Diagnosed on Fluorine-18 Labelled-2-Deoxy-2-Fluoro-D-Glucose Uptake in A Patient With Fever of Unknown Origin and A History of Non Hodgkin’s Lymphoma

There are increasing data demonstrating the role of 18F-flourodeoxyglucose positron emission tomography with computerized tomography fusion (18F-FDG PET/CT) in the diagnosis of large vessel vasculitis, including Takayasu arteritis and giant cell arteritis. We report a case of large vessel vasculitis detected on 18F-FDG PET/CT; a 32-year-old woman with history of Non Hodgkin Lymphoma, admitted with fever of unknown origin (FUO) of 2-months duration and asthenia. To exclude FUO of malignancy, in the suspect of NHL relapse, 18F-FDG PET/CT imaging was performed. The images demonstrated significant 18F-FDG uptake in aortic arch and no signs of NHL relapse. This case report supports the role of 18F-FDG PET/CT as a useful and noninvasive tool in diagnostic evaluation of patient with FUO, both by excluding a malignant etiology and providing information about other possible causes such as inflammation, including vasculitis. 18F-FDG PET/CT is very useful in the early diagnosis of active inflammation including vasculitis and provides timely information for appropriate therapy

Safety culture to improve accidental events reporting in radiotherapy

The potential for unintended and adverse radiation exposure in radiotherapy is real and should be studied because radiotherapy is a highly complex, multistep process which requires input from numerous individuals from different areas and steps of the radiotherapy workflow. The 'Incident' (I) is a consequence of which are not negligible from the point of view of protection or safety. A 'near miss' (NM) is defined as an event which is highly likely to happen but did not occur. The purpose of this work is to show that through a systematic reporting and analysis of these adverse events, their occurrence can be reduced

Vasculitis Diagnosed on Fluorine-18 Labelled-2-Deoxy-2-Fluoro-D-Glucose Uptake in A Patient With Fever of Unknown Origin and A History of Non Hodgkin’s Lymphoma

There are increasing data demonstrating the role of 18F-flourodeoxyglucose positron emission tomography with computerized tomography fusion (18F-FDG PET/CT) in the diagnosis of large vessel vasculitis, including Takayasu arteritis and giant cell arteritis. We report a case of large vessel vasculitis detected on 18F-FDG PET/CT; a 32-year-old woman with history of Non Hodgkin Lymphoma, admitted with fever of unknown origin (FUO) of 2-months duration and asthenia. To exclude FUO of malignancy, in the suspect of NHL relapse, 18F-FDG PET/CT imaging was performed. The images demonstrated significant 18F-FDG uptake in aortic arch and no signs of NHL relapse. This case report supports the role of 18F-FDG PET/CT as a useful and noninvasive tool in diagnostic evaluation of patient with FUO, both by excluding a malignant etiology and providing information about other possible causes such as inflammation, including vasculitis. 18F-FDG PET/CT is very useful in the early diagnosis of active inflammation including vasculitis and provides timely information for appropriate therapy

18f fdgpet ct diabetes and hyperglycaemia

BACKGROUND: Some patients who undergo 18F-FDG PET/CT for neoplastic or benign disease are also affected by diabetes or hyperglycaemia. We propose different preparation procedures in patients (pts) with hyperglycaemia (acute, temporary or chronic) or diabetes (type 1 or 2) at the time of the 18F-FDG injection, in order to improve the diagnostic scheduling of 18F-FDG PET/CT. MATERIAL AND METHODS: We evaluated a sample of 13,063 pts, examined in two different PET/CT centres, one with a stationary scanner (94.4%) and the other with a mobile device (5.6%). High blood sugar was present in 1,698 patients (13%) at the time of the 18F-FDG injection (hyperglycaemia was defined as fasting blood glucose > 11.1 mmol/l). We considered all 18F-FDG PET/CT tests performed over a period of 4 years (2006–2009). In the first 2 years (6,236 tests), scheduling was done directly by the administrative secretary. In the next two years, 6,827 pts underwent a preliminary visit to assess the test indications, medical history, and therapy as well as pre-test preparation. We evaluated different preparation protocols for hyperglycaemic or diabetic pts, especially those recommended in the guidelines of the European Association of Nuclear Medicine (EANM) and Society of Nuclear Medicine (SNM). RESULTS: In the four-year period, 713/13,063 patients (5.45%) were rescheduled; of these, 78.8% were rescheduled in the two years before the implementation of our preparation protocols and 21.2% in the next two years. Before the implementation of our preparation protocols, 562 patients (9%) presented occasional, acute or chronic hyperglycaemia (56.7%), or diabetes (43.3%), requiring postponement of the test to a later date. The test was not performed in 17 of 6,236 pts (0.27%) because of blood glucose levels above 11.1 mmol/l for several days, while in 16/6236 pts (0.26%) the 18F-FDG injection was performed despite high blood glucose levels, in view of the clinical urgency. After the implementation of the preparation protocols, 2.2% of pts were rescheduled because of occasional, acute or chronic hyperglycaemia (79%), or diabetes (21%); 0.1% of pts did not undergo the test because of chronic high blood glucose levels. Although the administration of insulin is recommended in the EANM and SNM guidelines, in our new preparation procedures experience it was not necessary, because we reduced the numbers of hyperglycaemic pts thanks to screening at the preliminary visit and a subsequent good preparation of the patient before scheduling. CONCLUSIONS: The application of our preparation protocols improves the on-time performance and diagnostic accuracy, and increases patients' compliance