One stop centre staging by contrast-enhanced 18F-FDG PET/CT in preoperative assessment of ovarian cancer and proposed diagnostic imaging algorithm: a single centre experience in Malaysia

Introduction: Suspicious adnexal masses need to be investigated thoroughly as it may represent ovarian cancer, which is the fourth most common gynaecological cancer in Malaysia. Conventional cross sectional imaging may reveal non-specific findings, thus lead to unnecessary biopsies. 18F-Fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) has emerged as a useful tool, for characterization of indeterminate adnexal masses. Most studies have been conducted in Western population, and little information is available in Asian population in general and Malaysian population in particular. Methods: Prospective study of women with suspicious adnexal masses, referred to the Centre for Nuclear Diagnostic Imaging, Universiti Putra Malaysia to undergo pre-operative whole-body contrast-enhanced 18F-FDG PET/CT scans from January 2014 to January 2016. Subjects underwent Contrast-Enhanced Computed Tomography (CECT) scans followed by positron emission tomography (PET) scans using a hybrid scanner. Two radiologists analyzed the CECT and PET/CT images by consensus; blinded to the HPE results. Then the PET/CT findings were correlated with HPE results as the gold standard. Results: 11 whole-body PET/CT scans and 18 adnexal masses (12 HPE-proven malignant lesions and 6 benign lesions) were analyzed. The sensitivity, specificity, PPV, and NPV of CECT alone compared to PET/CT was 91.7%, 50.0%, 78.6%, and 75.0% vs. 91.7%, 100%, 100% and 85.7% respectively. Conclusions: Improved diagnostic accuracy for characterizing benign and malignant adnexal masses can be achieved using contrast-enhanced 18F-FDG PET/CT, making it a potential investigation of choice which can help in treatment planning

Reliability of standardized uptake value normalized to lean body mass using the liver as a reference organ, in contrast-enhanced 18F-FDG PET/CT imaging

Purpose: To evaluate the reliability of standardized uptake value (SUV) normalized to lean body mass for maximum (SULmax) and mean values (SULmean) as well as maximum SUV values (SUVmax) in contrast-enhanced 18F-FDG PET/CT by assessment of inter-reader agreement, using the liver as a reference organ. Materials and methods: 272 images of baseline PET/CT scans were analyzed. A volume of interest (VOI) of 30-mm in diameter was placed by two independent readers in the right liver lobe to measure the parameters. An analysis was performed for the variance, intra-class correlation coefficient (ICC), and Bland-Altman plots. Results and discussion: For Reader 1, the SUVmax ranging from 1.33 to 5.94 (3.20 ± 0.69), SULmean ranging from 0.84 to 3.46 (1.90 ± 0.40) and SULmax ranging from 1.18 to 4.07 (2.38 ± 0.50), were obtained; for Reader 2 the SUVmax ranging from 1.47 to 5.43 (3.20 ± 0.70), SULmean ranging from 0.84 to 3.45 (1.90 ± 0.40), and SULmax ranging from 1.18 to 4.48 (2.38 ± 0.50), were obtained. The coefficient of variance for SUVmax, SULmean, and SULmax, were 21.9%, 21.1%, and 20.8%, respectively, having no significant differences between Reader 1 and Reader 2. The ICC of the two readers for SUVmax, SULmean and SULmax were 0.975, 0.982 and 0.977 (95% CI of 0.97, 0.98 and 0.97; p < .001) respectively. Bland-Altman plots revealed that SUVmax gave the best agreement with 97.1% of measurements falling within 2SD. Conclusion: There is an excellent inter-reader agreement for liver SUVmax, SULmean and SULmax, and the best reliability of measurements achieved with SULmax in contrast-enhanced PET/CT scans

Travellers' knowledge, attitudes and practices prevention of infectious diseases: a cross sectional study

International travel is common, increasing the risk for travel related infections, making it important to understand the knowledge, attitudes and practices (KAP) of international travellers regarding prevention of travel related illnesses. We aimed to determine the KAP of travellers at two Malaysian airports, in order to inform traveller health programs. We conducted face to face interviews with travellers at Kuala Lumpur International Airport and Sultan Abdul Aziz Shah Airport, Malaysia in 2014. Study subjects were selected via convenient sampling. Inclusion criteria were travellers aged ≥18 years who were departing from the studied airports, were able and willing to participate in the study. Subjects were asked about their KAP regarding various travel health subjects. The data from these interviews were collected, summarized and examined with SPSS version 21 and multiple logistic regression analysis to determine factors associated with poor KAP regarding travel health. A total of 316 subjects were included in the study; 57.6% were male and 55.4% were Malaysians. Forty point five percent of subjects sought pre-travel health advice. Of those who sought pre-travel health advice, 39.8% sought it from family or friends, 35.2% from the internet and 12.5% from a physicians. Fifty-two point eight percent of subjects had received pre-travel vaccinations. No subjects were traveling to a malaria high risk country as determined by the Centers for Disease Control and Prevention, 8.2% were travelling to a moderate risk country, 28.9% were travelling to a low risk country, 12.0% were travelling to a very low risk country and 50.9% were travelling to a country with no malaria risk. Four point one percent of subjects took malaria prophylaxis medication. On multivariate logistic regression analysis, the older the study subject age, the better the travel health knowledge [odds ratio (OR)=1.03; 95% confidence interval (CI): 1.01-1.05; p = 0.009]. Being female (OR: 1.92; 95%CI: 1.16-3.18; p = 0.011) and those who sought travel health advice (OR: 1.77; 95%CI: 1.06-2.95; p = 0.028) were more likely to have good practice on travel health. Therefore, awareness program should target the male travellers to improve health practices

Systematic review on the accuracy of positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging in the management of ovarian cancer: is functional information really needed?

Ovarian cancer (OC) often presents at an advanced stage with frequent relapses despite optimal treatment; thus, accurate staging and restaging are required for improving treatment outcomes and prognostication. Conventionally, staging of OC is performed using contrast-enhanced computed tomography (CT). Nevertheless, recent advances in the field of hybrid imaging have made positron emission tomography/CT (PET/CT) and PET/magnetic resonance imaging (PET/MRI) as emerging potential noninvasive imaging tools for improved management of OC. Several studies have championed the role of PET/CT for the detection of recurrence and prognostication of OC. We provide a systematic review and meta-analysis of the latest publications regarding the role of molecular imaging in the management of OC. We retrieved 57 original research articles with one article having overlap in both diagnosis and staging; 10 articles (734 patients) regarding the role of PET/CT in diagnosis of OC; 12 articles (604 patients) regarding staging of OC; 22 studies (1429 patients) for detection of recurrence; and 13 articles for prognostication and assessment of treatment response. We calculated pooled sensitivity and specificity of PET/CT performance in various aspects of imaging of OC. We also discussed the emerging role of PET/MRI in the management of OC. We aim to give the readers and objective overview on the role of molecular imaging in the management of OC