Publications by authors named "Thomas F Hany"

70 Publications

Combined PET/CT-perfusion in patients with head and neck cancers might predict failure after radio-chemotherapy: a proof of concept study.

BMC Med Imaging 2015 Dec 29;15:60. Epub 2015 Dec 29.

Department of Nuclear Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zuerich, Switzerland.

Background: [18F]FDG-PET/CT imaging is broadly used in head and neck cancer (HNSCC) patients. CT perfusion (CTP) is known to provide information about angiogenesis and blood-flow characteristics in tumors. The aim of this study was to evaluate the potential relationship of FDG-parameters and CTP-parameters in HNSCC preand post-therapy and the potential prognostic value of a combined PET/CT with CTP.

Methods: Thirteen patients with histologic proven HNSCC were prospectively included. All patients underwent a combined PET/CT with integrated CTP before and after therapy. Pre- and post-therapeutic data of CTP and PET of the tumors were compared. Differences were tested using Spearman's rho test and Pearson's correlation. A p-value of p <0.05 was considered statistically significant. Correlations were calculated using Pearson's correlation. Bootstrap confidence intervals were calculated to test for additive confidence intervals.

Results: Three patients died due to malignancy recurrence, ten patients were free of recurrence until the end of the follow-up period. Patients with recurrent disease had significantly higher initial CTP-values compared to the recurrence-free patients: BFpre 267.4 (171.2)ml/100 mg/min, BVpre 40.9 (8.4)ml/100 mg and MTTpre 8.2 (6.1)sec. No higher SUVs initially but significantly higher TLG compared to patients without recurrence were found. Post-therapeutic PET-values differed significantly between the two groups: SUVmaxpost 6.0 (3.2), SUVmeanpost 3.6 (2.0) and TLG 21751.7 (29794.0).

Conclusion: In our proof of concept study, combined PET/CT with integrated CTP might show complementary prognostic data pre- and post chemo-radiotherapy. CTP may be used to predict local tumor recurrence, while FDGPET/CT is still needed for whole-body staging.
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http://dx.doi.org/10.1186/s12880-015-0102-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696250PMC
December 2015

Dosimetry and first clinical evaluation of the new 18F-radiolabeled bombesin analogue BAY 864367 in patients with prostate cancer.

J Nucl Med 2015 Mar 12;56(3):372-8. Epub 2015 Feb 12.

Division of Nuclear Medicine, Department of Medical Radiology, University Hospital of Zurich, Zurich, Switzerland Division of Medical Oncology, Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland

Unlabelled: The aim of this first-in-man study was to demonstrate the feasibility, safety, and tolerability, as well as provide dosimetric data and evaluate the imaging properties, of the bombesin analogue BAY 864367 for PET/CT in a small group of patients with primary and recurrent prostate cancer (PCa).

Methods: Ten patients with biopsy-proven PCa (5 with primary PCa and 5 with prostate-specific antigen recurrence after radical prostatectomy) were prospectively selected for this exploratory clinical trial with BAY 864367, a new (18)F-labeled bombesin analogue. PET scans were assessed at 6 time points, up to 110 min after intravenous administration of 302 ± 11 MBq of BAY 864367. Imaging results were compared with (18)F-fluorocholine PET/CT scans. Dosimetry was calculated using the OLINDA/EXM software.

Results: Three of 5 patients with primary disease showed positive tumor delineation in the prostate, and 2 of 5 patients with biochemical relapse showed a lesion suggestive of recurrence on the BAY 864367 scan. Tumor-to-background ratio averaged 12.9 ± 7.0. The ratio of malignant prostate tissue to normal prostate tissue was 4.4 ± 0.6 in 3 patients with tracer uptake in the primary PCa. Mean effective dose was 4.3 ± 0.3 mSv/patient (range, 3.7-4.9 mSv).

Conclusion: BAY 864367, a novel (18)F-labeled bombesin tracer, was successfully investigated in a first-in-man clinical trial of PCa and showed favorable dosimetric values. Additionally, the application was safe and well tolerated. The tracer delineated tumors in a subset of patients, demonstrating the potential of gastrin-releasing-peptide receptor imaging.
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http://dx.doi.org/10.2967/jnumed.114.147116DOI Listing
March 2015

First clinical results of (D)-18F-Fluoromethyltyrosine (BAY 86-9596) PET/CT in patients with non-small cell lung cancer and head and neck squamous cell carcinoma.

J Nucl Med 2014 Nov 25;55(11):1778-85. Epub 2014 Sep 25.

Division of Nuclear Medicine, Department of Medical Radiology, University Hospital of Zurich, Zurich, Switzerland.

Unlabelled: (D)-(18)F-fluoromethyltyrosine (d-(18)F-FMT), or BAY 86-9596, is a novel (18)F-labeled tyrosine derivative rapidly transported by the l-amino acid transporter (LAT-1), with a faster blood pool clearance than the corresponding l-isomer. The aim of this study was to demonstrate the feasibility of tumor detection in patients with non-small cell lung cancer (NSCLC) or head and neck squamous cell cancer (HNSCC) compared with inflammatory and physiologic tissues in direct comparison to (18)F-FDG.

Methods: 18 patients with biopsy-proven NSCLC (n = 10) or HNSCC (n = 8) were included in this Institutional Review Board-approved, prospective multicenter study. All patients underwent (18)F-FDG PET/CT scans within 21 d before d-(18)F-FMT PET/CT. For all patients, safety and outcome data were assessed.

Results: No adverse reactions were observed related to d-(18)F-FMT. Fifty-two lesions were (18)F-FDG-positive, and 42 of those were malignant (34 histologically proven and 8 with clinical reference). Thirty-two of the 42 malignant lesions were also d-(18)F-FMT-positive, and 10 lesions had no tracer uptake above the level of the blood pool. Overall there were 34 true-positive, 8 true-negative, 10 false-negative, and only 2 false-positive lesions for d-(18)F-FMT, whereas (18)F-FDG was true-positive in 42 lesions, with 10 false-positive and only 2 false-negative, resulting in a lesion-based detection rate for d-(18)F-FMT and (18)F-FDG of 77% and 95%, respectively, with an accuracy of 78% for both tracers. A high d-(18)F-FMT tumor-to-blood pool ratio had a negative correlation with overall survival (P = 0.050), whereas the (18)F-FDG tumor-to-blood pool ratio did not correlate with overall survival.

Conclusion: d-(18)F-FMT imaging in patients with NSCLC and HNSCC is safe and feasible. The presented preliminary results suggest a lower sensitivity but higher specificity for d-(18)F-FMT over (18)F-FDG, since there is no d-(18)F-FMT uptake in inflammation. This increased specificity may be particularly beneficial in areas with endemic granulomatous disease and may improve clinical management. Further clinical investigations are needed to determine its clinical value and relevance for the prediction of survival prognosis.
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http://dx.doi.org/10.2967/jnumed.114.140699DOI Listing
November 2014

Integrated ¹⁸F-FDG PET/perfusion CT for the monitoring of neoadjuvant chemoradiotherapy in rectal carcinoma: correlation with histopathology.

Eur J Nucl Med Mol Imaging 2014 Aug 24;41(8):1563-73. Epub 2014 Apr 24.

Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland,

Purpose: The aim of this study was to prospectively monitor changes in the flow-metabolic phenotype (ΔFMP) of rectal carcinoma (RC) after neoadjuvant chemoradiotherapy (CRT) and to evaluate whether ΔFMP of RC correlate with histopathological prognostic factors including response to CRT.

Methods: Sixteen patients with RC (12 men, mean age 60.7 ± 12.8 years) underwent integrated (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/perfusion CT (PET/PCT), followed by neoadjuvant CRT and surgery. In 13 patients, PET/PCT was repeated after CRT. Perfusion [blood flow (BF), blood volume (BV), mean transit time (MTT)] and metabolic [maximum and mean standardized uptake values (SUVmax, SUVmean)] parameters as well as the FMP (BF × SUVmax) were determined before and after CRT by two independent readers and correlated to histopathological prognostic factors of RC (microvessel density, necrosis index, regression index, vascular invasion) derived from resected specimens. The diagnostic performance of ΔFMP for prediction of treatment response was determined.

Results: FMP significantly decreased after CRT (p < 0.001), exploiting higher changes after CRT as compared to changes of perfusion and metabolic parameters alone. Before CRT, no significant correlations were found between integrated PET/PCT and any of the histopathological parameters (all p > 0.05). After CRT, BV and SUVmax correlated positively with the necrosis index (r = 0.67/0.70), SUVmax with the invasion of blood vessels (r = 0.62) and ΔFMP with the regression index (r = 0.88; all p < 0.05). ΔFMP showed high accuracy for prediction of histopathological response to CRT (AUC 0.955, 95 % confidence interval 0.833-1.000, p < 0.01) using a cut-off value of -75%.

Conclusion: In RC, ΔFMP derived from integrated (18)F-FDG PET/PCT is useful for monitoring the effects of neoadjuvant CRT and allows prediction of histopathological response to CRT.
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http://dx.doi.org/10.1007/s00259-014-2752-4DOI Listing
August 2014

18F-FDG-PET/CT for the assessment of the contralateral neck in patients with head and neck squamous cell carcinoma.

Laryngoscope 2013 May 20;123(5):1210-5. Epub 2013 Feb 20.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.

Objectives/hypothesis: The aim was to compare the value of 18-Fluoro-Deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) regarding contralateral lymph node (LN) metastasis in the neck.

Study Design: Retrospective analysis of 61 patients staged by 18F-FDG-PET/CT.

Methods: Cytology/histology served as a reference standard. Further, metabolic midline invasion (MI) of the primary tumor and the presence of bilateral LN metastases were assessed.

Results: A true positive rate in the ipsilateral neck of 80% versus 65% in the contralateral neck was found (P = 0.067). Median-standardized uptake value (SUV)-max for suspicious LN ipsilaterally was 7.6 versus 5.8 contralaterally (P = 0.038). There was no positive correlation between metabolic MI and bilateral metastasis (P = 0.82).

Conclusions: The rate of true positive detected LN by 18F-FDG-PET/CT is less on the contralateral neck side; therefore, all suspicious LNs should be verified by cytology. A high SUV in the contralateral neck suggests metastatic disease regardless of nodal size. Metabolic MI needs to be addressed carefully as it was not predictive for bilateral LN involvement.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lary.23944DOI Listing
May 2013

Physiologic [18F]fluorodeoxyglucose uptake of floor of mouth muscles in PET/CT imaging: a problem of body position during FDG uptake?

Cancer Imaging 2013 Feb 20;13:1-7. Epub 2013 Feb 20.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.

Objective: Assess the influence of 2 different patient positions during [18F]fluorodeoxyglucose (FDG) uptake phase on physiologic FDG accumulation of the floor of mouth (FOM) muscles.

Study Design: A prospective study design was used.

Methods: Two hundred prospectively enrolled patients were included in the study: (a) head and neck cancer (HNC) patients in supine or (b) sitting position, (c) patients with other malignant tumours in supine or (d) sitting position. An intra-individual analysis was done on patients (b) and (d) when such scans were available. Maximum standardized uptake values without correction and corrected for blood pool activity were assessed.

Results: The inter-individual analysis (sitting vs supine) revealed no significant differences (P = 0.17 and P = 0.56). The subgroup analysis on the patients with HNC (P = 0.56 and P = 0.15) and in patients with other malignancies (P = 0.14 and P = 0.08) revealed no significant difference; neither did the intra-individual analysis.

Conclusions: The supine or sitting position during the uptake phase for FDG-positron emission tomography/computed tomography has no effect on the amount and distribution of physiologic FDG activity in the muscles of the FOM.
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http://dx.doi.org/10.1102/1470-7330.2013.0001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578222PMC
February 2013

Correlation between therapy response assessment using FDG PET/CT and histopathologic tumor regression grade in hepatic metastasis of colorectal carcinoma after neoadjuvant therapy.

Ann Nucl Med 2013 Feb 12;27(2):177-83. Epub 2012 Dec 12.

Division of Nuclear Medicine, Department Medical Radiology, University Hospital Zurich, Ramistr. 100, 8091, Zurich, Switzerland.

Purpose: To evaluate the correlation between change in FDG uptake before and after chemotherapy in hepatic metastases of colorectal carcinoma (HCRC) and a histopathologic tumor regression grade (TRG).

Methods: In patients with HCRC, PET/CT data prior to hepatic surgery were retrospectively analyzed under an IRB waiver. The maximum standard uptake value (SUVmax) was measured before and after chemotherapy. The relative change of FDG activity in the identified lesions was calculated (dSUV). Histopathological specimens of resected metastases were graded on a 5-score TRG scale. A TRG of 1-3 was rated as a responding to therapy, whereas TRG 4-5 were regarded as non-responding lesions.

Results: 31 lesions were identified in 23 patients. Mean SUVmax before and after therapy was 6.9 ± 3.7 and 3.5 ± 1.8, respectively. The area under the receiver operator characteristic curve revealed a conclusive correlation between TRG and dSUV (AUC 0.773; 95% confidence interval 0.599-0.946) with a cut off at 41% decrease in FDG activity yielding a sensitivity and specificity of 72 and 75%, respectively.

Conclusion: A relative change in FDG activity (dSUV) of more than 41% decrease correlated significantly with histopathological tumor regression and might be a prognostic tool for response to chemotherapy in HCRC.
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http://dx.doi.org/10.1007/s12149-012-0670-8DOI Listing
February 2013

Combined PET/CT-perfusion in patients with head and neck cancers.

Eur Radiol 2013 Jan 8;23(1):163-73. Epub 2012 Jul 8.

Department of Radiology, Division of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.

Objectives: Computed tomography perfusion (CTP) can provide information about angiogenesis and blood-flow characteristics in tumours. [18F]Fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) is one of the major oncological imaging techniques which provides information about viability of the tumour cell and partly also about its aggressiveness. The aim of the study was to investigate the relationship between FDG and CTP data in patients with head and neck cancers.

Materials And Methods: Forty-one patients with a clinically suspected head and neck cancer were prospectively included. All patients underwent a combined PET/CT with an integrated CTP examination in the area of the head and neck tumour. CTP data (BF, BV and MTT) and PET data (SUVmax, SUVmean, TLG, PETvol) were compared between tumours and (1) healthy contralateral tissue, (2) inflammatory lesions, (3) metastatic lymph nodes, and CTP data and PET data were correlated in tumours.

Results: Thirty-five patients had a head and neck cancer. All CTP data were statistically different between tumours, inflammatory lesions, healthy tissue and metastatic lymph nodes; PET/CT data were in part significantly different. CTP and PET parameters were not significantly correlated.

Conclusion: CTP and PET parameters were not significantly correlated; thus, the additional CTP values provide additional insights into tumour behaviour and their glycolytic status.
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http://dx.doi.org/10.1007/s00330-012-2564-5DOI Listing
January 2013

Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer.

Eur J Nucl Med Mol Imaging 2012 Jun 14;39(6):936-43. Epub 2012 Mar 14.

Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.

Purpose: To investigate the clinical value of (18)F-fluorocholine PET/CT (CH-PET/CT) in treatment decisions in patients with recurrent prostate cancer (rPCA).

Methods: The study was a retrospective evaluation of 156 patients with rPCA and CH-PET/CT for restaging. Questionnaires for each examination were sent to the referring physicians 14-64 months after examination. Questions included information regarding initial extent of disease, curative first-line treatment, and the treatment plan before and after CH-PET/CT. Additionally, PSA values at diagnosis, after initial treatment, before CH-PET/CT and at the end of follow-up were also obtained from the questionnaires.

Results: Mean follow-up was 42 months. The mean Gleason score was 6.9 at initial diagnosis. Initial treatment was: radical prostatectomy in 110 patients, radiotherapy in 39, and combined prostatectomy and radiotherapy in 7. Median PSA values before CH-PET/CT and at the end of follow-up were 3.40 ng/ml and 0.91 ng/ml. PSA levels remained stable, decreased or were below measurable levels in 108 patients. PSA levels increased in 48 patients. In 75 of the 156 patients (48%) the treatment plan was changed due to the CH-PET/CT findings. In 33 patients the therapeutic plan was changed from palliative treatment to treatment with curative intent. In 15 patients treatment was changed from curative to palliative. In 8 patients treatment was changed from curative to another strategy and in 2 patients from one palliative strategy to another. In 17 patients the treatment plan was adapted.

Conclusion: CH-PET/CT has an important impact on the therapeutic strategy in patients with rPCA and can help to determine an appropriate treatment.
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http://dx.doi.org/10.1007/s00259-012-2083-2DOI Listing
June 2012

Pain-related F-18 FDG uptake of the corrugator supercilii muscles in PET/CT.

Clin Nucl Med 2012 Jan;37(1):e11-2

Division of Nuclear Medicine, Department Medical Radiology, University Hospital of Zurich, Zurich, Switzerland.

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http://dx.doi.org/10.1097/RLU.0b013e318233641fDOI Listing
January 2012

Incidence and intensity of F-18 FDG uptake after vaccination with H1N1 vaccine.

Clin Nucl Med 2011 Oct;36(10):848-53

Division of Nuclear Medicine, Department Medical Radiology, University Hospital of Zurich, Zurich, Switzerland.

Objective: To analyze the effect of H1N1 influenza A virus vaccination in patients referred for staging or follow-up F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for different malignant tumors.

Method And Materials: Medical history of all patients scheduled for FDG PET/CT during the national vaccination campaign against H1N1 was evaluated for recent vaccination. Site of injection and time between PET/CT and the date of vaccination (dTime) was determined. A difference in the maximum SUV between ipsi- and contralateral deltoid muscle or axillary lymph node of more than 0.5 was determined as positive reaction. The best cut-off dTime for still visible reaction was calculated. All patients with positive ipsilateral lymph node were clinically followed. Institutional Review Board approval was waived.

Results: Of 269 patients, 58 (21.5%) were vaccinated for the H1N1 within 4 weeks prior to PET/CT (mean, 14.5 ± 8.7 days). Of them, 17 (29.3%) patients had FDG-positive lymph nodes (mean SUV, 1.43 ± 1.06), with a dTime range from 1 to 14 days. Only 2 of them had no increased FDG uptake in the ipsilateral deltoid muscle. The area under the receiver operator characteristic curve revealed a strong relation between time delay (dTime) and axillary activity (AUC, 0.9; 95% confidence interval, 0.816-0.983) with a cutoff at 8 days (Youden Index). At follow-up (mean, 183 days; range, 173-196 days), no patient was found to have required treatment or signs of axillary lymphadenopathy.

Conclusions: H1N1 vaccination can cause false-positive FDG PET/CT findings, when administered less than 14 days before the test, with the highest probability if the vaccination was administered less than 8 days ago. Increased FDG activity in the ipsilateral deltoid muscle is a key finding for accurate interpretation of increased FDG activity in axillary lymph nodes.
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http://dx.doi.org/10.1097/RLU.0b013e3182177322DOI Listing
October 2011

Profiling gastrin-releasing peptide receptor in prostate tissues: clinical implications and molecular correlates.

Prostate 2012 Feb 7;72(3):318-25. Epub 2011 Jul 7.

Institute of Clinical Pathology, University Hospital of Zürich, Zürich, Switzerland.

Background: The gastrin-releasing peptide receptor (GRPR) has emerged as an attractive target for both therapeutic and diagnostic appliances, but has only insufficiently been characterized in the human prostate so far. The aim of this study is to profile GRPR in a large cohort and correlate it with clinicopathologic and molecular parameters.

Methods: Benign and malignant (primary carcinoma, metastases, and castration-resistant prostate cancer) prostate samples from 530 patients were analyzed immunohistochemically for GRPR, androgen receptor and Cyclin D1 expression. Staining intensity was assessed assigning a semiquantitative score to each sample.

Results: Normal prostate tissues were mostly GRPR negative, significantly higher expression rates were seen in primary carcinomas and metastases. Significant inverse correlations were found for GRPR and increasing Gleason score, PSA value, and tumor size. A stratified Kaplan-Meyer analysis for GRPR and high AR expression shows a significant prognostic advantage for high GRPR expression, whereas GRPR expression alone shows no independent prognostic value. Highly significant correlations for GRPR, AR, and Cyclin D1 were found.

Conclusions: Our data show that GRPR is overexpressed in prostate cancer, particularly of lower grade and smaller size. These findings constitute a caveat for the use of GRPR as a target for diagnostic or therapeutic approaches to high grade or progressed prostate cancer.
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http://dx.doi.org/10.1002/pros.21434DOI Listing
February 2012

Initial staging of the neck in head and neck squamous cell carcinoma: a comparison of CT, PET/CT, and ultrasound-guided fine-needle aspiration cytology.

Head Neck 2012 Apr 20;34(4):469-76. Epub 2011 May 20.

Department of Otorhinolaryngology-Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland.

Background: The aim of this study was to compare imaging modalities for staging the neck in a prospective cohort of patients evaluated by CT, ultrasound with fine-needle aspiration cytology (FNAC), and [(18)F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/CT with the histologic evaluation of the neck dissection as the standard of reference.

Methods: In all, 76 consecutive patients were prospectively enrolled.

Results: Ultrasound-guided FNAC showed the highest level of agreement with histology for exact N classification. Ultrasound-guided FNAC showed the smallest percentage of overstaged patients, 7%, versus 16% with PET/CT, 13% with CT, and 13% with ultrasound. The rate of understaged patients was comparable between the imaging modalities. With regard to the endpoint N0 versus N+ there were no statistically significant differences to be found.

Conclusions: Ultrasound-guided FNAC seems to correlate best with histologic staging compared with PET/CT and CT. None of the modality is reliable enough to replace elective neck treatment in cN0 necks.
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http://dx.doi.org/10.1002/hed.21764DOI Listing
April 2012

FDG uptake in vaginal tampons is caused by urinary contamination and related to tampon position.

Eur J Nucl Med Mol Imaging 2011 Jan 21;38(1):90-6. Epub 2010 Sep 21.

Division of Nuclear Medicine, Department of Medical Radiology, University Hospital of Zurich, Ramistr. 100, 8091, Zurich, Switzerland.

Purpose: The aim of the study was to determine the aetiology of FDG uptake in vaginal tampons (VT), a known artefact in premenopausal women evaluated by PET/CT.

Methods: This Institutional Review Board approved study consisted of retrospective and prospective parts. The retrospective analysis included 685 women examined between January 2008 and December 2009 regarding VT presence. PET/CT images were analysed to determine the localization and the standardized uptake value (SUV) of VTs. We prospectively recruited 24 women (20-48 years old) referred for staging or follow-up in an oncology setting between February and April 2010, who were provided a commercial VT to be used during the entire examination after obtaining written informed consent. After image acquisition, VTs were individually analysed for creatinine concentration and blood traces. Statistical significance was tested with the Mann-Whitney U test.

Results: In the retrospective part, 38 of 685 women were found to have a VT of which 17 (45%) were FDG positive. A statistically significant correlation was found between FDG activity and VT position below the pubococcygeal line (PCL) (13 ± 11.2 mm). In the prospective study, 7 of 24 (29%) women had increased FDG activity in their VTs (SUV 18.8 ± 11 g/ml) but were not menstruating. FDG-positive VTs were significantly lower in position (14.6 ± 11.4 mm,below the PCL) than FDG-negative VTs (p = 0.039). The creatinine concentration was significantly increased in all seven positive VTs (931 ± 615 μmol/l).

Conclusion: FDG uptake in VTs is caused by urine contamination, which is likely related to localization below the PCL resulting in contact with urine during voiding.
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http://dx.doi.org/10.1007/s00259-010-1618-7DOI Listing
January 2011

Clinical value of a combined multi-phase contrast enhanced DOPA-PET/CT in neuroendocrine tumours with emphasis on the diagnostic CT component.

Eur Radiol 2011 Feb 15;21(2):256-64. Epub 2010 Aug 15.

Department of Medical Radiology, Division of Nuclear Medicine, University Hospital Zurich, Zuerich, Switzerland.

Objective: To assess the clinical value of multi-phase, contrast-enhanced DOPA-PET/CT with emphasis on the diagnostic CT component in patients with neuroendocrine tumours (NET).

Methods: Sixty-five patients with NET underwent DOPA-cePET/CT. The DOPA-PET, multi-phase CT and combined DOPA cePET/CT data were evaluated and diagnostic accuracies compared. The value of ceCT in DOPA cePET/CT concerning lesion detection and therapeutic impact was evaluated. Sensitivities, specificities and accuracies were calculated. Histopathology and clinical follow-up served as the standard of reference. Differences were tested for statistical significance by McNemar's test.

Results: In 40 patients metastatic and/or primary tumour lesions were detected. Lesion-based analysis for the DOPA-PET showed sensitivity, specificity and accuracy of 66%, 100% and 67%, for the ceCT data 85%, 71% and 85%, and for the combined DOPA cePET/CT data 97%, 71% and 96%. DOPA cePET/CT was significantly more accurate compared with dual-phase CT (p < 0.05) and PET alone (p < 0.05). Additional lesion detection was based on ceCT in 12 patients; three patients underwent significant therapeutic changes based on the ceCT findings.

Conclusion: DOPA cePET/CT was significantly more accurate than DOPA-PET alone and ceCT alone. The CT component itself had a diagnostic impact in a small percentage but contributed to the therapeutic strategies in selected patients.
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http://dx.doi.org/10.1007/s00330-010-1930-4DOI Listing
February 2011

Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with 18F-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI.

J Nucl Med 2010 May 15;51(5):692-9. Epub 2010 Apr 15.

Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.

Unlabelled: The purpose of this study was to compare the accuracy of lesion detection and diagnostic confidence between (18)F-FDG PET/CT, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, and retrospectively fused PET and MRI (PET/MRI).

Methods: Thirty-seven patients (mean age +/- SD, 60.2 +/- 12 y) with suspected liver metastases underwent PET/CT and Gd-EOB-DTPA-enhanced MRI within 0-30 d (mean, 11.9 +/- 9 d). PET and Gd-EOB-DTPA-enhanced MR image data were retrospectively fused. Images were reviewed independently by 2 readers who identified and characterized liver lesions using PET/CT, Gd-EOB-DTPA-enhanced MRI, and PET/MRI. Each liver lesion was graded on a 5-point confidence scale ranging from definitely benign (grade of 1) to definitely malignant (grade of 5). The accuracy of each technique was determined by receiver-operating-characteristic analysis. Histopathology served as the standard of reference for all patients with malignant lesions.

Results: A total of 85 liver lesions (55 liver metastases [65%] and 30 benign lesions [35%]) were present in 29 (78%) of the 37 patients. Twenty-four (65%) of the 37 patients had liver metastases. The detection rate of liver lesions was significantly lower for PET/CT than for Gd-EOB-DTPA-enhanced MRI (64% and 85%; P = 0.002). Sensitivity in the detection and characterization of liver metastases for PET/CT, Gd-EOB-DTPA-enhanced MRI, PET/MRI in reader 1, and PET/MRI in reader 2 was 76%, 91%, 93%, and 93%, respectively; the respective specificity values were 90%, 100%, 87%, and 97%. The difference in sensitivity between PET/CT and PET/MRI was significant (P = 0.023). The level of confidence regarding liver lesions larger than 1 cm in diameter was significantly higher in PET/MRI than in PET/CT (P = 0.046). Accuracy values (area under the receiver-operating-characteristic curve) for PET/CT, Gd-EOB-DTPA-enhanced MRI, PET/MRI in reader 1, and PET/MRI in reader 2 were 0.85, 0.94, 0.92, and 0.96, respectively.

Conclusion: The sensitivity of Gd-EOB-DTPA-enhanced MRI and PET/MRI in the detection of liver metastases is higher than that of PET/CT. Diagnostic confidence was significantly better with PET/MRI than with PET/CT regarding lesions larger than 1 cm in diameter. Compared with Gd-EOB-DTPA-enhanced MRI, PET/MRI resulted in a nonsignificant increase in sensitivity and diagnostic confidence.
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http://dx.doi.org/10.2967/jnumed.109.068510DOI Listing
May 2010

Influence of bowel preparation before 18F-FDG PET/CT on physiologic 18F-FDG activity in the intestine.

J Nucl Med 2010 Apr 17;51(4):507-10. Epub 2010 Mar 17.

Department of Nuclear Medicine, University Hospital, Zurich, Switzerland.

Unlabelled: Our objective was to investigate the use of bowel preparation before (18)F-FDG PET/CT to reduce intestinal (18)F-FDG uptake.

Methods: Sixty-five patients with abdominal neoplasias were assigned either to a bowel-preparation group (n = 26) or to a native group (n = 39). (18)F-FDG activity was measured in the small intestine and the colon.

Results: In the 26 patients with bowel preparation, average maximal standardized uptake value (SUVmax) was 3.5 in the small intestine and 4.4 in the colon. In the 39 patients without bowel preparation, average SUVmax was 2.6 in the small intestine and 2.7 in the colon. (18)F-FDG activity impaired diagnosis in 6 patients (23%) in the bowel-preparation group and 11 patients (28%) in the native group (P = 0.5). SUVmax in the colon was significantly higher in the bowel-preparation group (P = 0.002), but SUVmax in the small intestine did not significantly differ between the 2 groups (P = 0.088).

Conclusion: Bowel preparation increases (18)F-FDG activity in the large intestine and is therefore not useful before PET/CT.
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http://dx.doi.org/10.2967/jnumed.109.071001DOI Listing
April 2010

Therapeutic impact of [(18)F]fluoride positron-emission tomography/computed tomography on patients with unclear foot pain.

Skeletal Radiol 2010 Oct 23;39(10):987-97. Epub 2010 Feb 23.

Department of Nuclear Medicine, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.

Purpose: To evaluate the therapeutic impact of [(18)F]fluoride positron-emission tomography/computed tomography ([(18)F]fluoride PET/CT) imaging on patients with unclear foot pain.

Methods: Twenty-eight patients were prospectively included in this study. Therapeutic management was defined by two experienced dedicated foot surgeons before and after [(18)F]fluoride PET/CT imaging. Twenty-six patients underwent cross-sectional imaging [CT, magnetic resonance (MR)] prior to PET/CT. A retrospective analysis of the magnetic resonance imaging (MRI) diagnoses was performed when a therapy change occurred after PET/CT imaging.

Results: In 13/28 (46%) patients therapeutic management was changed due to PET/CT results. Management changes occurred in patients with the following diagnoses: os trigonum syndrome; sinus tarsi syndrome; os tibiale externum syndrome; osteoarthritis of several joints; non-consolidated fragments; calcaneo-navicular coalition; plantar fasciitis; insertional tendinopathy; suggestion of periostitis; neoarticulations between metatarsal bones. Os trigonum, os tibiale externum, subtalar osteoarthritis and plantar fasciitis were only seen to be active on PET/CT images but not on MR images.

Conclusion: [(18)F]fluoride PET/CT has a substantial therapeutic impact on management in patients with unclear foot pain.
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http://dx.doi.org/10.1007/s00256-010-0875-7DOI Listing
October 2010

Intraductal oncocytic papillary neoplasm of the pancreas: a radio-pathological case study.

JOP 2010 Jan 8;11(1):49-54. Epub 2010 Jan 8.

Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.

Context: An intraductal oncocytic papillary neoplasm is a rare pancreatic tumor with the potential of developing invasive carcinoma. Its differentiation from other cystic-like neoplasms of the pancreas, such as intraductal papillary mucinous neoplasms, is a challenge for pancreatic imaging.

Case Report: We present the case of a 76-year-old male with painless jaundice caused by an intraductal oncocytic papillary neoplasm of the pancreas. The imaging findings on computed tomography, magnetic resonance including diffusion-weighted imaging, and (18)F-fluorodeoxyglucose positron emission tomography are presented and the radio-pathological correlations are discussed.

Conclusion: An intraductal oncocytic papillary neoplasm of the pancreas appears as a cystic tumor communicating with the dilated pancreatic duct featuring intraductal tumor nodules. Intraductal oncocytic papillary neoplasms show a high (18)F-fluorodeoxyglucose-uptake in positron emission tomography and low diffusion values in diffusion-weighted imaging including apparent diffusion coefficient maps which may be a valuable attribute in distinguishing these rare lesions from intraductal papillary mucinous neoplasms.
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January 2010

Is there an additional value of SPECT/CT over planar lymphoscintigraphy for sentinel node mapping in oral/oropharyngeal squamous cell carcinoma?

Ann Surg Oncol 2009 Nov 28;16(11):3118-24. Epub 2009 Jul 28.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.

Background: Lymphatic mapping for sentinel node biopsy (SNB) has been shown to be crucial for detection of sentinel lymph nodes (SLN). Previous reports suggested a benefit of single photon emission computed tomography with CT (SPECT/CT) over dynamic planar lymphoscintigraphy (LS) alone. The aim was to assess whether there is an additional value of SPECT/CT over LS alone for lymphatic mapping of SLNs in oral/oropharyngeal SCC.

Methods: A consecutive cohort of 58 patients was evaluated using SNB with additional SPECT/CT to preoperative LS.

Results: In the entire cohort of 58 patients undergoing LS and SPECT/CT, hot spots could be revealed in all but 4 cases. The guidance of the handheld gamma probe was able to reveal 9 additional SLNs within 3 patients not detected by either modality. Lymphoscintigraphy showed full concordance with SPECT/CT in 81% of the cases. SPECT/CT was able to detect additional HS in 11 patients, in 1 case even with additional metastatic disease. The false negative rate for SNB was 6%, and the negative predictive value 98%.

Conclusions: SPECT/CT has the potential to detect more SLNs, which might harbor occult disease, than LS alone. With regard to the excellent results achieved with LS and the intraoperative use of the gamma probe, SPECT/CT is not indispensable for successful SNB. Both imaging modalities have difficulties in detecting level I sentinel nodes close to the injection site.
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http://dx.doi.org/10.1245/s10434-009-0632-0DOI Listing
November 2009

(18)F-FDG-PET/CT versus panendoscopy for the detection of synchronous second primary tumors in patients with head and neck squamous cell carcinoma.

Head Neck 2010 Mar;32(3):319-25

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.

Background: This study assesses the additional value of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/CT ((18)F-FDG-PET/CT) with respect to synchronous primaries in patients undergoing panendoscopy for staging of head and neck squamous cell carcinoma.

Methods: In all, 311 patients underwent both modalities. Cytology, histology, and/or clinical/imaging follow-up served as reference standard.

Results: The prevalence of second primary tumors detected by panendoscopy was 4.5%, compared with 6.1% detected by (18)F-FDG-PET/CT. The sensitivity for panendoscopy was 74%, the specificity was 99.7%, the positive predictive value (PPV) was 93%, and the negative predictive value (NPV) was 98%. The sensitivity for (18)F-FDG-PET/CT was 100%, the specificity was 95.7%, the PPV was 59%, and the NPV was 100%.

Conclusions: (18)F-FDG-PET/CT is superior to panendoscopy. With a negative (18)F-FDG-PET/CT, the extent of endoscopy can be reduced to the area of the primary tumor. Due to the costs, (18)F-FDG-PET/CT is recommended only in advanced disease to assess potential distant disease. In early-stage cancer, panendoscopy is accurate enough to rule out secondary tumors.
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http://dx.doi.org/10.1002/hed.21184DOI Listing
March 2010

Feasibility of integrated CT-liver perfusion in routine FDG-PET/CT.

Abdom Imaging 2010 Oct 11;35(5):528-36. Epub 2009 Jul 11.

Department of Medical Radiology, Division of Nuclear Medicine, University Hospital Zuerich, Raemistrasse 100, 8091, Zuerich, Switzerland.

Objective: To integrate CT-perfusion into a routine, clinical contrast-enhanced (ce) PET/CT protocol for the evaluation of liver metastases and to compare functional CT and PET parameters.

Materials And Methods: Forty-six consecutive patients (mean age: 60 (34-82) years; 20 f, 26 m) with known liver lesions (colorectal metastases (n = 34), primary liver cancer (n = 4), breast cancer (n = 3), anal cancer, gastric cancer, esophageal cancer, GIST, duodenal cancer (all: n = 1) who were referred for staging or therapy follow-up by [18F]-Fluoro-2-deoxy-D-glucose-positron-emission-tomography/computed-tomography imaging (FDG-PET/CT) were included. After acquisition of a low-dose PET/CT, a split-injection (70-90 mL) ce-CT-protocol, including a 35-s CT-perfusion scan of the liver and a diagnostic ce-CT of the thorax and/or abdomen (70 s delay, iv-contrast volume: 90 mL, 4 mL/s) was performed. CT-perfusion parameters (BF, BV, MTT,) and semi-quantitative PET-parameters (SUVmax, SUVmean, TLG, PETvol) were analyzed and compared.

Results: CT-perfusion data could be obtained in all but one patient with shallow breathing. In all patients, diagnostic ce-PET/CT quality was adequate without the use of additional contrast media. Significant correlations (P < 0.05) were found for each of BF, BV, MTT, and SUVmax, further, BF and MTT correlated with TLG. Several other correlations were seen for other perfusion and PET-parameters.

Conclusion: Combined CT-perfusion/PET/CT-protocol without the use of additional contrast media is feasible and can be easily integrated in clinical routine. Perfusion parameters and PET-parameters are only partly correlating and therefore have to be investigated further at fixed time points during the course of disease and therapy.
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http://dx.doi.org/10.1007/s00261-009-9559-yDOI Listing
October 2010

Head and neck squamous cell carcinoma (HNSCC)--detection of synchronous primaries with (18)F-FDG-PET/CT.

Eur J Nucl Med Mol Imaging 2009 Jun 10;36(6):919-27. Epub 2009 Feb 10.

Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zurich, Switzerland.

Purpose: The aim of the study was to evaluate (18)F-FDG-PET/CT for the detection of synchronous primaries at initial staging of patients with head and neck squamous cell carcinoma (HNSCC).

Methods: FDG-PET/CT images acquired between March 2001 and October 2007 in 589 consecutive patients (147 women, 442 men; mean age 61.5 years, age range 32-97 years) with proven HNSCC were reviewed for the presence of synchronous primaries. Cytology, histology and/or clinical and imaging follow-up served as reference standard.

Results: FDG-PET/CT showed 69 suspected synchronous primaries in 62 patients of which 56 were finally confirmed in 44 patients. Of the 56 second cancers, 46 (82%) were found in the aerodigestive tract in the following locations: lung (26, 46%), head and neck (15, 17%), oesophagus (5, 9%). Ten second cancers (18%) were located outside the aerodigestive tract (colon, five; stomach, lymphoma, breast, thymus and kidney, one each). Six patients had three synchronous primaries and three patients had four synchronous cancers. Nine synchronous cancers were not detected by PET/CT (four head and neck, two lung, two oesophageal, one gastric). False-positive PET/CT findings were mainly related to benign FDG uptake in the intestine due to benign or precancerous polyps or physiological FDG uptake in other head and neck regions. Overall the prevalence of synchronous second primaries according to the reference standard was 9.5%, of which 84% were detected with FDG-PET/CT. In 80% of the patients, therapy was changed because of the detection of a synchronous primary.

Conclusion: FDG-PET/CT detects a considerable number of synchronous primaries (8.0% prevalence) at initial staging of patients with HNSCC. Synchronous cancers were predominantly located in the aerodigestive tract, primarily in the lung, head and neck and oesophagus. Detection of second primaries has an important impact on therapy. PET/CT should be performed before panendoscopy.
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http://dx.doi.org/10.1007/s00259-009-1064-6DOI Listing
June 2009

Neoadjuvant chemotherapy generates a significant tumor response in resectable pancreatic cancer without increasing morbidity: results of a prospective phase II trial.

Ann Surg 2008 Dec;248(6):1014-22

Swiss HPB-Center, Department of Surgery and Institute of Surgical Pathology, Zurich, Switzerland.

Objective: To evaluate the morbidity of pancreaticoduodenectomy after neoadjuvant chemotherapy for resectable pancreatic cancer and to assess its histologic and metabolic response.

Background: Adjuvant chemotherapy improves the outcome of pancreatic cancer, but 25% of patients remain unfit after surgery. Neoadjuvant chemotherapy can be offered to all patients in a multimodality approach, but its efficacy and surgical morbidity are unknown.

Methods: Patients with resectable, cytologically proven adenocarcinoma of the pancreatic head received 4 bi-weekly cycles of gemcitabine (1000 mg/m(2)) and cisplatin (50 mg/m(2)) in this prospective phase II trial. Staging and restaging included chest x-ray, abdominal computed tomography (CT), positron emission tomography (PET)/CT, endoscopic ultrasound, and laparoscopy. Fluorodeoxyglucose uptake was quantified by the standard-uptake value (SUV) on baseline and restaging PET/CT. Immunohistochemistry for GLUT-1 and Ki-67 was performed. The histologic response, cytopathic effects, and surgical complications were graded by respective scores.

Results: Twenty-four of 28 patients had resection for histologically confirmed adenocarcinoma. The surgical morbidity was low without perioperative death and one pancreatic fistula. Histologic response was documented in 54% and cytopathic effects in 83% of the patients. A significant SUV decrease occurred during chemotherapy (P = 0.031), which correlated with the baseline SUV (P = 0.001), Ki-67 expression (P = 0.016), and histologic response (P = 0.01). Neither the metabolic nor the histologic response was predictive of the median disease-free (9.2 months) or overall survival (26.5 months).

Conclusion: Neoadjuvant chemotherapy induced a significant metabolic and histologic response, which was best predicted by PET. Most importantly, surgery after neoadjuvant chemotherapy for pancreatic cancer was safe.
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http://dx.doi.org/10.1097/SLA.0b013e318190a6daDOI Listing
December 2008

Positron emission tomography/computed tomography for staging and restaging of head and neck cancer: comparison with positron emission tomography read together with contrast-enhanced computed tomography.

Clin Imaging 2008 Nov-Dec;32(6):431-7

Institute of Medical Radiology, Buergerspital Solothurn/Spital Grenchen soH, Solothurn, Switzerland.

This retrospective study aimed to describe the differences between image readings done with combined positron emission tomography/computed tomography (PET/CT) and PET read together with contrast-enhanced CT (ceCT) in patients with squamous cell carcinoma of the head and neck. In 46 patients, no differences were found between the two readings for assessing infiltration of adjacent structures (P=.63), transgression of the midline (P=.67), lymph node involvement (P=.32), and T- and N stage. PET/CT and PET read together with ceCT have comparable diagnostic yield.
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http://dx.doi.org/10.1016/j.clinimag.2008.04.012DOI Listing
February 2009

Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer.

J Nucl Med 2008 Sep 14;49(9):1408-13. Epub 2008 Aug 14.

Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zurich, Switzerland.

Unlabelled: Patients with pancreatic cancer continue to have a poor prognosis, with a 5-y survival rate of less than 5%. Surgery is the only treatment that offers a potential cure. Determining resectability is the principal goal of staging in pancreatic cancer patients. Our objective was to evaluate the value of combined contrast-enhanced (18)F-FDG PET/CT in assessing the resectability of pancreatic cancer and to compare enhanced PET/CT with the performance of PET alone and unenhanced PET/CT.

Methods: Fifty patients (25 women and 25 men; mean age, 64.3 y; range, 39-84 y) with biopsy-proven pancreatic adenocarcinoma underwent enhanced (18)F-FDG PET/CT for the evaluation of resectability. Criteria for unresectability were distant metastases, peritoneal carcinomatosis, arterial infiltration, or invasion of neighboring organs other than the duodenum. The performance of enhanced PET/CT regarding resectability was compared with that of PET alone and unenhanced PET/CT. Histology, intraoperative findings, and follow-up CT with clinical investigations were used as the reference standard.

Results: According to the reference standard, 27 patients had disease that was not resectable because of distant metastases (n=17), peritoneal carcinomatosis (n=5), or local infiltration (n=5). In the assessment of resectability, PET alone had a sensitivity of 100%, specificity of 44%, accuracy of 70%, positive predictive value of 61%, and negative predictive value of 100%; unenhanced PET/CT had respective values of 100%, 56%, 76%, 66%, and 100%; and enhanced PET/CT, 96%, 82%, 88%, 82%, and 96%. In 5 patients, unresectability was missed by all imaging methods and was diagnosed intraoperatively. Enhanced PET/CT was significantly superior to PET alone (P=0.035), and there was a trend for enhanced PET/CT to be superior to unenhanced PET/CT (P=0.070).

Conclusion: The use of enhanced PET/CT as a 1-stop-shop imaging protocol for assessing the resectability of pancreatic cancer is feasible and accurate. Enhanced PET/CT is significantly superior to PET alone.
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http://dx.doi.org/10.2967/jnumed.108.051466DOI Listing
September 2008

Imaging and PET-PET/CT imaging.

J Radiol 2008 Mar;89(3 Pt 2):438-47; quiz 448

Department of Medical Radiology, Division of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.

PET-CT has grown because the lack of anatomic landmarks in PET makes "hardware-fusion" to anatomic cross-sectional data extremely useful. Addition of CT to PET improves specificity, but also sensitivity, and adding PET to CT adds sensitivity and specificity in tumor imaging. The synergistic advantage of adding CT is that the attenuation correction needed for PET data can also be derived from the CT data. This makes PET-CT 25-30% faster than PET alone, leading to higher patient throughput and a more comfortable examination for patients typically lasting 20 minutes or less. FDG-PET-CT appears to provide relevant information in the staging and therapy monitoring of many tumors, such as lung carcinoma, colorectal cancer, lymphoma, gynaecological cancers, melanoma and many others, with the notable exception of prostatic cancer. For this cancer, choline derivatives may possibly become useful radiopharmaceuticals. The published literature on the applications of FDG-PET-CT in oncology is still limited but several well-designed studies have demonstrated the benefits of PET-CT.
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March 2008

PET/CT in Gastrointestinal Cancer: Methodological Aspects.

Authors:
Thomas F Hany

PET Clin 2008 Apr 6;3(2):115-22. Epub 2008 Dec 6.

Division of Nuclear Medicine, Department of Medical Radiology, University Hospital, Raemistrasse 100, CH-8091 Zurich, Switzerland. Electronic address:

PET/CT methodology is intrinsically divided into PET and CT data acquisition, whereas CT data are used for attenuation correction of PET images. Because CT data are also used for lesion localization, attention has been turned on the optimization of CT protocols using oral and intravenous contrast agents. Using oral as well as intravenous contrast media, no significant qualitative as well as quantitative differences were found in corresponding PET data. Further, use of intravenous contrast enhances the diagnostic performance of integrated PET/CT especially for recurrent colorectal cancer, one of the major indications of PET/CT in gastrointestinal cancer.
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http://dx.doi.org/10.1016/j.cpet.2008.08.006DOI Listing
April 2008

Staging pathways in recurrent colorectal carcinoma: is contrast-enhanced 18F-FDG PET/CT the diagnostic tool of choice?

J Nucl Med 2008 Mar 20;49(3):354-61. Epub 2008 Feb 20.

Department of Nuclear Medicine, University Hospital Zuerich, Zurich, Switzerland.

Unlabelled: (18)F-FDG PET/CT has gained wide acceptance for evaluation of recurrent colorectal carcinoma. However in clinical practice, contrast-enhanced CT (ceCT) is still the first-line restaging tool. The aim of this study was to investigate the value of contrast-enhanced PET/CT (cePET/CT) as a first-line restaging tool with a special focus on the importance of the use of intravenous contrast.

Methods: Fifty-four patients (17 women, 37 men; mean age, 60.3 y), referred for restaging of colorectal carcinoma, were examined with cePET/CT. Retrospective analysis was performed by 2 experienced readers by consensus: first, ceCT alone; second, non-cePET/CT; and third, cePET/CT. The number, localization, and diagnostic certainty of lesions were evaluated. Additionally, the therapeutic impact of the findings was determined. In 29 patients, histology, clinical imaging, and clinical follow-up served as the reference standard. In 25 patients, clinical follow-up and imaging served as the reference standard.

Results: Overall, non-cePET/CT delivered correct additional information to the ceCT findings in 27 of 54 patients (50%). This occurred in (a) 20 of 30 patients, where ceCT was found to be inconclusive, and in (b) 7 of 24 patients with conclusive ceCT findings, where non-cePET/CT found additional lesions, leading to a therapy modification in 5 patients. Compared with non-cePET/CT, cePET/CT revealed additional information in 39 of 54 patients (72%), with therapeutic relevance in 23 patients. This large number was primarily due to correct segmental localization of liver metastases, which is crucial for surgical therapy planning.

Conclusion: On the basis of its higher accuracy and therapeutic impact compared with ceCT, our data suggest that cePET/CT might be considered as the first-line diagnostic tool for restaging in patients with colorectal cancer.
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http://dx.doi.org/10.2967/jnumed.107.048249DOI Listing
March 2008

Pathologies of the lower abdomen and pelvis: PET/CT reduces interpretation errors due to urinary contamination.

Clin Imaging 2008 Jan-Feb;32(1):16-21

Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Switzerland.

Aim: The aim of this study was to assess the frequency of indeterminate (18)F-fluorodeoxyglucose (FDG) accumulations on positron emission tomography (PET) and PET/computed tomography (CT) images in patients with pelvic pathologies.

Methods: We retrospectively evaluated 536 focal FDG accumulations of 166 PET/CT examinations. A consensus reading of PET/CT images, clinical data, and other imaging tests was the standard of reference to assess sensitivities and specificities of PET and PET/CT. Frequencies of indeterminate findings and intraobserver agreement were evaluated.

Conclusion: PET/CT improves the anatomic delineation and the correct assignment of physiologic and pathologic uptake.
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http://dx.doi.org/10.1016/j.clinimag.2007.07.004DOI Listing
March 2008
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