F-18 FDG PET/CT Imaging

Topic Information

Dear Colleagues,

Since its introduction in the 1970s, glucose analogue 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) has been applied in various clinical scenarios. Those include, but are not limited to, oncology, neurology, cardiology, rheumatology or infectious diseases. Several more specific radiotracers have been developed in recent years, but the broad availability of “the molecule of the 20th century” (Dr. Henry Wagner), along with its facile synthesis, renders this radiopharmaceutical as the workhorse in nuclear medicine. This particularly applies to nuclear oncology, where this radiotracer is frequently utilized, e.g., for staging, restaging or treatment monitoring in a longitudinal setting. Recent studies have also favored the use of this radiotracer for the improved risk stratification of patients being screened for theranostic procedures, e.g., for men affected with advanced metastatic prostate cancer or in aggressive neuroendocrine neoplasms. In nuclear cardiology, viability testing using this radiopharmaceutical can guide interventions, such as angioplasties, while for cardiovascular inflammations, it provides essential information on the current status quo, e.g., for suspected endocarditis or infections of left ventricular assist devices. In neurology, distinct patterns of radiotracer uptake can provide crucial information to distinguish between different subtypes of dementia. In addition, in various clinical studies, 18F-FDG serves as a comparator, thereby setting the benchmark in terms of sensitivity, specificity, or accuracy. In the present Special Issue, original articles, brief communications, or review articles on 18F-FDG will be provided, particularly in an oncological setting, but also for other applications in nuclear medicine.

Dr. Rudolf A. Werner
Dr. Steven P. Rowe
Dr. Lilja B. Solnes
Topic Editors

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Cancers cancers	4.5	8.0	2009	17.4 Days	CHF 2900
Diagnostics diagnostics	3.0	4.7	2011	20.3 Days	CHF 2600
Journal of Clinical Medicine jcm	3.0	5.7	2012	16 Days	CHF 2600
Radiation radiation	-	-	2021	24.6 Days	CHF 1000
Tomography tomography	2.2	2.7	2015	23.8 Days	CHF 2400

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Published Papers (7 papers)

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12 pages, 2378 KiB  

Open AccessArticle

Retrospective Analysis of the Predictive Value of ¹⁸F-FDG PET/CT Metabolic Parameters for PD-L1 Expression in Cervical Cancer

by Jianfeng Ji, Weiqiang Pang, Jinling Song, Xiawan Wang, Huarong Tang, Yunying Liu, Heqing Yi, Yun Wang, Qing Gu and Linfa Li

Diagnostics 2023, 13(6), 1015; https://doi.org/10.3390/diagnostics13061015 - 7 Mar 2023

Cited by 2 | Viewed by 1983

Abstract

Background: Immunotherapy targeting PD-1/PD-L1 has been proven to be effective for cervical cancer treatment. To explore non-invasive examinations for assessing the PD-L1 status in cervical cancer, we performed a retrospective study to investigate the predictive value of ¹⁸F-FDG PET/CT. Methods: The correlations [...] Read more.

Background: Immunotherapy targeting PD-1/PD-L1 has been proven to be effective for cervical cancer treatment. To explore non-invasive examinations for assessing the PD-L1 status in cervical cancer, we performed a retrospective study to investigate the predictive value of ¹⁸F-FDG PET/CT. Methods: The correlations between PD-L1 expression, clinicopathological characteristics and ¹⁸F-FDG PET/CT metabolic parameters were evaluated in 74 cervical cancer patients. The clinicopathological characteristics included age, histologic type, tumor differentiation, FIGO stage and tumor size. The metabolic parameters included maximum standard uptake (SUVmax), mean standard uptake (SUVmean), total lesion glycolysis (TLG) and tumor metabolic volume (MTV). Results: In univariate analysis, SUVmax, SUVmean, TLG, tumor size and tumor differentiation were obviously associated with PD-L1 status. SUVmax (rs = 0.42) and SUVmean (rs = 0.40) were moderately positively correlated with the combined positive score (CPS) for PD-L1 in Spearman correlation analysis. The results of multivariable analysis showed that the higher SUVmax (odds ratio = 2.849) and the lower degree of differentiation (Odds Ratio = 0.168), the greater probability of being PD-L1 positive. The ROC curve analysis demonstrated that when the cut-off values of SUVmax, SUVmean and TLG were 10.45, 6.75 and 143.4, respectively, the highest accuracy for predicting PD-L1 expression was 77.0%, 71.6% and 62.2%, respectively. The comprehensive predictive ability of PD-L1 expression, assessed by combining SUVmax with tumor differentiation, showed that the PD-L1-negative rate was 100% in the low probability group, whereas the PD-L1-positive rate was 84.6% in the high probability group. In addition, we also found that the H-score of HIF-1α was moderately positively correlated with PD-L1 CPS (rs = 0.51). Conclusions: The SUVmax and differentiation of the primary lesion were the optimum predictors for PD-L1 expression in cervical cancer. There was a great potential for ¹⁸F-FDG PET/CT in predicting PD-L1 status and selecting cervical cancer candidates for PD1/PD-L1 immune checkpoint therapy. Full article

(This article belongs to the Topic F-18 FDG PET/CT Imaging)

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11 pages, 1255 KiB  

Open AccessArticle

[¹⁸F]FDG PET/CT: Lung Nodule Evaluation in Patients Affected by Renal Cell Carcinoma

by Lighea Simona Airò Farulla, Laura Lavinia Travaini, Mariarosaria Cuomo, Domenico Galetta, Francesco Mattana, Samuele Frassoni, Giuseppe Buonsanti, Lorenzo Muraglia, Giulia Anna Zuccotti, Vincenzo Bagnardi, Lorenzo Spaggiari and Francesco Ceci

Tomography 2023, 9(1), 387-397; https://doi.org/10.3390/tomography9010031 - 10 Feb 2023

Cited by 1 | Viewed by 4416

Abstract

Renal Cell Carcinoma (RCC) is generally characterized by low-FDG avidity, and [¹⁸F]FDG-PET/CT is not recommended to stage the primary tumor. However, its role to assess metastases is still unclear. The aim of this study was to evaluate the diagnostic accuracy of [...] Read more.

Renal Cell Carcinoma (RCC) is generally characterized by low-FDG avidity, and [¹⁸F]FDG-PET/CT is not recommended to stage the primary tumor. However, its role to assess metastases is still unclear. The aim of this study was to evaluate the diagnostic accuracy of [¹⁸F]FDG-PET/CT in correctly identifying RCC lung metastases using histology as the standard of truth. The records of 350 patients affected by RCC were retrospectively analyzed. The inclusion criteria were: (a) biopsy- or histologically proven RCC; (b) Computed Tomography (CT) evidence of at least one lung nodule; (c) [¹⁸F]FDG-PET/CT performed prior to lung surgery; (d) lung surgery with histological analysis of surgical specimens; (e) complete follow-up available. A per-lesion analysis was performed, and diagnostic accuracy was reported as sensitivity and specificity, using histology as the standard of truth. [¹⁸F]FDG-PET/CT semiquantitative parameters (Standardized Uptake Value [SUVmax], Metabolic Tumor Volume [MTV] and Total Lesion Glycolysis [TLG]) were collected for each lesion. Sixty-seven patients with a total of 107 lesions were included: lung metastases from RCC were detected in 57 cases (53.3%), while 50 lesions (46.7%) were related to other lung malignancies. Applying a cut-off of SUVmax ≥ 2, the sensitivity and the specificity of [¹⁸F]FDG-PET/CT in detecting RCC lung metastases were 33.3% (95% CI: 21.4–47.1%) and 26% (95%CI: 14.6–40.3%), respectively. Although the analysis demonstrated a suboptimal diagnostic accuracy of [¹⁸F]FDG-PET/CT in discriminating between lung metastases from RCC and other malignancies, a semiquantitative analysis that also includes volumetric parameters (MTV and TLG) could support the correct interpretation of [¹⁸F]FDG-PET/CT images. Full article

(This article belongs to the Topic F-18 FDG PET/CT Imaging)

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3 pages, 506 KiB  

Open AccessInteresting Images

COVID-19-Associated Erythema Nodosum Detected on FDG PET/CT

by Nora Eberfalvi Lipositsne and Kirsten Bouchelouche

Diagnostics 2023, 13(3), 444; https://doi.org/10.3390/diagnostics13030444 - 26 Jan 2023

Cited by 2 | Viewed by 2240

Abstract

We report the case of a 69-year-old woman who underwent 18F-FDG PET/CT due to prolonged fever. One month before, the patient was diagnosed with COVID-19 infection. The 18F-FDG PET/CT showed several subcutaneous nodules with 18F-FDG uptake on the thorax and upper extremities and [...] Read more.

We report the case of a 69-year-old woman who underwent 18F-FDG PET/CT due to prolonged fever. One month before, the patient was diagnosed with COVID-19 infection. The 18F-FDG PET/CT showed several subcutaneous nodules with 18F-FDG uptake on the thorax and upper extremities and bilateral lung infiltrates due to organizing pneumonitis. Clinical examination revealed multiple tender nodules on thorax, arms, and legs, consistent with erythema nodosum (EN) induced by COVID-19 infection. The woman was treated with prednisone with a good effect on EN. To our knowledge, this is the first report on EN secondary to COVID-19 infection diagnosed on 18F-FDG PET/CT. Full article

(This article belongs to the Topic F-18 FDG PET/CT Imaging)

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6 pages, 1061 KiB  

Open AccessCase Report

Intense FDG Uptake in the Common Bile Duct Post-ERCP Mimics Acute Infectious Cholangitis

by Neel P. Mistry and Wanzhen Zeng

Tomography 2022, 8(6), 2946-2951; https://doi.org/10.3390/tomography8060248 - 18 Dec 2022

Cited by 1 | Viewed by 3105

Abstract

In patients with obstructive pancreatitis due to choledocholithiasis, endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care. ERCP-induced inflammation or infection of the common bile duct (i.e., cholangitis) is a rare complication with a high mortality rate in severe cases. We report an [...] Read more.

In patients with obstructive pancreatitis due to choledocholithiasis, endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care. ERCP-induced inflammation or infection of the common bile duct (i.e., cholangitis) is a rare complication with a high mortality rate in severe cases. We report an unusual case of incidental findings of intense FDG uptake in the common bile duct one month post-ERCP without clinical features of acute cholangitis, indicative of inflammation of CBD associated with or exaggerated by ERCP. Full article

(This article belongs to the Topic F-18 FDG PET/CT Imaging)

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5 pages, 19759 KiB  

Open AccessCase Report

A Rare Case of Thymic Rosai-Dorfman Disease Mimicking Malignancy on ¹⁸F-FDG PET/CT

by Tongtong Jia, Bin Zhang, Xiaoyi Zhang, Xin Xu, Shibiao Sang and Shengming Deng

Tomography 2022, 8(6), 2839-2843; https://doi.org/10.3390/tomography8060237 - 28 Nov 2022

Cited by 3 | Viewed by 1904

Abstract

Background Rosai-Dorfman disease (RDD), the massive lymphadenopathy characterized by the proliferation of sinus histiocytosis, is a relatively idiopathic benign disease with unknown etiology. We reported a rare case of thymic RDD detected by ¹⁸F-FDG PET/CT. A 23-year-old man with right-sided chest pain [...] Read more.

Background Rosai-Dorfman disease (RDD), the massive lymphadenopathy characterized by the proliferation of sinus histiocytosis, is a relatively idiopathic benign disease with unknown etiology. We reported a rare case of thymic RDD detected by ¹⁸F-FDG PET/CT. A 23-year-old man with right-sided chest pain underwent ¹⁸F-FDG PET/CT scan, showing increased ¹⁸F-FDG uptake in an anterior mediastinal mass corresponding to a thymic lesion at an enhanced CT scan. The patient was referred to surgery with the clinical suspicion of thymic malignancy. The histological examination and immunohistochemical results confirmed RDD. Conclusions This was the first case report of RDD isolated to the thymus and initially presented with chest pain. Moreover, there was no characteristic painless neck lymphadenopathy at any stage of the disease course. Thus, for young patients with thymus mass, RDD should be considered a rare but possible diagnosis. Full article

(This article belongs to the Topic F-18 FDG PET/CT Imaging)

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12 pages, 1321 KiB  

Open AccessArticle

Prognostic Value of [18F]-FDG PET/CT Radiomics Combined with Sarcopenia Status among Patients with Advanced Gastroesophageal Cancer

by Ricarda Hinzpeter, Seyed Ali Mirshahvalad, Roshini Kulanthaivelu, Claudia Ortega, Ur Metser, Zhihui A. Liu, Elena Elimova, Rebecca K. S. Wong, Jonathan Yeung, Raymond Woo-Jun Jang and Patrick Veit-Haibach

Cancers 2022, 14(21), 5314; https://doi.org/10.3390/cancers14215314 - 28 Oct 2022

Cited by 12 | Viewed by 2276

Abstract

We investigated, whether ¹⁸[18F]-FDG PET/CT-derived radiomics combined with sarcopenia measurements improves survival prognostication among patients with advanced, metastatic gastroesophageal cancer. In our study, 128 consecutive patients with advanced, metastatic esophageal and gastroesophageal cancer (n = 128; 26 females; 102 males; mean age [...] Read more.

We investigated, whether ¹⁸[18F]-FDG PET/CT-derived radiomics combined with sarcopenia measurements improves survival prognostication among patients with advanced, metastatic gastroesophageal cancer. In our study, 128 consecutive patients with advanced, metastatic esophageal and gastroesophageal cancer (n = 128; 26 females; 102 males; mean age 63.5 ± 11.7 years; age range: 29–91 years) undergoing ¹⁸[18F]-FDG PET/CT for staging between November 2008 and December 2019 were included. Segmentation of the primary tumor and radiomics analysis derived from PET and CT images was performed semi-automatically with a commonly used open-source software platform (LIFEX, Version 6.30, lifexsoft.org). Patients’ nutritional status was determined by measuring the skeletal muscle index (SMI) at the level of L3 on the CT component. Univariable and multivariable analyses were performed to establish a survival prediction model including radiomics, clinical data, and SMI score. Univariable Cox proportional hazards model revealed ECOG (<0.001) and bone metastasis (p = 0.028) to be significant clinical parameters for overall survival (OS) and progression free survival (PFS). Age (p = 0.017) was an additional prognostic factor for OS. Multivariable analysis showed improved prognostication for overall and progression free survival when adding sarcopenic status, PET and CT radiomics to the model with clinical parameters only. PET and CT radiomics derived from hybrid ¹⁸[18F]-FDG PET/CT combined with sarcopenia measurements and clinical parameters may improve survival prediction among patients with advanced, metastatic gastroesophageal cancer. Full article

(This article belongs to the Topic F-18 FDG PET/CT Imaging)

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13 pages, 2108 KiB  

Open AccessArticle

Radioembolization-Induced Changes in Hepatic [¹⁸F]FDG Metabolism in Non-Tumorous Liver Parenchyma

by Manon N. Braat, Caren van Roekel, Marnix G. Lam and Arthur J. Braat

Diagnostics 2022, 12(10), 2518; https://doi.org/10.3390/diagnostics12102518 - 17 Oct 2022

Viewed by 1529

Abstract

Background: [¹⁸F]FDG-PET/CT is increasingly used for response assessments after oncologic treatment. The known response criteria for [¹⁸F]FDG-PET/CT use healthy liver parenchyma as the reference standard. However, the [¹⁸F]FDG liver metabolism results may change as a result of [...] Read more.

Background: [¹⁸F]FDG-PET/CT is increasingly used for response assessments after oncologic treatment. The known response criteria for [¹⁸F]FDG-PET/CT use healthy liver parenchyma as the reference standard. However, the [¹⁸F]FDG liver metabolism results may change as a result of the given therapy. The aim of this study was to assess changes in [¹⁸F]FDG liver metabolism after hepatic ⁹⁰Y resin radioembolization. Methods: [¹⁸F]FDG-PET/CT scans prior to radioembolization and one and three months after radioembolization (consistent with the PERCIST comparability criteria), as well as ⁹⁰Y-PET/CT scans, were analyzed using 3 cm VOIs. The FDG activity concentration and absorbed dose were measured. A linear mixed-effects logistic regression model and logistic mixed-effects model were used to assess the correlation between the FDG-activity concentration, absorbed dose, and biochemical changes. Results: The median SUL_VOI,liver at baseline was 1.8 (range = 1.2–2.8). The mean change in SUL_VOI,liver per month with an increase in time was 0.05 (95%CI 0.02–0.09) at p < 0.001. The median absorbed dose per VOI was 31.3 Gy (range = 0.1–82.3 Gy). The mean percent change in ΔSUL_VOI,liver for every Gy increase in the absorbed dose was –0.04 (95%CI −0.22–0.14) at p = 0.67. The SUL_blood and SUL_spleen results showed no increase. Conclusions: The [¹⁸F]FDG metabolism in the normal liver parenchyma is significantly but mildly increased after radioembolization, which can interfere with its use as a threshold for therapy response. Full article

(This article belongs to the Topic F-18 FDG PET/CT Imaging)

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