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Critical Reviews in Oncology/hematology Nov 2019Sarcomas are a heterogeneous group of malignant tumours with variable clinical outcomes. Their presence in multiple body locations represents significant diagnostic and...
BACKGROUND
Sarcomas are a heterogeneous group of malignant tumours with variable clinical outcomes. Their presence in multiple body locations represents significant diagnostic and therapeutic challenges. Positron emission tomography/computed tomography (PET/CT) is an imaging tool that provides semiquantitative measurements of radiotracer concentration in tissue, such as SUV (standardised uptake value) and is increasingly used in clinical practice. This systematic review aims to evaluate the utility of PET/CT in sarcoma grading and prognostication, evaluation of treatment response, staging and restaging.
METHODS
Relevant studies published from January 2003 to August 2017 evaluating the utility of PET/CT in sarcoma grading and prognostication, staging, evaluation of treatment response and restaging were systematically searched for in scientific databases (e.g. PubMed, Medline and Embase) using key terms, including "soft tissue sarcoma," "osteosarcoma," "utility" and "PET/CT". Additionally, references of identified studies were reviewed. Study quality was assessed by "Quality Assessment of Diagnostic Accuracy Studies".
RESULTS
A total of 12 prospective studies (level II to III evidence) were included in the review for tumour grading and prognostication. There was a strong correlation between SUV and tumour grade where majority of intermediate/ high-grade STS have a significantly higher SUV. PET/CT has also shown potential in prognostication where decrease in SUV correlated with recurrence-free survival in both osteosarcoma and STS. Furthermore, 8 prospective trials of level II to IV evidence according to Oxford Centre of Evidence-based Medicine (CEBM) demonstrated the use of PET/CT in early identification of patients who will respond to treatment where ≥60% decrease in FDG uptake resulted in sensitivity and specificity of 100% and 71% respectively for assessment of histopathologic response. 11 retrospective trials (level III to IV evidence) reported on the use of PET/CT in staging and restaging with heterogeneous results.
CONCLUSION
Overall, higher quality evidence demonstrated PET/CT to be an important contributor towards sarcoma grading, prognostication and evaluation of treatment response. Larger prospective trials will be helpful to further establish the clinical value of PET/CT in sarcoma staging and restaging.
Topics: Bone Neoplasms; Fluorodeoxyglucose F18; Humans; Neoplasm Grading; Neoplasm Staging; Osteosarcoma; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sarcoma; Soft Tissue Neoplasms
PubMed: 31449981
DOI: 10.1016/j.critrevonc.2019.07.002 -
Cancer Apr 2012The goal of this study was to conduct a comparative analysis of whole body X-ray (WBXR) and (18) F-fluoro-deoxyglucose positron emission tomography ((18) FDG PET) in... (Comparative Study)
Comparative Study Review
BACKGROUND
The goal of this study was to conduct a comparative analysis of whole body X-ray (WBXR) and (18) F-fluoro-deoxyglucose positron emission tomography ((18) FDG PET) in staging and response assessment of multiple myeloma.
METHODS
We performed a systematic review of studies comparing (18) FDG PET with WBXR and/or magnetic resonance imaging in terms of sensitivity for myeloma-related bone disease at staging and during follow-up.
RESULTS
Eighteen studies involving 798 patients met the inclusion criteria. The mean Quality Assessment of Diagnostic Accuracy Studies (QUADAS) score, expressed as a percentage of the maximum score, was 61%. In 7 studies (n = 242 patients), concordance assessment between WBXR and (18) FDG PET scan was possible, showing a higher sensitivity of the (18) FDG PET in the detection of myeloma bone lesions in 6 studies. The only study reporting on the prognostic value of (18) FDG PET at staging found that the number of FDG-avid focal lesions was an independent prognostic parameter. In addition, the limited studies on response monitoring showed that normalization of (18) FDG PET during treatment correlated with a superior clinical outcome.
CONCLUSIONS
In general, (18) FDG PET has a superior sensitivity for myeloma bone lesions compared with WBXR. Future studies have to validate the additive value of myeloma-related bone disease detected on (18) FDG PET-computed tomography (CT) in predicting outcome. Response monitoring with the use of (18) FDG PET-CT during treatment is promising, allowing more precise prediction of prognosis compared with the standard response monitoring. In view of the expanding treatment options for multiple myeloma, this may provide important information for treatment decisions in the future.
Topics: Bone Neoplasms; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Multiple Myeloma; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Whole-Body Irradiation
PubMed: 21887677
DOI: 10.1002/cncr.26467 -
Movement Disorders : Official Journal... Jul 2022Mutations in the GBA gene cause Gaucher's disease (GD) and constitute the most frequent genetic risk factor for idiopathic Parkinson's disease (iPD). Nonmanifesting... (Review)
Review
BACKGROUND
Mutations in the GBA gene cause Gaucher's disease (GD) and constitute the most frequent genetic risk factor for idiopathic Parkinson's disease (iPD). Nonmanifesting carriers of GBA mutations/variants (GBA-NMC) constitute a potential PD preclinical population, whereas PD patients carrying some GBA mutations/variants (GBA-PD) have a higher risk of a more aggressive disease course. Different neuroimaging techniques are emerging as potential biomarkers in PD and have been used to study GBA-associated parkinsonism.
OBJECTIVE
The aim is to critically review studies applying neuroimaging to GBA-associated parkinsonism.
METHODS
Literature search was performed using PubMed and EMBASE databases (last search February 7, 2022). Studies reporting neuroimaging findings in GBA-PD, GD with and without parkinsonism, and GBA-NMC were included.
RESULTS
Thirty-five studies were included. In longitudinal studies, GBA-PD patients show a more aggressive disease than iPD at both structural magnetic resonance imaging and 123-fluoropropylcarbomethoxyiodophenylnortropane single-photon emission computed tomography. Fluorodeoxyglucose-positron emission tomography and brain perfusion studies reported a greater cortical involvement in GBA-PD compared to iPD. Overall, contrasting evidence is available regarding GBA-NMC for imaging and clinical findings, although subtle differences have been reported compared with healthy controls with no mutations.
CONCLUSIONS
Although results must be interpreted with caution due to limitations of the studies, in line with previous clinical observations, GBA-PD showed a more aggressive disease progression in neuroimaging longitudinal studies compared to iPD. Cognitive impairment, a "clinical signature" of GBA-PD, seems to find its neuroimaging correlate in the greater cortical burden displayed by these patients as compared to iPD. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Topics: Gaucher Disease; Glucosylceramidase; Humans; Neuroimaging; Parkinson Disease; Parkinsonian Disorders
PubMed: 35521899
DOI: 10.1002/mds.29047 -
Revista Brasileira de Reumatologia 2014Rheumatoid arthritis (RA) is a disease characterized by inflammation of the synovial membrane. Several authors have investigated the role of positron emission tomography... (Review)
Review
INTRODUCTION
Rheumatoid arthritis (RA) is a disease characterized by inflammation of the synovial membrane. Several authors have investigated the role of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ((18)F-FDG) in RA.
OBJECTIVES
To systematically review the current literature on the role of (18)F-FDG PET in the diagnosis, determination of disease activity and assessment of treatment response in patients with RA.
METHODS
Searches were conducted in Medline, Cochrane Library, Lilacs, Pubmed and Scopus in Portuguese, English and Spanish languages, using the keywords "rheumatoid arthritis", "synovitis", "FDG", "PET", "glycolytic metabolism" and "disease activity".
RESULTS
142o articles were initially identified, of which only 40 were related directly to the subject. Twelve original articles and three case reports that met the inclusion criteria were selected.
DISCUSSION
The presence of activated macrophages and fibroblasts in pannus are responsible for the intense periarticular uptake of (18)F-FDG. The uptake patterns do not allow the differential diagnosis with other arthritides. The uptake intensity and the number of joints involved are metabolic parameters of disease activity that correlate well with the composite indices. Longitudinal studies of PET have proven useful in assessing the response to treatment with anti-TNF. When performed early, PET can predict the therapeutic response.
CONCLUSION
Although the actual role of this new technique for the investigation of RA is not yet established, (18)F-FDG PET is a promising tool in determining the activity and prediction of response to treatment of patients with RA.
Topics: Arthritis, Rheumatoid; Fluorodeoxyglucose F18; Humans; Positron-Emission Tomography; Radiopharmaceuticals; Treatment Outcome
PubMed: 25458029
DOI: 10.1016/j.rbr.2014.07.002 -
Journal of Korean Medical Science Nov 2021We conducted a pooled analysis of the diagnostic accuracy of F-18 fluoroestradiol (F-18 FES) positron emission tomography/computed tomography (PET/CT) assessing estrogen... (Meta-Analysis)
Meta-Analysis
BACKGROUND
We conducted a pooled analysis of the diagnostic accuracy of F-18 fluoroestradiol (F-18 FES) positron emission tomography/computed tomography (PET/CT) assessing estrogen receptor expression of patients who have recurrent or metastatic breast cancer.
METHODS
Two investigators and seven related experts (from the departments of nuclear medicine, hematological oncology, surgery, and evidence-based medicine) evaluated the effectiveness of F-18 FES PET/CT according to diagnostic accuracy and correlation with immunohistochemistry tests via systematic literature review, and safety according to test-related side effects. The present study was conducted in accordance with the Scottish Intercollegiate Guidelines (SIGN), and the Cochrane, and Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. The SIGN tools were used for quality assessment.
RESULTS
Of the 512 articles retrieved in the literature search, 8 were deemed to be eligible for inclusion. Results of the evaluation indicated that the F-18 FES PET/CT test was safe because patients who reported pain in the injection site in the analyzed articles are most likely to be caused by mechanical injury from needle injection not by administration of radioactive materials. Assessment of diagnostic accuracy based on data from seven studies revealed a pooled sensitivity and specificity of 0.86 and 0.85, respectively.
CONCLUSION
As such, the test was evaluated to be a safe and effective and, considering the anatomical site where only invasive tests are possible, the test was deemed to have high clinical utility.
Topics: Breast Neoplasms; Estradiol; Female; Fluorine Radioisotopes; Humans; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sensitivity and Specificity
PubMed: 34725978
DOI: 10.3346/jkms.2021.36.e271 -
Diagnostics (Basel, Switzerland) Jul 2021The purpose of this paper is to investigate the prognostic value of fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters in... (Review)
Review
A Systematic Review and Meta-Analysis of the Prognostic Impact of Pretreatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Parameters in Patients with Locally Advanced Cervical Cancer Treated with Concomitant Chemoradiotherapy.
BACKGROUNDS
The purpose of this paper is to investigate the prognostic value of fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters in patients treated with concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC).
METHODS
Studies that met the following criteria were retrieved from PubMed and Embase: patients treated with CCRT for LACC; FDG PET/CT scans performed before CCRT treatment; and a detected relationship between the parameters of FDG PET/CT and the prognosis of patients. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were used to estimate the overall survival (OS) or event-free survival (EFS).
RESULTS
In total, 14 eligible studies with 1313 patients were included in this meta-analysis. Patients with a high maximum standardized uptake value (SUVmax) have a shorter OS than those with a low SUV (HR = 2.582, 95% = CI 1.936-3.443, < 0.001). Primary tumor SUV values (HR = 1.938, 95% CI = 1.203-3.054, = 0.004) were significantly correlated with EFS, with a relatively high heterogeneity ( = 84% and = 69.4%, respectively). Based on the limited data, the combined HR for EFS with the highest primary tumor total lesion glycolysis (TLG) and metabolic tumor volume (MTV) was 1.843 (95% CI = 1.100-3.086, = 0.02) and 2.06 (95% CI = 1.21-3.51, = 0.007), respectively. Besides, the combined HR for OS with the highest nodal SUV was 2.095 (95% CI = 2.027-2.166, < 0.001).
CONCLUSION
A high primary SUVmax has a significant correlation with the OS and EFS of patients treated with CCRT for LACC and may therefore serve as a prognostic predictor. Due to the limited data, to explore the correlation between survival and TLG, MTV, and nodal SUVmax, further large-scale prospective studies are needed.
PubMed: 34359345
DOI: 10.3390/diagnostics11071258 -
Cancer Medicine Jan 2019Studies on nasopharyngeal carcinoma (NPC) in five electronic databases were systematically searched online from the inception to June 5, 2018. Quality of the included... (Meta-Analysis)
Meta-Analysis
Positron emission tomography/computed tomography outperforms MRI in the diagnosis of local recurrence and residue of nasopharyngeal carcinoma: An update evidence from 44 studies.
Studies on nasopharyngeal carcinoma (NPC) in five electronic databases were systematically searched online from the inception to June 5, 2018. Quality of the included studies was assessed using the updated Quality Assessment of Diagnostic Accuracy Studies 2. Data of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the 95% confidence intervals were pooled using a bivariate random-effect model. Forty-four studies with 61 groups of data and totally 3369 patients were included in the qualitative and quantitative synthesis analysis. The overall estimated sensitivity and specificity of positron emission tomography/computed tomography/magnetic resonance imaging (PET-CT/MRI) for local recurrent/residual NPC were 0.90 and 0.85, respectively. The pooled area under the curve of (AUC) of PET-CT/MRI in the summary receiver operator characteristic curve was 0.94. Subgroup analysis showed MRI vs PET-CT had lower sensitivity (0.83 vs 0.92) and specificity (0.78 vs 0.89). The AUCs of MRI and PET-CT were 0.87 and 0.96, respectively. No-cross of 95% CI was found in MRI vs PET/CT (0.87-0.90 vs 0.94-0.98). Meta-regression showed PET/CT vs MRI was a potential source of heterogeneity. PET/CT and MRI both showed quite high overall ability in diagnosing local recurrent/residual NPC, but the subgroup analysis indicated PET-CT was superior over MRI in diagnosis of local recurrence and residue of NPC after radiotherapy. The examination methods affected the heterogeneity within studies.
Topics: Humans; Magnetic Resonance Imaging; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography
PubMed: 30578604
DOI: 10.1002/cam4.1882 -
Journal of Orthopaedic Surgery and... Jan 2023Fluorine-18 fluorodeoxyglucose positron emission tomography (F-FDG PET) and PET/CT have been suggested for confirming or excluding musculoskeletal infection but the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Fluorine-18 fluorodeoxyglucose positron emission tomography (F-FDG PET) and PET/CT have been suggested for confirming or excluding musculoskeletal infection but the diagnostic value of this tool for pyogenic spondylitis remains to be confirmed. This meta-analysis was performed to verify the accuracy of F-FDG PET and PET/CT in diagnosing suspected pyogenic spondylitis by performing a systematic review and meta-analysis.
METHODS
We conducted a comprehensive literature search of PubMed, Embase and Cochrane Library to retrieve diagnostic accuracy studies in which suspected pyogenic spondylitis was assessed with F-FDG PET or PET/CT. The pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), summarized receiver operating characteristic curve (sROC) and the area under the sROC (AUC) were calculated by using Stata software.
RESULTS
A total of 18 eligible studies (660 patients) with suspected pyogenic spondylitis were included in the quantitative analysis. F-FDG PET and PET/CT illustrated relatively high sensitivity (0.91, 95% CI: 0.84-0.95) and specificity (0.90, 95% CI: 0.79-0.95) for the diagnosis of pyogenic spondylitis. The pooled DOR and AUC were 86.00 (95% CI, 31.00-240.00) and 0.96 (95% CI, 0.94-0.97), respectively. For diagnosing pyogenic spondylitis without previous spine surgery, the pooled sensitivity, specificity, DOR and AUC were 0.93 (95% CI, 0.85-0.97), 0.91 (95% CI, 0.77-0.97), 136 (95% CI, 35-530) and 0.97 (95% CI, 0.95-0.98), respectively. For diagnosing postoperative pyogenic spondylitis, the pooled sensitivity, specificity, DOR and AUC were 0.85 (95% CI, 0.71 to 0.93), 0.87 (95% CI, 0.66 to 0.96), 38 (95% CI, 9 to 167) and 0.92 (95% CI, 0.89 to 0.94), respectively.
CONCLUSION
F-FDG PET and PET/CT presented satisfactory accuracy for diagnosing pyogenic spondylitis. The diagnostic effect of this nuclear imaging method for pyogenic spondylitis without previous spine surgery seems to be better than that for the postoperative ones. However, whether F-FDG PET and PET/CT could become a routine in patients with suspected pyogenic spondylitis remains to be confirmed.
LEVEL OF EVIDENCE
Level I evidence, a summary of meta-analysis.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Radiopharmaceuticals; Sensitivity and Specificity; Positron-Emission Tomography; Spondylitis
PubMed: 36627651
DOI: 10.1186/s13018-023-03507-z -
European Urology Open Science Nov 2021In December 2020, the US Food and Drug Administration approved a Ga-labeled prostate-specific membrane antigen ligand (Ga-PSMA-11) for positron emission tomography (PET)... (Review)
Review
Comparison of Ga-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography/Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography for Primary Staging of Prostate Cancer: A Systematic Review and Meta-analysis.
CONTEXT
In December 2020, the US Food and Drug Administration approved a Ga-labeled prostate-specific membrane antigen ligand (Ga-PSMA-11) for positron emission tomography (PET) in patients with suspected prostate cancer (PCa) metastasis who are candidates for initial definitive therapy. Ga-PSMA PET is increasingly performed for these patients and is usually combined with computed tomography (CT). In recent years, Ga-PSMA PET has been combined with high-resolution magnetic resonance imaging (MRI), which is beneficial for T staging and may further enhance the staging of primary PCa.
OBJECTIVE
To compare the diagnostic accuracy of Ga-PSMA PET/MRI with Ga-PSMA PET/CT for staging of primary PCa.
EVIDENCE ACQUISITION
A comprehensive literature search was performed using Embase, PubMed/Medline, Web of Science, Cochrane Library, and Google Scholar up to June 24, 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the QUADAS-2 tool.
EVIDENCE SYNTHESIS
The search identified 2632 articles, of which 27 were included. The diagnostic accuracy of Ga-PSMA PET/MRI, measured as the pooled natural logarithm of diagnostic odds ratio (lnDOR), was 2.27 (95% confidence interval [CI] 1.21-3.32) for detection of extracapsular extension (ECE), 3.50 (95% CI 2.14-4.86) for seminal vesicle invasion (SVI), and 4.73 (95% CI 2.93-6.52) for lymph node metastasis (LNM). For Ga-PSMA PET/CT, the analysis showed lnDOR of 2.45 (95% CI 0.75-4.14), 2.94 (95% CI 2.26-3.63), and 2.42 (95% CI 2.07-2.78) for detection of ECE, SVI, and LNM, respectively. The overall risk of bias and applicability concerns were assessed as moderate and low, respectively.
CONCLUSIONS
Ga-PSMA PET/MRI shows high diagnostic accuracy equivalent to that of Ga-PSMA PET/CT for detection of ECE, SVI, and LNM in staging of PCa. There is an urgent need for direct comparison of the two diagnostic tests in future research.
PATIENT SUMMARY
The use of radioactively labeled molecules that bind to prostate-specific membrane antigen (Ga-PSMA) for positron emission tomography (PET) scans combined with either computed tomography (CT) or magnetic resonance imaging (MRI) is increasing for prostate cancer diagnosis. There is a need for direct comparison of the two tests to demonstrate the benefit of Ga-PSMA PET/MRI for determining tumor stage in prostate cancer.
TAKE HOME MESSAGE
After the recent US Food and Drug Administration approval of Ga-labeled prostate-specific membrane antigen ligand (Ga-PSMA) positron emission tomography (PET) for staging of primary prostate cancer (PCa), it is expected that the use of this imaging modality will increase rapidly. Our review of the literature shows that Ga-PSMA PET/magnetic resonance imaging has high diagnostic accuracy equivalent to that of Ga-PSMA PET/computed tomography in primary PCa staging. There is an urgent need for direct head-to-head comparison of the two diagnostic tests in future research.
PubMed: 34632423
DOI: 10.1016/j.euros.2021.09.006 -
Arthritis Care & Research Jan 2014To determine the current status of positron emission tomography (PET) as a tool for diagnosis and monitoring of peripheral inflammatory arthritis (IA). (Review)
Review
OBJECTIVE
To determine the current status of positron emission tomography (PET) as a tool for diagnosis and monitoring of peripheral inflammatory arthritis (IA).
METHODS
For conducting this systematic review, the PubMed (Medline), Embase, and Cochrane Library databases were searched until December 31, 2012. Studies of PET for diagnosis and/or therapy monitoring of peripheral IA were included. Data were summarized qualitatively using best evidence synthesis.
RESULTS
Eighteen articles met our inclusion criteria. The majority of studies were feasibility studies with varying methods applied. All studies demonstrated that PET visualized IA with high sensitivity, corresponding to clinical assessments. PET outcome of clinically active IA also matched that of ultrasound and magnetic resonance imaging. PET differentiates from other modalities by (quantitative) imaging of molecular sites in the synovium. The first studies reporting on the potential clinical applications of PET to image subclinical synovitis in preclinical RA and during therapy have been published. The results are promising, but the number and study populations of these studies are still limited.
CONCLUSION
Thus far, a limited number of PET studies addressing IA imaging have been published. The PET modality seems to offer highly sensitive and potentially specific imaging of IA at the (quantitative) molecular level. Clinical application studies for early diagnostics and therapy monitoring are arising, but these topics should be further explored in future studies with larger cohorts. For integration in clinical practice, aspects such as radiation burden and cost-effectiveness should also be taken into account.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antirheumatic Agents; Arthritis; Child; Child, Preschool; Disease Management; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Sensitivity and Specificity; Synovial Membrane; Ultrasonography; Young Adult
PubMed: 24124027
DOI: 10.1002/acr.22184