A case series of FDG PET scan: hypometabolic lesions that matter in oncology

Chan, Tak Kwong; Ng, Koon Kiu; Kung, Boom Ting; Yong, Ting Kun Au

doi:10.1259/bjrcr.20220144

Cited by 2 publications

(4 citation statements)

References 10 publications

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“…In general, necrotic CRLM lesions are typically hypometabolic and hypodense and can hardly achieve satisfactory response [ 16 ]. That's why the temporarily responding segment II lesion has established the progression observed in the last two serial [ 18 F]FDG PET/CT scans.…”

Section: Discussionmentioning

confidence: 99%

Beyond CT: A Case Analysis of Serial [18F]FDG PET/CT for Assessment of Necrosis and Early Recurrence in Colorectal Liver Metastases

Al-Ibraheem,

Ruzzeh,

Badarneh

et al. 2023

Cureus

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Colorectal cancer is a common malignancy, with the liver being the most frequent site of metastases. [ 18 F] Fluorodeoxyglucose ([ 18 F]FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a valuable tool in detecting and evaluating liver metastases and extrahepatic disease. Herein, we present a case of a 76-year-old male with colorectal cancer associated with lung and liver metastases. The patient received 12 chemoimmunotherapy cycles and was then put on maintenance cetuximab; serial [ 18 F]FDG PET/CT scans were utilized to evaluate treatment response. The patient exhibited a positive response to chemoimmunotherapy, with regression of rectal disease and resolution of pulmonary metastatic nodules. Serial [ 18 F]FDG PET/CT scans unveiled three distinct necrotic patterns. The case report advocates that [ 18 F]FDG PET/CT plays an important role in evaluating colorectal liver metastases (CRLM) response to treatment, identifying transient necrosis, early recurrence, and emphasizing the limitations of post-treatment CT scans in identifying early CRLM recurrence. Integrating functional imaging, particularly [ 18 F]FDG PET/CT, promises for management monitoring and surveillance of CRLM patients.

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Section: Discussionmentioning

confidence: 99%

Beyond CT: A Case Analysis of Serial [18F]FDG PET/CT for Assessment of Necrosis and Early Recurrence in Colorectal Liver Metastases

Al-Ibraheem,

Ruzzeh,

Badarneh

et al. 2023

Cureus

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“…For patients having received radiation therapy for brain metastases, either radiation necrosis or recurrent metastases can exhibit hypometabolism [30]. Patients with previous cerebrovascular accident, epilepsy, cerebral trauma, cerebral infection, other brain neoplasm or neurodegenerative diseases may also show asymmetrical hypometabolism [6]. It is therefore important to refer to relevant clinical history when hypometabolism is identified.…”

Section: Addressing Hypometabolism and Previous Studiesmentioning

confidence: 99%

“…Metastatic brain lesions may manifest as hypometabolism due to perifocal vasogenic oedema, cystic, necrotic, calcific or haemorrhagic components or inherent properties of tumour cells [6]. Zidan MA et al reported that 57.7% of brain metastases detected on FDG PET showed hypometabolism [26].…”

Section: Addressing Hypometabolism and Previous Studiesmentioning

confidence: 99%

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The diagnostic performance of 18fluorine-fluorodeoxyglucose PET for brain metastases: a systematic review and meta-analysis

Chan

Lau

et al. 2023

Nuclear Medicine Communications

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Introduction Brain metastases may manifest as hypermetabolism or hypometabolism compared with normal brain activity on 18fluorine-fluorodeoxyglucose PET (18F-FDG PET). We aim to undertake a systematic review and meta-analysis to determine the diagnostic accuracy of FDG PET for detecting brain metastases from different extracranial primary cancers. Methods PubMed and EMBASE were searched systematically. Study selection and quality assessment were performed independently by two authors. Meta-analysis was performed using a bivariate random-effects model. Subgroup analysis and meta-regression would be performed if heterogeneity was found. Results A total of 2227 patients from 11 studies were included in the review and analysis. Using the bivariate random-effects model, summary patient-based sensitivity and specificity for all 11 studies were estimated to be 0.440 [95% confidence interval (CI)] 0.295–0.597) and 0.997 (95% CI, 0.977–1.000). In view of significant between-study heterogeneity (I 2 = 74.0% for sensitivity and I 2 = 67.3% for specificity), subgroup analyses were performed. Meta-regression showed significantly higher patient-based summary sensitivity for the three better-quality studies (a total of 1037 patients) with satisfactory index test (counting both hypermetabolism and hypometabolism as positive index test) and satisfactory reference standards (other imaging and clinical follow-up) compared with other included studies [0.735 (95% CI, 0.601–0.836) vs 0.304 (95% CI, 0.223–0.400), P value = 0.000]. Conclusion Our systematic review and meta-analysis showed that FDG PET has overall limited sensitivity and excellent specificity in the detection of brain metastases from extracranial primary cancers. Importantly, subgroup analyses showed that the sensitivity can be significantly improved by raising awareness of asymmetrical hypometabolism. Further studies are warranted to assess the benefits of including the brain in FDG PET studies for all or certain groups of oncological patients.

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A case series of FDG PET scan: hypometabolic lesions that matter in oncology

Cited by 2 publications

References 10 publications

Beyond CT: A Case Analysis of Serial [18F]FDG PET/CT for Assessment of Necrosis and Early Recurrence in Colorectal Liver Metastases

Beyond CT: A Case Analysis of Serial [18F]FDG PET/CT for Assessment of Necrosis and Early Recurrence in Colorectal Liver Metastases

The diagnostic performance of 18fluorine-fluorodeoxyglucose PET for brain metastases: a systematic review and meta-analysis

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