Are dual-phase 18F-FDG PET scans necessary in nasopharyngeal carcinoma to assess the primary tumour and loco-regional nodes?

Yen, Tzu‐Chen; Chang, Yue; Chan, Sheng-Chieh; Chang, Joseph Tung-Chieh; Hsu, Charles Ching–Hsiang; Lin, Kun‐Ju; Lin, Wuu-Jyh; Fu, Ying; Ng, Shu‐Hang

doi:10.1007/s00259-004-1719-2

Cited by 50 publications

(21 citation statements)

References 31 publications

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“…Although some studies have shown that a comparison of FDG uptake in the early phase and that in the delayed phase is useful for distinguishing malignancy from inflammation [18,[21][22][23][24][25][26], from results of our study, a one-phase scan might be sufficient to predict cause-specific survival and local control rates in patients who receive CRT for postoperative locoregional recurrent esophageal cancer. Furthermore, we showed that SUV max in FDG-PET before CRT tended to be correlated with cause-specific survival but not with local control rate.…”

Section: Discussionmentioning

confidence: 87%

18F-fluorodeoxyglucose positron emission tomography immediately after chemoradiotherapy predicts prognosis in patients with locoregional postoperative recurrent esophageal cancer

et al. 2010

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Section: Discussionmentioning

confidence: 87%

18F-fluorodeoxyglucose positron emission tomography immediately after chemoradiotherapy predicts prognosis in patients with locoregional postoperative recurrent esophageal cancer

et al. 2010

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“…These reports have generally been favorable showing improvement in detection or contrast for brain [2], breast [3], lung [4], pancreas [5][6][7], gallbladder [8], hepatocellular [9], cervical [10,11], intra-abdominal [12], intra-thoracic [13], soft-tissue [14], and other tumors [15,16]. For nasopharyngeal carcinoma, high sensitivity did not improve with delayed imaging [17]. Most of these studies demonstrate improvement in contrast or tumor detection; however, in some cases, the RI did not provide incremental improvement, and the change in SUV was in many cases close to the reported reproducibility limit of SUV measurements [18,19].…”

Section: Discussionmentioning

confidence: 93%

Increasing Uptake Time in FDG-PET: Standardized Uptake Values in Normal Tissues at 1 versus 3 h

et al. 2008

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On FDG imaging at 3 h compared to 1 h, significant changes were apparent, but the magnitude of changes was modest overall. Three-hour delayed imaging demonstrated significantly lower aortic blood pool and adipose tissue activity and significantly higher cerebellum, muscle, spleen, and bone marrow activity. Hepatic and lung activities were not significantly different. These results suggest that previously reported improvements in tumor image contrast with delayed imaging may be primarily due to cumulative FDG uptake within the tumor rather than reduction in normal background activity.

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“…72 In evaluating the locoregional status of nasopharyngeal carcinoma, the results of a prospective study, including 84 patients, indicated that FDG-PET is superior to MRI in identifying lower neck nodal metastasis, but 3-hour scans did not give further information in detecting both primary tumors or locoregional metastatic nodes with respect to 40-minute images. 73 Nevertheless, it is worth noting that in this study, diazepam 5 mg per os, was routinely given before FDG injection, and this fact might decrease the hexokinase/glucose-6-phosphatase ratio and so render the DP technique ineffective under these circumstances. 74 In fact, diazepam can reduce phosphorylation of glucose by inhibiting hexokinase activity, and its effect after orally administration commences approximately 30 minutes after ingestion and lasts many hours; therefore, it will likely minimally affect the early images (within the first hour), whereas it will significantly influence the FDG uptake on delayed images.…”

Section: Other Tumorsmentioning

confidence: 87%

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Schillaci

2012

Seminars in Nuclear Medicine

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Positron emission tomography (PET) and positron emission tomography/computed tomography imaging with fluorodeoxyglucose (FDG) are widely used as a powerful evaluation modality in oncological nuclear medicine not only for detecting tumors but also for staging and for therapy monitoring. Nevertheless, there are numerous causes of FDG uptake in benign processes seen on PET images. In fact, the degree of FDG uptake is related to the cellular metabolic rate and the number of glucose transporters. FDG accumulation in tumors is due, in part, to an increased number of glucose transporters in malignant cells. However, FDG is not specific for neoplasms: a similar situation exists in inflammation; activated inflammatory cells demonstrate increased expression of glucose transporters. Therefore, there is growing interest in improving the specificity of FDG-PET in patients with cancer. Preliminary studies showed that in several neoplasms, the uptake of FDG continues to increase for hours after radiopharmaceutical injection, and this difference in the time course of FDG uptake could be useful to improve the accuracy of PET to distinguish benign lesions from malignant ones. Also in experimental cultures, dual-point acquisition (early at 40-60 minutes postinjection and delayed at 90-270 minutes) demonstrated that it is able to differentiate inflammatory from neoplastic tissue. In general, inflammatory tissue is expected to reduce FDG uptake as the time goes by, whereas the uptake in the neoplastic lesions is supposed to be increasing. There is evidence in the recent literature of the clinical usefulness of dual-time-point FDG-PET imaging in a wide variety of malignancies, including those of head and neck, lung, breast, gallbladder, cervix, liver, and in brain tumors. A lesion is likely to be malignant if the standard uptake value increases over time, whereas it is likely to be benign if the standard uptake value is stable or decreases. It is worth noting that in many of these studies, dual-time-point PET improved not only the specificity but also the sensitivity in assessing breast, pulmonary, liver, and other tumors because of increased lesion-to-background ratio, as a consequence of FDG washout from the surrounding normal tissues and increasing neoplastic uptake. Semin Nucl Med 42:267-280

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Are dual-phase 18F-FDG PET scans necessary in nasopharyngeal carcinoma to assess the primary tumour and loco-regional nodes?

Abstract: 18F-FDG PET is superior to MRI in identifying lower neck nodal metastasis of NPC. Additional 3-h 18F-FDG PET contributes no further information in the detection of primary tumours or loco-regional metastatic nodes in untreated NPC patients.

Cited by 50 publications

References 31 publications

18F-fluorodeoxyglucose positron emission tomography immediately after chemoradiotherapy predicts prognosis in patients with locoregional postoperative recurrent esophageal cancer

18F-fluorodeoxyglucose positron emission tomography immediately after chemoradiotherapy predicts prognosis in patients with locoregional postoperative recurrent esophageal cancer

Increasing Uptake Time in FDG-PET: Standardized Uptake Values in Normal Tissues at 1 versus 3 h

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

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