Incidence and Economic Impact of Incidental Findings on <sup>18</sup>F-FDG PET/CT Imaging

Adams, Scott; Rakheja, Rajan; Bryce, Rhonda; Babyn, Paul

doi:10.1016/j.carj.2017.08.001

Cited by 37 publications

(27 citation statements)

References 22 publications

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“…Also in the present study, physiological intestinal tracer uptake led to misinterpretations; it led to futile additional testing, and, in one patient, IBD was overlooked. Overall, false positive and negative findings were rare, and in concordance with a previous study, relevant incidental findings in children were infrequent [ 10 ]. We did not present measures of diagnostic accuracy because sensitivity and specificity can vary over different suspected diagnoses, as does prior probability and thus predictive value.…”

Section: Discussionsupporting

confidence: 89%

“…In adults, the literature also includes prospective studies on the performance of FDG-PET/CT for various inflammatory or infectious diseases, such as FUO, gram-positive bacteremia and vasculitis [ 9 ]. It is likely that test performance in infection/inflammation is at least comparable in children with the advantage of a lower frequency of incidental findings, e.g., due to a lower incidence of malignancies in the pediatric population [ 10 ]. There are no studies describing the current practice of FDG-PET/CT in children, although its use is rising [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of FDG-PET/CT Use in Children with Suspected Infection or Inflammation

et al. 2020

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[18F]-FDG-PET/CT ([18F]-fluoro-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT)) is increasingly used as a diagnostic tool in suspected infectious or inflammatory conditions. Studies on the value of FDG-PET/CT in children are scarce. This study assesses the role of FDG-PET/CT in suspected infection or inflammation in children. In this multicenter cohort study, 64 scans in 59 children with suspected infection or inflammation were selected from 452 pediatric FDG-PET/CT scans, performed in five hospitals between January 2016 and August 2017. Main outcomes were diagnostic information provided by FDG-PET/CT for diagnostic scans and impact on clinical management for follow-up scans. Of these 64 scans, 50 were performed for primary diagnosis and 14 to monitor disease activity. Of the positive diagnostic scans, 23/27 (85%) contributed to establishing a diagnosis. Of the negative diagnostic scans, 8/21 (38%) contributed to the final diagnosis by narrowing the differential or by providing information on the disease manifestation. In all follow-up scans, FDG-PET/CT results guided management decisions. CRP was significantly higher in positive scans than in negative scans (p = 0.004). In 6% of diagnostic scans, relevant incidental findings were identified. In conclusion, FDG-PET/CT performed in children with suspected infection or inflammation resulted in information that contributed to the final diagnosis or helped to guide management decisions in the majority of cases. Prospective studies assessing the impact of FDG-PET/CT results on diagnosis and patient management using a structured diagnostic protocol are feasible and necessary.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Evaluation of FDG-PET/CT Use in Children with Suspected Infection or Inflammation

et al. 2020

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“…The authors included findings which were not considered “relevant” findings in our study (e.g., coronary artery calcifications or heart valve calcifications), and their rate of findings with impact on patient management was lower as compared to our study (114 of 912 findings versus 80 of 181 findings). The latter, may possibly be explained by the younger age (i.e., mean age 49) of the patient population in the study by Nihuis et al 24 , 25 , and also by a higher comorbidity rate in cardiovascular patients, in general 26 .…”

Section: Discussionmentioning

confidence: 90%

Impact of unknown incidental findings in PET/CT examinations of patients with proven or suspected vascular graft or endograft infections

Husmann

Eberhard

Huellner

et al. 2021

Sci Rep

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Vascular graft or endograft Infections (VGEI) are rare but severe complications of vascular reconstructive surgery, and associated with significant mortality and morbidity risk. Positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (PET/CT) has been shown to have a high diagnostic accuracy in the detection of VGEI. In this single-center prospective cohort study, we assessed the rate and the impact on patient management of relevant unknown incidental findings in PET/CT of patients with proven or suspected VGEI, and clinical follow-up of all patients was performed. Our study results show a comparably high rate of relevant unknown incidental findings (181 in 502 examinations), with documented direct impact on patient management in 80 of 181 (44%) of all findings. PET/CT scan- and patient-based evaluation revealed impact on patient management in 76 of 502 (17%) of all PET/CT scans, and in 59 of 162 (36%) of all patients, respectively. Furthermore, PET/CT correctly identified the final diagnosis in 20 of 36 (56%) patients without VGEI. In conclusion, in proven and suspected VGEI, PET/CT detects a high rate of relevant unknown incidental findings with high impact on patient management.

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“…The cost implications involved in further investigating these radiological findings also needs discussed. Adams et al calculated costs of follow-up in 215 consecutive patients undergoing PET-CT in Ontario, Canada [33]. Of these, 161 (74.9%) had incidental findings and 75 reports had recommendations for further follow-up.…”

Section: Discussionmentioning

confidence: 99%

Incidental uptake of fluorodeoxyglucose in the Waldeyer’s ring and risk of oropharyngeal malignancy

Bujoreanu

Gujral

Wallitt

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Fluorodeoxyglucose (FDG) positron emission tomography (PET) is increasingly used to diagnose and stage malignancy. The aim of this article is to investigate the significance of incidental FDG uptake in the Waldeyer’s ring and to assess its value in predicting clinically occult oropharyngeal malignancy. Methods All FDG-PET/CT scans performed in Imperial College NHS Foundation Trust, UK between January 2012 and November 2018 were included. Patients with known or suspected oropharyngeal malignancy or lymphoma were excluded. Minimum follow-up was 12 months. Results A total of 724 scans revealed oropharyngeal uptake of FDG. Of these, 102 were included in the study. Most patients (62.1%) were scanned as part of staging for other malignancies. Oropharyngeal FDG uptake was asymmetrical in 57.3% of the cases. Uptake was more common in the tonsils (56.3%), followed by the tongue base (31.1%) and both sites (12.6%). In 41.7% of reports, appearance was described as likely physiological; however, 52.4% of reports advised direct visualisation, clinical correlation or ENT opinion. Only 24.3% (25/102) of patients were referred and seen by ENT, 14.6% (15/102) of which had an interval PET scan and 8.7% (9/102) proceeded to tissue diagnosis. There was one oropharyngeal cancer identified and one unexpected metastasis from esophageal cancer. Conclusion Incidental uptake on PET/CT in the oropharynx is common. However, malignancy is rare (1.9%) and, when present, is associated with high SUVmax and asymmetrical uptake. Imaging results must be correlated clinically. These patients should be seen by an ENT specialist yet most may not require further investigations.

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Incidence and Economic Impact of Incidental Findings on ¹⁸F-FDG PET/CT Imaging

Abstract: As the incidence of incidental findings increases with age and a larger proportion of elderly patients is expected as population demographics change, it will be increasingly important to consider incidental findings on PET/CT imaging with standardized approaches to follow-up.

Cited by 37 publications

References 22 publications

Evaluation of FDG-PET/CT Use in Children with Suspected Infection or Inflammation

Evaluation of FDG-PET/CT Use in Children with Suspected Infection or Inflammation

Impact of unknown incidental findings in PET/CT examinations of patients with proven or suspected vascular graft or endograft infections

Incidental uptake of fluorodeoxyglucose in the Waldeyer’s ring and risk of oropharyngeal malignancy

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Incidence and Economic Impact of Incidental Findings on 18F-FDG PET/CT Imaging

Abstract: As the incidence of incidental findings increases with age and a larger proportion of elderly patients is expected as population demographics change, it will be increasingly important to consider incidental findings on PET/CT imaging with standardized approaches to follow-up.

Cited by 37 publications

References 22 publications

Evaluation of FDG-PET/CT Use in Children with Suspected Infection or Inflammation

Evaluation of FDG-PET/CT Use in Children with Suspected Infection or Inflammation

Impact of unknown incidental findings in PET/CT examinations of patients with proven or suspected vascular graft or endograft infections

Incidental uptake of fluorodeoxyglucose in the Waldeyer’s ring and risk of oropharyngeal malignancy

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Incidence and Economic Impact of Incidental Findings on ¹⁸F-FDG PET/CT Imaging