Cancer Treatment Today » PET Scan, CAT Scan, MRI, MRA

PET and MRI for prostate cancer – pro

M Levin, MD — Thu, 13 Sep 2012 13:51:07 +0000

Positron emission tomography (PET) is an imaging procedure that is unique by virtue of its ability to image biochemical reactions and physiological functions. This is accomplished by measuring concentrations of radioactive chemicals that are partially metabolized in the body region of interest.

PET with fluorodeoxyglucose (FDG) has been quite successful in the imaging evaluation of a large number of tumor types. Prostate cancer, however, has variable accumulation of FDG, which is probably a reflection of the heterogeneous nature of the disease. Early studies of FDG-PET in prostate cancer have shown that FDG accumulation in the primary prostate cancer may be low and overlap with the uptake in benign prostatic hyperplasia, in normal gland, and in postoperative scar or local recurrence. However, animal and preliminary clinical studies have demonstrated that FDG-PET may be useful in the evaluation of advanced disease and in patients with high Gleason scores and serum prostate-specific antigen (PSA) levels, in the detection of active osseous and soft tissue metastases, and in the assessment of response after androgen ablation and treatment with novel chemotherapies.

NCCN now does recommend PET for prostate cancer staging and restaging. There has been a recent shift in this are with the availability of mew contrast materials, including choline, PMSA and the recent approval of Axilium. NCCN now does recommend PET for prostate cancer staging and restaging. In the seminal publication26 leading to FDA approval in 2012, fluciclovine-PET/CT was found superior to CT alone at detecting local and distant recurrences, with a sensitivity of 88.6% and accuracy of 78.4%. In another study, fluciclovine-PET/CT was compared with 11C-choline-PET/CT, and it showed superiority for detecting local (in-gland, nodal, and prostatectomy bed) recurrences, especially in those with low PSA values.

MRI may be helpful to assess local invasion. Current recommendations vary; bone scan and pelvic CT or MRI are suggested for those with serum PSA >20 ng/ml or Gleason score =8, or for stage T3 or T4 disease. It is indicated to do a MRI (NCCN, p.6) under some circumstances.

MCG, Ambulatory Care, PET, 18th edition

NNCCN Guidelines for Prostate Cancer
V.2.2017

UpToDate. V.25.5
Prostate cancer: Risk stratification and choice of initial treatment
Author: Eric A Klein, MD
Literature review current through: Oct 2017. | This topic last updated: Aug 08, 2017.

UpToDate. V.25.5
Rising serum PSA following local therapy for prostate cancer: Diagnostic evaluation
Authors: Judd W Moul, MD, FACSW ; Robert Lee, MD, MS, Med
Literature review current through: Oct 2017. | This topic last updated: Feb 08, 2017

Thomas Anderson et al,
Pictorial Review of NCCN Guidelines for Use of FDG PET in Oncology. J Nucl Med May 1, 2017 vol. 58 no. supplement 1 974

Odewole OA, Tade FI, Nieh PT, et al. Recurrent prostate cancer detection with anti-3-[(18)F]FACBC PET/CT: comparison with CT. Eur J Nucl Med Mol Imaging. 2016;43:1773-1783.

Nanni C, Zanoni L, Pultrone C, et al. (18)F-FACBC (anti1-amino-3-(18)F-fluorocyclobutane-1-carboxylic acid) versus (11)C-choline PET/CT in prostate cancer relapse: results of a prospective trial. Eur J Nucl Med Mol Imaging. 2016;43:1601-1610.

Dietlein M, Kobe C, Kuhnert G, et al. Comparison of [(18)F]DCFPyL and [ (68)Ga]Ga-PSMA-HBED-CC for PSMA-PET imaging in patients with relapsed prostate cancer. Mol Imaging Biol. 2015;17:575-584.

PET for sarcoma – pro

M Levin, MD — Thu, 13 Sep 2012 13:44:23 +0000

Lay Summary: PET is ocasionally useful in staging sarcoma but not well accepted for restaging. Diagnostic procedures, such as PET scan and CT scan, may help doctors predict a patient’s response to treatment and may help plan the best treatment. Drugs used in chemotherapy, such as doxorubicin and ifosfamide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving chemotherapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.Imaging may assist in evaluating a cancer for resection. PET is ocasionally useful in staging sarcoma but not well accepted for restaging. Whether PET/CT is more accurate for staging is not known. NCCN says that PET can be occasionally useful. A recent review says: “In sarcoma, PET scans provide useful complementary information that must be interpreted in the overall context of the patient’s imaging and other evaluations. PET can be used for grading of disease and differentiating between benign and malignant disease, biopsy evaluation, staging and restaging, assessing local recurrence, and therapeutic monitoring. However, further studies are required to improve quantitation of response, because SUVs and TBRs are at best semiquantitative, and comparison among different sites and use in clinical trials will require additional study.”
Positron emission tomography (PET) scanning may be helpful in specific circumstances (e.g., prior to radical amputation following recurrent disease), but cannot at the present time be recommended as a routine staging investigation in patients with STS.1

1.Robert Grimer ET AL, Guidelines for the Management of Soft Tissue Sarcomas. Volume 2010 (2010), Article ID 506182, 15 pages

2.nccn, SARCOMA 2014.

3.Vlker T, Denecke T, Steffen I, et al.: Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol 25 (34): 5435-41, 2007

CAT scans and radiation exposure – pro

M Levin, MD — Thu, 13 Sep 2012 13:34:14 +0000

Any unecessary exposure that is not supported by credible literature is inappropiate and should be avoided. Several articles comment on radiation exposure from CT scans. Trigaux and Lacrosse recognize that computed tomography is a diagnostic procedure that involves relatively high radiation doses. Crawley et al confirm that as a diagnostic imaging modality, CT gives higher patient radiation dose in comparison with other imaging modalities. In the UK, patient doses from radiological procedures were considerably reduced, but the efforts were largely offset by a corresponding rise in the collective dose from CT. A recent report from the Royal College of Radiologists in the United Kingdom acknowledges computed tomography as the single largest contributor to the collective dose from medical x-rays.

According to Seeram, patients are exposed to higher radiation levels from the use of computed tomography compared to most imaging techniques. There is a lack of awareness of the actual risks involved. The exposure to ionizing radiation in CT is emphasized in the CT versus MRI debate. MRI is safe. But MRI is more expensive and has limited availability. With health care costs already spiraling out of control, it is unlikely to supercede CT and the possible replacement has not occurred.

Therefore radiation exposure from computed tomography is still a matter of concern. The well known BMJ editorial by Rehani and Berry “Radiation doses in computed tomography. The increasing doses of radiation need to be controlled” published in the year 2000 is a discussion on the controversy. In the editorial, the authors point out the potential for increased radiation exposure from the advances in CT technology. Control of radiation burden is regarded as one of the parameters of quality control in computed tomography .
The advances in computed tomography ensure that it remains a versatile, affordable and readily available diagnostic modality more than three decades after its introduction. CT scans enjoy a pride of place in diagnostic radiology that was challenged but not usurped by MRI. The radiation risk is a disadvantage inasmuch the procedure involves exposure to relatively high levels. The issue of radiation exposure is once more the focus of current debate.

It should be admitted at the outset that there is no conclusive evidence of radiation risk. Although radiation doses are considerable, the doses are still well below acceptable limits of exposure. Expert opinion is divided on whether the increase in radiation exposure from CT scans is a matter of concern or not. Moreover, there is no doubt that the benefits outweigh the risks when there is a strong indication for a CT scan. The key issue is that there must be a valid indication for a CT scan to be performed. While this may appear to be a relatively simple matter, it is actually difficult to ensure the judicious use of CT scans in practice. With the increased dependence of modern medicine on technology, coupled with the significant contribution that CT technology continues to make to medicine, it is difficult for health care providers to forego a quick, non-invasive diagnostic tool.

An increased number of physicians and scientists agree that concerted efforts are required in order to reduce radiation doses from computed tomography. The shielding of superficial radiosensitive tissues and the optimum selection of settings are some of the technical possibilities. Manufacturers of CT scanners are capable of significant contributions in the development of low dose technology. The evaluation of acceptability of low dose techniques from a clinical perspective remains a potential challenge. Therefore, most modifications have inherent disadvantages and barriers to implementation.

Finally, CT scans are now used as a screening procedure. The full body CT scan though restricted to those can afford it has a wide appeal. The commercial potential of full body CT screening makes it an attractive commodity, but the long term benefits and risks are not clear at this time. The cost-effectiveness and large scale benefit of full body scans are still to be established.

1.Rehani MM, Berry M. Radiation doses in computed tomography. The increasing doses of radiation need to be controlled. BMJ. 2000 Mar 4;320(7235):593-4.

2. Crawley MT, Booth A, Wainwright A. A practical approach to the first iteration in the optimization of radiation dose and image quality in CT: estimates of the collective dose savings achieved. Br J Radiol 2001 Jul;74(883):607-14

3. Trigaux JP, Lacrosse M. Radiation exposure and computed tomography. Rev Mal Respir. 1999 Apr;16(2):127-36.

4. Royal College of Radiologists. Making the best use of department of clinical radiology: guidelines for doctors. 4th ed. London: Royal College of Radiologists, 1998.

5. Seeram E. Radiation dose in computed tomography. Radiol Technol 1999 Jul-Aug;70(6):534-52; quiz 553-6

6. Rockstroh G, Lieberenz S, Straubel U. [Quality control in computed tomography] Radiol Diagn (Berl) 1989;30(3):339-45

7. Nishizawa K, Maruyama T, Takayama M, et al. [Estimation of effective dose from CT examination] Nippon Igaku Hoshasen Gakkai Zasshi 1995 Sep;55(11):763-8

8. Wall BF, Hart D. Revised radiation doses for typical X-ray examinations. Report on a recent review of doses to patients from.medical X-ray examinations in the UK by NRPB. National Radiological Protection Board. Br J Radiol 1997 May;70(833):437-

9. Dhingsa R, Finlay DB, Robinson GD, et al. Assessment of agreement between general practitioners and radiologists as to whether a radiation exposure is justified. Br J Radiol. 2002 Feb;75(890):136-9.

10. Hopper KD, King SH, Lobell ME et al. The breast: in- plane x-ray protection during diagnostic thoracic CT-Shielding with bismuth radioprotective garments. Radiology 1997;205:853-858[Medline].

PET scan in small cell lung cancer – pro

M Levin, MD — Thu, 13 Sep 2012 13:21:34 +0000

PET with 2-[fluorine 18]-fluoro-2-deoxy-D-glucose (FDG) has recently received attention, and growing evidence suggests its superiority in the staging of lung cancer. However, PET is more frequently used in evaluating patients with NSCLC to identify surgical candidates. It is less commonly used in patients with SCLC because most of these patients are not candidates for surgery. PET may be useful for evaluating cases in which recurrent disease but this is questionable.Generally, the resolution of PET is not considered good for lesions smaller than 1 cm. The PET results can also overlap with the standard uptake values (SUVs) in some benign lesions and malignant lesions.Unfortunately, specificity, sensitivity and accuracy compared to CT are not securely known. The utility of positron emission tomography (PET) scanning in patients with SCLC has been recently reported in two small prospective studies. In a study reported by Hauber et al, PET scans detected all primary lesions, lymph node metastases, and distant metastases that had been detected by other standard staging procedures. In a second study, 30 patients with SCLC were evaluated with 36 PET scan examinations, and the results were compared with the sum of the other staging procedures. The results of 23 of the 36 PET scan examinations were concordant with those of the other staging procedures. In seven cases, the PET scan examination resulted in upward staging of the patient, and in one instance the PET scan revealed the presence of a viable tumor when conventional staging procedures had revealed no residual disease. PET scan identified all areas of tumor involvement detected by other staging procedures. A third study looked at the accuracy of PET scanning in detecting bony metastases in patients with SCLC and NSCLC, comparing the PET scans to bone scans and single-photon emission CT scans. In this study, PET scans were found to be the most accurate whole-body imaging modality for the screening of bone metastases. These and similar studies suggested that PET scanning is likely to be a useful staging tool in patients with SCLC. However, all the studies were small, and the experience with PET scan as a staging tool remains largely limited.

NCCN 2015, SCL – 1 says that PET should be used only if limited disease is suspected. On p. SCL-6 it mentions “other imaging studies” as clinically indicated.

PET scan has not been sufficiently studied for small celll lung cancer to be considered standard and it is not Medicare approved. NCCN mentions PET for initial staging but not for restaging.

P. Chirrmeister, H, Glatting, G, Hetzel, J, et al Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 2001;42,1800-1804

Hauber, HP, Bohuslavizki, KH, Lund, CH, et al Positron emission tomography in the staging of small-cell lung cancer: a preliminary study. Chest 2001;119,950-954

Schumacher, T, Brink, I, Mix, M, et al FDG-PET imaging for the staging and follow-up of small cell lung cancer. Eur J Nucl Med 2001;28,483-48

Seute T, Leffers P, ten Velde GP, Twijnstra A. Detection of brain metastases from small cell lung cancer: consequences of changing imaging techniques (CT versus MRI). Cancer. Apr 15 2008;112(8):1827-34.

Lee HY, Chung JK, Jeong JM, Lee DS, Kim DG, Jung HW, et al. Comparison of FDG-PET findings of brain metastasis from non-small-cell lung cancer and small-cell lung cancer. Ann Nucl Med. May 2008;22(4):281-6.

C-11 Acetate PET for prostate cancer – pro

M Levin, MD — Thu, 13 Sep 2012 13:17:44 +0000

FDG PET is not very sensitive in staging prostate cancer. Studies of C-11 suggest that it may be useful in the assessment of nasopharyngeal carcinoma, renal cell carcinoma, glial and meningeal brain tumors, and prostate cancer. C-11 acetate may accumulate more than FDG in prostate cancer; the reasons and modulating factors for this observation are unclear. Shreve and colleagues showed, in an in vitro study, that cellular retention of radiolabeled acetate in prostate cancer cell lines is primarily caused by incorporation of the radiocarbon into phosphatidylcholine and neutral lipids of the cells.

The lack of accumulation of acetate in urine is also advantageous to imaging prostate cancer, because the prostate bed remains unobstructed by the adjacent high levels of radioactivity in the urinary bladder, which is a common problem with FDG. More studies are required before teh role of this type of PET is more clearly defined in prostate cancer.

Shreve PD, Iannone P, Weinhold P. Cellular metabolism of [1-C14]-acetate in prostate cancer cells in vitro. J Nucl Med. 2002;43(5 suppl):272P.
Seltzer MA, Jahan S, Dahlbom M, et al. C-11 acetate PET imaging of primary and locally recurrent prostate cancer: comparison to normal controls. J Nucl Med. 2002;43(5 suppl):117P.
Schiepers C, Hoh CK, Seltzer M, et al. Quantification of dynamic PET studies in prostate cancer: which model applies for C-11 acetate? J Nucl Med. 2002;43(5 suppl):118P.

Magnetic Resonance Spectroscopy requires more study – pro

M Levin, MD — Thu, 13 Sep 2012 13:15:14 +0000

Magnetic resonance spectroscopy measures levels of different metabolites in body tissues and produces an image of resonances that correspond to different molecular arrangements of the “excited” isotopes. Magnetic resonance spectroscopic imaging (MRSI) in addtion incorporates imaging to produce spatially localized spectra from within the sample or patient.

The role of MRS in diagnosis and therapeutic planning has not been established by adequate clinical studies. There have been no credible prospective clinical trials demonstrating improved outcomes in patients evaluated with MRS compared to patients evaluated with conventional imaging modalities. The consensus of experts is that further studies are necessary.

An assessment of MRS prepared by the Tuft’s-New England Medical Center Evidence-Based Practice Center for the Agency for Healthcare Research and Quality (AHRQ) (Jordan et al, 2003) states: “Human studies conducted on the use of MRS for brain tumors demonstrate that this non-invasive method is technically feasible and suggest potential benefits for some of the proposed indications. However, there is a paucity of high quality direct evidence demonstrating the impact on diagnostic thinking and therapeutic decision-making. In addition, the techniques of acquiring the MRS spectra and interpreting the results are not well standardized. In summary, while there are a large number of studies that confirm MRS’ technical feasibility, there are very few published studies to evaluate its diagnostic accuracy and whether it can positively affect diagnostic thinking and therapeutic choice. Those studies that do address these areas often have significant design flaws including inadequate sample size, retrospective design and other limitations that could bias the results.”

A review of MRS for evaluation of suspected brain tumor by the BlueCross BlueShield Association Technology Evaluation Center (2003) concluded that “[t]he evidence is insufficient to permit conclusions concerning the effect of magnetic resonance spectroscopy on health outcomes.”

The Center for Medicare and Medicaid Services (2004) has determined that there is insufficient evidence to deem MRS “reasonable and necessary” for brain tumor diagnosis. Due to “methodological shortcomings” in the 11 studies reviewed on the use of MRS for brain lesion detection and a lack of a controlled comparison of MRS and traditional diagnostic strategies, CMS has announced that it will continue its current national non-coverage determination. Guidelines on bone tumors by ACR’s expert panel on musculoskeletal imaging (Morrison et al, 2005) noted that MRS has potential to differentiate benign from malignant lesions, but recommended more research.

P.C. Sundgren, MR Spectroscopy in Radiation Injury AJNR 2009 30: 1469-1476
W. Hollingwortha, L.S. Medinac, R.E. Lenkinskid, D.K. Shibataa, B. Bernalc, D. Zurakowskie, B. Comstockb and J.G. Jarvika A Systematic Literature Review of Magnetic Resonance Spectroscopy for the Characterization of Brain Tumors American Journal of Neuroradiology 27:1404-1411, August 2006

Moller-Hartmann W, Herminghaus S, Krings T, et al. Clinical application of proton magnetic resonance spectroscopy in the diagnosis of intracranial mass lesions. Neuroradiology 2002;44:371–81

Shah N, Sattar A, Benanti M, Hollander S, Cheuck L. Magnetic resonance spectroscopy as an imaging tool for cancer: A review of the literature. J Am Osteopath Assoc. 2006;106(1):23-27

Majos C, Aguilera C, Alonso J, Julia Sape M, Castener S, Sanchez JJ. Proton MR spectroscopy improves discrimination between tumor and pseudotumoral lesion in solid brain masses. AJNR Am J Neuroradiol 2009; 30: 544-51.

Davison JE, Davies NP, English MW, Philip S, MacPherson LK, Gissen P, Peet AC.
Magnetic resonance spectroscopy in the diagnostic evaluation of brainstem lesions in Alexander disease.J Child Neurol. 2011 Mar;26(3):356-60.

American College of Radiology. Practice Guideline for the Performance and Interpretation Of Magnetic Resonance Spectroscopy of the Central Nervous System. Available at: www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/head-neck/mr_spectroscopy.aspx. 2011

F-DOPA PET scans – pro

M Levin, MD — Mon, 10 Sep 2012 21:18:41 +0000

Tumors of ganglion cell origin including ganglioneuroma, neuroblastoma glioblastoma and ganglioneuroblastoma, all dopamine using cells, are appropriate for visualization using L-DOPA PET technology. These tumors accumulate decarboxylate 5′-hydroxytryptamine and L-3,4-dihydroxyphenylalanine (L-DOPA), and these can be used instead of FDG as the contrast agent. This modality is also being explored in neuroendocrine cancer imaging.One study revealed that for neuroendocrine tumors, 18F-FDOPA was more accurate (sensitivity, 100%; specificity, 91%) in the detection of skeletal lesions than octreotide scintigraphy or CT but was insensitive (sensitivity, 20%; specificity, 94%) in the lung, ostensibly because of respiratory motion during image acquisition. Octreotide scintigraphy yielded its best results in the liver (sensitivity, 75%; specificity, 100%); however, it was less accurate than PET in all organs. However, 18F-FDOPA PET is less sensitive than FDG PET and standard imaging procedures for the staging of small cell lung cancer It is an experimental technique at this time and not for routine clinical use.

Imaging of Advanced Neuroendocrine Tumors with 18F-FDOPA PET
Alexander Becherer, Monica Szabó, Georgios Karanikas, Patrick Wunderbaldinger, Peter Angelberger, Markus Raderer, Amir Kurtaran, Robert Dudczak, and Kurt Kletter J Nucl Med 45: 1161-1167

D. J. A. Margolis, J. M. Hoffman, R. J. Herfkens, R. B. Jeffrey, A. Quon, and S. S. Gambhir
Molecular Imaging Techniques in Body Imaging
Radiology, November 1, 2007; 245(2): 333 – 356.

Becherer A, Szabo M, Karanikas G, et al. Imaging of advanced neuroendocrine tumors with (18)F-FDOPA PET. J Nucl Med 2004;45:1161–1167.

Jacob T, Grahek D, Younsi N, et al. Positron emission tomography with [(18)F]FDOPA and [(18)F]FDG in the imaging of small cell lung carcinoma: preliminary results. Eur J Nucl Med Mol Imaging 2003;30:1266–1269.

PET for thymus cancer – pro

M Levin, MD — Mon, 10 Sep 2012 21:13:28 +0000

Thymoma is a n uncommon cancer of the thymus. Limited information is available about sensitivity and specificity of PET for thymojma. Unfortunately, baseline thymic uptake is common. One study examined thymic uptake at 18F-FDG PET in 94 patients ranging from 18 to 29 years of age and found that 32 of these patients exhibited normal physiologic thymic uptake. The criteria for “normal” in these patients included a normal thymus identified at CT, absence of clinical symptoms of thymus-related disease, and absence of mediastinal tumor at follow-up ranging from 6 to 69 months.
Sasaki et al found a mean SUV of 7.2 ± 2.9 for patients with thymic carcinoma (n = 9). This value was significantly greater than the values found for invasive thymoma (3.8 ± 1.3) and noninvasive thymoma (3.0 ± 1.0). By using an SUV of 5.0 as a cutoff, the authors achieved reasonable sensitivity (84.6%), specificity (92.3%), and accuracy (88.5%) in differentiating thymic carcinoma from thymoma. They found no statistically significant difference in SUV between invasive and noninvasive thymomas, a finding that is consistent with the histologic similarity of the two tumors. This finding is also consistent with earlier work by Liu et al, which failed to demonstrate a significant difference in 18F-FDG uptake between different stages of thymoma. Brink et al also presented one case of thymic carcinoma with an SUV of 9.6. On the basis of these limited data, it appears that 18F-FDG PET will prove to be effective in differentiating thymic carcinoma from other entities within the thymus but will likely prove equivocal in differentiating invasive and noninvasive thymoma from each other and from thymic hyperplasia. More study is clearly required.

Brett Ferdinand, Pramod Gupta, and Elissa L. Kramer Spectrum of Thymic Uptake at 18F-FDG PET RadioGraphics 2004 24: 1611-1616.

M. M. Abouzied, E. S. Crawford, and H. A. Nabi
18F-FDG Imaging: Pitfalls and Artifacts
J. Nucl. Med. Technol., September 1, 2005; 33(3): 145 – 155.

PET for staging mesothelioma – pro

M Levin, MD — Mon, 10 Sep 2012 21:12:17 +0000

Staging is the process of finding out how far the cancer has spread. Staging of mesothelioma is based on imaging studies such as x-rays, CT scans, and MRI scans.

Earlier studies indicate that PET holds great promise for Earlier studies indicate that PET holds great promise for diagnosing mesothelioma and determining mesothelioma staging, or the extent to which tumors have spread. At the University of Pennsylvania Medical Center, researchers evaluated 28 patients for mesothelioma using the sugar tracer fluoro–2–deoxy–D–glucose (FDG) and PET (Chest. 1998 Sep; 114(3): 713–22). In a comparison of PET imaging with thoracoscopy or surgical biopsies, PET successfully indicated the presence of disease in 24 patients, and of benign conditions in the other four. The uptake of FDG was significantly higher in diseased cells, and PET analysis also showed tumors in the lymph nodes of 9 patients. The lymph nodes appeared normal in CT scans. Another study at Brigham and Women’s Hospital and Harvard Medical School in Boston traced 15 patients, 11 of whom had mesothelioma and four who were disease–free. PET results were compared with laboratory analysis of biopsied fluids and tissues. PET detected all 11 primary tumors, and confirmed the absence of disease in the other four patients. Out of 28 disease–positive lesions, PET accurately detected. The exact role, however, is not etablished and I was not able to find any guidelines recommending PET over CT for staging. There are no guidelines that recommend routine PET surveillance of either mesothelioma or metastatic cancer to the pertineunum.

Aaseboe U, Billing B, Bjørck T, Brodin O, Brunsvig P, Forsløw U, Frank H, Hansen O, Harving H, Hillerdal G, Jakobsen KD, Johansson A, Ladegaard L, Lindh B, Melgaard P, Mygind N, Månsson T, Palshof T, Sundstrøm S, Sørensen P, Vigander T. Preoperative staging of mesothelioma by 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography fused imaging and mediastinoscopy compared to pathological findings after extrapleural pneumonectomy European Journal of Cardio-Thoracic Surgery. 2008 Nov;34(5):1090-6. Epub 2008 Sep 16.

Gerbaudo VH, Sugarbaker DJ, Britz-Cunningham S, Di Carli MF, Mauceri C, Treves ST. Assessment of malignant pleural mesothelioma with (18)F-FDG dual-head gamma-camera coincidence imaging: comparison with histopathology.Nucl Med. 2002 Sep;43(9):1144-9

Hinshaw JL, Pickhardt PJ. Imaging of primary malignant tumors of peritoneal and retroperitoneal origin Cancer Treatment and Research. 2008;143:281-97.

PET for Castleman’s Disease – pro

M Levin, MD — Mon, 10 Sep 2012 21:10:45 +0000

Castleman’s disease, also called angiofollicular lymph node has two forms, localized and a multicentric. The clinical and biological signs are varied and heterogeneous, and the diagnostic is made on the histologic examination. There are no expert assessment, guidelines or consensus statements, policy statements or formal technology assessments for this disease. Only case reports about PET in this condition are found in the literature. Sensitivity and specificity of PET is not known and PET is not well established.

Italiano A, Butori C, Verge M, Mouroux J, Thyss A.Fortuitous diagnosis of Castleman’s disease by FDG-PET Scan during the follow-up of a renal cancer patient]
Rev Med Interne. 2005 Jul;26(7):597-9.

Robinson H, Prince HM, Ramdave S, Seymour JF, Elliott P, Hicks R.
reliminary experience of 18F-fluorodeoxyglucose positron emission tomography in Castleman’s disease.Leuk Lymphoma. 2006 Dec;47(12):2664-6.