Molecular Imaging Insight - September 2007 - (Page 19) The accuracy of PET/CT was sufficiently high to justify an aggressive approach in metabolically active lesions and a wait-and-watch strategy in those lesions with low FDG uptake. Access article: http://jnm.snmjournals.org/cgi/content/ abstract/48/2/214 Contrast-Enhanced FDG-PET/CT vs. SPIo-Enhanced MrI vs. FDG-PET vs. CT in Patients with liver Metastases from Colorectal Cancer: A Prospective Study with Interoperative Confirmation Ñ Acta Radiologica, 48:4, 369-378 When comparing the accuracy of detection of extrahepatic tumors in patients with colorectal cancer using CT, MRI, PET and PET/CT—PET/CT is most accurate, so says a study published in January authored by E.D. Rappeport and colleagues from Copenhagen University Hospital in Denmark. This is important because detecting extrahepatic tumors prior to liver surgery allows for better selection of patients who will survive long term. This study examined 35 patients with suspected liver metastases (LM) and extrahepatic tumors from Colorectal tumor with liver colorectal cancer using MRI, PET/CT, and lung metastases CT and PET. CT and superparamag- Beijing Hospital netic iron oxide (SPIO)-enhanced MRI was more sensitive but less specific than PET in the detection of LM, while PET/CT detected more extrahepatic tumors than CT alone, the researchers said. Lesion-by-lesion sensitivity and accuracy for liver lesions were 54 and 77 percent for PET alone, 66 and 83 percent for PET/CT, 82 and 82 percent for SPIO-enhanced MRI imaging, and 89 percent and 77 percent for CT alone, respectively. For extrahepatic tumor, sensitivity and specificity was 83 percent and 96 percent for PET/CT and 58 percent and 87 percent for CT, respectively. Access article: http://www.informaworld.com/smpp/content?con tent=10.1080/02841850701294560 ColorECTAl CAnCEr/lIVEr METASTASES Bone Involvement in Patients with lymphoma: The role of FDG-PET/CT Ñ Eur J Nucl Med Mol Imaging (2007) 34:60-67 In evaluating patients with Hodgkin’s disease or aggressive non-Hodgkin’s lymphoma with FDG-avid bone lesions, PET/CT is superior to CT alone or in combination with unilateral bone marrow biopsy (BMB) in detecting bone marrow involvement. This can lead to an upstaging in a relevant percentage of patients, according to this study by Niklaus G. Schaefer, MD, and colleagues at University Hospital Zurich in Switzerland. This study of 50 patients aims to evaluate the diagnostic value and clinical significance of PET/CT as the first step in staging lymphoma patients for bone involvement. It found that in patients with FDG-avid bone lesions, direct PET/CT-guided bone biopsy appears to be more accurate than standard BMB in confirming bone involvement. “In the future, the decision to perform a BMB in patients with HD or NHL and the type of biopsy procedure should thus be guided Lymphoma by the results of FDG-PET/CT as the Siemens initial staging procedure,” it recommends. The study clarifies that a BMB is still warranted in FDG-negative cases, while FDG-positive bone lesions need evaluation via direct bone biopsy or MRI. Access article: http://www.springerlink.com/content/ 80345352x5868570/ lyMPhoMA/hoDGkIn’S DISEASE FEVEr oF unknoWn orIGIn F-FDG PET and PET/CT in Fever of unknown origin Ñ J Nucl Med 2007; 48:35-45 FDG PET/CT is proving to be valuable in the quest to determine fevers of unknown origin (FUO). Research at the University of Gottingen in Gottingen, Germany, shows that PET has the potential to replace other imaging studies in patients with FUO. Compared with labeled white blood cells (WBCs), FDG PET/CT allows diagnosis of a wider spectrum of diseases. It is more sensitive than Ga-imaging and improves the accuracy of PET alone by increasing its specificity. Researchers are optimistic that a swifter diagnosis may be obtained much earlier with PET/CT than with other radionuclide techniques. Challenges still remain, though, such as the need for multicenter studies on larger populations of patients with FUO. The full impact of the technology on several infectious and noninfectious inflammatory diseases needs large, prospective studies. Promising results also have been found with FDG-labeled WBCs and FDG PET/CT, namely in diagnosis of soft-tissue, musculoskeletal and abdominal infections. Access article: http://jnm.snmjournals.org/cgi/content/ abstract/48/1/35 Molecular Imaging Insight 19 hodgkin Disease: Diagnostic Value of FDG PET/CT after Firstline Therapy – Is Biopsy of FDG-avid lesions Still needed? Ñ Radiology 2007; 244:257-262 A just-published study, also authored by Schaefer and colleagues, found that FDG PET/CT can help confirm remission of Hodgkin’s disease after first-line therapy. However, due to some false-positive results and toxicity of salvage chemotherapy, biopsy of FDG-avid lesions is necessary. It is believed to be the first study of its kind to determine the accuracy of PET/CT in patients with Hodgkin’s disease and suspected recurrence after first-line therapy. The study validated previous findings that PET/CT provides high sensitivity and specificity for this disease type — with a sensitivity of 100 percent, specificity of 91 percent, a negative predictive value after first-line therapy of 100 percent, and a positive predictive value of 85 percent. 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