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Geiger KR, Pasvolsky O, Berger T, Raanani P, Shochat T, Gurion R, Anati T, Groshar D, Gafter-Gvili A, Bernstine H. Effect of steroid treatment on the diagnostic yield of baseline 18f-fluorodeoxyglucose positron emission tomography in aggressive B cell lymphoma. EJNMMI Res 2022; 12:59. [PMID: 36104603 PMCID: PMC9474759 DOI: 10.1186/s13550-022-00924-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/17/2022] [Indexed: 01/18/2023] Open
Abstract
Aggressive B cell lymphoma often requires prompt steroid treatment, even before baseline 18f-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and definitive treatment, to alleviate symptoms or prevent organ damage. Since lymphoma is a steroid-sensitive malignancy, there are concerns that steroids might affect the results of FDG PET/CT and decrease its diagnostic yield. The aim of the current study was to evaluate the effect of steroids administered before baseline PET/CT on the maximum standardized uptake value (SUVmax) and additional PET/CT parameters. Retrospective review of the database in a tertiary medical center yielded 178 patients newly diagnosed with aggressive B cell lymphoma between January 2017 and May 2020 who had an available baseline FDG PET/CT scan. The cohort was divided into patients who received steroids before PET/CT (n = 47) and those who did not (n = 131), and the groups were compared for SUVmax and additional PET/CT parameters. The steroid-treated group had a higher disease stage and lactate dehydrogenase level compared to the steroid-naïve group, with a trend toward a higher international prognostic index. There was no significant between-group difference in SUVmax (P = 0.61). This finding remained consistent across steroid treatment durations and dosage regimens. Further evaluation revealed a significantly larger mean tumor volume and a trend toward a higher tumor metabolic burden in the steroid-treated group, yet no between-group difference in SUV mean or other PET/CT parameters. In this retrospective analysis of patients with aggressive B cell lymphoma, steroid prophase prior to baseline PET/CT did not decrease the diagnostic yield of the scan. However, further studies are required to fully appreciate the impact of steroids on PET CT parameters.
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Nakajo M, Nakajo M, Nakayama H, Jinguji M, Nakabeppu Y, Higashi M, Nakamura Y, Sato M, Yoshiura T. Dexamethasone Suppression FDG PET/CT for Differentiating between True- and False-Positive Pulmonary and Mediastinal Lymph Node Metastases in Non-Small Cell Lung Cancer: A Pilot Study of FDG PET/CT after Oral Administration of Dexamethasone. Radiology 2015; 279:246-53. [PMID: 26579562 DOI: 10.1148/radiol.2015150883] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To examine whether dexamethasone suppression can reduce fluorine 18 fluorodeoxyglucose (FDG) uptake in false-positive (FP) findings in pulmonary and mediastinal lymph nodes in non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Institutional ethics review board approved this prospective study with written informed consent. The study population was composed of 17 patients with NSCLC who underwent both baseline and dexamethasone suppression (24 hours after oral administration of 8 mg dexamethasone) FDG positron emission tomography/computed tomography and surgery. FDG uptake was evaluated by using a five-point visual scoring system (negative findings, score of 0-1; positive findings, score of 2-4) and maximum standardized uptake value (SUVmax). The Mann-Whitney U, Wilcoxon signed-rank, Kruskal-Wallis, or Spearman rank correlation tests were used as necessary for statistical evaluations. RESULTS In 17 primary lesions, no significant difference was noted in visual score between baseline (mean, 3.4 ± 1.2) and dexamethasone suppression scans (mean, 3.3 ± 1.2; P = .16), although SUVmax was significantly lower on dexamethasone suppression scans (mean, 7.1 ± 5.2) than on baseline scans (mean, 8.6 ± 6.6; P = .005). In eight nodes with true-positive (TP) findings, there were no significant differences in visual score (mean for both, 3.8 ± 0.5) and SUVmax (mean, 5.3 ± 2.3 vs 5.5 ± 2.5, respectively; P = .81) between baseline and dexamethasone suppression scans. In 19 nodes with FP findings at baseline, dexamethasone suppression resulted in significantly lowered visual score (mean, 3.4 ± 0.6 vs 2.4 ± 0.8, respectively; P < .001) and SUVmax (mean, 3.5 ± 0.8 vs 2.7 ± 0.7, respectively; P < .001), and four nodes with FP findings were rated as true-negative findings on dexamethasone suppression scans, which resulted in a significant difference in SUVmax between nodal lesions with TP and FP findings (P = .014). CONCLUSION Oral dexamethasone has the potential to reduce FDG uptake in pulmonary and mediastinal nodes with FP findings in NSCLC.
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Affiliation(s)
- Masatoyo Nakajo
- From the Departments of Radiology (Masatoyo Nakajo, M.J., Y. Nakabeppu, T.Y.), Human Pathology (M.H.), and Thoracic Surgery (Y. Nakamura, M.S.), Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; Department of Radiology, Nanpuh Hospital, Kagoshima, Japan (Masayuki Nakajo); and Department of Radiology, Kagoshima City Hospital, Kagoshima, Japan (H.N.)
| | - Masayuki Nakajo
- From the Departments of Radiology (Masatoyo Nakajo, M.J., Y. Nakabeppu, T.Y.), Human Pathology (M.H.), and Thoracic Surgery (Y. Nakamura, M.S.), Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; Department of Radiology, Nanpuh Hospital, Kagoshima, Japan (Masayuki Nakajo); and Department of Radiology, Kagoshima City Hospital, Kagoshima, Japan (H.N.)
| | - Hirofumi Nakayama
- From the Departments of Radiology (Masatoyo Nakajo, M.J., Y. Nakabeppu, T.Y.), Human Pathology (M.H.), and Thoracic Surgery (Y. Nakamura, M.S.), Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; Department of Radiology, Nanpuh Hospital, Kagoshima, Japan (Masayuki Nakajo); and Department of Radiology, Kagoshima City Hospital, Kagoshima, Japan (H.N.)
| | - Megumi Jinguji
- From the Departments of Radiology (Masatoyo Nakajo, M.J., Y. Nakabeppu, T.Y.), Human Pathology (M.H.), and Thoracic Surgery (Y. Nakamura, M.S.), Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; Department of Radiology, Nanpuh Hospital, Kagoshima, Japan (Masayuki Nakajo); and Department of Radiology, Kagoshima City Hospital, Kagoshima, Japan (H.N.)
| | - Yoshiaki Nakabeppu
- From the Departments of Radiology (Masatoyo Nakajo, M.J., Y. Nakabeppu, T.Y.), Human Pathology (M.H.), and Thoracic Surgery (Y. Nakamura, M.S.), Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; Department of Radiology, Nanpuh Hospital, Kagoshima, Japan (Masayuki Nakajo); and Department of Radiology, Kagoshima City Hospital, Kagoshima, Japan (H.N.)
| | - Michiyo Higashi
- From the Departments of Radiology (Masatoyo Nakajo, M.J., Y. Nakabeppu, T.Y.), Human Pathology (M.H.), and Thoracic Surgery (Y. Nakamura, M.S.), Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; Department of Radiology, Nanpuh Hospital, Kagoshima, Japan (Masayuki Nakajo); and Department of Radiology, Kagoshima City Hospital, Kagoshima, Japan (H.N.)
| | - Yoshihiro Nakamura
- From the Departments of Radiology (Masatoyo Nakajo, M.J., Y. Nakabeppu, T.Y.), Human Pathology (M.H.), and Thoracic Surgery (Y. Nakamura, M.S.), Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; Department of Radiology, Nanpuh Hospital, Kagoshima, Japan (Masayuki Nakajo); and Department of Radiology, Kagoshima City Hospital, Kagoshima, Japan (H.N.)
| | - Masami Sato
- From the Departments of Radiology (Masatoyo Nakajo, M.J., Y. Nakabeppu, T.Y.), Human Pathology (M.H.), and Thoracic Surgery (Y. Nakamura, M.S.), Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; Department of Radiology, Nanpuh Hospital, Kagoshima, Japan (Masayuki Nakajo); and Department of Radiology, Kagoshima City Hospital, Kagoshima, Japan (H.N.)
| | - Takashi Yoshiura
- From the Departments of Radiology (Masatoyo Nakajo, M.J., Y. Nakabeppu, T.Y.), Human Pathology (M.H.), and Thoracic Surgery (Y. Nakamura, M.S.), Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; Department of Radiology, Nanpuh Hospital, Kagoshima, Japan (Masayuki Nakajo); and Department of Radiology, Kagoshima City Hospital, Kagoshima, Japan (H.N.)
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Detection of recurrence in glioma: a comparative prospective study between Tc-99m GHA SPECT and F-18 FDG PET/CT. Clin Nucl Med 2011; 36:650-5. [PMID: 21716014 DOI: 10.1097/rlu.0b013e318217aee0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early and correct diagnosis of tumor recurrence and its differentiation from therapy-related changes is crucial for prompt and adequate management of glioma patients. The purpose of this study was to compare the efficacies of Tc-99m glucoheptonate (GHA) single photon emission tomography (SPECT) and F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in detection of recurrence in patients with glioma. METHODS A total of 90 patients with histopathologically proven glioma who had suspicion of recurrence clinically or on magnetic resonance imaging were evaluated using Tc-99m GHA SPECT and FDG PET/CT. Combination of clinical follow-up, repeat imaging, and biopsy (when available) was taken as gold standard. RESULTS On the basis of gold standard, 59 patients were positive and 31 were negative for tumor recurrence. The sensitivity, specificity, and accuracy of GHA SPECT were 85%, 97%, and 89%, respectively, whereas those of FDG PET/CT were 70%, 97%, and 80%, respectively. On subgroup analysis, GHA SPECT performed better than FDG PET/CT in all grades except for grade II gliomas, where both were equally effective. In all, 15 patients had intermodality discordance, with GHA SPECT being correct in 13 of them. CONCLUSIONS GHA SPECT appears to be a better imaging modality than FDG PET/CT for detection of recurrent gliomas.
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Zhao S, Kuge Y, Kohanawa M, Takahashi T, Kawashima H, Temma T, Takei T, Zhao Y, Seki KI, Tamaki N. Extensive FDG uptake and its modification with corticosteroid in a granuloma rat model: an experimental study for differentiating granuloma from tumors. Eur J Nucl Med Mol Imaging 2007; 34:2096-105. [PMID: 17763849 DOI: 10.1007/s00259-007-0529-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Accepted: 07/03/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Increased (18)F-fluorodeoxyglucose (FDG) uptake in inflammatory lesions, particularly in granulomatous inflammation (e.g., sarcoidosis), makes it difficult to differentiate malignant tumors from benign lesions and is the main source of false-positive FDG-PET findings in oncology. Here, we developed a rat granuloma model and examined FDG uptake in the granuloma. The effects of corticosteroid on FDG uptake in the granuloma were compared with those in a malignant tumor. METHODS Rats were inoculated with Mycobacterium bovis bacillus Calmette-Guérin (BCG) or allogenic hepatoma cells, and subdivided into control and pretreated (methylprednisolone acetate, 8 mg/kg i.m.) groups. Radioactivity in tissues was determined 1 h after the FDG injection. FDG-PET was performed in rats bearing BCG granulomas or tumors before and after prednisolone treatment. RESULTS Mature epithelioid cell granuloma-formation and massive lymphocyte-infiltration were observed in the control group of granuloma, histologically similar to sarcoidosis. The mean FDG uptake in the granuloma was comparable to that in the hepatoma. Prednisolone reduced epithelioid cell granuloma-formation and lymphocyte-infiltration. Prednisolone significantly decreased the level of FDG uptake in the granuloma (52% of control), but not in the hepatoma. The FDG uptake levels in the granulomas and tumors were clearly imaged with PET. CONCLUSION We developed an intramuscular granuloma rat model that showed a high FDG uptake comparable to that of the tumor. The effect of prednisolone pretreatment on FDG uptake was greater in the granuloma than in the tumor. These results suggest that BCG-induced granuloma may be a valuable model and may provide a biological basis for FDG studies.
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Affiliation(s)
- Songji Zhao
- Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Kita 15 Nishi 7, Kita-ku, Sapporo, Japan
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