The aim of the study was to assess the association between the burden of metastatic bone disease measured on F-NaF PET/computed tomography (CT) studies and the overall survival (OS) of patients with ...medullary thyroid cancer (MTC).
We retrospectively analyzed 31 patients with MTC who performed 18F-NaF PET/CT studies to assess skeletal metastases. The outcomes of the patients (dead or alive) were established based on the last information available on their files. In the studies considered positives for skeletal metastases, the burden of metastatic bone disease was established calculating the fluoride tumor volume (FTV). The FTV was defined using isocontour thresholds based on percentages of maximal standardized uptake values (SUVmax) in the lesions. These percentages varied from lesion to lesion and were established by visual analysis. The patients were divided into three groups as follows: without skeletal metastases (n = 11), with low FTV (≤50 cm; n = 11) and with high FTV (>50cm; n = 9). The Kaplan-Meier curves were used to analyze the OS in the three groups of patients and the log-rank test was used to determine the statistical significance of the difference between the groups.
There were statistically significant differences in the OS between the group with high FTV and the groups of patients with low FTV (P = 0.036) and without skeletal metastases (P = 0.001). There was not a statistically significant difference between the groups of patients with low FTV and without skeletal metastases (P = 0.147).
In patients with MTC, the burden of metastatic bone disease is associated with OS.
Purpose
To compare the
18
F-NaF PET/CT studies (
18
F-NaF) with other imaging methods in the detection of skeletal metastases (SM) in patients with medullary thyroid cancer (MTC).
Methods
We ...retrospectively analyzed 31 patients with MTC who performed
18
F-NaF to assess SM. The results of the
18
F-NaF were compared with other imaging methods performed for metastasis detection:
99
Tc-MDP bone scan (BS), magnetic resonance imaging (MRI), contrast-enhanced CT (CT), and
68
Ga-Dotatate and
18
F-FDG PET/CT studies. A qualitative analysis comparing the
18
F-NaF findings with the ones of the other methods was performed, and the results were classified as superior (>), equal (=), and inferior (<).
Results
Eleven patients had no bone metastases detected on any of the imaging methods used. Twenty patients presented SM depicted on
18
F-NaF. Of these 20 patients, 12 performed bone scan (in 9
18
F-NaF > BS and in 3
18
F-NaF = BS), 1 performed
18
F-FDG (
18
F-NaF >
18
F-FDG), 4 performed
68
Ga-Dotatate (in 2
18
F-NaF >
68
Ga-Dotatate and in 2
18
F-NaF =
68
Ga-Dotatate), 20 performed CT of at least one body segment (in 15
18
F-NaF = CT and in 5
18
F-NaF > CT), and 16 performed MRI of at least one body segment, and in all of them, the
18
F-NaF was equal to the MRI. Beside this, the
18
F-NaF detected SM in body segments not routinely scanned in MRI and CT.
Conclusion
In patients with MTC, the
18
F-NaF seems to be equal or superior to other imaging modalities in the detection of SM and allows the analysis of the whole skeletal in a single study.
Herein, we report a case of a 19-year-old man with multiple endocrine neoplasia type 2B (MEN2B) and medullary thyroid carcinoma (MTC) diagnosed when he was 12 years of age. The patient had previously ...undergone total thyroidectomy, cervical radiotherapy, and chemotherapy. He progressed with known bone, pulmonary, and lymph node metastases and was scanned with
18
F-fluoride (
18
F-NaF) and
68
Ga-dotatate whole-body positron emission tomography/computed tomography (PET/CT) for metastatic disease monitoring. We found that the MTC bone metastases and soft tissue calcified metastases were better characterized on
18
F-NaF PET/CT than on
68
Ga-dotatate PET/CT. This case illustrates that the
18
F-NaF PET/CT could be helpful not only to the detection of bone metastases but also to the detection of calcified soft tissue metastases in patients with MTC.
We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, ...melanoma, and pelvic tumors.
From 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of (99m)Tc-colloid particles. Surgery was performed the same or next day.
Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P < 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer.
SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI.
The aim of this study was to compare oral and IV administrations of 18 F-NaF PET/CT for detection of suspicious bone metastatic lesions of breast and prostate cancers.
Thirty-six patients with breast ...(n = 23) or prostate (n = 13) cancers and high risk for bone metastases were prospectively evaluated. All patients underwent 2 PET/CT studies after IV and oral 18 F-NaF administration within a 2 to 23 days interval between them. The maximum SUVs from the same suspicious lesions (≤5 index lesions per patient) in both studies were measured. The target-to-background ratio (TBR), defined as the relation between the lesion maximum SUV and the whole skeletal mean SUV, was calculated for each lesion. The TBRs in the same lesion calculated using the 2 administration routes were compared. The agreements between 2 physicians in the definition of the number of lesions in both studies were also assessed using weighted κ.
One hundred thirty-four pairs of lesions were analyzed. There was no significant statistical difference between the median TBRs ( P = 0.212) for IV (10.33) and oral (10.85). Excellent intraobserver agreement was observed between IV and oral routes: weighted κ of 1.0 (95% confidence interval, 0.92-1.0) and 0.92 (95% confidence interval, 0.81-0.99) for physicians 1 and 2, respectively. The interobserver coefficients were 0.82 and 0.87 for "oral versus oral" and "IV versus IV," respectively.
18 F-NaF PET/CT studies using oral and IV routes present comparable performance; thus, it is possible to use oral route in patients with difficult venous access.
To compare the
F-NaF PET/CT studies (
F-NaF) with other imaging methods in the detection of skeletal metastases (SM) in patients with medullary thyroid cancer (MTC).
We retrospectively analyzed 31 ...patients with MTC who performed
F-NaF to assess SM. The results of the
F-NaF were compared with other imaging methods performed for metastasis detection:
Tc-MDP bone scan (BS), magnetic resonance imaging (MRI), contrast-enhanced CT (CT), and
Ga-Dotatate and
F-FDG PET/CT studies. A qualitative analysis comparing the
F-NaF findings with the ones of the other methods was performed, and the results were classified as superior (>), equal (=), and inferior (<).
Eleven patients had no bone metastases detected on any of the imaging methods used. Twenty patients presented SM depicted on
F-NaF. Of these 20 patients, 12 performed bone scan (in 9
F-NaF > BS and in 3
F-NaF = BS), 1 performed
F-FDG (
F-NaF >
F-FDG), 4 performed
Ga-Dotatate (in 2
F-NaF >
Ga-Dotatate and in 2
F-NaF =
Ga-Dotatate), 20 performed CT of at least one body segment (in 15
F-NaF = CT and in 5
F-NaF > CT), and 16 performed MRI of at least one body segment, and in all of them, the
F-NaF was equal to the MRI. Beside this, the
F-NaF detected SM in body segments not routinely scanned in MRI and CT.
In patients with MTC, the
F-NaF seems to be equal or superior to other imaging modalities in the detection of SM and allows the analysis of the whole skeletal in a single study.
Our objective was to test the hypothesis that variability in SUV normalized by skeletal volume (SV) in
F-fluoride (
F-NaF) PET/CT studies is lower than variability in SUV normalized by body weight ...(BW).
The mean SUV (SUV
) was obtained for whole skeletal volume of interest (wsVOI) in 163 selected
F-NaF PET/CT studies. These studies were performed to investigate bone metastases and were considered to have normal results. SUV
was calculated with normalization by BW (BW SUV
), with normalization by SV (SV SUV
), and without normalization (WN SUV
). The total SV for each patient was also estimated on the basis of the wsVOI defined on the CT component of the PET/CT study. SUV
variability for each patient was estimated as the absolute value of the difference between the SUV
for the patient and the mean of the SUV
for the whole group of patients, divided by the mean of the SUV
for the whole group of patients. The variabilities of SUV
calculated by the 3 methods were compared using a paired 1-tailed Wilcoxon test.
The mean variability for the BW, SV, and WN SUV
was 0.16, 0.13, and 0.16, respectively. There were statistically significant differences between SV and BW SUV
variability (
= 0.03) and between SV and WN SUV
variability (
< 0.01). There was no statistically significant difference between BW and WN SUV
variability (
= 0.4).
In patients with normal
F-NaF PET/CT results, SV SUV
presents lower variability than BW SUV
.
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