1 / 33

Gino Pepe Medicina Nucleare – PET H.SanRaffaele IRCCS - Milano

CT. [ 18 F]FDG PET. L'uso della PET nella diagnosi precoce e la valutazione del SUV come indicatore di prognosi. Gino Pepe Medicina Nucleare – PET H.SanRaffaele IRCCS - Milano. [ 18 F]FDG-PET. Why [ 18 F]FDG-PET in tumors?. Why [ 18 F]FDG-PET in tumors?.

awen
Download Presentation

Gino Pepe Medicina Nucleare – PET H.SanRaffaele IRCCS - Milano

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. CT [18F]FDG PET L'uso della PET nella diagnosi precoce e la valutazione del SUV come indicatore di prognosi Gino Pepe Medicina Nucleare – PET H.SanRaffaele IRCCS - Milano

  2. [18F]FDG-PET

  3. Why [18F]FDG-PET in tumors?

  4. Why [18F]FDG-PET in tumors? Elevated glucose metabolism in tumor

  5. Why [18F]FDG-PET in tumors? Elevated glucose metabolism in tumor [18F]FDG is a glucose analog

  6. Why [18F]FDG-PET in tumors? Elevated glucose metabolism in tumor [18F]FDG is a glucose analog [18F]FDG uptake into viable neoplastic cells

  7. [18F]FDG PET: APPLICATION IN LUNG CANCER • Differentiating benign from malignant lesions (SPN) • Staging N and M and re-staging for therapy planning • Predicting and monitoring response to therapy

  8. Solitary Pulmonary Nodule (SPN) • Solitary lung lesion < 3 cm in diameter • 20% - 40% of SPN are malignant • Initial presentation in 20% - 30% of lung cancer Coleman et al. J Nuc Med 1999

  9. [18F]FDG PET Measure of metabolic activity of SPN • Visual Analysis • Quantitative analysis CT CT [18F]FDG PET [18F]FDG PET SUV = 7.3

  10. [18F]FDG PET Measure of metabolic activity of SPN • Visual Analysis: nodule activity vs mediastinal blood pool activity • Quantitative analysis CT CT [18F]FDG PET [18F]FDG PET SUV = 7.3

  11. [18F]FDG PET Measure of metabolic activity of SPN • Visual Analysis: nodule activity vs mediastinal blood pool activity • Quantitative analysis CT CT [18F]FDG PET [18F]FDG PET SUV = 7.3

  12. [18F]FDG PET Measure of metabolic activity of SPN • Visual Analysis • Quantitative analysis: SUV (standardized uptake value) CT CT [18F]FDG PET [18F]FDG PET SUV = 7.3

  13. Standardized Uptake Value = SUV • SUVBW = Ct/(ID/BW) = (kBq/ml) / (MBq/Kg) • SUVLBM = Ct/(ID/LBM) = (kBq/ml) / (MBq/Kg) • LBM uomini =1.1 * W - 128 *(W/h)2 • LBM donne = 1.07 * W - 148 *(W/h)2 • SUVBSA = Ct/(ID/BSA) = (kBq/ml) / (MBq/m2) • BSA = 0.007184 * W 0.425 * h 0.725

  14. [18F]FDG PET Measure of metabolic activity of SPN • Visual Analysis • Quantitative analysis: SUV (standardized uptake value) CT CT [18F]FDG PET [18F]FDG PET SUV = 7.3

  15. [18F]FDG PET Measure of metabolic activity of SPN • Visual Analysis • Quantitative analysis: SUV (standardized uptake value) CT CT [18F]FDG PET [18F]FDG PET SUV = 7.3 SUV = 7.9

  16. [18F]FDG PET Lung cancer is hypermetabolic A SPN with SUV more than 2.5 is considered to be malignant No difference between visual vs. quantitative analysis Sens Spec PPV NPV Acc • Visual 100 69 90 100 92 • SUV 96 69 90 85 89 Hain SF et al. Eur J Nucl Med 2001

  17. CT [18F]FDG PET Fused SPN: 1.2 cm in diameter HSR - Milano

  18. CT [18F]FDG PET CT- PET SPN: 1.4 cm in diameter HSR - Milano

  19. Accuracy of PET with [18F]FDG in SPN or Pulmonary Opacity Authors Sensitivity Specificity Accuracy Duhaylongsod (1995) 97% 82% 92% Bury (1996) 100% 88% 96% Lowe (1998) 98% 69% 89% Prauer (1998) 90% 83% 87% Graeber (1999) 97% 89% 92% Hung (2001) 95% 50% 86% Hellwig (2001) (meta-analysis) 96% 80% - Gould (2001) (meta-analysis) 97% 78% - Hickeson (2002) (using PET-CT)97% 82%92%

  20. Limitations of FDG-PET for Lung Nodule Characterization:False-positive results Inflammatory lesions (mainly granulomas) • Tubercolosis • Sarcoidosis • Aspergillosis • Histoplasmosis • Cryptococcosis

  21. Limitations of FDG-PET for Lung Nodule Characterization:False-negative results Small lesion < 5-6 mm % of viable neoplastic cells in SPN • Lesion Dimension • Histological Type • Hyperglycemia

  22. CT [18F]FDG PET ? Fused R. F. 53 aa Lung nodule 4 mm in diameter HSR - Milano

  23. CT [18F]FDG PET CT- PET Z. A. 41 aa SPN: 4 mm in diameter HSR - Milano

  24. Limitations of FDG-PET for Lung Nodule Characterization:False-negative results • Lesion Dimension • Histological Type • Hyperglycemia Carcinoid Pure Bronchioloalveolar Carcinoma (BAC), mucinous ca, neuroendocrine tumor Well differentiated type

  25. [18F]FDG PET CT CARCINOID HSR - Milano

  26. CT [18F]FDG PET PET/CT P. G. 68 aa SPN: 10 mm in diameter Well differentiated tumor HSR - Milano

  27. [18F]FDG PET IN LUNG CANCERSUV and histological type Mean SUV • BAC (12) 1.3 • Well Differentiated (10) 3.1 • Moderately differentiated (12) 4.3 • Poorly differentiated (4) 5.6 Higashi et al. Nucl Med Comm 2000

  28. [18F]FDG PET IN LUNG CANCERFDG uptake in BAC No [18F]FDG uptake in more than 50% of patients with BAC 85,7% of BAC are negative for Glut-1 (glucose transporter) expression (Higashi 2000) [18F]FDG-PET FN A different PET tracer may solve the problem

  29. [11C]Choline PET Pure Bronchioloalveolar Carcinoma CT [18F]FDG PET SUV = 1.73 B. A. 65 aa HSR Milano

  30. Limitations of FDG-PET for Lung Nodule Characterization:False-negative results • Lesion Dimension • Histological Type • Hyperglycemia > 200 mg/dl = PET not performed

  31. VALUTAZIONE DELLA RISPOSTA ALLA TERAPIA con PET e [18F]FDG NEL TUMORE POLMONARE 113 pazienti con neoplasia polmonare NSC trattati con chemio o radiochemioterapia Differenza significativa nella sopravvivenza tra pazienti con PET positiva e pazienti con PET negativa Mediana di sopravvivenza 12.1 mesi nei pz con PET + dopo terapia 34.2 mesi nell’85% dei pz con PET - dopo terapia Patz et al AJR, 2000

  32. FDG-PET: VALUTAZIONE PRECOCE DELLA RISPOSTA ALLA CHEMIOTERAPIA 57 pazienti in stadio IIIB o IV studiati con PET prima e dopo I° ciclo di chemio PET Responder (SUV –61%) PR in 20/28 PET responders (71%) SD o PD in 26/27 PET non responders (96%) Weber et al.,J Clin Oncol 2003; 21:2651

  33. PET in SPN • Who: • Patient with indetermined lung nodule • When: • After a CT study • Why: • Metabolic characterization of indetermined lung nodule (benign vs malignant)

More Related