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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two patients are described who showed abnormal fluorine-18 fluorodeoxyglucose (F-18 FDG) uptake that was due to benign disease, specifically tuberculous lymphadenitis and pneumonitis. The first patient had ulceration and oozing of the left nipple that was related to Paget's disease. An F-18 FDG PET, whole-body scan, which was performed for staging, showed no breast uptake. However, there was intense multifocal uptake in mediastinal, supraclavicular, and para-aortic areas that was confirmed radiologically to represent widespread lymphadenopathy. Pathologic examination of a mediastinal lymph node showed active tuberculosis. The second patient showed intense focal F-18 FDG uptake in mediastinal and supraclavicular areas and para-aortic lymphadenopathy due to non-Hodgkin's lymphoma. In addition, there was abnormal F-18 FDG lung uptake that revealed the presence of acid-fast bacilli on bronchial lavage. Intense focal F-18 FDG uptake in widespread lymphadenopathy or in the lung could be caused by infectious diseases such as tuberculosis. This possibility should be considered when whole-body scans of patients with cancer are interpreted, especially in those with a high incidence of infectious disease.
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PMID:F-18-FDG uptake in tuberculosis. 981 59

We retrospectively evaluated the use of 18F-FDG PET for assessment of residual disease in 27 patients after therapy for malignant lymphoma. The images were evaluated qualitatively and quantitatively using standardized uptake values (SUV). All findings were validated either by biopsy or by clinical follow-up and compared with corresponding CT findings. The impact of blood glucose concentration, body weight, body surface area, lesion diameter and the time between injection and imaging on the SUVs were analysed. All 15 patients with biopsy-proven residual disease or relapse during follow-up and 11 of 12 patients who remained relapse-free were correctly identified by qualitative interpretation of the PET images. A case of pneumonitis after radiotherapy/chemotherapy accounted for the only false-positive finding. Compared with CT imaging, PET had a significantly higher specificity (P < 0.01), accuracy (P < 0.05) and positive predictive value (P < 0.05). The mean and maximum SUV of the tumour lesions were positively correlated to lesion diameter (P < 0.01) and imaging time post-injection (P < 0.01). Standardized uptake values corrected for the partial volume effect and normalized to a standardized imaging time (SUVBPT) were significantly higher (P < 0.05) in high-grade than in low-grade non-Hodgkin's lymphoma. In conclusion, 18F-FDG PET may help in the identification of patients who need additional treatment after the completion of conventional therapy. Qualitative image interpretation appears sufficient for this purpose.
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PMID:Positron emission tomography with 18F-FDG to detect residual disease after therapy for malignant lymphoma. 986 22

To evaluate the value of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans, we performed FDG-PET scans in 23 patients with indeterminate pulmonary nodules less than 3 cm in size and analyzed these scans qualitatively and semiquantitatively. Histologic specimens were obtained by thoracoscopic excisional biopsy in 16 patients, CT-guided needle aspiration cytology in three, and bronchoscopic brushing cytology in four. Pathological diagnoses were lung cancer in 16 patients, benign inflammation in six, and malignant lymphoma in one. Sensitivity, specificity and accuracy of the FDG-PET scans were 88% (15/17), 67% (4/6) and 83% (19/23), respectively. There were two false-positive cases (organizing pneumonia and cryptococcosis) and two false-negative ones (slow-growing adenocarcinoma and malignant lymphoma). Although a few false-positive cases of granulomatous disease were yielded, the FDG-PET scans were highly sensitive in the detection of lung cancer. We conclude that the FDG-PET scanning in a useful diagnostic imaging modailty in the management of indeterminate pulmonary nodules.
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PMID:[Efficacy of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans in diagnosis of pulmonary nodules]. 1003 34

The PET-FDG is a useful method to assess the post-radiotherapy residual masses in supradiaphragmatic lymphoma patients. We present the case of a patient with residual mediastinic mass revealed by CT after the patient had completed treatment for Hodgkin's disease and in whom the PET study demonstrated a typical pattern of post-radiation pneumonitis. When these patients are re-assessed early after radiotherapy, the different tracer uptake patterns should be taken into account in order to identify the existence of radiotherapy sequela and avoid false positive results.
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PMID:[Post-radiation pneumonitis in a case of Hodgkin's lymphoma assessed with PET-FDG by residual mediastinal mass]. 1106

Purpose: We evaluated the usefulness of FDG-PET in the assessment of patients with suspected pancreatic carcinoma who have previously undergone a Whipple procedure.Methods and Materials: Attenuation-corrected FDG-PET was performed in 11 patients (5 males, 6 females, age range 52-76 years), with suspected recurrent pancreatic carcinoma after Whipple procedure. Recurrence was suspected based on clinical, laboratory (CA19-9 serum tumor marker level), or abdominal CT findings. Diagnostic validation was by histology in 2 patients and radiologic or clinical follow-up (5 to 48 months) in 9 patients. Changes in therapeutic management that were prompted by PET were tabulated.Results: PET was concordant with the findings of abdominal CT in 7 patients (6 true-positive, 1 true-negative). PET detected unsuspected lung lesions in 1 of these patients that was subsequently confirmed by a chest CT. PET was discordant with abdominal CT in 4 patients. PET detected tumor recurrence in 3 of 4 patients in this group (27% of total) who had non-diagnostic CT and elevated CA19-9 serology. Chemotherapy was initiated in 2 of these 3 patients (18% of total), while the other patient died shortly after the PET study from pneumonia and recurrent tumor was confirmed at autopsy. The remaining 1 of 4 patients in the discordant group had a false-positive PET study due to relatively high FDG localization in a displaced loop of bowel.Conclusion: PET is useful in localizing the tumor in post-Whipple patients with suspected recurrent pancreatic carcinoma and can impact their clinical management.
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PMID:2. Diagnostic Utility of FDG-PET in the Clinical Management of Patients with Suspected Recurrent Pancreatic Carcinoma after Whipple Procedure. 1115 Jul 59

Purpose: To examine the value of PET in diagnosis and staging of suspected lung cancer.Methods: 20 (13 male; mean age: 56 yr., range: 22-83 yr.) patients with chest X-ray findings suspicious of malignancy were staged a) "clinically" (X-ray, history/physical examination, lung function), b) by chest CT of thorax/upper abdomen, and c) by whole-body PET (GE Advance, visual analysis). The CT and PET studies were performed within 2 weeks of admission and read blinded to all information except the chest X-ray report. The decision to refer to mediastinoscopy/thoracotomy was made by a tumor board using clinical information, CT and PET findings. In principle, suspected metastatic lesions were biopsied before surgery. The gold standard was histology from biopsy or thoracotomy, or resolution of the X-ray findings and symptoms.Results: One patient was excluded because of uncertain diagnosis. In 3 (15%) patients surgery was avoided mainly because of the PET findings. In one SCLC patient and one lymphoma patient, PET showed extensive disease, which changed the chemotherapy regime. Accuracy was 83% for clinical stage, 79% for CT and 77% for PET. Four (20%) false positive PET findings were caused by granuloma, pneumonia and BOOP. These nodules were only 1 to <3 cm, while malignant nodules were 2-8 cm. There were no false negative PET or CT studies.Conclusion: FDG-PET is valuable in patients suspected for pulmonary malignancy, since thoracotomy was avoided in 15% of patients and in 10% of patients more extensive disease was found which changed the chemotherapy regime.
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PMID:4. Preliminary Findings of a Prospective Study of FDG-PET in Patients with Possible Lung Cancer. 1115 Jul 61

PURPOSE: Following radiation therapy for bronchogenic carcinoma, increased FDG accumulation within the irradiated tissue can be identified. This finding has not been well characterized. Therefore, we retrospectively evaluated the time course, frequency, and intensity of increased FDG uptake over a one-year period in patients who had been treated with radiation therapy. MATERIALS AND METHODS: Serial FDG-PET studies (n = 38) were performed in patients (n = 12) with bronchogenic carcinoma before and after radiation therapy. Regions of interest (ROIs) were placed in the chest wall and activity concentrations of posttherapy studies were compared to pretherapy studies. FDG uptake was also described qualitatively relative to mediastinal activity (1-4 scale) by two observers blinded from clinical information. RESULTS: Chest wall radiation port ROI uptake was 18% higher in the 2-month (P = 0.08), 40% higher in the 6-month (P = 0.003), and 32% higher in the 12-month (P = 0.04) posttherapy studies than in non-port ROIs. In 6 patients that clinically had radiation-induced chest wall fibrosis or pneumonitis, visual interpretation identified abnormal chest wall or pleural region FDG uptake in 5/6. In 2/6 patients without clinical chest wall fibrosis, abnormal, chest wall FDG uptake was seen. CONCLUSIONS: Radiation therapy occasionally causes modestly increased soft tissue FDG uptake within irradiated soft tissue in patients being treated for bronchogenic carcinoma, which persists for up to one year after therapy.
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PMID:Serial Evaluation of Increased Chest Wall F-18 Fluorodeoxyglucose (FDG) Uptake Following Radiation Therapy in Patients With Bronchogenic Carcinoma. 1451 93

This study was performed to investigate the feasibility of FDG- and L-[methyl-11C]methionine (Met)-PET for the follow up of lung cancer after stereotactic radiotherapy (SRT). Nine patients (pt) with solitary lung cancer underwent SRT. Met- and FDG-PET studies were performed one week before SRT and from one week to 8 months after SRT. Responses to SRT were complete in 2 pt and partial in 7 pt. Met- and FDG-PET scan showed high tracer uptake in all tumors before SRT. After SRT, standardized uptake values (SUV) of FDG and Met changed concordantly. Both decreased with time in 5 pt but did not decrease steadily in 4 pt, where 2 pt showed an increase at 1 to 2 weeks after SRT and 2 pt showed an increase at more than 3 months after SRT. The former appears to reflect the acute reaction to SRT and the latter radiation-induced pneumonitis. Although the addition of Met-PET did not provide additional information over FDG-PET, FDG- and Met-PET could be used to evaluate the treatment effect of SRT.
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PMID:18F-FDG and 11C-methionine PET for evaluation of treatment response of lung cancer after stereotactic radiotherapy. 1568 47

We reviewed our initial institutional experience with the use of stereotactic hypofractionated radiation therapy (SFRT) in patients with stage I non-small cell lung cancer (NSCLC). Thirty patients with inoperable stage I non-small cell lung cancer due to a severe chronic obstructive pulmonary disease (COPD) and/or chronic heart disease (Eastern Cooperative Oncology Group (ECOG) performance status of 0-2) were treated between December 2000 and October 2003 with SFRT in curative intent. Infiltration of locoregional lymph nodes and distant metastases were ruled out by computerized tomography (CT) scan of the brain, thorax, and abdomen, and by whole body FDG-positron emission tomography scan in all patients. Total RT doses ranged from 24.0 to 37.5 Gy, given in 3-5 fractions to the 60% isodose encompassing the planning target volume. Immobilization was carried out by a vacuum couch and a low-pressure foil. The clinical target volume was the tumor as it appeared in lung windowing on lung CT scan. Organ movements (caused by breathing; range, 6-22 mm) and reproducibility of patient positioning in the couch (range, 3-12 mm) were calculated by sequential CT and orthogonal films. The individual values were taken into account as a safety margin for the definition of the planning target volume (PTV). The median follow-up of living patients is 18 months (range, 6-38 months). As maximum response, there were 10 (33%) complete responses (CRs) and 14 (47%) partial responses (PRs), resulting in a total response rate of 80%. Stable disease was observed in 6 (20%) patients, while no patient experienced progressive disease. During follow-up, 2 (7%) local recurrences were observed (after 17 and 18 months, respectively). Of 5 (17%) patients who developed distant metastasis, 1 patient developed it in liver (3 months), another one in brain (6 months), and another one in the lung (36 months), while 2 patients developed it in mediastinal lymph nodes (after 8, and 11 months, respectively) only. Of 9 (30%) patients who have died, only 3 (10%) died of cancer, while 6 (20%) died of cancer-unrelated or unknown causes. Acute side effects were mild and affected 9 (33%) patients during the RT course (fatigue being the most frequent one in 6 patients). There were 22 acute events occurring in 19 (63%) patients during the first 3 months post-SFRT, the most frequent one being pneumonitis observed in 14 (46%) patients. However, there was only one (3%) grade 3 acute toxicity and no patient experienced greater than grade 3 toxicity during this study. One (3%) patient experienced rib fracture as the late event. SFRT is a feasible and safe treatment method in inoperable patients with stage I NSCLC having reduced lung capacity. Longer follow-up is necessary to get robust data on late toxicity as well as survival.
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PMID:Stereotactic hypofractionated radiation therapy for stage I non-small cell lung cancer. 1577 77

A patient who presented with weight loss and recurrent left lower lobe pneumonia was diagnosed with endobronchial carcinoid. Chest CT scan demonstrated extensive mediastinal and hilar lymphadenopathy suggesting stage IIIB disease, but radionuclide imaging with In-111 pentetreotide and F-18 FDG PET diagnosed 2 distinct pathologic processes based on functional differences between neuroendocrine tumors (expressing somatostatin receptors) and sarcoidosis (intensely FDG-avid). The possible association of carcinoid with sarcoidosis and sarcoid-like reactions in regional lymph nodes should always be considered, and the staging process should include both anatomic and functional imaging and biopsy confirmation of suspected metastatic lesions.
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PMID:Differentiation between carcinoid and sarcoid with F-18 FDG PET and In-111 pentetreotide. 1655 10


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