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Skull base metastases, including those from small‐cell lung carcinoma (SCLC), can present with various syndromes depending on the site of involvement, such as orbital syndrome, parasellar syndrome, middle fossa syndrome, jugular foramen syndrome, and occipital condyle syndrome (OCS). One such example is OCS, which consists of unilateral occipital headache accompanied with ipsilateral hypoglossal palsy. This case report describes a 51‐year‐old man initially diagnosed with OCS, which led to the discovery of systemic bone metastases from SCLC. Magnetic resonance imaging showed lesions in the occipital condyle and hypoglossal canal, while positron emission tomography‐computed tomography identified a lung mass and widespread metastases. SCLC is highly aggressive and metastatic, with the bone being a common site of spread. In this case, the OCS preceded the diagnosis of the underlying malignancy. Prompt diagnosis and treatment are crucial, as patients with OCS often have advanced disease. This case highlights the importance of considering SCLC as a potential etiology for OCS, given the propensity for bone metastases. Early recognition and evaluation of OCS is essential to initiate appropriate management. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Sarcomatoid carcinoma, a rare and aggressive subtype of bladder cancer, accounting for 0.3% of cases, is more aggressive than urothelial carcinomas. Accurate diagnosis, crucial for treatment, can be challenging. We present a characterized case of sarcomatoid carcinoma of the urinary bladder using multimodal imaging and pathology. [ABSTRACT FROM AUTHOR]

Watchful waiting is an acceptable management strategy for advanced‐stage, low tumor burden (LTB) patients with follicular lymphoma (FL). However, the prediction of how long this treatment‐free observation period will last remains imperfect. We explored whether total metabolic tumor volume (TMTV) and other positron emission tomography parameters were predictive of time to first treatment (TTFT). We analyzed 97 grade 1–3A advanced‐stage LTB FL patients and found that a high TMTV was associated with other tumor burden features at diagnosis. Patients with a TMTV above our established cutoff of 50 mL had a significantly shorter median duration of observation (2.6 vs. 8.8 years; p = 0.001). At 5 years, 77% of patients with a high TMTV and 46% of patients with a low TMTV required treatment. In the multivariable analysis, a high TMTV was the only independent factor predicting TTFT (hazard ratio = 2.09; p = 0.017). Overall, TMTV is a strong predictor of the duration of observation in LTB FL patients. Upon validation of our cutoff in external series and standardization of the methodology, the TMTV could become an additional factor to consider deferring or initiating treatment in otherwise LTB patients. [ABSTRACT FROM AUTHOR]

Aim: To investigate the clinical and radiological outcomes and glucocorticoid‐sparing effect of rituximab therapy in 13 patients with retroperitoneal fibrosis (RPF). Methods: We analyzed the data of both glucocorticoid‐naive and glucocorticoid‐resistant RPF patients who were treated with rituximab. Demographic features, positron emission tomography computed tomography (PET‐CT) findings, and clinical and histopathologic outcomes were collected retrospectively. Results: We evaluated the data of 13 RPF patients (8M/5F). The median follow‐up duration was 28 months (interquartile range [IQR] 24.5–55.5 months) and median age at the time of diagnosis was 50.8 years (IQR 46.5–54.5 years). PET‐CT scans showed that following the rituximab therapy, the craniocaudal diameter of the RPF mass reduced from 74 mm (IQR 50.5–130 mm) to 52 mm (IQR 35–77 mm; p =.06), and periaortic thickness of the RPF mass reduced from 14 mm (5.5–21.9 mm) to 7 mm (4.5–11 mm; p =.12). The maximum standardized uptake value (based on body weight) of the RPF mass decreased from 5.8 (4.3–9.7) to 3.1 (2.8–5.3) after the therapy (p =.03). The number of patients with hydronephrosis reduced from 11 to 6 following rituximab therapy (p =.04). Before rituximab, nine patients received a median dose of 10 mg (IQR 0–27.5 mg) prednisolone per day. After the rituximab treatment, we discontinued prednisolone treatment for four out of nine patients and reduced the daily dose for the remaining patients. At the time of the final evaluation of the patients, the median prescribed prednisolone dose was 5 mg/day (IQR 2.5–7.5 mg/day; p =.01). Conclusion: Our study shows that rituximab may be a favorable treatment option for glucocorticoid‐refractory RPF patients with high disease activity on PET‐CT scans. [ABSTRACT FROM AUTHOR]

Background Study Design Endpoints Eligibility Criteria Patients and Methods Trial Registration Salvage radiation therapy (SRT) and surveillance for low‐risk prostate‐specific antigen (PSA) recurrence have competing risks and benefits. The efficacy of early SRT to the prostate bed with or without pelvic lymph nodes compared to surveillance in patients with PSA recurrence after radical prostatectomy and no identifiable recurrent disease evident on prostate specific membrane antigen‐positron emission tomography/computer tomography (PSMA‐PET/CT) is unknown.The Dedicated Imaging Post‐Prostatectomy for Enhanced Radiotherapy outcomes (DIPPER) is an open‐label, multicentre, randomised Phase II trial.The primary endpoint is 3‐year event‐free survival, with events comprising one of PSA recurrence (PSA ≥0.2 ng/mL higher than baseline), radiological evidence of metastatic disease, or initiation of systemic or other salvage treatments. Secondary endpoints include patient‐reported outcomes, treatment patterns, participant perceptions, and cost‐effectiveness.Eligible participants have PSA recurrence of prostate cancer after radical prostatectomy, defined by serum PSA level of 0.2–0.5 ng/mL, deemed low risk according to modified European Association of Urology biochemical recurrence risk criteria (International Society for Urological Pathology Grade Group ≤2, PSA doubling time >12 months), with no definite/probable recurrent prostate cancer on PSMA‐PET/CT.A total of 100 participants will be recruited from five Australian centres and randomised 1:1 to SRT or surveillance. Participants will undergo 6‐monthly clinical evaluation for up to 36 months. Androgen‐deprivation therapy is not permissible. Enrolment commenced May 2023.This trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN: ACTRN12622001478707). [ABSTRACT FROM AUTHOR]

A 45‐year‐old male with cardiac sarcoidosis verified by cardiac biopsy presented with multiple coexisting arrhythmias, including ventricular tachycardia of more than 1000 episodes per 24 h, paroxysmal atrial fibrillation, and third‐degree atrioventricular block. He did not respond to corticosteroids dose of 20–60 mg once daily and mycophenolate mofetil dose of 1 g twice daily for 6 months. Cardiac magnetic resonance (CMR) demonstrated inflammation and late gadolinium enhancement on right ventricular wall and interventricular septum. Positron emission tomography‐computed tomography (PET‐CT) showed multifocal 18F‐fluorodeoxyglucose uptake in the heart. We replaced mycophenolate mofetil with adalimumab, a tumour necrosis factor‐α inhibitor. After 3 months, his arrhythmias improved significantly, manifesting as premature ventricular contractions of only 500 beats per 24 h and first‐degree atrioventricular block. CMR showed a significant reduction in inflammation and late gadolinium enhancement, and PET‐CT showed a complete resolution of fluorodeoxyglucose uptake. [ABSTRACT FROM AUTHOR]

Background: The neural basis of rosacea is not well understood. This study aimed to determine whether cerebral glucose metabolism (CGM) changes on 18F‐fluorodeoxyglucose (18F‐FDG) positron emission tomography (PET)/computed tomography (CT) scans can detect functional network changes in specific brain areas in patients with rosacea. Materials and methods: Eight adults with rosacea and 10 age/sex‐matched healthy adults (controls) were enrolled in the study. 18F‐FDG PET/CT brain images for all eight patients and whole‐body images for two of the patients were analyzed qualitatively and semi‐quantitatively. Differences between the study groups were examined using Fischer's exact test and a Student's t‐test. A voxel‐based analysis using statistical parametric mapping was performed to compare the brain metabolism of the patients with that of the controls. Results: Compared with the controls, the patients with rosacea showed extensive changes in the CGM signals in the cerebral cortex and limbic system, with less CGM shown in the right superior parietal lobule, right postcentral gyrus, right parahippocampal gyrus, left superior frontal gyrus, and lateral posterior thalamic nucleus and more CGM in the right precentral gyrus, left inferior frontal gyrus, and cerebellar tonsil. No dysmetabolic lesions were found in the whole‐body 18F‐FDG PET/CT images. Conclusion: Specific neural functional changes occur in patients with rosacea that may explain its pathogenesis. [ABSTRACT FROM AUTHOR]

Non‐secretory multiple myeloma (NSMM) is a rare type of multiple myeloma characterized by the absence of the M protein, making its diagnosis challenging. Here, we report a 67‐year‐old female patient eventually diagnosed as NSMM with positron emission tomography‐computed tomography (PET/CT) imaging as a clue. [ABSTRACT FROM AUTHOR]

To compare the clinical application value of positron emission tomography–computed tomography (PET‐CT) and magnetic resonance imaging (MRI) in the diagnosis of cervical cancer lymph node metastasis. We searched PubMed and other databases for the studies comparing the use of PET‐CT and MRI for the diagnosis of cervical cancer lymph node metastasis up to January 20, 2021. We strictly followed the inclusion and exclusion criteria to screen the literature and extract the data. Quality Assessment of Diagnostic Accuracy Studies (QUADAS)‐2 tool was used for quality evaluation of included studies, and Revman 5.3 and Stata 15.0 software were used for evaluating heterogeneity, synthesize sensitivity (SEN), specificity (SPE), positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and the area under the curve (AUC) and comparing the pretest and posttest probabilities. Finally, 11 studies were included for meta‐analysis. The synthesized results indicated that the SEN value of PET‐CT was 0.65 (0.60 ~ 0.69) and SPE was 0.93 (0.91 ~ 0.94), and the SEN value of MRI was 0.58 (0.54 ~ 0.63) and SPE was 0.91 (0.90 ~ 0.92). AUC of PET‐CT was 0.824, which was significantly higher than that of MRI (AUC = 0.702; p <.05). The subgroup analysis showed that the AUC value of the study based on study design and use of blinding methods was not statistically significant (all p >.05). There was no obvious publication bias in the synthesized analysis of the diagnostic value of PET‐CT and MRI (all p >.05). Highlights: To compare positron emission tomography–computed tomography (PET‐CT) and magnetic resonance imaging (MRI) in diagnosis of cervical cancer lymph node metastasis.Synthesize sensitivity value of PET‐CT was comparable with that of MRI.Area under the curve of PET‐CT was significantly higher than that of MRI.There was no obvious publication bias in synthesized analysis. [ABSTRACT FROM AUTHOR]

We report an extremely rare case of an 18‐year‐old girl with chronic progressive speech and gait disturbances due to abnormalities around the fourth ventricle, diagnosed as classic medulloblastoma with WNT signaling dysregulation by brain biopsy. Brain MRI showed atypical findings of symmetrical midline located adult medulloblastoma with no mass effect. PET‐CT scans revealed marked uptake of only 11C‐methionine. Medulloblastoma with atypical MRI findings should be considered in the differential diagnosis of tumors around the fourth ventricle in adults, even approximately symmetrical midline tumors with no mass effect. 11C‐methionine PET‐CT may be superior in detecting adult medulloblastomas with unique characteristics. [ABSTRACT FROM AUTHOR]

Background: Diffusion‐weighted whole‐body imaging with background suppression (DWIBS) is used for the diagnosis and staging of cancers. The medical cost of an MR examination including DWIBS is $123, which is 80% less expensive than the cost ($798) of F18‐fluorodeoxyglucose positron emission tomography/computed tomography (FDG‐PET/CT) examination. Methods: This study examined the efficacy of DWIBS for relapses after lung cancer resection. A total of 55 patients who had pulmonary resection of lung cancer, postoperative computed tomography (CT) every six months, and DWIBS and FDG‐PET/CT (every year) were enrolled in this study. If a metastatic lesion was detected on CT scan, DWIBS and FDG‐PET/CT were also used. Results: A total of 55 patients who underwent pulmonary resections for lung cancer, and had CT, DWIBS and FDG‐PET/CT examination during follow‐up after pulmonary resection were enrolled in this study. Lung cancer in 32 patients relapsed. Postoperative radiographic examinations revealed pulmonary metastases in 17 patients, bone metastases in seven, liver metastases in five, lymph node metastases in five, pleural metastases in four, metastases to the chest wall in two, brain metastases in two, adrenal gland metastasis in one, and renal metastasis in one. The mean apparent diffusion coefficient (ADC) value of the relapse was 0.9 to 1.70 × 10−3 mm2/s. The accuracy 0.98 (54/55) of DWIBS for detecting multiple metastatic lesions was likely to be higher than 0.94 (52/55) of CT or 0.94 (52/55) of FDG‐PET/CT, but there were no significant differences. Conclusions: DWIBS can detect multiple metastatic lesions throughout the entire body and differentiate malignancy from benignity in only one examination. DWIBS has benefits of diagnostic accuracy and is less expensive in medical costs for the detection of a relapse. DWIBS could potentially replace FDG‐PET/CT after lung cancer resection. [ABSTRACT FROM AUTHOR]

Background: Prostate‐specific membrane antigen (PSMA) is a prostatic epithelial protein that is used as a radiotracer (68Ga‐PSMA‐11) for prostate cancer staging. PSMA‐PET/CT (positron emission tomography/computed tomography) performed for prostate cancer has been observed to detect melanoma metastases. The aim of this study was to investigate the performance of PSMA immunohistochemistry on resected melanoma metastases to explore its use as a diagnostic imaging biomarker for melanoma. Methods: A total of 41 specimens with stage III/IV melanoma were stained with PSMA immunohistochemistry. All specimens required both disease and control regions. Two pathologists scored the specimens and a receiver operating characteristic (ROC) curve was plotted. Western blot and multiplex immunofluorescence were also performed. Results: The area under the ROC curve was 0.82, suggesting that PSMA has excellent discriminatory power in melanoma metastases. Sensitivity is 82.9% and specificity 73.2%. Immunohistochemistry and Western blot reveal that PSMA staining in melanoma consistently and most intensely occurs in tumor neovasculature. Multiplex immunofluorescence shows that melanocytes may also weakly express PSMA. Conclusion: The performance of PSMA immunohistochemistry in melanoma metastases contrasts with that reported in prostate cancer studies. This study indicates that PSMA shows promise for use as a novel biomarker in melanoma and justifies further research in the clinical setting with potential as a PET/CT radiotracer and intraoperative fluorescence marker for melanoma. [ABSTRACT FROM AUTHOR]

Objectives: Target volumes for irradiation remain ill‐defined for squamous cell cancer of unknown primary in the head and neck (SCCUP). The aim of this study was to compare involved neck only (INO) radiotherapy (RT) with irradiating involved neck plus potential mucosal primary sites and contralateral neck (MUC) in patients diagnosed and treated with modern diagnostics and techniques. Design: This is a retrospective cohort study. Patients with a diagnosis of SCCUP with unilateral neck disease were included. Results: Thirty patients were identified. All underwent FDG PET‐CT. 47% of patients had HPV‐positive SCC. 20 patients received RT to INO, 10 patients to MUC, all with volumetric modulated arc therapy (VMAT). A significantly lower dose for each organ at risk was delivered in INO‐treated patients, with mean dose to contralateral parotid gland 57% less. The proportion of patients with late grade 2 or worse xerostomia was higher in MUC patients. The incidence of grade 2‐3 mucositis (89% vs 45%) and grade 3 or worse dysphagia (50% vs 10%) was higher in MUC patients. Median follow‐up was 31 months. No mucosal primaries emerged. Progression‐free survival at 2 years was 74.7% for INO patients, 70% in the MUC group. Overall survival at 2 years was 79.7% in the INO group and 70% in the MUC patients. Conclusion: INO radiotherapy for patients with SCCUP of the head and neck is a safe treatment strategy resulting in clinically significant lower RT doses to OARS. Acute and late toxicities are reduced without detriment to patient survival. [ABSTRACT FROM AUTHOR]

A 77-year-old woman presented to our hospital with complaints of persistent cough and low-grade fever for two months. On radiological analysis, she had moderate right-sided pleural effusion with right hilar and subcarinal lymphadenopathies. Thoracentesis showed chylothorax of unknown cause. Bronchoscopy revealed a non-specific inflammatory process. However, thoracoscopic surgery demonstrated a curiously enlarged lymphatic duct with its proximal portion compressed by subcarinal lymphadenopathies, pathologically diagnosed as granulomatous lymphadenitis. Hence, tuberculous lymphadenitis was proven to be the cause of chylothorax. Interestingly, cauterization of the lymphatic duct decreased the total amount of right-sided pleural effusion along with a change in colour from milky yellow to red. These were in favour of tuberculosis (TB)-associated chylothorax with the advent of the TB pleuritis. All symptoms and pleural effusion disappeared after the initiation of anti-tuberculous drugs. The present case showed definite evidence of TB-associated chylothorax development mechanism via compression of the lymphatic duct by mediastinal lymphadenopathies. [ABSTRACT FROM AUTHOR]

Abstract: The goal of this prospective pilot study was to use naturally occurring canine mast cell tumors of various grades and stages as a model for attempting to determine how glucose uptake and markers of biologic behavior are correlated. It was hypothesized that enhanced glucose uptake, as measured by 2‐[fluorine‐18]fluoro‐ d‐glucose‐positron emission tomography/computed tomography (F18 FDG PET‐CT), would correlate with histologic grade. Dogs were recruited for this study from a population referred for treatment of cytologically or histologically confirmed mast cell tumors. Patients were staged utilizing standard of care methods (abdominal ultrasound and three view thoracic radiographs), followed by a whole body F18 FDG PET‐CT. Results of the F18 FDG PET‐CT were analyzed for possible metastasis and standard uptake value maximum (SUVmax) of identified lesions. Incisional or excisional biopsies of the accessible mast cell tumors were obtained and histology performed. Results were then analyzed to look for a possible correlation between the grade of mast cell tumors and SUVmax. A total of nine animals were included in the sample. Findings indicated that there was a correlation between grade of mast cell tumors and SUVmax as determined by F18 FDG PET‐CT (p‐value = 0.073, significance ≤ 0.1). Based on the limited power of this study, it is felt that further research to examine the relationship between glucose utilization and biologic aggressiveness in canine mast cell tumors is warranted. This study was unable to show that F18 FDG PET‐CT was a better staging tool than standard of care methods. [ABSTRACT FROM AUTHOR]

Although clinical use of positron emission tomography-computed tomography (PET-CT) scans is well established in aggressive lymphomas, its prognostic value in marginal zone lymphoma (MZL) remains yet unclear. Hence, we investigated potential role of PET-CT in predicting MZL patients' outcomes following systemic chemotherapy. A total of 32 patients with MZL who received first-line chemotherapy were included in the analysis. They all underwent pretreatment, interim, and posttreatment PET-CT scans. The primary objective was to evaluate the role of complete metabolic response (CMR) in posttreatment PET-CT scans in predicting progression-free survival (PFS). Compared with non-CMR group, 5-year PFS rate was significantly higher in patients who achieved CMR in posttreatment PET-CT (54.2% vs 0.0%, P = .003) and also in patients gaining CMR in interim PET-CT scans (62.5% vs 15.6%, P = .026). Interestingly, early CMR group, who achieved and maintained CMR in both interim and posttreatment PET-CT scans, showed significantly higher 5-year PFS than those with delayed or never CMR group (62.5% vs 37.5% vs 0%, P = .008). Therefore, interim and/or posttreatment CMR can be prognostic at least in these subsets of patients with MZL treated with chemotherapy. [ABSTRACT FROM AUTHOR]

Positron emission tomography (PET) with fluorodeoxyglucose F18 (18F-FDG) is useful for detecting malignancies, but benign lesions occasionally have false-positive 18F-FDG uptake. Here, we report the cases of five postmenopausal women with solid ovarian tumors suspected to be ovarian cancer on magnetic resonance imaging and 18F-FDG uptake. Mean age of the five patients was 57 years (range, 53-65 years). Average early standardized uptake value (SUV) of 18F-FDG was 5.76 (range, 2.2-12.0) and delayed SUV was 6.56 (range, 2.4-13.8). In all five patients, frozen section diagnosis at surgery was thecoma, and bilateral salpingo-oophorectomy was performed. On immunohistochemistry, immunoreactive glucose transporter 5 (GLUT5) expression was detected in thecoma tissues. This case shows that thecoma sometimes has positive 18F-FDG uptake on positron emission tomography-computed tomography (PET-CT), indicating the need for caution regarding false-positive PET-CT in patients with benign solid ovarian tumor. [ABSTRACT FROM AUTHOR]

We examined the outcome of a cohort of patients with Hodgkin lymphoma ( HL) in order to assess if fluorodeoxyglucose ( FDG) positron emission tomography-computed tomography ( PET/ CT) at the end of treatment (end- PET) can be omitted when the interim PET (int- PET) is negative. Seventy-six ABVD(adriamycin, bleomycin, vinblastine, dacarbazine)-treated patients were retrospectively included. No change in treatment was made on the basis of int- PET results. Suspicious foci on end- PET received biopsy confirmation whenever possible. Median follow-up was 58·9 months. Uptake on int- PET higher than liver (scores 4-5) was rated positive according to the Lugano classification, while a positive end- PET corresponded to scores 3, 4 and 5. Fifteen patients had treatment failure. Sensitivity, specificity, positive predictive value ( PPV), negative predictive value and accuracy of int- PET were 46·7%, 85·2%, 43·8%, 86·7% and 77·6%, respectively. For end- PET the figures were: 80%, 93·4%, 75%, 95% and 90·8%. Eight patients with negative int- PET had treatment failure; six of them were identified as non-responders with end- PET. The 5-year progression-free survival ( PFS) was 87% for patients with negative int- PET versus 56% with positive int- PET. The 5-year PFS was 96% with negative end- PET versus 23% with positive end- PET. The prognostic information from int- PET as regards PFS (log-rank test P = 0·0048) was lower than that provided by end- PET ( P < 0·0001). Int- PET predicted only half of the failures. When used in clinical routine, a negative int- PET study cannot obviate the need for end- PET examination. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Head and neck squamous cell carcinomas of unknown primary (HNSCCUP) accounts for up to 10% of presenting head and neck squamous cell carcinomas. Identification of the primary site allows for directed therapy. Where initial investigations have failed to locate the primary site, 18-fludeoxyglucose positron emission tomography-computed tomography (PET/CT) has emerged as a useful tool with improved sensitivity over positron emission tomography alone. Following PET/CT scan, the role of subsequent panendoscopy ± biopsy has not been fully assessed. We aim to evaluate and quantify the role of PET/CT and subsequent panendoscopy in HNSCCUP.Study Design: Retrospective cohort study.Methods: Patients with HNSCCUP presenting between January 2005 and December 2010 at a regional oncology referral center were studied. All patients who presented with a metastatic neck node and unknown primary who had undergone PET/CT prior to panendoscopy were included. The accuracy of PET/CT was calculated and compared with panendoscopy and histopathological findings.Results: Fifty-two patients were included. Twenty-seven PET/CT scans suggested a primary site. Calculated diagnostic parameters were 83% sensitivity, 87% specificity, positive predictive value 89%, and negative predictive value 80%. Three false-positive PET/CT scans were noted after panendoscopy and normal histology. Importantly, three confirmed tongue base tumors were found on panendoscopy, which were undetected on PET/CT.Conclusions: PET/CT is a valuable resource for locating tumors in HNSCCUP. It helps direct biopsy and aids in the detection of local and distant metastases along with synchronous primary tumors. Importantly, due to both false-positive and false-negative PET/CT rates, panendoscopy and biopsy remains an essential adjunct investigation irrespective of PET/CT results.Level Of Evidence: 4 Laryngoscope, 126:1354-1358, 2016. [ABSTRACT FROM AUTHOR]

Substantial individual differences characterize the changes induced by total sleep deprivation on cognitive functions. Despite some progress having been achieved, the mechanisms of individual differences in response to total sleep deprivation have not been clearly elucidated. Cerebral metabolism in the resting state is among the key physiological processes supporting the daily function of the brain, and may play an important role in these individual differences. Twenty-two right-handed participants (nine females and 13 males) between 20 and 26 years old completed a mathematical processing task both in resting wakefulness and after 24 h of total sleep deprivation. Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography was used to investigate brain metabolism changes. The mathematical task was performed after the positron emission tomography scans were completed. Correlation analysis was used to investigate the correlations between cognitive performance changes and brain metabolism changes. Large inter-individual differences were found in the throughput changes, but these inter-individual differences were not associated with baseline or post-deprivation performance levels. Specifically, deterioration of throughput on the mathematical processing task was significantly correlated with metabolism changes in the superior frontal medial gyrus. These findings suggested that frontal metabolic activity contributes to individual differences in waking-induced impairment of cognitive performance. [ABSTRACT FROM AUTHOR]

To determine the correlation of 11C-PD153035 uptake with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFRTKI) sensitivity and phosphorylated EGFR (pEGFR) expression in non-small cell lung cancer (NSCLC) cell lines with different EGFR-TKI sensitivities and in their corresponding xenografts. Four human NSCLC cell lines (HCC827, PC9, A549, and H1975) in the logarithmic phase were co-incubated with 11C-PD153035 to analyze the correlation of 11C-PD153035 uptake with EGFR-TKI sensitivity, and EGFR/pEGFR expression. Nude mice xenograft models bearing the four NSCLCs were prepared. 11C-PD153035 positron-emission tomography (PET)-computed tomography (CT) was used to image the xenografts and observe radioactive uptakes. Correlation of the in vivo uptakes with EGFR-TKI sensitivity, and EGFR/pEGFR expression was analyzed. HCC827 and PC9 cells, which were highly sensitive to EGFR-TKIs, exhibited higher 11C-PD153035 uptakes than the other cells. A549 cells, which were moderately sensitive to EGFR-TKIs, showed higher uptake than the EGFR-TKI-resistant H1975 cells, which showed little or no uptake. Radioactive uptakes were positively correlated with pEGFR expression in all cells. PET-CT showed that radioactivity was highest in HCC827 xenografts. The radioactivity in PC9 xenografts was higher than that in A549 and H1975 xenografts. Tumor vs. non-tumor tissue ratio values were positively correlated with pEGFR expression in HCC827 and PC9 xenografts, but not in A549 and H1975 xenografts. In conclusion, 11C-PD153035 can serve as an EGFR imaging agent in vitro and in vivo, and predicts sensitivity to EGFR-TKIs. This will provide an experimental basis for clinical applications of 11C-PD153035 and individualized NSCLC therapy. [ABSTRACT FROM AUTHOR]

Key Clinical Message Refractory empyema occasionally reflects hidden malignant disease. We presented a rare case of rapidly progressive malignant mesothelioma of the pleura ( MPM) mimicking empyema. Physicians should be aware of MPM when patients with empyema are refractory to the standard treatment, and PET- CT may be helpful in establishing a precise diagnosis in such cases. [ABSTRACT FROM AUTHOR]

Cholangiocarcinoma ( CCA) is an important public health problem in several parts of South East Asia, particularly in Thailand. The limited availability of effective diagnostic tools for early stage CCA, including chemotherapeutic options, constitutes a major problem for treatment and control of CCA. The aim of the present study was to assess the anti- CCA activity and pharmacokinetics of β-eudesmol in CCA-xenografted nude mouse model and healthy mice. Positron emission tomography-computed tomography ( PET- CT) with 18F-fluorodeoxyglucose was used for detecting and monitoring tumour development, and PET- CT with technetium-99m was used to investigate its pharmacokinetics property. Results support the role of PET- CT as a potential tool for detecting and monitoring the progress of lung metastasis. Tumour size and lung metastasis were significantly inhibited by 91.6% (of baseline) and 95% (of total lung mass), respectively, following treatment with high-dose β-eudesmol (100 mg/kg body weight for 30 days). Survival time was prolonged by 64.4% compared with untreated controls. Systemic clearance of the compound was rapid, particularly during the first 60 min. The compound was distributed to the vital organs at maximum levels 2 h after oral administration and 15 min after intravenous injection. Results from the present study suggest the potential of β-eudesmol as a promising candidate for further development as an anti- CCA drug with respect to its pharmacodynamics and pharmacokinetic properties. PET- CT, with radiotracers 18F-fluorodeoxyglucose and technetium-99m, was shown to be a reliable tool in the investigation of anti- CCA and pharmacokinetic properties of β-eudesmol in CCA-xenografted and healthy mice. [ABSTRACT FROM AUTHOR]

Determination of pleural dissemination of lung cancer helps define the treatment strategy. Positron emission tomography‐computed tomography imaging could be false‐negative for dry pleural dissemination of lung cancer. Clinicians should consider preoperative thoracoscopy in affected patients showing limited pleural effusion, interlobar fine granular shadows, and no metastasis on high‐resolution computed tomography. [ABSTRACT FROM AUTHOR]

Background Positron emission tomography-computed tomography ( PET- CT) is recommended to triage women for exenterative surgery and surveillance after treatment for advanced cervical cancer. Objective To evaluate diagnostic accuracy of additional whole body PET- CT compared with CT/magnetic resonance imaging ( MRI) alone in women with suspected recurrent/persistent cervical cancer and in asymptomatic women as surveillance. Design Systematic reviews. Subjective elicitation to supplement diagnostic information. Search strategy/Selection criteria/Data collection and analysis Searches of electronic databases were performed to June 2013. Studies in women with suspected recurrent/persistent cervical cancer and in asymptomatic women undergoing follow up with sufficient numeric data were included. We calculated sensitivity, specificity and corresponding 95% confidence intervals. Meta-analyses employed a bivariate model that included a random-effects term for between-study variations ( CT studies) and univariate random effects meta-analyses ( PET- CT studies) for sensitivity and specificity separately. Subjective elicitation Prevalence of recurrence and the accuracy of imaging elicited using the allocation of points technique. Coherence of elicited subjective probabilities with estimates in the literature examined. Results We identified 15 relevant studies; none directly compared additional PET- CT with MRI or CT separately. Most CT and MRI studies used older protocols and the majority did not distinguish between asymptomatic and symptomatic women. Meta-analysis of nine PET- CT studies in mostly symptomatic women showed sensitivity of 94.8 (95% CI 91.2-96.9), and specificity of 86.9% (95% CI 82.2-90.5). The summary estimate of the sensitivity of CT for detection of recurrence was 89.64% (95% CI 81.59-94.41) and specificity was 76% (95% CI 43.68-92.82). Meta-analysis for MRI test accuracy studies was not possible because of clinical heterogeneity. The sensitivity and specificity of MRI in pelvic recurrence varied between 82 and 100% and between 78 and 100%, respectively. Formal statistical comparisons of the accuracy of index tests were not possible. Subjective elicitation provided estimates comparable to the literature. Subjective estimates of the increase in accuracy from the addition of PET- CT were less than elicited increases required to justify the use in PET- CT for surveillance. Conclusion Evidence to support additional PET- CT is scarce, of average quality and does not distinguish between application for surveillance and diagnosis. Guidelines recommending PET- CT in recurrent cervical cancer need to be reconsidered in the light of the existing evidence base. [ABSTRACT FROM AUTHOR]

Oncocytoma is a rare, benign salivary neoplasm composed of mitochondria-rich cells called oncocytes. Although oncocytoma usually occurs in the parotid glands, it has much less commonly been reported to occur in minor salivary gland tissues. Although there have been a few reported cases of oncocytomas being found in the parapharyngeal space, most if not all cases seem to be extensions of deep lobe parotid tumors. We present a case of a 73-year-old man with a previous history of prostate cancer that had the incidental finding of an 18F-fluorodeoxyglucose (FDG) image of a highly avid parapharyngeal space lesion noted on a follow-up positron emission tomography–computed tomography (PET/CT) scan. Excision of the mass, through a transcervical approach, demonstrated it to be an isolated oncocytoma of the parapharyngeal space, noncontiguous with the parotid gland. Based on our literature search, this may be the first such reported case. A brief review of the available literature examining the known body of knowledge regarding these neoplasms is presented. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To evaluate the efficacy of combined positron emission tomography-computed tomography (PET-CT) in identifying salivary gland malignancies and to examine the role of PET-CT in the management of these patients. Study Design: Retrospective chart review. Methods: Fifty-five patients with diagnosed salivary gland cancer who had undergone PET-CT scanning were retrospectively reviewed from January 2000 to October 2008. PET-CT scans using intravenous contrast were correlated with clinicopathological information to determine diagnostic accuracy of disease extent. The impact of PET-CT findings on therapeutic management was analyzed. All histopathologic grades were included in the study. Results: Overall, PET-CT demonstrated a sensitivity of 74.4%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 61.5%. PET-CT also identified unrecognized distant metastases in the following sites: six lung, five bone, two distant lymph nodes, and one liver. PET-CT added to management in 26 patients (47.3%), and it was the deciding diagnostic modality in eight patients (14.5%). Of these 26 patients, 14 patients underwent additional surgery. Three patients with recurrence underwent PET-CT scan-directed radiation and/or chemotherapy, whereas nine patients diagnosed with distant disease received palliative treatment. Conclusions: PET-CT is useful for planning the most appropriate treatment by identifying clinically unrecognized disease. PET-CT shows a high diagnostic accuracy for detecting disease recurrence and distant metastases, thus helping to determine whether patients are candidates for potentially curative or palliative treatment. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

The article presents a case study of a 11 month old boy with mixed lineage leukemia who was diagnosed with B-precursor ALL, rearrangement diagnosed on fluorescence in situ hybridization, which was refractory to conventional chemotherapy. It notes that bone marrow graft from his father was used before 2 years of age with a conditioning treatment. The article discusses slow progressive acute lymphoblastic leukemia after stem cell transplantation.