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Up to now, there were some studies about the role of 18F-FDG PET or PET/CT in the diagnosis of prosthetic joint infection after arthroplasty with different values of sensitivity and specificity. The purpose of this study was to systematically review the published data regarding the diagnostic performance of positron emission tomography (PET) or PET/computed tomography (PET/CT) in prosthetic infection after arthroplasty. A comprehensive computer literature search of studies published regarding PET or PET/CT in patients suspicious of prosthetic infection was performed. Pooled sensitivity, specificity and area under the receiver operating characteristic (ROC) curve of PET or PET/CT in patients suspicious of prosthetic infection on a per prosthesis-based analysis were calculated. Sixteen studies comprising 1101 prosthesis with suspicious of prosthetic infection after arthroplasty were included in this meta-analysis. The pooled sensitivity of PET or PET/CT in detecting prosthetic infection was 87% [95% confidence interval (CI) 83–90%] on a per prosthesis-based analysis. The pooled specificity of PET or PET/CT in detecting prosthetic infection was 87% (95% CI 85–89%) on a per prosthesis-based analysis. The area under the ROC curve was 0.94 on a per prosthesis-based analysis. 18F-FDG PET or PET/CT demonstrated high sensitivity and specificity in subjects suspicious of prosthetic infection. However, various degrees of uptake in the asymptomatic patients are very common. Physicians should recognize these characteristics, and then 18F-FDG PET or PET/CT can act as an effective method in the diagnosis of prosthetic infection.

A 48-year-old woman with gradually growing left lung nodule underwent FDG PET/CT scan, which demonstrated mild F-FDG uptake in the nodule of the left lobe, suggestive of malignancy. Unexpectedly, increased FDG uptake in bilateral gluteus medius, gluteus minimus, and piriformis was shown. She described having sexual activity in missionary position the night prior. The case emphasizes the importance of avoiding sexual activity before the FDG PET/CT study.

A 22-year-old woman with acute lymphoblastic leukemia underwent FDG PET/CT to evaluate possible extramedullary disease. The patient experienced severe nausea and vomiting due to ongoing chemotherapy. The image demonstrated increased FDG uptake in multiple muscle groups, including intercostal, bilateral external oblique, internal oblique, transverse abdominal muscles, and psoas major. One week after the patient stopped vomiting, a repeated PET/CT showed much less muscle uptake.

Abdominal enhanced CT of a 72-year-old woman demonstrated 1 enhancing lesion in the left kidney, which suggested malignancy. No significant findings were reported in the right kidney and ureter. A Tc-DTPA renography was performed as part of the presurgical evaluation. However, the dynamics of urine elimination by the left kidney was normal, whereas elimination of the urine on the right one delayed, which was unexpected. The patient's CT images were further analyzed. An enhancing lesion in the right ureter was noted by further review, suggesting malignancy, which was subsequently pathologically proven as low-grade papillary urothelial carcinoma.

Background 99mTc-sestamibi (MIBI) parathyroid SPECT is generally regarded as the best preoperative localizing method in patients with hyperparathyroidism (HPT). However, 99mTc-MIBI SPECT is false negative in approximately 25% of adenomas. 11C-methionine positron emission tomography (PET) has been used in HPT with negative 99mTc-MIBI SPECT scan results. Purpose To systematically review and conduct a meta-analysis of published data on the performance of 11C-methionine PET in patients with HPT with negative 99mTc-MIBI SPECT. Material and Methods A comprehensive review of the literature was performed. Pooled sensitivity and specificity of 11C-methionine PET in patients with HPT and a negative 99mTc-MIBI SPECT was calculated on a per-patient basis using receiver-operating characteristic (ROC) methodology. Results Nine studies that met all inclusion and exclusion criteria were included into our meta-analysis, comprising a total sample size of 137 patients. Pooled sensitivity and specificity of 11C-methionine PET in patients with HPT with negative or inconclusive 99mTc-MIBI SPECT scans was 86% and 86%, respectively. The area under the ROC curve was 0.87. Conclusion By merit of the high overall sensitivity, specificity, and accuracy, 11C-methionine PET can potentially complement the diagnostic workup of patients with HPT and negative or inconclusive 99mTc-MIBI SPECT. 11C-methionine PET appears to be a promising diagnostic modality in complicated cases with HPT.

Purpose We aimed to evaluate the value of 18F-FDG positron emission tomography/computed tomography (PET/CT) for identifying the possible causes of secondary hemophagocytic lymphohistiocytosis (HLH). Methods Forty-five cases (17 female, 28 male; age, 17-79 years) with secondary HLH were included. The standard of reference for diagnosis in all patients was a combination of histology, clinical results (medical history, physical examination, and laboratory test results), and follow-up imaging for at least 12 months. All cases underwent 18F-FDG PET/CT to identify the possible trigger in HLH. Results Of 45 secondary HLH cases 10 (22.2%) were associated with infection, seven (15.6%) with rheumatic disease, and 28 (62.2%) with lymphoma. PET/CT images of 22 secondary HLH cases (48.9%) showed true positive results. PET/CT images demonstrated obvious tracer uptake in five of 10 secondary HLH cases with infection, one of three cases with lupus, two of two cases with rheumatoid arthritis, one of two cases with adult-onset Still disease, and 13 of 28 cases with lymphoma. Conclusion PET/CT is helpful for identifying the possible trigger (infection or malignant disease) and extent of secondary HLH. However, PET/CT alone is not sufficient to make a correct differential diagnosis.

Metastasis from squamous cell carcinoma of the lung to the stomach is extremely rare. F-FDG PET/CT demonstrated intense F-FDG uptake in the lower lobe of the left lung, stomach, and mediastinal lymph node in a 61-year-old man. Lower lobe of the left lung resection, mediastinal lymphadenectomy, partial gastrectomy, and esophagogastric anastomosis was performed. Immunohistochemical studies revealed squamous cell lung carcinoma in the left lung and metastatic carcinoma of gastric and lymph nodes. The present case further demonstrated the value of F-FDG PET/CT in the staging of malignant disease.

A 1-year 5-month-old male patient had a history of recurrent cough and pneumonia, which required antibiotics and bronchodilators. CT suggested the possibility of congenital tracheobiliary fistula. However, a diagnosis could not be made based on CT alone. A Tc-EHIDA hepatobiliary scintigraphy was then performed, which led to a definite diagnosis of tracheobiliary fistula.

OBJECTIVE. Surgical intervention in the form of parathyroidectomy is generally considered only for severe secondary hyperparathyroidism (sHPT). However, correct location of the parathyroid glands b...

The aim of this study was to systematically review and perform a meta-analysis of published data on the diagnostic value of F-fluorodeoxyglucose (F-FDG) PET/CT in the diagnosis of patients with fever of unknown origin (FUO).A comprehensive computer literature search of studies published through 31 March 2012 on the use of F-FDG PET/CT in patients with FUO was performed in PubMed/MEDLINE, Embase, and Scopus databases. The pooled sensitivity of F-FDG PET/CT in patients with FUO on a per-patient-based analysis was calculated. The area under the receiver-operating characteristic curve was calculated to measure the accuracy of F-FDG PET/CT in the diagnosis of patients with FUO.Fifteen studies comprising 595 patients with FUO were included in this meta-analysis. The pooled sensitivity of F-FDG PET/CT in detecting the cause of FUO was 85% (95% confidence interval 81-88%) on a per-patient-based analysis. The area under the receiver-operating characteristic curve was 0.88.F-FDG PET/CT demonstrated high sensitivity for the diagnosis of patients with FUO. F-FDG PET/CT is an accurate technique in this setting, but the possibility of false-positive results should be kept in mind. This meta-analysis demonstrated the value of F-FDG PET/CT in the diagnosis of patients with FUO.

A 5-year-old boy was admitted due to shortness of breath. Blood gas analysis showed hypoxemia. However, thoracic and abdominal CT, brain MRI, and MR angiography were all normal. A Tc-MAA pulmonary scintigraphy revealed right-to-left shunting of the blood. Further genetic analysis showed the mutations in the activin receptor-like kinase 1 gene, and a diagnosis of hereditary hemorrhagic telangiectasia was made.

A 66-year-old man presented to our hospital because of abdominal pain for 5 days. A contrast abdominal CT raised the possibility of pancreatic carcinoma. FDG PET/CT showed increased FDG accumulation not only in the pancreas and the retroperitoneum, but also in the posterior mediastinum, which was not typical of pancreatic carcinoma. The patient was subsequently diagnosed having immunoglobulin G4-related disease following the histopathologic examination.

// Jiannan Liu 1, * , Xiaofang Zhang 2, * , Aina Liu 1 , Daoping Zhang 3 , Yi Su 1 , Ying Liu 1 , Dong You 1 , Leilei Yuan 4 , Xiangshuo Kong 1 , Xiaodan Wang 1 , Ping Sun 1 1 Department of Oncology, Yuhuangding Hospital, Yantai, Shandong, 264000, P. R. China 2 Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, 250012, P. R. China 3 Department of Rehabilitation, Qianfoshan Hospital, Jinan, Shandong, 250014, P. R. China 4 Department of Radiology, Taian Central Hospital, Taian, Shandong, 271000, P. R. China * These authors are contributed equally to this work Correspondence to: Xiaofang Zhang, email: xiaofangzhang@sdu.edu.cn Ping Sun, email: sunping20039@hotmail.com Keywords: glucosylceramide synthase, DNA methylation, 5-Aza-dc, breast cancer Received: October 17, 2015 Accepted: April 16, 2016 Published: May 13, 2016 ABSTRACT Overexpression of glucosylceramide synthase ( GCS ) increases multidrug resistance (MDR) in many cancer cells. However, its mechanism is unknown. The aim of the present study is to detect the association of methylation at the GCS gene promoter with its expression and MDR in invasive ductal breast cancer. 40 cases GCS -positive and 40 cases GCS -negative primary breast carcinoma samples, three drug-sensitive breast cancer cell lines and one multidrug-resistant breast cancer cell line were used. Immunohistochemistry, methylation-specific PCR (MSP), quantitative real-time (qPCR), westernblot and cytotoxicity assay techniques were employed. Thwe results revealed that there was a statistically negative correlation between GCS CpG islands methylation and GCS phenotype in patients with breast cancer. GCS CpG islands methylation was negatively associated with high ER, meanwhile positively with high HER-2 status. Similar results were obtained from the analysis of breast cancer cell lines. Treatment with the demethylating agent 5-aza-2′-deoxycytidine (5-Aza-dc) changed the GCS promoter methylation pattern in three sensitive cells and also caused increased drug resistance of them. These results suggested that the changes of DNA methylation status of the GCS promoter correlates with multidrug resistance in breast cancer.

Background Anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid (anti-3-18F-FACBC) positron emission tomography/computed tomography (PET/CT), 11 C-choline PET/CT, 111In–capromab pendetide, and T2-weighted magnetic resonance imaging (MRI) have been used for detecting prostate carcinoma relapse. Purpose To systematically review and perform a meta-analysis of published data regarding the performance of 18F-FACBC PET/CT in the diagnosis of recurrent prostate carcinoma. Material and Methods A comprehensive review of the literature regarding the role of 18F-FACBC PET/CT in the diagnosis of recurrent prostate carcinoma was performed. Pooled sensitivity, specificity, and the area under the receiver-operating characteristic of 18F-FACBC PET/CT in the diagnosis of recurrent prostate carcinoma were calculated based on the included studies. Results Six studies comprising 251 patients, suspicious of prostate carcinoma recurrence, were included in this meta-analysis. 18F-FACBC PET/CT had an 87% pooled sensitivity, 66% pooled specificity, 0.93 the area under the receiver-operating characteristic curve on a per patient-based analysis in detecting prostate carcinoma recurrence. Conclusion 18F-FACBC PET/CT was a non-invasive, metabolic imaging technique in the diagnosis of prostate carcinoma relapse.

99mTc-methylene diphosphonate (MDP) bone scan was performed in a 49-year-old female patient who had non-Hodgkin lymphoma. 99mTc-MDP uptake was significant in both lungs. Bilateral bacterial pneumonia associated with secondary hemophagocytic lymphohistiocytosis was diagnosed after extensive examination.

Background Ventilation perfusion single photon emission computed tomography (V/Q SPECT) and CT pulmonary angiography have all been used in the diagnosis of acute PE. Previous studies have shown higher sensitivity and specificity and a marked decrease in the non-diagnostic rate of V/Q SPECT than planar scan. Purpose To systematically review and perform a meta-analysis of published data on the performance of V/Q SPECT in the diagnosis of acute PE. Material and Methods A comprehensive computer search was conducted on literature published through 31 December 2013 in an effort to find relevant articles on the diagnostic performance of V/Q SPECT in the diagnosis of PE patients. Pooled sensitivity, specificity, negative likelihood ratio (LR), and positive LR, the area under the receiver-operating characteristic (ROC) curve of V/Q SPECT in the diagnosis of PE patients were calculated. Results Nine studies, comprising a total sample size of 3454 patients, were included in our meta-analysis. The pooled sensitivity, specificity of V/Q SPECT in the diagnosis of acute PE patients, calculated on a per-patient-based analysis, was 96% (95% confidence interval [CI], 95–97%), 97% (95% CI, 96–98%). The pooled negative LR, positive LR of V/Q SPECT in acute PE patients was 0.06 (range, 0.02–0.19) and 16.64 (range, 9.78–31.54). The area under the ROC curve of V/Q SPECT in the diagnosis of acute PE patients was 0.99 on a per-patient-based analysis. Conclusion V/Q SPECT is an accurate method in acute PE patients with high sensitivity and high specificity in the diagnosis of PE.

Background Gallium-68 somatostatin receptor positron emission tomography (PET) has been used in the diagnosis of neuroendocrine tumors (NETs). The compounds often used in molecular imaging of NETs with PET are 68Ga-DOTATOC, 68Ga-DOTATATE, and 68Ga-DOTANOC. There is varying affinity to different somatostatin receptors. Purpose To systematically review and perform a meta-analysis of published data regarding the diagnostic role of 68Ga-DOTATOC and 68Ga-DOTATATE PET in the diagnosis of NETs. Material and Methods A comprehensive literature search of studies published through 30 April 2013 regarding 68Ga-DOTATOC and 68Ga-DOTATATE PET in the diagnosis of NETs was performed using the PubMed/MEDLINE, Embase, and Scopus databases. Pooled sensitivity and specificity of 68Ga-DOTATOC and 68Ga-DOTATATE PET in the diagnosis of NETs were calculated. The area under the receiver-operating characteristic (ROC) curve was calculated to measure the accuracy of 68Ga-DOTATOC and 68Ga-DOTATATE PET in the diagnosis of NETs. Results Ten studies comprising 416 patients with NETs were included in this meta-analysis. The pooled sensitivity of 68Ga-DOTATOC and 68Ga-DOTATATE PET in the diagnosis of NETs calculated on a per-patient-based analysis was 93% (95% confidence interval [CI] 89–96%) and 96% (95% CI 91–99%). The pooled specificity of 68Ga-DOTATOC and 68Ga-DOTATATE PET in diagnosing NETs was 85% (95% CI 74–93%) and 100% (95% CI 82–100%). The area under the ROC curve of 68Ga-DOTATOC and 68Ga-DOTATATE PET was 0.96 and 0.98, respectively, on a per-patient-based analysis. Conclusion The molecular imaging agents 68Ga-DOTATOC and 68Ga-DOTATATE demonstrated high sensitivity and specificity in the diagnosis of NETs on PET scan. Although both are accurate tools in the diagnosis of NETs, 68Ga-DOTATATE PET may be more sensitive and specific than 68Ga-DOTATOC PET scan.

Brown adipose tissue (BAT) functions as a thermogenic organ by producing heat to maintain body temperature in many mammals, especially in the young. BAT is generally found in deep cervical, supraclavicular, interscapular, and paravertebral regions, as well as areas near large vessels. If not recognized, BAT activity can considerably interfere with 18F-fluorodeoxyglucose position emission tomography (PET)/computed tomography (CT) image interpretation. BAT activation can be influenced by several factors and reduced by different methods. In this paper, we review BAT distribution and factors influencing BAT activity on FDG PET/CT scan. The purpose of this review is to enhance the recognition of pediatric-related physician of BAT on FDG PET/CT scan.

Congenital hyperinsulinism (CHI) during infancy is characterized by inappropriate insulin secretion resulting in persistent hypoglycemia. This can lead to irreversible severe neurological damage in the infant. There are two main histologic subtypes: diffuse and focal, both of which may require different surgical strategies. It is very important to differentiate focal leisons from diffuse leisons. However, the differentiation of diffuse leisons from focal leisons is challenging. Affected pancreatic areas utilize dihydroxyphenylalanine (DOPA) at a higher rate than normal pancreatic tissues; thus, labeling of L-DOPA with fluorine-18 (18F-DOPA) allows functional mapping of hyperinsulinism using positron emission tomography/computed tomography (PET/CT). In this article, we reviewed the 18F-DOPA PET/CT application in CHI. The aim of this review is to enhance the recognition of 18F-DOPA PET/CT application in the diagnosis of CHI.

Graves' disease (GD) is the most common cause of hyperthyroidism in pediatric patients. Most pediatric thyroid cancer is differentiated thyroid cancer (DTC). The two diseases can be treated using different methods, such as antithyroid drug, radioactive iodine (RAI), and surgery for GD and surgery and RAI for DTC. RAI can be used to treat pediatric GD and DTC. In the article, we reviewed the RAI application in pediatric GD and DTC.

Purpose The goal of this study is to investigate whether combined application of ultrasound and 99mTc-sestamibi SPECT/CT had the incremental value in accurately detecting parathyroid tissue in patients with SHPT over either method alone. Patients and methods Sixty patients with SHPT on hemodialysis were evaluated preoperatively with parathyroid 99mTc-sestamibi SPECT/CT scintigraphy and ultrasound prior to parathyroidectomy. The sensitivity, specificity and accuracy of 99mTc-sestamibi SPECT/CT scintigraphy, ultrasound and combined application were determined respectively. Results The sensitivity, specificity and accuracy of ultrasound were 81% (155/192), 47% (17/36) and 82% (172/228), respectively. The sensitivity, specificity and accuracy of 99mTc-sestamibi SPECT/CT were 85% (163/192), 58% (21/36) and 89% (184/228) respectively. The accuracy of 99mTc-sestamibi SPECT/CT in the diagnosis of parathyroid tissue in patients with SHPT is significantly higher than that of ultrasound. The sensitivity, specificity and accuracy of combined application of ultrasound and 99mTc-sestamibi SPECT/CT were 93% (178/192), 61% (22/36) and 97% (200/228). The sensitivity, specificity and accuracy of combined application of ultrasound and 99mTc-sestamibi SPECT/CT were higher than those of either ultrasound or 99mTc-sestamibi SPECT/CT. Conclusions The combined application of ultrasound and 99mTc-sestamibi SPECT/CT had incremental value in accurately detecting parathyroid tissue in patients with SHPT over either method alone.