Impaired lung function is associated with an increased risk for cognitive decline. F-18 fluorodeoxyglucose (FDG) PET is a well-known neurodegenerative biomarker for dementia. We investigated the association between lung and brain function using FDG PET in patients with lung cancer.A random sub-sample of 102 patients with lung cancer and without a self-reported history of neuropsychiatric disorders were recruited and underwent both lung function tests and FDG PET scans before treatment. Lung function was analyzed as the percentage predicted value (% pred) of forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1). FDG uptake was measured as standardized uptake values (SUVs) in the frontal, parietal, temporal, and occipital cortices and cognition-related regions. Regional SUV ratios (SUVRs) were calculated by dividing the SUV in each region by the whole-brain SUV and were then evaluated against lung function indices and clinical variables.After excluding five patients with brain metastases, 97 patients were included in the final analysis (mean age, 67.7 ± 10.3 years). Mean FVC and mean FEV1 were 80.0% ± 15.4% and 77.6% ± 17.8%, respectively. Both FVC and FEV1 were positively correlated with SUVRs in all brain regions after adjusting the data for clinical variables. The degree of decrease in SUVRs related to lung function was not significantly different between cognition-related regions and other regions.Impaired lung function was associated with decreased glucose metabolism in all regions of the brain, indicating that cognitive decline related to decreased glucose metabolism may be due to reduced perfusion.
621 Objectives Flare phenomenon on bone scan after initiation of systemic treatment seriously complicates evaluations of the therapeutic response in breast cancer patients with bone metastases. Aim of the study was to search clinic-pathologic markers which can differentiate the flare from disease progression in the patients. Methods We reviewed breast patients with bone metastasis (n=79) who newly received systemic therapy either chemotherapy, hormonal therapy or target therapy. Pretreatment baseline and follow-up data including age, pathological factors, type of systemic therapy, alkaline phosphatase (ALP) and bone scan findings were evaluated. Univariate and multivariate analyses of these factors was performed to predict the flare. Results Bone scans were performed before and mean 2 months (1~6 mo) after therapy. Increased extent or new lesions were found in 31 patients (39.2 %) on the follow-up bone scan after therapy. Among the 31 patients, 14 (17.7 %) patients had improvement on subsequent bone scan (flare), while subsequent scans also showing increased uptake in 17 (21.5%)(progression). The univariate analyses showed that no baseline parameters were associated with flare, but hormonal therapy, the post-treatment ALP reduction and changed ALP ratio were significantly associated with flare (p = 0.029, p = 0.002 and p = 0.039, respectively). Multiple regression analysis revealed that the post-treatment ALP reduction (p = 0.004, OR = 8.0) was the most powerful independent predictor for the flare, followed by hormonal therapy (p = 0.035, OR = 4.4). Conclusions Results of the study suggested that ALP is a useful biomarker to differentiate the flare from disease progression in breast patients with bone metastasis. Clinical interpretation for the scintigraphic aggravation can be further improved by the ALP data and it may prevent fruitless change of therapeutic modality as a result of the flare.
Objectives The aim of the current study was to evaluate the value of preoperative 18F-FDG (FDG) PET/CT in predicting cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). Methods One hundred and ninety-three newly diagnosed PTC patients (M: F = 25:168, age = 46.8 ± 12.2) who had undergone pretreatment FDG PET/CT and had neck node dissection were included in this study. The FDG avidity of the primary tumor and the SUVmax of the primary tumor (pSUVmax) were analyzed for prediction of LN metastasis. Detectability by ultrasonography (US) and FDG PET/CT for cervical LN metastasis were also assessed and compared with the pSUVmax. Results The FDG avidity of the primary tumor was identified in 118 patients (FDG avid group: 61.0%, M: F = 16:102, age 47.0 ± 12.7 years) and pSUVmax ranged from 1.3 to 35.6 (median 4.6) in the FDG avid group. The tumor size in the FDG avid group was bigger and there was a higher incidence of LN metastasis compared to the FDG non-avid group (0.93 vs. 0.59 cm, p <0.001 and 49.2 vs. 33.3%, p <0.05). In the FDG avid group, patients with LN metastasis had higher pSUVmax than patients without LN metastasis (8.7 ± 8.3 vs. 5.7 ± 5.1, p <0.001). The incidence of central LN metastasis in patients with a pSUVmax >4.6 was 54%; however, the detectability of central LN metastasis by US and FDG PET/CT were 10.3% and 3.6%, respectively. Conclusion A high FDG avidity of the primary tumor was related to LN metastasis in PTC patients. Therefore, patients with a high pSUVmax should be cautiously assessed for LN metastasis and might need a more comprehensive surgical approach.
Background: The aim of this study was to evaluate the prognostic implication of asphericity (ASP); spatial irregularity; of pretherapeutic 18F 2-deoxy-2-fluoro-D-glucose (18F FDG) tumor uptake in patients with invasive ductal carcinoma (IDC) of the breast. Methods: One hundred thirty-one female IDC patients (mean age = 48.1 ± 10.4 years), with pathological tumor size greater than 2 cm were retrospectively evaluated using 18F FDG positron emission tomography/computed tomography (PET/CT). ASP of 18F FDG distribution was calculated on the basis of the deviation of the tumor shape from spherical symmetry. Progression-free survival (PFS) was predicted on the basis of the univariate and multivariate analyses of the measured clinicopathologic factors and metabolic PET parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)]. Results: The PFS rate among the 131 patients was 90.1%. The mean follow-up time was 50 months for the entire study cohort and 26 months for the patients with recurrent disease. It is evident from the univariate analysis that N stage, hormonal receptor (Estrogen, ER/Progesterone, PR) status, MTV (≤4.2 mL), and ASP (≤15.1%) affected the PFS. Hazard ratios (HRs) estimated from the multivariate Cox regression analysis show that N stage (HR = 17.6), ASP (HR = 11.9), and hormonal receptor status (HR = 6.9) were independent prognostic factors in predicting PFS. In the subgroup of patients with lymph node metastasis, ASP (HR = 10.9) and hormonal receptor status (HR = 9.1) were independent prognostic factors for PFS. Conclusion: ASP of 18F FDG uptake is an independent predictor of outcome in IDC patients, and can be used for prognostic stratification.
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