Standardized Uptake Value (SUV)

Purpose
Diagnostic tools having reached maturity in breast cancer (BC) diagnosis have, in general, evolved independently. The purpose of this study is to assess the diagnostic confidence of an integrated approach to BC patient management, by the combined use of: a) the quantization of the choline levels as measured by  Magnetic Resonance Spectroscopy (MRS) and b) the quantification of glucose uptake as measured by 18FDG PET.
Subjects and Methods
17 women with biopsy proven BC have been enrolled in the study. All patients were examined with 1H MRS and 18FDG PET-CT before surgical resection of breast lesion. Absolute choline concentration has been quantified using water as internal reference and integral of choline signal (Cho) has been calculated with the AMARES algorithm [1]. Averaged body-weight SUV with Partial Volume Correction was calculated using a Recovery Coefficient-based method [2]. Correlation between Cho  and SUV was evaluated using Pearson’s correlation coefficient.
Results
Invasive Ductal Carcinoma (IDC) was found in 14 patients and Invasive Lobular Carcinoma (ILC) in 3 patients. All IDC patients were choline positive at MRS (Cho > 0.002 mmoli/Kg, average Cho = 7.03 mmoli/Kg) and at PET (minimum SUV> 3.32g/cc, average SUV = 8.58 g/cc), except one who was choline negative at MRS (cholin signal not present) but positive at PET (SUV = 8.6 g/cc). All ILC patients were negative at MRS and at PET  except one who was positive at PET (SUV =3.22g/cc) - even though the lesion appeared not clearly visible - and choline negative at MRS. SUV and Cho values were found correlated in both IDC (rho=0.57, p=0.031) and ILC patients (rho~1, p<0.001).
Conclusions
The presence of the Choline Signal and/or an SUV > 3.32g/cc was found discriminating IDC from ILC. Although obtained from a limited number of patients, this integrated approach based on PET 18FDG SUV (with PVC) and MRS was found enhancing the diagnostic confidence of BC. Moreover, the correlation among the two approaches appears in agreement with the only three papers published on the same subject (for a Review see [3] and related citations) in which the possibility to utilize MRS instead of PET to prevent from ionizing radiations has been underlined.

A novel bridged binuclear Cu(II) complex with mixed ligands, di-μ-(2-aminopyridine(N,N′))-bis[(2,6-pyridinedicarboxylate)aquacopper(II)] tetrahydrate, formulated as [Cu(μ-ap)(dipic)(H2O)]2·4H2O (1) (dipic = 2,6-pyridinedicarboxylate, ap = 2-aminopyridine), has been synthesized and characterized by elemental, spectral (IR and UV–Vis.), thermal analysis, magnetic measurements and single crystal X-ray diffraction analysis. The central Cu(II) ion resides on a centre of symmetry in a distorted square-pyramid coordination environment comprising of two N atoms, one from dipic and one from the ap ring, two carboxylate O atoms from dipic, and one O atom from water. Intermolecular N–H⋯O and O–H⋯O hydrogen bonds and π–π stacking interactions seem to be effective in the stabilization of the crystal structure. The free ligands and the complex were also evaluated for their antimicrobial and radical scavenging activities (DPPH = 1,1-diphenyl-2-picrylhydrazyl hydrate) using in vitro microdilution methods. Antimicrobial screening of the free ligands and their complex showed that the free ligands and the complex possess antifungal activity against Candida sp.

Purpose: To explore the prognostic value of metabolic tumor volume measured on postradiation ¹F-fluorodeoxyglucose positron emission tomography (PET) imaging in patients with head-and-neck cancer. Methods and Materials: Forty-seven patients with head-and-neck cancer who received pretreatment and posttreatment PET/computed tomography (CT) imaging along with definitive chemoradiotherapy were included in this study. The PET/CT parameters evaluated include the maximum standardized uptake value,

Objetive To assess the safety and efficacy of FDG-PET in breast cancer in the diagnostic of primary tumours, lymph node staging, the detection of recurrent disease/metastases, and the assessment of chemotherapy treatment. Methods A systematic review was undertaken. A search was made for primary studies, other systematic reviews, and health technology assessment reports in different databases. Results A total of 73 reports were included. FDG-PET does not appear to be sufficiently accurate to be used in isolation for ruling out the presence of a primary tumour. In lymph gland staging, FDG-PET does not appear to be accurate enough to detect occult axillary metastases or micrometastases (sensitivity 20 and 50%, respectively); sentinel node biopsy is required for confirmation. In the detection of bone metastases, FDG-PET should be complemented with other tests such as bone gammagraphy or SPECT. The assessment of response to chemotherapy, there seems to be no uniform criterion for establishing a standardized uptake value (SUV) for FDG that would allow responders and non-responders to be distinguished. Conclusions FDG-PET is insufficiently sensitive to rule out small primary tumours. Due to the high number of false positives returned, it cannot replace axillary dissection in axillary lymph gland staging. A complete biochemical response identified by FDG-PET should not be relied upon to mean an absence of disease since the technique cannot detect residual microscopic elements.

Objective The aim of this study was to evaluate a 3D tumor segmentation method for fluorodeoxyglucose positron emission tomography (FDG-PET) in the context of noninvasive estimation of tumor metabolic length (L m), as it correlates with surgical pathology and phantom results. Methods Thirty-four patients (7 women, 27 men) with esophageal cancer were retrospectively evaluated. All patients underwent FDG-PET-computed tomography (CT) imaging following endoscopic ultrasound (EUS). Seventeen patients had esophagectomy after PET/CT, without prior neoadjuvant therapy. Tumor length was assessed by EUS (L e, n = 31) and histopathology (L p, n = 17). Images were evaluated quantitatively with a 3D threshold-based region-growing program (Medical Image Processing Analysis and Visualization). L m, total metabolic volume (V m), maximum standardized uptake value (SUVmax), and average SUV (SUVa) over the entire tumor were obtained for several threshold values (mean activity in the liver plus 0-, 1-, 2-, 3-, and 4-SD of the activity in the liver). Results L m showed a good correlation with L p for all thresholds (best correlation for L m(2-SD), r = 0.74, P < 0.001). A positive nonsignificant correlation was observed between L p and L e (r = 0.30, P = 0.29). L m(2-SD) correlated well with L e (r = 0.71, P < 0.001). Good correlations were also observed between L m(2-SD) and V m(2-SD) (r = 0.89, P < 0.001) and SUVa(2-SD) (r = 0.38, P < 0.05). V m(2-SD) also had a significant correlation with L p (r = 0.61, P < 0.05) and L e (r = 0.57, P < 0.001). Conclusions FDG-PET-derived tumor metabolic length of untreated esophageal carcinomas correlates well with surgical pathology results, and provides preliminary evidence that noninvasive delineation of the superior and inferior extent of viable tumor involvement might be feasible using computer-generated metabolic length measurements.

A 74-year-old woman presented with symptoms consistent with hyperadrenocorticism and hyperca-techolaminism. She had a cushingoid appearance and her cortisol level was elevated. Her serum dopamine and noradrenalin levels were also elevated. Computed tomography detected a left adrenal mass measuring 3.5 cm multiply 3.0 cm in diameter. Metaiodobenzylguanidine scintigraphy was negative. Unexpectedly, the serum Serum carcinoembryonic antigen (CEA) level was elevated. Fluorodeoxyglucose positron emission tomography showed increased uptake in the adrenal tumor only, with a maximum standardized uptake value of 2.8. Selective venography and blood sampling revealed that the concentrations of cortisol, catecholamines and CEA were significantly elevated in the vein draining the tumor. A diagnosis of CEA-producing benign adenoma was made. After preoperative management, we performed a combined lateral and anterior transperitoneal laparoscopic adrenectomy. Her vital signs remained stable during surgery. Histopathological examination revealed a benign adenoma. Her cortisol, catecholamine and CEA levels normalized immediately after surgery. We present, to the best of our knowledge, the first case of CEA-producing adrenal adenoma, along with a review of the relevant literature, and discuss our laparoscopic surgery techniques.

18F-Fluorodeoxyglucose positron emission tomography (18FDG-PET) is a new diagnostic technique for the diagnosis and staging of cholangiocarcinoma. For diagnosis of a primary cholangiocarcinoma, 18FDG-PET seems to be helpful to discriminate between malignant and benign lesions. However, the accuracy of 18FDG-PET seems to be dependent on the anatomic location, growth pattern, and pathologic characteristics of the lesion. It has been proved

The aim of this study was to evaluate the test-retest variability of standardized uptake values (SUVs) in normal tissues and the impact of various methods for measuring the SUV. SUVs were determined in 70 cancer-free patients (40 female and 30 male) on 2 occasions an average of 271 d apart. Mean values for body weight and height, blood glucose level, injected dose, and uptake period did not change between the 2 groups of studies. Four regions of interest (ROIs) were placed-on the liver, lung, mediastinum, and trapezius muscle. Mean and maximum SUVs normalized for body weight were obtained, and normalizations were then applied for lean body mass (LBM), LBM and blood glucose level, body surface area (BSA), and BSA and blood glucose level. In the lungs and muscle, metabolic activity within the ROIs was significantly different in the 2 studies, no matter which method was used for the SUVs. The differences ranged from 0.02 to 0.1 for SUV normalized for body weight and SUV normalized for ...

Synthesis and biological assessment of six novel 2-substituted mercaptobenzimidazole derivatives is performed. The title compounds are characterized by their analytical and spectral data. All the synthesized compounds are screened for their anti-ulcer and anti-microbial activity. 2-(1H-benzimidazole-2-sulfinyl) –N-(4-benzyloxy-phenyl)-acetamide, N-(4-benzyloxy-phenyl)-4-(1H-benzimidazole-2-sulfinyl)-butyramide, N-(4-benzyloxy phenyl)-4-(5-methoxy 1H-benzimidazole-2-sulfinyl)-butyramide showed significant antiulcer activity. All the compounds moderate antibacterial and antifungal activity.

Purpose. This study was done to analyse the additional morphological and functional information provided by the integration of [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography ([18F]-FDG-PET) with contrast-enhanced multidetector computed tomography (MDCT) in the characterisation of indeterminate solitary pulmonary nodules (SPNs). Materials and methods. Fifty-six SPNs, previously classified as indeterminate, were evaluated using a Discovery ST16 PET/CT system (GE Medical Systems) with nonionic iodinated contrast material and [18F]-FDG as a positron emitter. Images were evaluated on a dedicated workstation. Semiquantitative parameters of [18F]-FDG uptake and morphological, volumetric and densitometric parameters before and after contrast administration were analysed. Results were correlated with the histological and follow-up findings. Results. Twenty-six SPNs were malignant and 30 were benign. Malignant lesions at both PET/CT and histology had a mean diameter of 1.8±1.2 cm, a volume doubling time (DT) of 222 days, a mean standardized uptake value (SUV) of 4.7 versus 1.08 in benign lesions and a mean postcontrast enhancement of 44.8 HU as opposed to 4.8 HU in benign nodules. Malignant lesions had a significantly shorter doubling time and significantly greater postcontrast enhancement compared with benign nodules. Based on the SUV and using a cut-off value of >2.5, PET/CT had a sensitivity of 76.9%, specificity of 100%, diagnostic accuracy of 89.2%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 83.3%. Based on doubling time (cut off <400 days), it had a sensitivity of 76.9%, specificity of 93.3%, accuracy of 85.7%, PPV of 90.9% and NPV of 82.3%. Based on postcontrast enhancement (cut off >15 HU), it had a sensitivity of 92.3%, specificity of 100%, accuracy of 96.4%, PPV of 100% and NPV of 93.7%. Conclusion. PET/CT allows accurate analysis of anatomical/morphological and metabolic/functional correlations of SPN, providing useful data for identifying and locating the disease, for differentiating between malignant and benign nodules and for establishing the aggressiveness and degree of vascularity of pulmonary lesions. Therefore, partly in view of the considerable reduction in time and cost of the single examinations, we believe that PET/CT will gain an increasingly dominant role in the diagnostic and therapeutic approach to lung cancer, especially in the preclinical phase.

Fine-needle aspiration biopsy (FNAB) is inconclusive in up to 20% of patients with solitary thyroid nodules. In these cases, hemithyroidectomy is necessary, but only 20% of the nodules prove to be thyroid carcinoma. The aim of this study was to explore the potential of (18)F-FDG PET to reduce the number of unnecessary hemithyroidectomies in the preoperative assessment of thyroid nodules with inconclusive FNAB results. Forty-four consecutive patients, scheduled for hemithyroidectomy because of inconclusive FNAB findings, participated in this prospective study. (18)F-FDG PET of the thyroid region was performed before hemithyroidectomy, and standardized uptake values were calculated. The final histopathologic diagnosis served as a standard of reference. Histopathologic examination of the surgical specimens revealed 7 well-differentiated thyroid carcinomas in 6 patients, all accumulating (18)F-FDG (negative predictive value, 100%). (18)F-FDG accumulated in 13 of 38 benign nodules. The p...

Cu-Diacetyl-bis(N(4)-methylthiosemicarbazone) (Cu-ATSM) is a recently developed PET imaging agent for tumor hypoxia. However, its accuracy and reliability for measuring hypoxia have not been fully characterized in vivo. The aim of this study was to evaluate (64)Cu-ATSM as a hypoxia PET marker by comparing autoradiographic distributions of (64)Cu-ATSM with a well-established hypoxia marker drug, EF5. R3230 mammary adenocarcinomas (R3230Ac), fibrosarcomas (FSA), and 9L gliomas (9L) were used in the study. EF5 and Hoechst 33342, a vascular perfusion marker, were administered to the animal for immunohistochemical analysis. (64)Cu-ATSM microPET and autoradiography were performed on the same animal. The tumor-to-muscle ratio (T/M ratio) and standardized uptake values (SUVs) were characterized for these 3 different types of tumors. Five types of images-microPET, autoradiography, EF5 immunostaining, Hoechst fluorescence vascular imaging, and hematoxylin-and-eosin histology-were superimposed...

Mazabraud’s syndrome is a rare disorder, the main characteristics of which are fibrous dysplasia of bone associated with intramuscular myxomas. The metabolic characteristics of intramuscular myxomas, associated with fibrous dysplasia, have not previously been described with 18F-FDG-PET. Our case demonstrates that there is low, but not insignificant uptake associated with these intramuscular myxomas, with a standardized uptake value (SUV) range between 1.3 and 2.6. As such, this entity merits consideration when evaluating hypoattenuating intramuscular masses, particularly in the context of fibrous dysplasia.

Recent studies suggest a somewhat selective uptake of O-(2-[18F]fluoroethyl)-L-tyrosine (FET) in cerebral gliomas and in squamous cell carcinoma (SCC) and a good distinction between tumor and inflammation. The aim of this study was to investigate the diagnostic potential of 18F-FET PET in patients with SCC of the head and neck region by comparing that tracer with 18F-FDG PET and CT. Twenty-one patients with suspected head and neck tumors underwent 18F-FET PET, 18F-FDG PET, and CT within 1 wk before operation. After coregistration, the images were evaluated by 3 independent observers and an ROC analysis was performed, with the histopathologic result used as a reference. Furthermore, the maximum standardized uptake values (SUVs) in the lesions were determined. In 18 of 21 patients, histologic examination revealed SCC, and in 2 of these patients, a second SCC tumor was found at a different anatomic site. In 3 of 21 patients, inflammatory tissue and no tumor were identified. Eighteen of...