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Anticancer evaluation of ruthenium(III) complexes with N-donor ligands tethered to coumarin or uracil moieties
JIMSA January-March 2013 Vol. 26 No. 1
75
FUTURE TRENDS
Infection/inflammation: FDG-labeled leukocytes and FDG-labeled antitubercular drugs may be available for assessment of intra-abdominal, renal,
intracerebral, and cardiac infections.
REFERENCES
Figure 4: PET-CT images (colored image) showing multi-organ lesions in
sarcoidosis with corresponding PET (gray image) image in coronal plane.
MISCELLANEOUS INFLAMMATIONS
In large-vessel arteritis, PET-CT is helpful in diagnosis and assessment of
treatment response especially when perivascular tissues are also involved21.
Examination is false-negative in blood vessel is smaller than 4 mm in
diameter.
If the clinical & laboratory suspicion is high, whole body imaging with PETCT is useful in identifying multi-organ involvement in sarcoidosis and also
deciding the site of biopsy (figure 4)22.
Drug induced lung injury is commonest with bleomycin. Early changes may
be masked by dependant atelectasis on HRCT lungs and needs prone position
scanning. However, PET-CT is useful not only in early detection but is also
a good indicator of treatment response23.
In AIDS, PET-CT imaging helps in localization of infectious foci / tumoral
lesions with sensitivity and specificity being approximately up 92% and
94%24. Differentiation between CNS lymphoma, toxoplasmosis, and other
nonmalignant CNS lesions becomes easier as CNS lymphoma demonstrate
high FDG uptake while Toxoplasmosis demonstrates relatively low FDG
activity. However, it is not as useful in distinguishing infection from tumor
outside the central nervous system.
Ø Assessment of myocardial viability: F18-FDG PET-CT allows
simultaneous assessment of physiology and anatomy. The effect of
coronary atherosclerosis on myocardium can also be studied25, 26.
Ø Guidance for interventions: Apart from diagnostic and staging work
up, PET-CT and PET-MR images can be used for intervention procedures.
PET-CT is valuable in the identification & localization of multiple lesions
and helps in selecting the appropriate lesion for biopsy19, 24, 27. Sampling
errors can be avoided if metabolically active areas of the tumor are
biopsied. Also, when the lesion is not well appreciated on CT scan, this
technique helps to get good tissue samples. Pre-procedural PET-CT is
adequate for most large lesions while fusion of the needle in-situ CT
mage with pre-needle insertion PET image is more suitable for small
lesions. Needle is hardly apparent on coarse PET images.
Check-list
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1. Ozulker T, Uzun, AK, Ozulker F, Ozpacac T. Comparison of 18F-FDG-PET/CT with 99mTc-MDP
bone scintigraphy for the detection of bone metastases in cancer patients. Nuclear Medicine Communications 2010; 31(6): 597-603.
2. Britz-Cunningham SH, Millstine JW, Gerbaudo VH. Improved discrimination of benign and malignant lesions on FDG PET/CT, using comparative activity ratios to brain, basal ganglia, or cerebellum.
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in the assessment of bone metastases in prostate cancer: correlation with morphological changes on
CT. Mol Imaging Biol 2010; 12 (1): 98-107.
5. Ledezma CJ, et al. 18F-FDOPAPET/MRI fusion in patients with primary/recurrent gliomas: Initial
experience, Eur J Radiol (2008), doi:10.1016/j.ejrad.2008.04.018
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7. Gondim CFJL, Barbosa da FLM, Côrtes DR, Côrtes DR, Souza de MNLS, Leandro GE. Brain 18FFDG PET-MRI coregistration: iconographic essay. Radiol Bras 2010; 43(3): 195-201.
8. Dumarey N, Egrise D, Blocklet D, Stallenberg B, Remimlink M, del Marmol V, et al. Imaging Infection with 18F-FDG–Labeled Leukocyte PET/CT: Initial Experience in 21 Patients. J Nucl Med, 2006;
47(4): 625-632.
9. Strobel K, Stumpe KD. PET/CT in musculoskeletal infection. Semin Musculoskelet Radiol, 2007;
11(4): 353-364.
10. Walker R, Karunasaagarar K, Lorenz E. Pyrexia of unknown origin: A review of the role of FDGPET/CT. J Nucl Med, 2007; 48 (Suppl 2): 210.
11. Takabatake D, Taira N, Aogi K, Ohsumi S, Takashima S, Inoue T, et al. Two cases of occult breast
cancer in which PET-CT was helpful in identifying primary tumors. Breast Cancer 2008; 15(2): 181184.
12. Harishankar CNB, Mittal BR, Bhattacharya A, Parmar M, Singh B. Aseptic Loosening of Elbow
Prostheses Diagnosed on F-18 FDG PET/CT. Clinical Nuclear Medicine, 2010; 35(11): 886-887.
13. Keidar Z, Militianu D, Melamed E, Bar-Shalom R, Israel O. The diabetic foot: initial experience with
18F-FDG PET/CT. J Nucl Med, 2005; 46(3): 444-449.
14. Liu Y. Orthopedic surgery-related benign uptake on FDG-PET: case examples and pitfalls. Ann Nuc
Med, 2009; 23(8):701-708.
15. Vind SH, Hess S. Possible role of PET/CT in infective endocarditis. J Nucl Cardiol 2009; 17(3): 516519.
16. Davison JM, Montilla-Soler Jl, Broussard E, Wilson R, Cap A, Allen T. F-18 FDG PET-CT imaging
of a mycotic aneurysm. Clin Nucl Med, 2005; 30(7):483-7.
17. Kilk K, Hyhlik-Durr A, Afshar-Oromieh A, Bockler D. Chronic abdominal aortic graft infection:
Detection with 18F-FDG-PET/CT. Chirurg, 2010; 81(7): 653-656.
18. Alexanderson E, Somka P, Cheng V, Meave A, Saldana Y, Garcia-Roias L, et al. Fusion of positron
emission tomography and coronary computed tomographic angiography identifies fluorine 18
fluorodeoxyglucose uptake in the left main coronary artery soft plaque. J Nucl Cardiol, 2008; 5(6):
841-843.
19. Jimenez-Bonilla JF, Quirce R, Calabia ER, Banzo I, Martinez-Rodriguez I, Carril JM. Hepatorenal
Polycystic Disease and Fever: Diagnostic Contribution of Gallium Citrate Ga 67 Scan and Fluorine F
18 FDG-PET/CT. European Urology, 2011; 59(2): 183-316.
20. Spier BJ, Perlman SB, Jaskowiak CJ, Reichelderfer M. PET/CT in the evaluation of inflammatory
bowel disease: studies in patients before and after treatment. Mol Imaging Biol, 2010; 12(1):85-8.
21. Akin E, Coen A, Momeni M. PET-CT findings in large vessel vasculitis presenting as FUO, a case
report. Clinical Rheumatology, 2009; 28(6): 737-738.
22. Braun JJ, Kessler R, Constantinesco A, Imperiale A. 18F-FDG PET/CT in sarcoidosis management:
review and report of 20 cases. Eur J Nucl Med Mol Imaging, 2008;35(8):1537-43.
23. Song BI, Lee SW, Lee HJ, Kang S, Jeong SY, Seo JH, et al. Rituximab-Induced Pneumonitis on F-18
FDG PET/CT in Patient with Non-Hodgkin Lymphoma. Clinical Nuclear Medicine, 2010; 35(8): 601603.
24. Castaigne C, Tondeur M, de Wit S, Hildebrand M, Clumeck N, Dusart M. Clinical value of FDGPET/CT for the diagnosis of human immunodeficiency virus-associated fever of unknown origin: a
retrospective study. Nucl Med Commun 2009; 30(1): 41-7.
25. Saraste A, Ukkonen H, Kajander S, Knuuti J. Integrated anatomy and viability assessment PET-CT.
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