PURPOSE: To determine the value of combined (18)F-FDG PET/CT with diagnostic contrast-enhanced CT (CECT) in detecting primary malignancies and metastases in patients with paraneoplastic neurological syndromes (PNS) and to compare this with CECT alone. METHODS: PET/CT scans from 66 patients with PNS were retrospectively evaluated. Two blinded readers initially reviewed the CECT portion of each PET/CT scan. In a second session 3 months later, the readers analysed the combined PET/CT scans. Findings on each study were assessed using a four-point-scale (1 normal/benign; 2 inconclusive, further diagnostic work-up may be necessary; 3 malignant; 4 inflammatory). Sensitivity and specificity for malignant findings were calculated for PET/CT and CECT. Interreader agreement was determined by calculating Cohen's kappa. Pooled data from clinical follow-up (including histopathology and follow-up imaging, median follow-up 20.0 months) served as the reference gold standard. RESULTS: Both readers classified 12 findings in ten patients (15%) as malignant on the PET/CT scans (two patients had two primary tumours). One such imaging finding (suspected thymic cancer) was false-positive (i.e. benign histology). The most common tumours were bronchial carcinoma (n = 3), lymph node metastases of gynaecological tumours (n = 3) and tonsillar carcinoma (n = 2). Three of 12 findings (25%) were not detected by CECT alone (cervical carcinoma, lymph node metastasis and tonsillar carcinoma). In a per-patient analysis, sensitivity and specificity for malignant findings were 100% and 90% for PET/CT and 78% and 88% for CECT. In 24% (reader 1) and 21% (reader 2) of the patients, the PET/CT findings were inconclusive. Of these findings, 57% (reader 1) and 56% (reader 2) were only diagnosed with PET (e.g. focal FDG uptake of the thyroid, gastrointestinal tract and ovaries). On follow-up, none of these findings corresponded to malignancy. Overall agreement between the two readers was excellent with a Cohen's kappa of 0.95 ± 0.04 (p < 0.001) for PET/CT and 0.97 ± 0.03 (p < 0.001) for CECT alone. CONCLUSION: In this cohort of patients with PNS, PET/CT exhibited improved detection of underlying malignancy versus CECT alone. While hybrid imaging produces a greater number of inconclusive findings, sensitivity is increased for the detection of head and neck and gynaecological malignancies as well as metastatic lymph node involvement.
PURPOSE: To determine the value of combined (18)F-FDG PET/CT with diagnostic contrast-enhanced CT (CECT) in detecting primary malignancies and metastases in patients with paraneoplastic neurological syndromes (PNS) and to compare this with CECT alone. METHODS: PET/CT scans from 66 patients with PNS were retrospectively evaluated. Two blinded readers initially reviewed the CECT portion of each PET/CT scan. In a second session 3 months later, the readers analysed the combined PET/CT scans. Findings on each study were assessed using a four-point-scale (1 normal/benign; 2 inconclusive, further diagnostic work-up may be necessary; 3 malignant; 4 inflammatory). Sensitivity and specificity for malignant findings were calculated for PET/CT and CECT. Interreader agreement was determined by calculating Cohen's kappa. Pooled data from clinical follow-up (including histopathology and follow-up imaging, median follow-up 20.0 months) served as the reference gold standard. RESULTS: Both readers classified 12 findings in ten patients (15%) as malignant on the PET/CT scans (two patients had two primary tumours). One such imaging finding (suspected thymic cancer) was false-positive (i.e. benign histology). The most common tumours were bronchial carcinoma (n = 3), lymph node metastases of gynaecological tumours (n = 3) and tonsillar carcinoma (n = 2). Three of 12 findings (25%) were not detected by CECT alone (cervical carcinoma, lymph node metastasis and tonsillar carcinoma). In a per-patient analysis, sensitivity and specificity for malignant findings were 100% and 90% for PET/CT and 78% and 88% for CECT. In 24% (reader 1) and 21% (reader 2) of the patients, the PET/CT findings were inconclusive. Of these findings, 57% (reader 1) and 56% (reader 2) were only diagnosed with PET (e.g. focal FDG uptake of the thyroid, gastrointestinal tract and ovaries). On follow-up, none of these findings corresponded to malignancy. Overall agreement between the two readers was excellent with a Cohen's kappa of 0.95 ± 0.04 (p < 0.001) for PET/CT and 0.97 ± 0.03 (p < 0.001) for CECT alone. CONCLUSION: In this cohort of patients with PNS, PET/CT exhibited improved detection of underlying malignancy versus CECT alone. While hybrid imaging produces a greater number of inconclusive findings, sensitivity is increased for the detection of head and neck and gynaecological malignancies as well as metastatic lymph node involvement.
Authors: F Graus; F Keime-Guibert; R Reñe; B Benyahia; T Ribalta; C Ascaso; G Escaramis; J Y Delattre Journal: Brain Date: 2001-06 Impact factor: 13.501
Authors: M Hadjivassiliou; S J Alder; E J R Van Beek; M B Hanney; E Lorenz; D G Rao; B Sharrack; W B Tindale Journal: Acta Neurol Scand Date: 2008-10-06 Impact factor: 3.209
Authors: C A Vedeler; J C Antoine; B Giometto; F Graus; W Grisold; I K Hart; J Honnorat; P A E Sillevis Smitt; J J G M Verschuuren; R Voltz Journal: Eur J Neurol Date: 2006-07 Impact factor: 6.089
Authors: F Graus; J Y Delattre; J C Antoine; J Dalmau; B Giometto; W Grisold; J Honnorat; P Sillevis Smitt; Ch Vedeler; J J G M Verschuuren; A Vincent; R Voltz Journal: J Neurol Neurosurg Psychiatry Date: 2004-08 Impact factor: 10.154
Authors: S Younes-Mhenni; M F Janier; L Cinotti; J C Antoine; F Tronc; V Cottin; P J Ternamian; P Trouillas; J Honnorat Journal: Brain Date: 2004-09-10 Impact factor: 13.501
Authors: Rathan M Subramaniam; Anthony F Shields; Archana Sachedina; Lucy Hanna; Fenghai Duan; Barry A Siegel; Bruce E Hillner Journal: Oncologist Date: 2016-07-08
Authors: Ana María García Vicente; Roberto C Delgado-Bolton; Mariano Amo-Salas; Jesús López-Fidalgo; Ana Paula Caresia Aróztegui; José Ramón García Garzón; Javier Orcajo Rincón; María José García Velloso; María de Arcocha Torres; Soledad Alvárez Ruíz Journal: Eur J Nucl Med Mol Imaging Date: 2017-05-27 Impact factor: 9.236
Authors: F J Pena Pardo; A M García Vicente; M Amo-Salas; J F López-Fidalgo; J A Garrido Robles; J Á de Ayala Fernández; P Del Saz Saucedo; M Muñoz Pasadas; A Soriano Castrejón Journal: Clin Transl Oncol Date: 2016-05-02 Impact factor: 3.405
Authors: Knut Kurt William Kampe; Roman Rotermund; Milena Tienken; Götz Thomalla; Marc Regier; Susanne Klutmann; Stefan Kluge Journal: Front Neurol Date: 2017-02-14 Impact factor: 4.003