• The Korean Journal of Nuclear Medicine
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• v.33 no.1
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• pp.65-75
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• 1999

Purpose: The aim of this study is to demonstrate the feasibility of 2-[fluorine-18] fluoro-2-deoxy-D-glucose (F-18-FDG) whole body scan (FDG W/B Scan) using dual-head gamma camera equipped with ultra high energy collimator in patients with various cancers, and compare the results with those of coincidence imaging. Materials and Methods: Phantom studies of planar imaging with ultra high energy and coincidence tomography (FDG CoDe PET) were performed. Fourteen patients with known or suspected malignancy were examined. F-18-FDG whole body scan was performed using dual-head gamma camera with high energy (511 keV) collimators and regional FDG CoDe PET immediately followed it Radiological, clinical follow up and histologic results were correlated with F-18-FDG findings. Results: Planar phantom study showed 13.1 mm spatial resolution at 10 cm with a sensitivity of 2638 cpm/MBq/ml. In coincidence PET, spatial resolution was 7.49 mm and sensitivity was 5351 cpm/MBq/ml. Eight out of 14 patients showed hypermetabolic sites in primary or metastatic tumors in FDG CoDe PET. The lesions showing no hypermetabolic uptake of FDG in both methods were all less than 1 cm except one lesion of 2 cm sized metastatic lymph node. The metastatic lymph nodes of positive FDG uptake were more than 1.5 cm in size or conglomerated lesions of lymph nodes less than 1cm in size. FDG W/B scan showed similar results but had additional false positive and false negative cases. FDG W/B scan could not visualize liver metastasis in one case that showed multiple metastatic sites in FDG CoDe PET. Conclusion: FDG W/B scan with specially designed collimators depicted some cancers and their metastatic sites, although it had a limitation in image quality compared to that of FDG CoDe PET. This study suggests that F-18-FDG positron imaging using dual-head gamma camera is feasible in oncology and helpful if it should be more available by regional distribution of FDG.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.sup1
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• pp.17-28
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• 2008

This review focuses on the clinical use of $^{18}F-FDG$ PET to evaluate solitary pulmonary nodule (SPN) and non-small cell lung cancer (NSCLC). When SPN or mass without calcification is found on chest X-ray or CT, $^{18}F-FDG$ PET is an effective modality to differentiate benign from malignant lesions. For initial staging of NSCLC, $^{18}F-FDG$ PET is useful, and proved to be cost-effective in several countries. $^{18}F-FDG$ is useful for detecting recurrence, restaging and evaluating residual tumor after curative therapy in NSCLC. For therapy response assessment, $^{18}F-FDG$ PET may be effective after chemotherapy or radiation therapy. $^{18}F-FDG$ PET is useful to predict pathological response after neoadjuvant therapy in NSCLC. For radiation therapy planning, $^{18}F-FDG$ PET may be helpful, but requires further investigations. PET/CT is better for evaluating NSCLC than conventional PET.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.sup1
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• pp.32-38
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• 2008

This review focuses on the clinical use of $^{18}F-FDG$ PET in esophageal cancer. For initial staging of esophageal cancer, $^{18}F-FDG$ PET is better than chest CT and is complementary to endoscopic ultrasound. Due to its good results for detecting distant metastasis, $^{18}F-FDG$ PET evades unnecessary curative surgery. Also, PET findings are associated with prognosis in esophageal cancer. $^{18}F-FDG$ PET seems to be useful for detecting recurrence and restaging in esophageal cancer. For therapy response assessment, $^{18}F-FDG$ PET is effective after chemotherapy or radiation therapy. $^{18}F-FDG$ PET is useful to predict pathological response after neoadjuvant therapy in esophageal cancer, which is better than chest CT and endoscopic ultrasound. For radiation therapy planning, $^{18}F-FDG$ PET may be helpful, but requires further investigations.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.6
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• pp.3647-3652
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• 2013

Purpose: To evaluate the diagnostic value of $^{18}F$-FDG PET/CT for detection of bone metastasis in comparison with the efficacies of $^{18}F$-FDG PET/CT, CT, $^{18}F$-FDG PET and conventional planar bone scintigraphy in a series of cancer patients. Methods: Five hundred and thirty patients who underwent both $^{18}F$-FDG PET/CT and bone scintigraphy within 1 month were retrospectively analyzed. The skeletal system was classified into 10 anatomic segments and interpreted blindly and separately. For each modality, the sensitivity, specificity, accuracy, PPV and NPV were calculated and the results were statistically analyzed. Results: Bone metastases were confirmed in 117 patients with 459 positive segments. On patient-based analysis, the sensitivity, specificity, accuracy, PPV and NPV of $^{18}F$-FDG PET/CT were significantly higher than bone scintigraphy, CT and $^{18}F$-FDG PET (P<0.05). On segment-based analysis, the sensitivity of CT, bone scintigraphy, $^{18}F$-FDG PET and $^{18}F$-FDG PET/CT were 70.4%, 89.5%, 89.1% and 97.8%, respectively (P<0.05, compared with $^{18}F$-FDG PET/CT). The overall specificity and accuracy of the four modalities were 89.1%, 91.8%, 90.3%, 98.2% and 90.3%, 90.9%, 89.8%, 98.0%, respectively (P<0.05, compared with $^{18}F$-FDG PET/CT). The PPV and NPV were 89.8%, 87.6%, 85.6%, 97.2% and 85.6%, 93.2%, 92.8%, 98.6%, respectively. Three hundred and twelve lesions or segments were presented as lytic or sclerotic changes on CT images at the corresponding sites of increased $^{18}F$-FDG uptake. In lytic or mixed lesions, the sensitivity of $^{18}F$-FDG PET/CT and $^{18}F$-FDG PET were better than bone scintigraphy, while in osteoblastic lesions bone scintigraphy had a similar performance with $^{18}F$-FDG PET/CT but better than $^{18}F$-FDG PET alone. Conclusion: Our data allow the conclusion that $^{18}F$-FDG PET/CT is superior to planar bone scintigraphy, CT or $^{18}F$-FDG PET in detecting bone metastasis. $^{18}F$-FDG PET/CT may enhance our diagnosis of tumor bone metastasis and provide more information for cancer treatment.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.1
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• pp.22-29
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• 2007

Purpose: Metastatic thyroid cancers with I-131 uptake have been known to show no increase of FDG uptake whereas those without I-131 uptake tend to demonstrate increased uptake on PET. In this study, we evaluated the degree of FDG uptake in primary thyroid cancers of papillary histology before surgery. Material & Methods: Forty FDG PET studies were performed on the patients who had papillary cancer proven by fine needle aspiration. The degree of FDG uptake was visually categorized as positive or negative (positive if the tumor showed discernible FDG; negative if the tumor didn't) and the peak standard uptake value (peak SUV) of the papillary thyroid cancer (PTC) were compared with the size of PTC. Results: The mean size of 26 PTC with positive FDG uptake was $1.9{\pm}1.4\;cm(0.5{\sim}5\;cm)$. In 13 PTC with negative FDG uptake, the mean size of those was $0.5{\pm}0.2\;cm\;(0.2{\sim}0.9\;cm)$. All PTC larger than 1cm ($2.5{\pm}1.4\;cm,\;1{\sim}5\;cm$) have positive FDG uptake (peak $SUV=6.4{\pm}5.7,\;1.7{\sim}22.7$). Among the micropapillary thyroid cancer (microPTC; PTC smaller than 1cm), 8 microPTC show positive FDG uptake(peak $SUV=2.9{\pm}1.3,\;1.7{\sim}5.5$), while 13 microPTC show negative finding(peak $SUV=1.3{\pm}0.2,\;1.1{\sim}1.7$). The size of microPTC with positive FDG uptake is significantly larger than that of microPTC with negative FDG uptake ($0.7{\pm}0.1\;cm$ vs $0.4{\pm}0.2\;cm$, p=0.01). Conclusion: All PTCs larger than 1cm show positive FDG uptake in our study. In other words, thyroid lesions larger than 1cm with negative FDG uptake are unlikely to be PTC. So far, only poorly differentiated thyroid cancers are known to show increased FDG uptake. Our results seem to be contradictory to what is known in the literature. Further study is needed to understand better the significance of increased FDG uptake in PTC in relation to expression of NIS and GLUT.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.1
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• pp.29-38
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• 2008

Purpose: The aim of this study was to investigate the feasibility of 3 ' -[F-18]fluoro-3 ' -deoxythymidine positron emission tomography(FLT-PET) for the detection of locally advanced breast cancer and to compare the degree of FLT and 2' -deoxy-2 ' -[F-18]fluoro-d-glucose(FDG) uptake in primary tumor, lymph nodes and other normal organs. Material & Methods: The study subjects consisted of 22 female patients (mean age; $42{\pm}6$ years) with biopsy-confirmed infiltrating ductal carcinoma between Aug 2005 and Nov 2006. We performed conventional imaging workup, FDG-PET and FLT PET/CT. Average tumor size measured by MRI was $7.2{\pm}3.4$ cm. With visual analysis, Tumor and Lymph node uptakes of FLT and FDG were determined by calculation of standardized uptake value (SUV) and tumor to background (TB) ratio. We compared FLT tumor uptake with FDG tumor uptake. We also investigated the correlation between FLT tumor uptake and FDG tumor uptake and the concordant rate with lymph node uptakes of FLT and FDG. FLT and FDG uptakes of bone marrow and liver were measured to compare the biodistribution of each other. Results: All tumor lesions were visually detected in both FLT-PET and FDG-PET. There was no significant correlation between maximal tumor size by MRI and SUVmax of FLT-PET or FDG-PET (p>0.05). SUVmax and $$SUV_{75} (average SUV within volume of interest using 75% isocontour) of FLT-PET were significantly lower than those of FDG-PET in primary tumor (SUVmax; $6.3{\pm}5.2\;vs\;8.3{\pm}4.9$, p=0.02 /$SUV_{75};\;5.3{\pm}4.3\;vs\;6.9{\pm}4.2$, p=0.02). There is significant moderate correlation between uptake of FLT and FDG in primary tumor (SUVmax; rho=0.450, p=0.04 / SUV75; rho=0.472, p=0.03). But, TB ratio of FLT-PET was higher than that of FDG-PET($11.7{\pm}7.7\;vs\;6.3{\pm}3.8$, p=0.001). The concordant rate between FLT and FDG uptake of lymph node was reasonably good (33/34). The FLT SUVs of liver and bone marrow were $4.2{\pm}1.2\;and\;8.3{\pm}4.9$. The FDG SUVs of liver and bone marrow were $1.8{\pm}0.4\;and\;1.6{\pm}0.4$. Conclusion: The uptakes of FLT were lower than those of FDG, but all patients of this study revealed good FLT uptakes of tumor and lymph node. Because FLT-PET revealed high TB ratio and concordant rate with lymph node uptakes of FDG-PET, FLT-PET could be a useful diagnostic tool in locally advanced breast cancer. But, physiological uptake and individual variation of FLT in bone marrow and liver will limit the diagnosis of bone and liver metastases.

• The Korean Journal of Nuclear Medicine
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• v.36 no.1
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• pp.53-63
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• 2002

FDG PET is a functional imaging modality whose ability to detect lesions is directly based on a change of the glycolytic metabolism of targeted tissues, may be advantageous over other techniques. Combined with excellent image qualify, high spatial resolution, and whole body imaging capability, it has become popular as a new approach in the evaluation of patients with various malignancies. Initial staging of nodal and extranodal lymphoma using FDG PET has been proven to be at least equal or superior to conventional imaging modalities. For the assessment of treatment responsiveness, FDG PET has a major impact on the management of patients in differentiating residual lymphoma from treatment related benign changes. Residual FDG uptake after the completion of chemotherapy is a good predictor of early relapse. However, it seems that the absence of FDG uptake in tumor mass may not exclude minimal residual disease causing later relapse. In the early evaluation of treatment response only after a few cycles of chemotherapy, FDG PET may have a promising role in identifying non-responders who could benefit from a different treatment strategy. At present, FDG PET appears to be the cost-effective, diagnostic modality of choice in the management of lymphoma patients. The role of FDG PET based-systems in terms of affecting long-term prognosis and survival benefit should be further elucidated in future prospective studios.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.sup1
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• pp.172-176
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• 2008

FDG PET has been used as a diagnostic tool for localization of seizure focus for last 2-3 decades. In this article, the clinical usefulness of FDG PET in the management of patients with epilepsy has been reviewed, which provided the evidences to justify the medicare reimbursement for FDG PET in management of patients with epilepsy. Literature review demonstrated that FDG PET provides an important information in localization of seizure focus and determination whether a patients is a surgical candidate or not. FDG PET has been reported to have high diagnostic performance in localization of seizure focus in neocortical epilepsy as well as temporal lobe epilepsy regardless of the presence of structural lesion on MRI. Particularly, FDG PET can provide the additional information when the results from standard diagnositic modality such as interictal or video-monitored EEG, and MRI are inconclusive or discordant, and make to avoid invasive study. Furthermore, the presence of hypometabolism and extent of metabolic extent has been reported as an important predictor for seizure free outcome. However, studies suggested that more accurate localization and better surgical outcome could be expected with multimodal approach by combination of EEG, MRI, and functional studies using FDG PET or perfusion SPECT rather than using a single diagnostic modality in management of patients with epilepsy. Complementary use of FDG PET in management of epilepsy is worth for good surgical outcome in epilepsy patients.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.sup1
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• pp.66-70
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• 2008

Reports about FDG PET in biliary tumor are limited and there are almost no reports regarding its efficacy. Biliary tumor is divided to intrahepatic and extrahepatic bile duct cancer, and intrahepatic bile duct cancer can be further divided to peripheral type which occurs at lobular duct and hilar type which occurs at hepatic hilum. Surgical resection is the only curative method for bile duct tumor, and accurate staging plays an important role in deciding treatment modality. Among intrahepatic bile duct tumors, peripheral type and hilar type have the same histological characteristics, but different clinical manifestations and tumor growth pattern. On PET image, FDG uptake is also different between peripheral type and hilar type. Most of the former shows high FDG uptake at primary and metastasis site so it is very useful for determining stage and changing treatment plans. However, the later is diversified among low uptake and very high uptake. The FDG uptake pattern of hilar type is similar to that of extrahepatic bile duct cancer, and mucinous component is an important factor, which affects FOG uptake. When tumor cells are scattered in desmoplatsic stroma, then FDG uptake is low as well. In contrast, when FDG uptake is high, it is likely to be tubular type which has high tumor density. Tumor growth pattern also affects FDG uptake. Nodular type mostly takes higher FDG compared to infiltrative type. There are many cases where benign inflammatory diseases take high FDG that PET alone can not distinguish malignant lesion from benign lesion. In conclusion, studies about PET using FDG are still limited. Thus, it is hard to make accurate conclusion about the roles of PET or PET/CT in biliary cancers, but peripheral type intrahepatic bile duct cancers and mass forming hilar and extrahepatic bile duct cancers appear to be good indications performing FDG PET or PET/CT.

• The Korean Journal of Nuclear Medicine
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• v.33 no.6
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• pp.502-511
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• 1999

Purpose: F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been proven to be useful in the differential diagnosis of breast mass and staging of breast cancer. This study assessed the diagnostic accuracy of F-18-FDG PET in the differentiation of breast mass and staging of breast cancer. Materials and Methods: Total 42 patients who had breast mass underwent F-18-FDG PET (all female, 40: 10 year old). We compared F-18 FDG PET results with pathologic findings in 24 patients Results: In the differentiation of breast mass, sensitivity and specificity were 95% (19/20) and 77% (7/9) respectively. Three false positive cases were due to inflammation and one false negative patient had small tumor less than 1 cm. In the assessment of axillary lymph node status, sensitivity and specificity were 73% (8/11) and 100% (7/7) respectively. We found distant metastasis that were not suspected before F-18-FDG PET in 2 patients. Conclusion: F-18-FDG PET shows good diagnostic performance in differentiation of breast mass and staging of breast cancer.