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See detailWhole-body positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures for staging patients with Hodgkin's disease.
Jerusalem, Guy ULg; Beguin, Yves ULg; Fassotte, Marie-France ULg et al

in Haematologica (2001), 86(3), 266-73

BACKGROUND AND OBJECTIVES: Accurate staging is essential in order to determine appropriate treatment in Hodgkin's disease (HD). (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) offers ... [more ▼]

BACKGROUND AND OBJECTIVES: Accurate staging is essential in order to determine appropriate treatment in Hodgkin's disease (HD). (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) offers the advantage of metabolic imaging that is largely independent of morphologic criteria. In the present study we evaluated the role of (18)F-FDG PET compared to routine procedures for the staging of patients with HD. DESIGN AND METHODS: Thirty-three patients with HD underwent standard staging procedures (clinical examination, laboratory screening, chest X-ray, computed tomography (CT) of the chest and abdomen and bilateral bone marrow biopsies) and a whole-body (18)F-FDG PET study. In clinical examination, an isolated lymph node > 1 cm or multiple lymph nodes > or = 1 cm in size were considered abnormal. Positive findings at both clinical examination or CT and (18)F-FDG PET were regarded as actual locations of disease. Negative findings with both methods were regarded as true negative (no involvement by HD). In cases of discrepancy, response to treatment and follow-up data were used to assess the overall accuracy of the patient's original evaluation. RESULTS: Completely concordant results in lymph node staging were observed in 20 patients. The two staging procedures indicated complementary information in 1 patient. Conventional staging indicated more pathologic lymph node areas in 6 patients (at least 1 false positive). (18)F-FDG PET showed more sites in 6 patients. The sensitivity of (18)F-FDG PET in detecting all known pathologic lymph nodes was 83% for peripheral lymph nodes, 91% for thoracic lymph nodes and 75% for abdominal and pelvic lymph nodes. Conventional staging procedures and (18)F-FDG PET indicated the same tumor stage in 26 patients. Based on (18)F-FDG PET, downstaging was suggested in 4 patients, including a biopsy-proven case. However in 1 of these cases this was incorrect. (18)F-FDG PET suggested upstaging in 3 patients. Based on conventional staging or (18)F-FDG PET the same treatment strategy was defined in 32 patients. In one patient (18)F-FDG PET downstaged disease extension (stage IIIA-->IIA) that would have suggested radiotherapy as a possible treatment option. INTERPRETATION AND CONCLUSIONS: (18)F-FDG PET provides an easy and efficient whole-body method for the evaluation of patients with HD. (18)F-FDG PET never missed tumor masses >1 cm. (18)F-FDG PET detected additional sites of disease not seen by conventional procedures and identified absence of disease in some sites suspected to be involved. However, in our patients this did not translate into changes in treatment strategy. [less ▲]

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See detailPersistent tumor 18F-FDG uptake after a few cycles of polychemotherapy is predictive of treatment failure in non-Hodgkin's lymphoma.
Jerusalem, Guy ULg; Beguin, Yves ULg; Fassotte, Marie-France ULg et al

in Haematologica (2000), 85(6), 613-8

BACKGROUND AND OBJECTIVE: Early recognition of the ineffectiveness of chemotherapy could result in lower cumulative drug toxicity and tumor burden at the start of salvage therapy, which might improve ... [more ▼]

BACKGROUND AND OBJECTIVE: Early recognition of the ineffectiveness of chemotherapy could result in lower cumulative drug toxicity and tumor burden at the start of salvage therapy, which might improve clinical outcome. Therefore, we studied the value of (18)F-FDG PET for early evaluation of response in patients with non-Hodgkin's lymphoma (NHL). DESIGN AND METHODS: We studied 28 patients by (18)F-FDG PET after a median of 3 cycles of polychemotherapy. The presence or absence of abnormal (18)F-FDG uptake was correlated to clinical outcome (median follow-up: 17.5 months, range 4-47 months). RESULTS: Five of 28 patients still had increased (18)F-FDG uptake in one or more sites previously shown to be involved by lymphoma at baseline evaluation. Only one of these five patients entered complete remission (CR), whereas among the 23 patients with negative (18)F-FDG PET studies, two died of toxicity during chemotherapy and all the others entered clinical CR (p<0.00001). All five patients with and 7/21 patients without residual abnormal (18)F-FDG uptake relapsed or reprogressed (positive predictive value for relapse: 100%, negative predictive value: 67%). By Kaplan-Meier analysis, progression-free survival (PFS) at 1 and 2 years was respectively 20+/-18% and 0% for (18)F-FDG PET positive patients and 81+/-9% and 62+/-12% for (18)F-FDG PET negative patients (p=0.0001). Overall survival (OS) at 1 and 2 years was respectively 20+/-18% and 0% for (18)F-FDG PET positive and 87+/-7% and 68+/-11% for (18)F-FDG PET negative patients (p<0.0001). INTERPRETATION AND CONCLUSIONS: Persistent tumoral (18)F-FDG uptake after a few cycles of polychemotherapy is predictive of CR, PFS and OS in NHL. Further studies are warranted to determine whether (18)F-FDG PET has a predictive value independent from conventional prognostic factors. However, the sensitivity of qualitative (18)F-FDG PET imaging in identifying patients with a poor outcome was insufficient. Earlier evaluation after only one cycle of chemotherapy and quantitative analysis might increase the sensitivity of 18F-FDG PET is predicting treatment failure. [less ▲]

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See detailInteret clinique de la tomographie a emission de positons dans la detection et le bilan d'extension des recidives des cancers colorectaux
Hustinx, Roland ULg; Paulus, P.; Daenen, Frédéric ULg et al

in Gastroentérologie Clinique et Biologique (1999), 23(3), 323-9

BACKGROUND: Positron emission tomography (PET) has been shown useful for the staging of patients with various carcinomas. METHODS: We have applied this technique to 54 cases of colorectal carcinoma and ... [more ▼]

BACKGROUND: Positron emission tomography (PET) has been shown useful for the staging of patients with various carcinomas. METHODS: We have applied this technique to 54 cases of colorectal carcinoma and compared it to conventional imaging techniques. RESULTS: PET had moderately higher sensitivity and specificity than conventional techniques to detect individual lesion sites (75% vs 70.8% and 63% vs 21% respectively). It detected the same number of patients with recurrences (35/39) but overestimated disease less frequently (5 cases vs 12). PET favorably influenced therapeutic management in 17 patients, indicating different or additional surgery in 9 while avoiding surgery with curative intent or unnecessary surgery in 8. In 5 cases, erroneous information provided by PET could be corrected by conventional imaging techniques. CONCLUSION: We conclude that PET appears to provide complementary information useful for staging patients with colorectal carcinomas. It can significantly modify patients management. These data should be confirmed by a prospective study. [less ▲]

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See detailWhole-Body 18f-Fdg Pet for the Evaluation of Patients with Hodgkin's Disease and Non-Hodgkin's Lymphoma
Jerusalem, Guy ULg; Warland, V.; Najjar, F. et al

in Nuclear Medicine Communications (1999), 20(1), 13-20

Whole-body metabolic information provided by 18F-FDG PET could help in the evaluation of lymphoma patients at diagnosis and follow-up. We studied 60 patients, 42 at initial presentation and 18 for disease ... [more ▼]

Whole-body metabolic information provided by 18F-FDG PET could help in the evaluation of lymphoma patients at diagnosis and follow-up. We studied 60 patients, 42 at initial presentation and 18 for disease recurrence (23 aggressive non-Hodgkin's lymphoma, 21 low-grade non-Hodgkin's lymphoma and 16 Hodgkin's disease). All patients underwent a clinical examination, computed tomography (CT) and a non-attenuated PET scan within 1 week. The patients received 222-296 MBq (6-8 mCi) 18F-FDG intravenously and emission scans were recorded 45-90 min later. 18F-FDG PET detected more lymph nodes than the clinical examination or CT, but this rarely resulted in upstaging (two patients). The concordance between PET and CT for the evaluation of the spleen, liver and digestive tract was quite good. Discordance was noted in 12 patients for the evaluation of bone marrow infiltration, but confirmation by MRI or focal biopsy was not always obtained. We conclude that non-attenuated 18F-FDG PET is an easy and efficient whole-body method for the evaluation of patients with lymphomas. Compared with conventional techniques, however, it does not appear to offer much improvement for staging but provides a satisfactory base for follow-up. [less ▲]

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See detailWhole-body positron emission tomography using 18F-fluorodeoxyglucose for posttreatment evaluation in Hodgkin's disease and non-Hodgkin's lymphoma has higher diagnostic and prognostic value than classical computed tomography scan imaging.
Jerusalem, Guy ULg; Beguin, Yves ULg; Fassotte, Marie-France ULg et al

in Blood (1999), 94(2), 429-33

A residual mass after treatment of lymphoma is a clinical challenge, because it may represent vital tumor as well as tissue fibrosis. Metabolic imaging by 18F-fluorodeoxyglucose (18F-FDG) positron ... [more ▼]

A residual mass after treatment of lymphoma is a clinical challenge, because it may represent vital tumor as well as tissue fibrosis. Metabolic imaging by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) offers the advantage of functional tissue characterization that is largely independent of morphologic criteria. We compared 18F-FDG PET to computed tomography (CT) in the posttreatment evaluation of 54 patients with Hodgkin's disease (HD) or intermediate/high-grade non-Hodgkin's lymphoma (NHL). Residual masses on CT were observed in 13 of 19 patients with HD and 11 of 35 patients with NHL. Five of 24 patients with residual masses on CT versus 1 of 30 patients without residual masses presented a positive 18F-FDG PET study. Relapse occurred in all 6 patients (100%) with a positive 18F-FDG PET, 5 of 19 patients (26%) with residual masses on CT but negative 18F-FDG PET, and 3 of 29 patients (10%) with negative CT scan and 18F-FDG PET studies (P </=.0001). We observed a higher relapse and death rate in patients with residual masses at CT compared with patients without residual masses at CT (progression-free survival at 1 year: 62 +/- 10 v 88 +/- 7%, P =. 0045; overall survival at 1 year: 77 +/- 5 v 95 +/- 5%, P =.0038). A positive 18F-FDG PET study was even more consistently associated with poorer survival: compared with patients with a negative 18F-FDG PET study, the 1-year progression-free survival was 0% versus 86% +/- 5% (P <.0001) and the 1-year overall survival was 50% +/- 20% versus 92% +/- 4% (P <.0001). The detection of vital tumor by 18F-FDG PET after the end of treatment has a higher predictive value for relapse than classical CT scan imaging (positive predictive value: 100% v 42%). This could help identify patients requiring intensification immediately after completion of chemotherapy. However, 18F-FDG PET mainly predicts for early progression but cannot exclude the presence of minimal residual disease, possibly leading to a later relapse. [less ▲]

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See detailRôle de la TEP au 18FDG dans le bilan d'extension ganglionnaire et la détection des récidives des cancers de la tête et du cou.
PAULUS, P.; VIVEGNIS, D.; SAMBON, A. et al

in Médecine Nucléaire : Imagerie Fonctionnelle et Métabolique (1997), 21

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See detailWhole-body FDG-PET as a firstline procedure for detection and staging of recurrent rectal or digmoid carcinoma: preliminary results.
HUSTINX, Roland ULg; PAULUS, P.; JACQUET, N. et al

in European Journal of Nuclear Medicine (1997), 24

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See detailImproved head and neck FDG-PET imaging using segmented attenuation correction.
PAULUS, P.; HENRY, S.; HUSTINX, Roland ULg et al

in European Journal of Nuclear Medicine (1997), 24

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See detailUsefulness of 18fdg Positron Emission Tomography in Detection and Follow-up of Digestive Cancers
Paulus, P.; Hustinx, Roland ULg; Daenen, Frédéric ULg et al

in Acta Gastro-Enterologica Belgica (1997), 60(4, Oct-Dec), 278-80

PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the distribution of positron emitting radionuclides in the human body. Recent technological developments allow ... [more ▼]

PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the distribution of positron emitting radionuclides in the human body. Recent technological developments allow the use of whole-body PET devices in clinical oncology. 18FDG is a glucose analog transported and competitively used with glucose reflecting the increased glucose metabolism into malignant cells. Differential diagnosis between chronic pancreatitis and pancreatic cancer is already a well-documented indication. For initial staging of gastro-esophageal and colorectal tumours, results are preliminary but the clinical impact seems to be rather limited. At present, the major indication of FDG-PET is the detection and staging of colorectal cancer recurrences. FDG-PET allows the differentiation between scared tissue and tumour when structural imaging is often confusing. In the same time, the whole-body imaging capability provides unique information that can modify loco-regional and liver staging. Overall, FDG-PET affects the clinical management of 30 to 40% of these patients. Quantitative assessment of therapeutic response to chemotherapy regimen appears to be one of the most promising applications of FDG-PET. Since the most effective therapy of colorectal cancer are often surgical, the role of chemotherapy in colorectal cancer remains limited to adjuvant therapy and in advanced disease. However, FDG-PET could be of great value in assessing the response of oesophageal carcinomas to chemo-radio therapy, before surgery. In our experience, FDG-PET appears to be the first line diagnostic method in the detection and staging of colorectal recurrence and differential diagnosis of pancreatic tumour versus chronic pancreatitis. [less ▲]

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See detailEfficacy of Tc-99m P829, a radiolabelled somatostatin analog in visualising mediastinal spread of non-small cell lung cancer
HUSTINX, Roland ULg; PAULUS, P.; BURY, Thierry ULg et al

in European Journal of Nuclear Medicine (1997), 24

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See detailEvaluation of pleural diseases with FDG-PET imaging: preliminary report.
Bury, Thierry ULg; Paulus, P; Dowlati, A et al

in Thorax (1997), 52(2), 187-9

BACKGROUND: Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is an accurate method for differentiating benign from malignant disease. The use of FDG-PET for the aetiological diagnosis ... [more ▼]

BACKGROUND: Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is an accurate method for differentiating benign from malignant disease. The use of FDG-PET for the aetiological diagnosis of pleural disease was investigated in 25 patients. METHODS: PET was performed on each subject before invasive procedures were used to determine the aetiological diagnosis. The PET data were analysed by visual interpretation of coronal, sagittal, and transverse slices. RESULTS: Sixteen patients were found to have malignant pleural disease and nine had benign disease. All patients with histologically confirmed malignant disease showed FDG uptake within the pleural thickening which was intense in 14 cases and moderate in two. PET imaging showed the absence of FDG uptake and correctly categorised seven non-malignant lesions. Two patients with infectious pleural diseases showed a localised and moderate FDG uptake. CONCLUSION: Our preliminary results suggest that FDG-PET could be an effective tool for differentiating between benign and malignant pleural diseases. [less ▲]

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See detailClinical PET in oncology
Rigo, P.; Paulus, P.; Bury, Thierry ULg et al

in Radioactive Isotopes in Clinical Medicine Research XXII (1997)

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See detailStaging of the Mediastinum: Value of Positron Emission Tomography Imaging in Non-Small Cell Lung Cancer
Bury, Thierry ULg; Paulus, P.; Dowlati, A. et al

in European Respiratory Journal : Official Journal of the European Society for Clinical Respiratory Physiology (1996), 9(12), 2560-4

Recent studies have shown limitations of morphological imaging in staging mediastinal lymph node involvement in lung cancer. In contrast to computed tomography (CT), which depends primarily on anatomical ... [more ▼]

Recent studies have shown limitations of morphological imaging in staging mediastinal lymph node involvement in lung cancer. In contrast to computed tomography (CT), which depends primarily on anatomical imaging features, positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) depends mainly on the metabolic characteristics of a tissue for the diagnosis of disease. We have performed a prospective study comparing FDG-PET and CT of the thorax in the presurgical assessment of the mediastinum in 50 patients with newly diagnosed non-small cell lung cancer (NSCLC). CT and PET scans were interpreted separately, and results were compared to pathological staging obtained during thoracotomy. Hilar or mediastinal lymph node involvement was present in 58%. In staging for lymph node involvement, CT had a sensitivity of 72% and specificity of 81%, whereas PET had a sensitivity and specificity of 90% and 86%, respectively. When the PET study was compared to histological results, there were four cases showing more advanced mediastinal involvement with PET and four cases showing less involvement with PET. From our preliminary results, we conclude that positron emission tomography with 18-fluorodeoxyglucose is significantly more accurate than computed tomography in the mediastinal staging of non-small cell lung cancer. [less ▲]

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See detailDetection of recurrent colorectal carcinoma with whole-body FDG-PET
DAENEN, Frédéric ULg; HUSTINX, Roland ULg; PAULUS, P. et al

in Journal of Nuclear Medicine (The) (1996, May), 37

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See detailPET imaging of liver metastases: a retrospective study.
HUSTINX, Roland ULg; PAULUS, P.; DAENEN, Frédéric ULg et al

in Journal of Nuclear Medicine (The) (1996, May), 37

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See detailEvaluation of the Solitary Pulmonary Nodule by Positron Emission Tomography Imaging
BURY, Thierry ULg; Dowlati, A.; Paulus, P. et al

in European Respiratory Journal (1996), 9(3), 410-4

Current noninvasive imaging methods are not sufficiently reliable for accurate detection of malignancy in most solitary pulmonary nodules (SPNs). Positron emission tomography (PET) using 18 ... [more ▼]

Current noninvasive imaging methods are not sufficiently reliable for accurate detection of malignancy in most solitary pulmonary nodules (SPNs). Positron emission tomography (PET) using 18-fluorodeoxyglucose (FDG), showing increased FDG uptake and retention in malignant cells, has proved useful to differentiate malignant from benign tissue and could, therefore, contribute to the evaluation of the SPN. We performed a prospective study of 50 patients referred to the Pneumology Department with unclear diagnoses of SPN after conventional radiological screening. PET study was performed on each subject before an invasive procedure was proposed. Thirty three patients had a malignant nodule and 17 had a benign nodule. The mean size of malignant nodule was 3 cm (range 1.5-4.5 cm). All showed a marked increase in 18-FDG uptake. The mean size of benign nodule was 1.8 cm (range 0.5-3.5 cm). PET imaging showed the absence of 18-FDG uptake and correctly identified 15 of 17 benign nodules. There was two false-positive cases with a moderate increase in 18-FDG uptake (1 postprimary tuberculosis; and 1 anthracosilicotic nodule with nonspecific inflammation). At present, the sensitivity and specificity of the method are 100 and 88%, respectively. The positive and negative predictive values of PET imaging for SPNs are 94 and 100%, respectively. Our preliminary results demonstrate that PET-FDG imaging is a noninvasive technique, which appears highly accurate in differentiating malignant SPN from benign SPN. [less ▲]

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See detailFDG-PET and lung cancer: evaluation of solitary pulmonary nodule and mediastinal staging.
PAULUS, P.; HUSTINX, Roland ULg; BURY, Thierry ULg et al

in Proceedings of the VIIth International PET Conference, Institute for Clinical PET (1996)

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See detailClinical value of whole body-body PET-FDG in the detection of liver metastases: preliminary results.
HUSTINX, Roland ULg; PAULUS, P.; BENOIT, Thérèse ULg et al

in European Journal of Nuclear Medicine (1996), 23

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See detailTomographie a emission de positons dans l'evaluation de l'extension ganglionnaire intrathoracique du cancer bronchique non petites cellules. Etude preliminaire chez 30 patients.
Bury, Thierry ULg; CORHAY, Jean-Louis ULg; Paulus, P et al

in Revue des Maladies Respiratoires (1996), 13(3), 281-286

Current methods for evaluating the mediastinum include chest radiography, computed tomography (CT) or magnetic resonance (MR) imaging and mediastinoscopy. Despite advances in morphologic imaging, some ... [more ▼]

Current methods for evaluating the mediastinum include chest radiography, computed tomography (CT) or magnetic resonance (MR) imaging and mediastinoscopy. Despite advances in morphologic imaging, some lung cancer patients are found to have unresectable disease at surgery. In contrast to CT scan or MR imaging, which depend primarily on anatomic and morphological criteria, positron emission tomography (PET) with 18fluorodeoxyglucose (FDG) depends mainly of the metabolic characteristics of a tissue for the diagnosis of disease. We perform a prospective study to compare FDG-PET and CT of the thorax in the presurgical assessment of the mediastinum in patients with newly diagnosed non-small cell lung cancer. Thirty patients have been included. CT and PET-scans were interpreted separately and results were compared to surgical staging during thoracotomy. In assessing mediastinal involvement, CT scan had a sensitivity of 56% and a specificity of 64%. For diagnosis mediastinal nodal disease, FDG-PET was 87% sensitive and 78% specific. Its positive predictive value was 82%, and the negative value was 83%. In conclusion, our preliminary results show that FDG-PET appears more accurate than CT in staging of mediastinal non-small cell lung cancer. [less ▲]

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