Radiology - Research Publications

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Author: Hicks, Rodney × Author: Seymour, John × End date: 2012 ×

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    Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients
    Guy, SD ; Tramontana, AR ; Worth, LJ ; Lau, E ; Hicks, RJ ; Seymour, JF ; Thursky, KA ; Slavin, MA (SPRINGER, 2012-08)
    PURPOSE: Febrile neutropenia (FNP) is a frequent complication of cancer care and evaluation often fails to identify a cause. [(18) F]FDG PET/CT has the potential to identify inflammatory and infectious foci, but its potential role as an investigation for persistent FNP has not previously been explored. The aim of this study was to prospectively evaluate the clinical utility of FDG PET/CT in patients with cancer and severe neutropenia and five or more days of persistent fever despite antibiotic therapy. METHODS: Adult patients with a diagnosis of an underlying malignancy and persistent FNP (temperature ≥38°C and neutrophil count <500 cells/μl for 5 days) underwent FDG PET/CT as an adjunct to conventional evaluation and management. RESULTS: The study group comprised 20 patients with FNP who fulfilled the eligibility criteria and underwent FDG PET/CT in addition to conventional evaluation. The median neutrophil count on the day of the FDG PET/CT scan was 30 cells/μl (range 0-730 cells/μl). Conventional evaluation identified 14 distinct sites of infection, 13 (93 %) of which were also identified by FDG PET/CT, including all deep tissue infections. FDG PET/CT identified 9 additional likely infection sites, 8 of which were subsequently confirmed as "true positives" by further investigations. FDG PET/CT was deemed to be of 'high' clinical impact in 15 of the 20 patients (75 %). CONCLUSION: This study supports the utility of FDG PET/CT scanning in severely neutropenic patients with five or more days of fever. Further evaluation of the contribution of FDG PET/CT in the management of FNP across a range of underlying malignancies is required.
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    Early therapeutic response assessment by 18FDG-positron emissiontomography during chemotherapy in patients with diffuse large B-celllymphoma: isolated residual positivity involving bone is not usually a predictor of subsequent treatment failure
    Ng, Ashley P. ; WIRTH, ANDREW ; SEYMOUR, JOHN ; Lee, Michael ; Hogg, Annette ; JANUSZEWICZ, HENRY ; WOLF, MIECZYSLAW ; Prince, H Miles ; MACMANUS, MICHAEL ; Hicks, Rodney J. (Taylor & Francis, 2007-03)
    Residual 2-fluoro-2-deoxyglucose (FDG) – positron emission tomography (PET) positivity during treatment of patients withdiffuse large B-cell lymphoma (DLBLC) prospectively identifies a subgroup at high likelihood of subsequent treatmentfailure. A single institution clinical audit of FDG-PET performance for this indication was undertaken for patients withDLBCL treated with anthracycline-based chemotherapy+radiotherapy. Of 45 eligible patients, 14 (31%) were PETpositiveafter a median of three chemotherapy cycles (range 1 – 5), of which 10 (71%) progressed at a median of 6.5 months.An interim positive PET was a statistically significant adverse prognostic factor for treatment failure (P=0.0001, log-rankanalysis) with a hazard ratio for a positive interim-treatment PET of 9 (95% confidence interval 4 – 55) and positivepredictive value of 71% and negative predictive value of 90%. Notably, four patients with low-grade FDG-avidity limited tosites previously involved by biopsy-proven osseous lymphoma, remain progression-free (median follow-up 62 months). LowgradeFDG-avidity on interim restaging at sites of bone involvement by DLBCL at diagnosis, appears to be less predictive ofdisease progression than residual nodal or extra-nodal soft tissue abnormality by PET.