Our objective was to evaluate the association of arterial ¹⁸F-FDG uptake and calcifications in large arteries as detected by ¹⁸F-FDG PET/CT with the subsequent occurrence of vascular events in otherwise asymptomatic cancer patients. Methods: Clinical follow-up information was obtained for 932 cancer patients examined with whole-body ¹⁸F-FDG PET/CT (median follow-up time, 29 mo). Among this cohort, 279 patients had died from their oncologic disease. In 15 of 932 patients (1.6%), a vascular event, defined as ischemic stroke, myocardial infarction, or revascularization, was registered. The maximal standardized uptake value (SUV) was divided by the blood-pool SUV, yielding a target-to-background ratio (TBR) for each arterial segment. The mean TBR as well as a calcified plaque sum score per patient were calculated in the major vessels: ascending, descending, and abdominal aorta, aortic arch, as well as iliac and carotid arteries. Results: A significant correlation was observed between mean TBR and calcified plaque sum (P < 0.001). Although calcified plaque sum significantly correlated with all conventional risk factors for vascular events, mean TBR correlated only with age, the male sex, and hypertension. The Cox regression hazard model identified a mean TBR ≥ 1.7 and a calcified plaque sum ≥ 15 as independent predictors for the occurrence of a vascular event. Patients with both mean TBR and calcified plaque sum above these thresholds were identified as having the highest risk for a future vascular event. However, a mean TBR ≥ 1.7 had greater prognostic value than did a calcified plaque sum ≥ 15. Conclusion: In a large cohort of cancer patients, increased ¹⁸F-FDG uptake in major arteries emerged as the strongest predictor of a subsequent vascular event. Concomitant severe vascular calcifications seemed to impart a particularly high risk. Given the small event rate in the present study, larger, prospective trials of patients without cancer are required to substantiate these promising results.

This prospective trial was designed to compare the performance characteristics of five different screening tests in parallel for the detection of advanced colonic neoplasia: CT colonography (CTC), colonoscopy (OC), flexible sigmoidoscopy (FS), faecal immunochemical stool testing (FIT) and faecal occult blood testing (FOBT). Average risk adults provided stool specimens for FOBT and FIT, and underwent same-day low-dose 64-multidetector row CTC and OC using segmentally unblinded OC as the standard of reference. Sensitivities and specificities were calculated for each single test, and for combinations of FS and stool tests. CTC radiation exposure was measured, and patient comfort levels and preferences were assessed by questionnaire. 221 adenomas were detected in 307 subjects who completed CTC (mean radiation dose, 4.5 mSv) and OC; 269 patients provided stool samples for both FOBT and FIT. Sensitivities of OC, CTC, FS, FIT and FOBT for advanced colonic neoplasia were 100% (95% CI 88.4% to 100%), 96.7% (82.8% to 99.9%), 83.3% (95% CI 65.3% to 94.4%), 32% (95% CI 14.9% to 53.5) and 20% (95% CI 6.8% to 40.7%), respectively. Combination of FS with FOBT or FIT led to no relevant increase in sensitivity. 12 of 45 advanced adenomas were smaller than 10 mm. 46% of patients preferred CTC and 37% preferred OC (p5 mm. For patients who refuse full bowel preparation and OC or CTC, FS should be preferred over stool tests. However, in cases where stool tests are performed, FIT should be recommended rather than FOBT.