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Chandekar KR, Satapathy S, Dharmashaktu Y, Ballal S, Ranjan P, Batra A, Gogia A, Mathur S, Bal C. Somatostatin receptor-targeted theranostics in patients with estrogen receptor-positive metastatic breast cancer-a prospective exploratory study. Breast Cancer Res Treat 2025; 211:363-373. [PMID: 40000538 DOI: 10.1007/s10549-025-07651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 02/11/2025] [Indexed: 02/27/2025]
Abstract
PURPOSE Somatostatin receptor (SSTR) expression has been reported in estrogen receptor-positive (ER +) metastatic breast cancer (mBC) by pathology and immunohistochemistry studies. We aimed to investigate whether SSTR could be a viable target for PET imaging and potential theranostics in ER + mBC. METHODS Thirty prospectively recruited patients with ER + mBC underwent PET/CT imaging with [18F]FDG and [68Ga]Ga-DOTATATE (within three weeks). Detection rates (per-patient, per-region), number of lesions detected, SUVmax values, Krenning scores, SSTR-FDG visual scores, and PET-based staging with both radiotracers were compared. RESULTS [18F]FDG and [68Ga]Ga-DOTATATE PET/CT had similar per-patient detection rates (100% vs 96.7%, P = 1.0). Per-region and per-lesion analyses revealed comparable detection of local/breast lesions, nodal, and skeletal metastases. However, [18F]FDG outperformed [68Ga]Ga-DOTATATE in detecting visceral/other metastases (235 vs 128 lesions, P = 0.003). [68Ga]Ga-DOTATATE resulted in a lower PET-based M-stage compared to [18F]FDG in 10% of patients, although T-/N-stages were concordant in all patients. HER2- patients showed a trend of higher [68Ga]Ga-DOTATATE lesional SUVmax values compared to the HER2 + sub-group (median 9.0 vs 3.8, P = 0.078). 3/30 (10%) participants had a patient-level Krenning score ≥ 3 ([68Ga]Ga-DOTATATE uptake higher than liver background in majority of the lesions), potentially making them suitable for SSTR-targeted radionuclide therapy. CONCLUSIONS SSTR-targeted theranostics may represent a novel potential alternative in a subset of patients with ER + mBC. Its generalized applicability is limited by poor sensitivity for visceral metastases and significant inter-lesion heterogeneity. Future studies must identify how tumor subtype, proliferation, and prior systemic therapies impact SSTR expression levels in these patients to ensure meaningful clinical translation. CLINICAL TRIAL REGISTRATION Clinical Trials Registry-India: CTRI/2023/03/051025 (prospectively registered on 23.03.2023).
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Affiliation(s)
- Kunal Ramesh Chandekar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Yamini Dharmashaktu
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjana Ballal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Piyush Ranjan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Atul Batra
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Singleton M, Tam K, Weiner A, Clark LH. Review of Bone Metastasis in Gynecologic Malignancies: Evaluation and Treatment. Curr Treat Options Oncol 2025; 26:331-340. [PMID: 40186836 DOI: 10.1007/s11864-025-01312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2025] [Indexed: 04/07/2025]
Abstract
OPINION STATEMENT Metastatic bone disease (MBD) is a significant source of morbidity and mortality in cancer patients with solid tumors, including those with gynecologic malignancies. Infiltration of tumor cells within the bone microenvironment disrupts bone homeostasis and leads to osteoblastic, osteolytic, or mixed bone lesions. Greater than two thirds of those with MBD experience cancer-induced bone pain (CIBP) and one to two-thirds will develop a skeletal-related event (SRE). Various pharmacologic, surgical, and radiation treatments exist for the palliation of bone metastases and the prevention of SREs. It is paramount to understand the diagnostic evaluation and evidence-based treatment paradigms of bone metastases to decrease healthcare utilization, alleviate financial burden, mitigate disability, and improve quality of life.
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Affiliation(s)
- Miller Singleton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Houpt Physicians Office Building, B103, Campus Box 7572, 170 Manning Drive, Chapel Hill, NC, 27599, USA.
| | - Kevin Tam
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Ashley Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Leslie H Clark
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Houpt Physicians Office Building, B103, Campus Box 7572, 170 Manning Drive, Chapel Hill, NC, 27599, USA
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Belotta AF, Beazley S, Hutcheson M, Mayer M, Beaufrère H, Sukut S. Comparison of sedation and general anesthesia protocols for 18F-FDG-PET/CT studies in dogs and cats: Musculoskeletal uptake and radiation dose to workers. Vet Radiol Ultrasound 2025; 66:e13439. [PMID: 39388650 DOI: 10.1111/vru.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 08/02/2024] [Accepted: 09/09/2024] [Indexed: 10/12/2024] Open
Abstract
In veterinary medicine, PET/CT scans are generally performed with the patient under general anesthesia. The aim of this prospective crossover study was to compare the musculoskeletal uptake of 18F-FDG and radiation doses to workers during PET/CT studies of healthy dogs and cats between sedation and general anesthesia. Volume and maximal standard uptake values (SUVmax) values of abnormal 18F-FDG uptake in the skeletal musculature, presence of misregistration artifact, and radiation doses to workers for each PET/CT study were recorded. Sedation was associated with increased volume of 18F-FDG uptake in the musculature of the thoracic limbs (p = .01), cervical (p = .02), and thoracic (p = .03) spine. Increased volume and SUVmax of the musculature assessed altogether were associated with the lighter degree of sedation (p = .04 for both). A significant decrease in the odds of misregistration artifact was observed for anesthetized animals in comparison with sedated (OR: 0.0, 95% CI: 0.0-0.0, p = .01). Radiation doses to workers were significantly higher for sedation compared with general anesthesia (p = .01) and for the anesthesia technician compared with the nuclear medicine technologist (p = .01). Use of sedation for PET/CT studies in dogs and cats is feasible. However, it is associated with increased physiologic musculoskeletal uptake of 18F-FDG in the thoracic limbs, cervical, and thoracic spine, with increased frequency of misregistration artifact, and with increased radiation doses to workers. These limitations can be overcome by recognition of the uptake pattern and monitoring/rotation of the involved staff at institutions where a high caseload is expected.
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Affiliation(s)
- Alexandra F Belotta
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shannon Beazley
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Matthew Hutcheson
- Safety Resources, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Monique Mayer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hugues Beaufrère
- Department of Veterinary Medicine and Epidemiology, UC Davis School of Veterinary Medicine, Davis, California, USA
| | - Sally Sukut
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Reshtebar N, Hosseini SA, Zhuang M, Rahmim A, Karakatsanis NA, Sheikhzadeh P. Assessment of dual time point protocols to produce parametric K i images in FDG PET/CT: A virtual clinical study. Med Phys 2024; 51:9088-9102. [PMID: 39341228 DOI: 10.1002/mp.17391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 07/15/2024] [Accepted: 08/14/2024] [Indexed: 09/30/2024] Open
Abstract
PURPOSE This simulation study investigated the feasibility of generating Patlak Ki images using a dual time point (DTP-Ki) scan protocol involving two 3-min/bed routine static PET scans and, subsequently, assessed DTP-Ki performance for an optimal DTP scan time frame combination, against conventional Patlak Ki estimated from complete 0-93 min dynamic PET data. METHODS Six realistic heterogeneous tumors of different characteristic spatiotemporal [18F]FDG uptake distributions for three noise levels commonly found in clinical studies and 20 noise realizations (N = 360 samples) were produced by analytic simulations of the XCAT phantom. Subsequently, DTP-Ki images were generated by performing standard linear indirect Patlak analysis with t*≥ 12 $ \ge 12$ -min (Patlakt* = 12) using a scaled population-based input function (sPBIF) model on 66 combinations of early and late 3-min/bed static whole-body PET reconstructed images. All DTP-Ki images were evaluated against respective DTP-Ki images estimated with Patlakt* = 12 and 0-93 min individual input functions (iIFs) and against gold standard Ki images estimated with Patlakt* = 12, 0-93 min iIFs and tissue time activity curves from all reconstructed WB passes 12-93 min post injection. The optimal combination of early and late frames, in terms of attaining the highest correlation between DTP-Ki with sPBIF and gold standard Ki was also determined from a set of 66 different combinations of 2-min early and late frames. Moreover, the performance of DTP-Ki with sPBIF was compared against that of the retention index (RI) in terms of their correlation to the gold standard Ki. Finally, the feasibility and practicality of DTP protocol in the clinic were assessed through the analysis of nine patients. RESULTS High correlations (>0.9) were observed between DTP-Ki values from sPBIF and those from iIFs for all evaluated DTP protocols while the mean AUC difference between sPBIF and iIFs was less than 10%. The percentage difference of mean values between DTP-Ki from sPBIF and from iIFs was less than 1%. DTP Ki from sPBIF exhibited significantly higher correlation with gold standard Ki, in contrast to RI, across all 66 DTP protocols (p < 0.05 using the two-tailed t-test by Williams) with the highest correlation attained for the 50-53-min early + 90-93-min late scan time frames (optimal DTP protocol). CONCLUSION Feasibility of generating Patlak Ki [18F] FDG images from an early and a late post injection 3-min/bed routine static scan using a population-based input function model was demonstrated and an optimal DTP scan protocol was determined. The results indicated high correlations between DTP-Ki and gold-standard Ki images that are significantly larger than those between RI and gold-standard Ki.
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Affiliation(s)
- Niloufar Reshtebar
- Department of Energy Engineering, Sharif University of Technology, Tehran, Iran
| | | | - Mingzan Zhuang
- Department of Nuclear Medicine, Meizhou People's Hospital, Meizhou, China
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Departments of Radiology and Physics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas A Karakatsanis
- Department of Radiology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Peyman Sheikhzadeh
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Nuclear Medicine Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Li MHG, Boktor RR, Rowe C, Weinberg L, Riedel B. A novel method in myocardial injury risk stratification using intravenous fat emulsion as sole rapid preparation for unfasted patients to suppress myocardial 18F-fluorodeoxyglucose uptake for optimal cardiac PET imaging: a proof-of-concept randomized-crossover trial. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2024; 4:1412917. [PMID: 39513151 PMCID: PMC11541950 DOI: 10.3389/fnume.2024.1412917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 09/25/2024] [Indexed: 11/15/2024]
Abstract
Objectives Optimal imaging of ischemic or inflammed myocardium via 18F-FDG PET imaging requires suppression of background carbohydrate metabolism in normal myocardium. Sole administration of intravenous lipid emulsion has not previously been used to rapidly prepare unfasted patients, such as in emergent clinical situations. In this proof-of-concept pilot, we posited that intravenous fat emulsion suppresses physiological metabolic uptake of in non-ischemic, non-inflammatory myocardium in unprepared and unfasted setting for enhanced cardiac positron emission tomography (PET) imaging. Methods We conducted an ethics-approved, single-blind, prospective randomized crossover trial of 10 healthy volunteers from January 2020 to June 2021. Participants were unfasted and rendered hyperglycemic before being administered either high dose intravenous lipid emulsion-1.5 ml kg of 20% lipid emulsion, followed by 15 ml/kg/hr for 30mins-or saline prior to 18F-FDG injection and subsequent cardiac PET imaging. Assessors undertook image analysis for maximum standard uptake value (SUVmax), minimum standard uptake value (SUVmin) and qualitative assessment, and groups were compared using univariate analysis. Results The study population age was 44.5 years [IQR 32.5-56.5], with 50% male and a median BMI of 22.75 [IQR 25.0-28.5] kg/m2. The study was feasible and there were no adverse side effects from the interventions. In these participants with normal myocardium, 18F-FDG uptake was reduced by intravenous lipid emulsion as assessed by SUVmax and qualitative assessment (p = 0.042, r = 0.454 and p = 0.009, r = -0.581, respectively). Conclusions Intravenous lipid emulsion suppresses background metabolic uptake of 18F-FDG even in unprepared and unfasted patients. Our findings prove and expand the possible applications for cardiac 18F-FDG PET in various settings, including in emergent settings as a means of rapid preparation in place of current more time-consuming standard protocols, allowing time-critical management to be effected.
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Affiliation(s)
- Michael H-G. Li
- Department of Anaesthesia, Austin Health, Heidelberg, VIC, Australia
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Raef R. Boktor
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, VIC, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia
- School of Cancer Medicine, La Trobe University, Bundoora, VIC, Australia
| | - Christopher Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, VIC, Australia
- Florey Department of Neuroscience and Mental Health, Austin Health, Heidelberg, VIC, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, VIC, Australia
- Department of Critical Care, The University of Melbourne, Parkville, VIC, Australia
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Parkville, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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Zhao Y, Lv T, Xu Y, Yin J, Wang X, Xue Y, Zhu G, Yu W, Wang H, Li X. Application of Dynamic [ 18F]FDG PET/CT Multiparametric Imaging Leads to an Improved Differentiation of Benign and Malignant Lung Lesions. Mol Imaging Biol 2024; 26:790-801. [PMID: 39174787 DOI: 10.1007/s11307-024-01942-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/18/2024] [Accepted: 07/24/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE To evaluate the potential of whole-body dynamic (WBD) 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) multiparametric imaging in the differential diagnosis between benign and malignant lung lesions. PROCEDURES We retrospectively analyzed WBD PET/CT scans from patients with lung lesions performed between April 2020 and March 2023. Multiparametric images including standardized uptake value (SUV), metabolic rate (MRFDG) and distribution volume (DVFDG) were visually interpreted and compared. We adopted SUVmax, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) for semi-quantitative analysis, MRmax and DVmax values for quantitative analysis. We also collected the patients' clinical characteristics. The variables above with P-value < 0.05 in the univariate analysis were entered into a multivariate logistic regression. The statistically significant metrics were plotted on receiver-operating characteristic (ROC) curves. RESULTS A total of 60 patients were included for data evaluation. We found that most malignant lesions showed high uptake on MRFDG and SUV images, and low or absent uptake on DVFDG images, while benign lesions showed low uptake on MRFDG images and high uptake on DVFDG images. Most malignant lesions showed a characteristic pattern of gradually increasing FDG uptake, whereas benign lesions presented an initial rise with rapid fall, then kept stable at a low level. The AUC values of MRmax and SUVmax are 0.874 (95% CI: 0.763-0.946) and 0.792 (95% CI: 0.667-0.886), respectively. DeLong's test showed the difference between the areas is statistically significant (P < 0.001). CONCLUSIONS Our study demonstrated that dynamic [18F]FDG PET/CT imaging based on the Patlak analysis was a more accurate method of distinguishing malignancies from benign lesions than conventional static PET/CT scans.
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Affiliation(s)
- Yihan Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tao Lv
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yue Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiankang Yin
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yangyang Xue
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Gan Zhu
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenjing Yu
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaohu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, China.
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Fox R, Chang S, Hicks L, Mooney S, Rogers PAW, Hicks RJ, Tyson K, Holdsworth-Carson SJ. Positron emission tomography in the evaluation of endometriosis: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 299:258-265. [PMID: 38917749 DOI: 10.1016/j.ejogrb.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/19/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024]
Abstract
Despite the profound impact of endometriosis worldwide, delays in diagnosis and suboptimal surveillance techniques are well-recognised issues. Case studies have reported incidental uptake of 18F-FDG PET tracer in endometriotic lesions. However, the utility of PET imaging as a non-invasive diagnostic tool for endometriosis is currently unclear. The purpose of this systematic review was to summarise the existing evidence and determine the value of available PET scanning techniques in the detection and monitoring of endometriosis. MEDLINE, EMBASE, CENTRAL, SCOPUS and Web of Science were searched from conception to 05/03/23. Eligible studies included participants with a history of known or suspected endometriosis who underwent a PET scan for any indication. All PET tracers and protocols were eligible. Outcomes included correlation of PET tracer uptake with the presence of endometriosis seen at laparoscopy or confirmed on histology, sensitivity of tracer uptake, specificity of tracer uptake, site of lesions with tracer uptake, stage of lesions with tracer uptake, SUVmax of endometriosis lesions and adverse reactions to PET imaging. The protocol for this review was registered with PROSPERO (ID: CRD42023405260). Eight studies describing 110 participants were eligible for inclusion. Six studies assessed 18F-FDG with combined PET-CT, one study assessed 18F-FDG PET alone, and the remaining study assessed PET-CT with an alternative tracer, 68Ga-DOTATATE. For 18F-FDG imaging, the correlation of PET avidity with lesions or sites of endometriosis ranged from 0-55 %. Pre-operative 68Ga-DOTATATE PET-CT detected endometriosis in 33 % of cases. All included studies were cohort studies, six were assessed to have low risk of bias, one with moderate risk and one with high risk of bias. Overall, 18F-FDG PET scanning does not appear to consistently identify endometriotic lesions, and therefore its reliability and usefulness in endometriosis diagnosis is limited. The utility of 68Ga-DOTATATE PET-CT remains uncertain. Findings are constrained by limited available evidence reporting outcomes of PET imaging for endometriosis. Other existing PET tracers with biological plausibility in the detection or monitoring of endometriosis warrant further investigation.
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Affiliation(s)
- Rachael Fox
- The Royal Women's Hospital, 20 Flemington Rd, Parkville 3052, Victoria, Australia; Julia Argyrou Endometriosis Centre, Epworth HealthCare, Victoria, Australia.
| | - Sarah Chang
- University of Melbourne, Parkville 3052, Victoria, Australia
| | - Lauren Hicks
- The Royal Women's Hospital, 20 Flemington Rd, Parkville 3052, Victoria, Australia; Julia Argyrou Endometriosis Centre, Epworth HealthCare, Victoria, Australia
| | - Samantha Mooney
- Julia Argyrou Endometriosis Centre, Epworth HealthCare, Victoria, Australia; Gynaecology Research Centre, The Royal Women's Hospital, Victoria, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Victoria, Australia
| | - Peter A W Rogers
- Gynaecology Research Centre, The Royal Women's Hospital, Victoria, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Victoria, Australia
| | - Rodney J Hicks
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Victoria, Australia; Melbourne Theranostic Innovation Centre, Victoria, Australia
| | - Kate Tyson
- Julia Argyrou Endometriosis Centre, Epworth HealthCare, Victoria, Australia
| | - Sarah J Holdsworth-Carson
- Julia Argyrou Endometriosis Centre, Epworth HealthCare, Victoria, Australia; Gynaecology Research Centre, The Royal Women's Hospital, Victoria, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Victoria, Australia
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Zhou M, Yin X, Chen B, Hu S, Zhou W. A PET probe targeting polyamine transport system for precise tumor diagnosis and therapy. Asian J Pharm Sci 2024; 19:100924. [PMID: 38903130 PMCID: PMC11186966 DOI: 10.1016/j.ajps.2024.100924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/02/2024] [Accepted: 03/04/2024] [Indexed: 06/22/2024] Open
Abstract
Polyamine metabolism dysregulation is a hallmark of many cancers, offering a promising avenue for early tumor theranostics. This study presents the development of a nuclear probe derived from spermidine (SPM) for dual-purpose tumor PET imaging and internal radiation therapy. The probe, radiolabeled with either [68Ga]Ga for diagnostic applications or [177Lu]Lu for therapeutic use, was synthesized with exceptional purity, stability, and specific activity. Extensive testing involving 12 different tumor cell lines revealed remarkable specificity towards B16 melanoma cells, showcasing outstanding tumor localization and target-to-non-target ratio. Mechanistic investigations employing polyamines, non-labeled precursor, and polyamine transport system (PTS) inhibitor, consistently affirmed the probe's targetability through recognition of the PTS. Notably, while previous reports indicated PTS upregulation in various tumor types for targeted therapy, this study observed no positive signals, highlighting a concentration-dependent discrepancy between targeting for therapy and diagnosis. Furthermore, when labeled with [177Lu], the probe demonstrated its therapeutic potential by effectively controlling tumor growth and extending mouse survival. Investigations into biodistribution, excretion, and biosafety in healthy humans laid a robust foundation for clinical translation. This study introduces a versatile SPM-based nuclear probe with applications in precise tumor theranostics, offering promising prospects for clinical implementation.
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Affiliation(s)
- Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| | - Xiaoqin Yin
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| | - Bei Chen
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders (Xiangya), Changsha 410008, China
| | - Wenhu Zhou
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
- National Clinical Research Center for Geriatric Disorders (Xiangya), Changsha 410008, China
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Ioannidis I, Lefkaritis G, Georgiades SN, Pashalidis I, Kontoghiorghes GJ. Towards Clinical Development of Scandium Radioisotope Complexes for Use in Nuclear Medicine: Encouraging Prospects with the Chelator 1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic Acid (DOTA) and Its Analogues. Int J Mol Sci 2024; 25:5954. [PMID: 38892142 PMCID: PMC11173192 DOI: 10.3390/ijms25115954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/15/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
Scandium (Sc) isotopes have recently attracted significant attention in the search for new radionuclides with potential uses in personalized medicine, especially in the treatment of specific cancer patient categories. In particular, Sc-43 and Sc-44, as positron emitters with a satisfactory half-life (3.9 and 4.0 h, respectively), are ideal for cancer diagnosis via Positron Emission Tomography (PET). On the other hand, Sc-47, as an emitter of beta particles and low gamma radiation, may be used as a therapeutic radionuclide, which also allows Single-Photon Emission Computed Tomography (SPECT) imaging. As these scandium isotopes follow the same biological pathway and chemical reactivity, they appear to fit perfectly into the "theranostic pair" concept. A step-by-step description, initiating from the moment of scandium isotope production and leading up to their preclinical and clinical trial applications, is presented. Recent developments related to the nuclear reactions selected and employed to produce the radionuclides Sc-43, Sc-44, and Sc-47, the chemical processing of these isotopes and the main target recovery methods are also included. Furthermore, the radiolabeling of the leading chelator, 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA), and its structural analogues with scandium is also discussed and the advantages and disadvantages of scandium complexation are evaluated. Finally, a review of the preclinical studies and clinical trials involving scandium, as well as future challenges for its clinical uses and applications, are presented.
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Affiliation(s)
- Ioannis Ioannidis
- Department of Chemistry, University of Cyprus, 2109 Nicosia, Cyprus; (I.I.); (G.L.); (S.N.G.); (I.P.)
| | - George Lefkaritis
- Department of Chemistry, University of Cyprus, 2109 Nicosia, Cyprus; (I.I.); (G.L.); (S.N.G.); (I.P.)
| | - Savvas N. Georgiades
- Department of Chemistry, University of Cyprus, 2109 Nicosia, Cyprus; (I.I.); (G.L.); (S.N.G.); (I.P.)
| | - Ioannis Pashalidis
- Department of Chemistry, University of Cyprus, 2109 Nicosia, Cyprus; (I.I.); (G.L.); (S.N.G.); (I.P.)
| | - George J. Kontoghiorghes
- Postgraduate Research Institute of Science, Technology, Environment and Medicine, 3021 Limassol, Cyprus
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Lee H, Hwang KH. Focal incidental colorectal fluorodeoxyglucose uptake: Should it be spotlighted? World J Clin Cases 2024; 12:2466-2474. [PMID: 38817235 PMCID: PMC11135452 DOI: 10.12998/wjcc.v12.i15.2466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/17/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a cornerstone in cancer evaluation imaging, with a well-established history spanning several years. This imaging modality, encompassing the examination of the body from the base of the skull to the upper thighs, comprehensively covers the chest and abdominopelvic regions in a singular scan, allowing for a holistic assessment of nearly the entire body, including areas of marginal interest. The inherent advantage of this expansive scan range lies in its potential to unveil unexpected incidental abnormal hypermetabolic areas. The identification of incidental focal FDG uptake within colorectal regions during PET/CT scans is not an uncommon occurrence, albeit fraught with challenges associated with non-specific FDG uptake. The presence of benign colorectal lesions or physiological uptake poses a particular obstacle, as these may manifest with FDG uptake levels that mimic malignancy. Consequently, physicians are confronted with a diagnostic dilemma when encountering abnormal FDG uptake in unexpected colorectal areas. Existing studies have presented divergent results concerning these uptakes. Standardized uptake value and its derivatives have served as pivotal metrics in quantifying FDG uptake in PET images. In this article, we aim to succinctly explore the distinctive characteristics of FDG, delve into imaging findings, and elucidate the clinical significance of incidental focal colorectal uptake. This discussion aims to contribute valuable insights into the nuanced interpretation of such findings, fostering a comprehensive understanding.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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11
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Lee H, Hwang KH. Unexpected focal fluorodeoxyglucose uptake in main organs; pass through or pass by? World J Clin Cases 2024; 12:1885-1899. [PMID: 38660550 PMCID: PMC11036514 DOI: 10.12998/wjcc.v12.i11.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Since the inception of fluorine-18 fluorodeoxyglucose (F-18 FDG), positron emission tomography/computed tomography (PET/CT) utilizing F-18 FDG has become widely accepted as a valuable imaging modality in the field of oncology, with global prevalence in clinical practice. Given that a single Torso PET/CT scan encompasses the anatomical region from the skull base to the upper thigh, the detection of incidental abnormal focal hypermetabolism in areas of limited clinical interest is both feasible and not uncommon. Numerous investigations have been undertaken to delineate the distinctive features of these findings, yet the outcomes have proven inconclusive. The incongruent results of these studies present a challenge for physicians, leaving them uncertain about the appropriate course of action. This article provides a succinct overview of the characteristics of fluorodeoxyglucose, followed by a comprehensive discussion of the imaging findings and clinical significance associated with incidental focal abnormal F-18 FDG activity in several representative organs. In conclusion, while the prevalence of unrecognized malignancy varies across organs, malignancies account for a substantial proportion, ranging from approximately one-third to over half, of incidental focal uptake. In light of these rates, physicians are urged to exercise vigilance in not disregarding unexpected uptake, facilitating more assured clinical decisions, and advocating for further active evaluation.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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12
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Ebrahimi S, Lundström E, Batasin SJ, Hedlund E, Stålberg K, Ehman EC, Sheth VR, Iranpour N, Loubrie S, Schlein A, Rakow-Penner R. Application of PET/MRI in Gynecologic Malignancies. Cancers (Basel) 2024; 16:1478. [PMID: 38672560 PMCID: PMC11048306 DOI: 10.3390/cancers16081478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
The diagnosis, treatment, and management of gynecologic malignancies benefit from both positron emission tomography/computed tomography (PET/CT) and MRI. PET/CT provides important information on the local extent of disease as well as diffuse metastatic involvement. MRI offers soft tissue delineation and loco-regional disease involvement. The combination of these two technologies is key in diagnosis, treatment planning, and evaluating treatment response in gynecological malignancies. This review aims to assess the performance of PET/MRI in gynecologic cancer patients and outlines the technical challenges and clinical advantages of PET/MR systems when specifically applied to gynecologic malignancies.
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Affiliation(s)
- Sheida Ebrahimi
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Elin Lundström
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
- Department of Surgical Sciences, Radiology, Uppsala University, 751 85 Uppsala, Sweden
- Center for Medical Imaging, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Summer J. Batasin
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Elisabeth Hedlund
- Department of Surgical Sciences, Radiology, Uppsala University, 751 85 Uppsala, Sweden
| | - Karin Stålberg
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Eric C. Ehman
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vipul R. Sheth
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA; (V.R.S.)
| | - Negaur Iranpour
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA; (V.R.S.)
| | - Stephane Loubrie
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Alexandra Schlein
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
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13
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Sun C, Ma X, Meng F, Chen X, Wang X, Sun W, Xu Y, He H, Zhang H, Ma K. Tumor microenvironment(TME) and single-source dual-energy CT(ssDECT) on assessment of inconformity between RECIST1.1 and pathological remission in neoadjuvant immunotherapy of NSCLC. Neoplasia 2024; 50:100977. [PMID: 38354688 PMCID: PMC10876687 DOI: 10.1016/j.neo.2024.100977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The inconformity (IC) between pathological and imaging remissions after neoadjuvant immunotherapy in patients with NSCLC can affect the evaluation of curative effect of neoadjuvant therapy and the decision regarding the chance of surgery. MATERIALS AND METHODS Patients who achieved disease control(CR/PR/SD) after neoadjuvant chemoimmunotherapy from a clinical trial (NCT04326153) and after neoadjuvant chemotherapy during the same period were enrolled in this study. All patients underwent radical resection and systematic mediastinal lymphadenectomy after neoadjuvant treatments. The pathological remission, immunohistochemistry (CD4, CD8, CD20, CD56, FoxP3, CD68, CD163, CD11b tumor-infiltrating lymphocytes, or macrophages), and single-source dual-energy computed tomography (ssDECT) scans were assessed. The IC between imaging remission by CT and pathological remission was investigated. The underlying cause of IC, the correlation between IC and DFS, and prognostic biomarkers were explored. RESULTS After neoadjuvant immunotherapy, enhanced immune killing and reduced immunosuppressive performance were observed. 70 % of neoadjuvant chemoimmunotherapy patients were in high/medium IC level. Massive necrosis and repair around and inside the cancer nest were the main pathological changes observed 30-45 days post-treatment with PD1/PD-L1 antibody and were the main causes of IC between the pathology and imaging responses after neoadjuvant immunotherapy. High IC and preoperative CD8 expression (H score ≥ 3) indicate a high pathological response rate and prolonged DFS. Iodine material density ssDECT images showed that the iodine content in the lesion causes hyperattenuation in post-neoadjuvant lesion in PCR patient. CONCLUSIONS Compared to chemotherapy and targeted therapy, the efficacy of neoadjuvant immunotherapy was underestimated based on the RECIST criteria due to the unique antitumor therapeutic mechanism. Preoperative CD8+ expression and ssDECT predict this IC and evaluate the residual tumor cells. This is of great significance for screening immune beneficiaries and making more accurate judgments about the timing of surgery.
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Affiliation(s)
- Chao Sun
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Xiaobo Ma
- Pathological Department, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Fanyang Meng
- Radiology Department, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, Jilin 130021, China
| | - Xi Chen
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Xu Wang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Wenyu Sun
- Oncology Department, Jilin Cancer Hospital, Changchun, Jilin 130000, China
| | - Yinghui Xu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Hua He
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Huimao Zhang
- Radiology Department, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, Jilin 130021, China.
| | - Kewei Ma
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, China.
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Reshtebar N, Hosseini SA, Zhuang M, Sheikhzadeh P. Estimation of kinetic parameters in dynamic FDG PET imaging based on shortened protocols: a virtual clinical study. Phys Eng Sci Med 2024; 47:199-213. [PMID: 38078995 DOI: 10.1007/s13246-023-01356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/12/2023] [Indexed: 03/26/2024]
Abstract
This study investigated the estimation of kinetic parameters and production of related parametric Ki images in FDG PET imaging using the proposed shortened protocol (three 3-min/bed routine static images) by means of the simulated annealing (SA) algorithm. Six realistic heterogeneous tumors and various levels of [18F] FDG uptake were simulated by the XCAT phantom. An irreversible two-tissue compartment model (2TCM) using population-based input function was employed. By keeping two routine clinical scans fixed (60-min and 90-min post injection), the effect of the early scan time on optimizing the estimation of the pharmacokinetic parameters was investigated. The SA optimization algorithm was applied to estimate micro- and macro-parameters (K1, k2, k3, Ki). The minimum bias for most parameters was observed at a scan time of 20-min, which was < 10%. A highly significant correlation (> 0.9) as well as limited bias (< 10%) were observed between kinetic parameters generated from two methods [two-tissue compartment full dynamic scan (2TCM-full) and two-tissue compartment by SA algorithm (2TCM-SA)]. The analysis showed a strong correlation (> 0.8) between (2TCM-SA) Ki and SUV images. In addition, the tumor-to-background ratio (TBR) metric in the parametric (2TCM-SA) Ki images was significantly higher than SUV, although the SUV images provide better Contrast-to-noise ratio relative to parametric (2TCM-SA) Ki images. The proposed shortened protocol by the SA algorithm can estimate the kinetic parameters in FDG PET scan with high accuracy and robustness. It was also concluded that the parametric Ki images obtained from the 2TCM-SA as a complementary image of the SUV possess more quantification information than SUV images and can be used by the nuclear medicine specialist. This method has the potential to be an alternative to a full dynamic PET scan.
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Affiliation(s)
- Niloufar Reshtebar
- Department of Energy Engineering, Sharif University of Technology, Tehran, 8639-11365, Iran
| | - Seyed Abolfazl Hosseini
- Department of Energy Engineering, Sharif University of Technology, Tehran, 8639-11365, Iran.
| | - Mingzan Zhuang
- Department of Nuclear Medicine, Meizhou People's Hospital, Meizhou, 514011, China
| | - Peyman Sheikhzadeh
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Nuclear Medicine Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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15
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Aso K, Gohda Y, Hotta M, Minamimoto R, Shimizu Y, Uemura Y, Yano H. Clinical Effectiveness of Preoperative 18F-FDG PET/CT in Predicting Pathological Tumor Grade in Patients with Pseudomyxoma Peritonei Originating from Appendix: A Retrospective Cohort Study. Ann Surg Oncol 2024; 31:1990-1995. [PMID: 38082170 DOI: 10.1245/s10434-023-14755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/25/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is the standard treatment for patients with pseudomyxoma peritonei (PMP). In some malignancies, the standard uptake value of positron emission tomography with 2-deoxy-2-18F-fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) is now accepted as a reliable indicator of neoplastic behavior. This study aimed to evaluate the association between the maximum standardized uptake value (SUVmax) and pathological grade in patients with PMP and to investigate the significance of SUVmax in the preoperative assessment of these patients. PATIENTS AND METHODS In this retrospective single-center study, consecutively enrolled patients diagnosed with PMP of appendiceal origin underwent preoperative 18F-FDG PET/CT. SUVmax was calculated as the highest SUVmax value in the abdomen excluding the primary site. SUVmax was compared with the pathological grade (low or high grade) of PMP tumors according to the World Health Organization classification and further analyzed with respect to the estimated cutoff point, sensitivity, specificity, and receiver operating characteristic. RESULTS In total, 160 patients were included. CRS was successfully performed in 93 patients and palliative debulking surgery in 67 patients. The pathological grade was high in 45 patients and low in 115. High-grade patients had a higher median SUVmax on 18F-FDG PET/CT than did low-grade patients (3.83 versus 2.34, p < 0.001). The highest area under the curve was 0.81, with a sensitivity of 77.8%, specificity of 72.3%, and cutoff point of 2.63. CONCLUSION This study suggests that the SUVmax of preoperative 18F-FDG PET/CT is associated with the pathological grade in patients with PMP.
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Affiliation(s)
- Kenta Aso
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimasa Gohda
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Masatoshi Hotta
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yosuke Shimizu
- Center of Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukari Uemura
- Center of Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideaki Yano
- Consultant Colorectal Surgeon, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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16
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Tarai S, Lundström E, Sjöholm T, Jönsson H, Korenyushkin A, Ahmad N, Pedersen MA, Molin D, Enblad G, Strand R, Ahlström H, Kullberg J. Improved automated tumor segmentation in whole-body 3D scans using multi-directional 2D projection-based priors. Heliyon 2024; 10:e26414. [PMID: 38390107 PMCID: PMC10882139 DOI: 10.1016/j.heliyon.2024.e26414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Early cancer detection, guided by whole-body imaging, is important for the overall survival and well-being of the patients. While various computer-assisted systems have been developed to expedite and enhance cancer diagnostics and longitudinal monitoring, the detection and segmentation of tumors, especially from whole-body scans, remain challenging. To address this, we propose a novel end-to-end automated framework that first generates a tumor probability distribution map (TPDM), incorporating prior information about the tumor characteristics (e.g. size, shape, location). Subsequently, the TPDM is integrated with a state-of-the-art 3D segmentation network along with the original PET/CT or PET/MR images. This aims to produce more meaningful tumor segmentation masks compared to using the baseline 3D segmentation network alone. The proposed method was evaluated on three independent cohorts (autoPET, CAR-T, cHL) of images containing different cancer forms, obtained with different imaging modalities, and acquisition parameters and lesions annotated by different experts. The evaluation demonstrated the superiority of our proposed method over the baseline model by significant margins in terms of Dice coefficient, and lesion-wise sensitivity and precision. Many of the extremely small tumor lesions (i.e. the most difficult to segment) were missed by the baseline model but detected by the proposed model without additional false positives, resulting in clinically more relevant assessments. On average, an improvement of 0.0251 (autoPET), 0.144 (CAR-T), and 0.0528 (cHL) in overall Dice was observed. In conclusion, the proposed TPDM-based approach can be integrated with any state-of-the-art 3D UNET with potentially more accurate and robust segmentation results.
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Affiliation(s)
- Sambit Tarai
- Department of Surgical Sciences, Uppsala University, SE-75185, Uppsala, Sweden
| | - Elin Lundström
- Department of Surgical Sciences, Uppsala University, SE-75185, Uppsala, Sweden
| | - Therese Sjöholm
- Department of Surgical Sciences, Uppsala University, SE-75185, Uppsala, Sweden
| | - Hanna Jönsson
- Department of Surgical Sciences, Uppsala University, SE-75185, Uppsala, Sweden
| | | | - Nouman Ahmad
- Department of Surgical Sciences, Uppsala University, SE-75185, Uppsala, Sweden
| | - Mette A Pedersen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Biomedicine, Aarhus University, 8000 Aarhus C, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Daniel Molin
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-75185 Uppsala, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-75185 Uppsala, Sweden
| | - Robin Strand
- Department of Information Technology, Uppsala University, SE-75237, Uppsala, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Uppsala University, SE-75185, Uppsala, Sweden
- Antaros Medical AB, SE-43153, Mölndal, Sweden
| | - Joel Kullberg
- Department of Surgical Sciences, Uppsala University, SE-75185, Uppsala, Sweden
- Antaros Medical AB, SE-43153, Mölndal, Sweden
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Kumar SA, Mittal BR, Sindhu T, Kumar R. "Bilateral Hot Forearm Sign": Ingeminating the Pattern of Physiological Uptake of 18F-Fludeoxyglucose. Indian J Nucl Med 2024; 39:61-62. [PMID: 38817722 PMCID: PMC11135376 DOI: 10.4103/ijnm.ijnm_145_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 06/01/2024] Open
Abstract
Exertion and exercise increase glucose metabolism within the skeletal muscles causing increased fludeoxyglucose (FDG) uptake on 18F-FDG positron emission tomography/computed tomography (PET/CT). Here, we present findings of 18F-FDG PET/CT in a patient with acute viral hepatitis A-induced liver failure with multiple foci of pyoderma and incessant itching resulting in increased FDG uptake in the muscles of the bilateral forearm, producing the "bilateral hot forearm sign."
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Affiliation(s)
- Srinivas Ananth Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanigassalam Sindhu
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Wada N, Kurokawa Y, Takahashi T, Saito T, Yamamoto K, Yamashita K, Tanaka K, Makino T, Nakajima K, Tatsumi M, Eguchi H, Doki Y. Accurate Preoperative Evaluation of the Location of Esophagogastric Junction Adenocarcinoma Using Positron Emission Tomography-Computed Tomography. Am Surg 2023; 89:6005-6012. [PMID: 37312037 DOI: 10.1177/00031348231183120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The surgical procedure for esophagogastric junction (EGJ) adenocarcinoma usually depends on the location of its epicenter or proximal margin, but accurate evaluation of these positions is often difficult. The usefulness of positron emission tomography-computed tomography (PET-CT) for this purpose is unknown. METHODS Between June 2005 and February 2015, we enrolled 30 patients with cT2-4 EGJ adenocarcinoma (Siewert type I/II) who underwent surgical resection. We ascertained the sensitivity and specificity of preoperative PET-CT for identifying the primary tumor and regional lymph node metastasis, and compared PET-CT and pathological findings in terms of the distance from the EGJ to the tumor epicenter or proximal tumor margin. RESULTS PET-CT detected the primary tumor with a sensitivity of 97% (29/30), and detected lymph node metastasis with a sensitivity and specificity of 22% (4/18) and 100% (8/8), respectively. No significant association was observed between the maximal standardized uptake value and histological type, tumor size, or pT status. Regarding the accuracy of evaluating tumor location, the median differences between PET-CT and pathological measurements were .6 cm for the tumor epicenter and .5 cm for the proximal margin from the EGJ. PET-CT and pathological findings showed agreement regarding Siewert classification type (I or II) and lengths of esophageal involvement exceeding 4 cm or 2 cm in 77% (10/13), 85% (11/13), and 85% (11/13) of cases, respectively. DISCUSSION PET-CT had high sensitivity for primary EGJ adenocarcinoma. It may effectively locate the tumor epicenter and proximal margin and thus help clinicians determine the optimal surgical procedure.
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Affiliation(s)
- Noriko Wada
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Surgery, Ikeda City Hospital, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsuaki Tatsumi
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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19
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Gil J, Choi H, Paeng JC, Cheon GJ, Kang KW. Deep Learning-Based Feature Extraction from Whole-Body PET/CT Employing Maximum Intensity Projection Images: Preliminary Results of Lung Cancer Data. Nucl Med Mol Imaging 2023; 57:216-222. [PMID: 37720886 PMCID: PMC10504178 DOI: 10.1007/s13139-023-00802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 03/20/2023] [Accepted: 04/03/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose Deep learning (DL) has been widely used in various medical imaging analyses. Because of the difficulty in processing volume data, it is difficult to train a DL model as an end-to-end approach using PET volume as an input for various purposes including diagnostic classification. We suggest an approach employing two maximum intensity projection (MIP) images generated by whole-body FDG PET volume to employ pre-trained models based on 2-D images. Methods As a retrospective, proof-of-concept study, 562 [18F]FDG PET/CT images and clinicopathological factors of lung cancer patients were collected. MIP images of anterior and lateral views were used as inputs, and image features were extracted by a pre-trained convolutional neural network (CNN) model, ResNet-50. The relationship between the images was depicted on a parametric 2-D axes map using t-distributed stochastic neighborhood embedding (t-SNE), with clinicopathological factors. Results A DL-based feature map extracted by two MIP images was embedded by t-SNE. According to the visualization of the t-SNE map, PET images were clustered by clinicopathological features. The representative difference between the clusters of PET patterns according to the posture of a patient was visually identified. This map showed a pattern of clustering according to various clinicopathological factors including sex as well as tumor staging. Conclusion A 2-D image-based pre-trained model could extract image patterns of whole-body FDG PET volume by using anterior and lateral views of MIP images bypassing the direct use of 3-D PET volume that requires large datasets and resources. We suggest that this approach could be implemented as a backbone model for various applications for whole-body PET image analyses.
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Affiliation(s)
- Joonhyung Gil
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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Kato T, Ichikawa H, Shibutani T, Kita A, Watanabe M, Tada H, Sugiura A. A novel objective method for discriminating pathological and physiological colorectal uptake in the lower abdominal region using whole-body dynamic 18F-FDG-PET. Ann Nucl Med 2023; 37:561-571. [PMID: 37523072 DOI: 10.1007/s12149-023-01857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To investigate whether the center-of-mass shift distance (CMSD) analysis on whole-body dynamic positron emission tomography (WBD-PET) with continuous bed motion is an objective index for discriminating pathological and physiological uptake in the lower abdominal colon. METHODS We retrospectively analyzed the CMSD in 39 patients who underwent delayed imaging to detect incidental focal uptake that was difficult to determine as pathological and physiological on a conventional early-PET (early) image reconstructed by 5-phase WBD-PET images. The CMSD between each phase of WBD-PET images and between conventional early and delayed (two-phase) PET images were classified into pathological and physiological uptake groups based on endoscopic histology or other imaging diagnostics. The diagnostic performance of CMSD analysis on WBD-PET images was evaluated by receiver operator characteristic (ROC) analysis and compared to that of two-phase PET images. RESULTS A total of 66 incidental focal uptake detected early image were classified into 19 and 47 pathological and physiological uptake groups, respectively. The CMSD on WBD-PET and two-phase PET images in the pathological uptake group was significantly lower than that in the physiological uptake group (p < 0.01), respectively. The sensitivity, specificity, and accuracy in CMSD analysis on WBD-PET images at the optimal cutoff of 5.2 mm estimated by the Youden index were 94.7%, 89.4%, and 89.4%, respectively, which were not significantly different (p = 0.74) from those of two-phase PET images. CONCLUSIONS The CMSD analysis on WBD-PET was useful in discriminating pathological and physiological colorectal uptake in the lower abdominal region, and its diagnostic performance was comparable to that of two-phase PET images. We suggested that CMSD analysis on WBD-PET images would be a novel objective method to omit unnecessary additional delayed imaging.
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Affiliation(s)
- Toyohiro Kato
- Department of Radiology, Toyohashi Municipal Hospital, 50 Hakken-nishi, Aotake, Toyohashi, Aichi, 441-8570, Japan.
| | - Hajime Ichikawa
- Department of Radiology, Toyohashi Municipal Hospital, 50 Hakken-nishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Akinobu Kita
- Radiological Center, University of Fukui Hospital, 23-3, Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Masanori Watanabe
- Department of Radiology, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroomi Tada
- Department of Diagnostic Radiology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto, Shizuoka, 411-8777, Japan
| | - Akie Sugiura
- Department of Radiological Technology, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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21
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Vatsa R, Kaur D, Shekhar SS, Chhabra A, Chakraborty S, Dash A, Shukla J, Mittal BR. Comparison of 99m Tc-methylenediphosphonate and 68 Ga-BPAMD PET/computed tomography imaging in bone metastasis. Nucl Med Commun 2023; 44:463-470. [PMID: 36897059 DOI: 10.1097/mnm.0000000000001685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Bone is considered as the third most common site of metastases, besides lung and liver. Early detection of skeletal metastases aids in better management of skeletal-related events. In the present study cold kit-based 2,2 ' ,2 '' -(10-(2-((diphosphonomethyl)amino)-2-oxoethyl)-1,4,7,10-tetraazacyclododecane-1,4,7-triyl) triacetic acid (BPAMD) was labeled with 68 Ga. The radiolabeling parameters and clinical evaluation in patients with suspected bone metastases were compared with routinely used 99m Tc-methylenediphosphonate ( 99m Tc-MDP). METHODOLOGY The kit components of MDP were incubated with at room temperature for 10 min, followed by radiochemical purity testing using thin-layer chromatography. For radiolabeling of BPAMD, the cold kit components reconstituted in 400 μL of HPLC grade water were transferred and incubated with 68 GaCl 3 in the reactor vessel of the fluidic module at 95°C for 20 min. Radiochemical yield and purity were determined with instant thin-layer chromatography using 0.5 M sodium citrate as mobile phase. For clinical evaluation, patients ( n = 10) with suspected bone metastases were enrolled. 99m Tc-MDP and 68 Ga-BPAMD scans were performed on two different days in random order. Imaging outcomes were noted and compared. RESULTS Radiolabeling of both tracers is facile using cold kit, although BPAMD requires heating. The radiochemical purity was observed to be greater than 99% for all preparations. Both MDP and BPAMD detected skeletal lesions; however, additional lesions were detected in total of seven patients which were not visualized clearly on 99m Tc-MDP scan. CONCLUSION BPAMD can be easily tagged with 68 Ga using cold kits. The radiotracer is suitable and efficient for detection of bone metastases using PET/computed tomography.
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Affiliation(s)
- Rakhee Vatsa
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Damanpreet Kaur
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Shashank Singh Shekhar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Anupriya Chhabra
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | | | - Ashutosh Dash
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Jaya Shukla
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
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22
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Einerhand SMH, Zuur LG, Wondergem MJ, Boellaard TN, Barwari K, van Leeuwen PJ, van Rhijn BWG, Mertens LS. The Implementation of FDG PET/CT for Staging Bladder Cancer: Changes in the Detection and Characteristics of Occult Nodal Metastases at Upfront Radical Cystectomy? J Clin Med 2023; 12:jcm12103367. [PMID: 37240473 DOI: 10.3390/jcm12103367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Occult lymph node (LN)-metastases are frequently found after upfront radical cystectomy (uRC) for bladder cancer (BC). We evaluated whether the implementation of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET/CT) influenced nodal staging at uRC. All consecutive BC patients who underwent uRC with bilateral pelvic lymph node dissection (PLND) were identified and divided into two cohorts: cohort A consisted of patients staged with FDG PET/CT and contrast-enhanced CT (CE-CT) (2016-2021); cohort B consisted of patients staged with CE-CT only (2006-2011). The diagnostic performance of FDG PET/CT was assessed and compared with that of CE-CT. Thereafter, we calculated the occult LN metastases proportions for both cohorts. In total, 523 patients were identified (cohort A n = 237, and cohort B n = 286). Sensitivity, specificity, PPV and NPV of FDG PET/CT for detecting LN metastases were 23%, 92%, 42%, and 83%, respectively, versus 15%, 93%, 33%, 81%, respectively, for CE-CT. Occult LN metastases were found in 17% of cohort A (95% confidence interval (CI) 12.2-22.8) and 22% of cohort B (95% CI 16.9-27.1). The median size of LN metastases was 4 mm in cohort A versus 13 mm in cohort B. After introduction of FDG PET/CT, fewer and smaller occult LN metastases were present after uRC. Nevertheless, up to one-fifth of occult (micro-)metastases were still missed.
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Affiliation(s)
- Sarah M H Einerhand
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Lotte G Zuur
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Maurits J Wondergem
- Department of Nuclear Medicine, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Kurdo Barwari
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Urology, Caritas St Josef Medical Centre, University of Regensburg, 93053 Regensburg, Germany
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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23
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Shankar LK, Schöder H, Sharon E, Wolchok J, Knopp MV, Wahl RL, Ellingson BM, Hall NC, Yaffe MJ, Towbin AJ, Farwell MD, Pryma D, Poussaint TY, Wright CL, Schwartz L, Harisinghani M, Mahmood U, Wu AM, Leung D, de Vries EGE, Tang Y, Beach G, Reeves SA. Harnessing imaging tools to guide immunotherapy trials: summary from the National Cancer Institute Cancer Imaging Steering Committee workshop. Lancet Oncol 2023; 24:e133-e143. [PMID: 36858729 PMCID: PMC10119769 DOI: 10.1016/s1470-2045(22)00742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 03/02/2023]
Abstract
As the immuno-oncology field continues the rapid growth witnessed over the past decade, optimising patient outcomes requires an evolution in the current response-assessment guidelines for phase 2 and 3 immunotherapy clinical trials and clinical care. Additionally, investigational tools-including image analysis of standard-of-care scans (such as CT, magnetic resonance, and PET) with analytics, such as radiomics, functional magnetic resonance agents, and novel molecular-imaging PET agents-offer promising advancements for assessment of immunotherapy. To document current challenges and opportunities and identify next steps in immunotherapy diagnostic imaging, the National Cancer Institute Clinical Imaging Steering Committee convened a meeting with diverse representation among imaging experts and oncologists to generate a comprehensive review of the state of the field.
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Affiliation(s)
- Lalitha K Shankar
- Clinical Trials Branch, National Cancer Institute, Rockville, MD, USA.
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elad Sharon
- Investigational Drug Branch, National Cancer Institute, Rockville, MD, USA
| | - Jedd Wolchok
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Michael V Knopp
- Department of Radiology, Ohio State University, Columbus, OH, USA
| | - Richard L Wahl
- Department of Radiology, Washington University, St Louis, MO, USA
| | - Benjamin M Ellingson
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Nathan C Hall
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin J Yaffe
- Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Alexander J Towbin
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Michael D Farwell
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Pryma
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Anna M Wu
- Department of Immunology & Theranostics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Steven A Reeves
- Coordinating Center for Clinical Trials, National Cancer Institute, Rockville, MD, USA
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24
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Li C, Luan X, Bi X, Chen S, Pan Y, Zhang J, Han Y, Xu X, Wang G, Xu B. Multiparameter diagnostic model based on 18F-FDG PET metabolic parameters and clinical variables can differentiate nonmetastatic gallbladder cancer and cholecystitis. BMC Cancer 2023; 23:119. [PMID: 36747196 PMCID: PMC9901059 DOI: 10.1186/s12885-023-10599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic value of a multiparameter model based on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) metabolic parameters and clinical variables in differentiating nonmetastatic gallbladder cancer (GBC) from cholecystitis. PATIENTS AND METHODS In total, 122 patients (88 GBC nonmetastatic patients and 34 cholecystitis patients) with gallbladder space-occupying lesions who underwent 18F-FDG PET/CT were included. All patients received surgery and pathology, and baseline characteristics and clinical data were also collected. The metabolic parameters of 18F-FDG PET, including SUVmax (maximum standard uptake value), SUVmean (mean standard uptake value), SUVpeak (peak standard uptake value), MTV (metabolic tumour volume), TLG (total lesion glycolysis) and SUVR (tumour-to-normal liver standard uptake value ratio), were evaluated. The differential diagnostic efficacy of each independent parameter and multiparameter combination model was evaluated using the receiver operating characteristic (ROC) curve. The improvement in diagnostic efficacy using a combination of the above multiple parameters was evaluated by integrated discriminatory improvement (IDI), net reclassification improvement (NRI) and bootstrap test. Decision curve analysis (DCA) was used to evaluate clinical efficacy. RESULTS The ROC curve showed that SUVR had the highest diagnostic ability among the 18F-FDG PET metabolic parameters (area under the curve [AUC] = 0.698; sensitivity = 0.341; specificity = 0.971; positive predictive value [PPV] = 0.968; negative predictive value [NPV] = 0.363). The combined diagnostic model of cholecystolithiasis, fever, CEA > 5 ng/ml and SUVR showed an AUC of 0.899 (sensitivity = 0.909, specificity = 0.735, PPV = 0.899, NPV = 0.758). The diagnostic efficiency of the model was improved significantly compared with SUVR. The clinical efficacy of the model was confirmed by DCA. CONCLUSIONS The multiparameter diagnostic model composed of 18F-FDG PET metabolic parameters (SUVR) and clinical variables, including patient signs (fever), medical history (cholecystolithiasis) and laboratory examination (CEA > 5 ng/ml), has good diagnostic efficacy in the differential diagnosis of nonmetastatic GBC and cholecystitis.
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Affiliation(s)
- Can Li
- grid.414252.40000 0004 1761 8894Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Xiaohui Luan
- grid.414252.40000 0004 1761 8894Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Graduate School, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Xiao Bi
- grid.414252.40000 0004 1761 8894Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Shengxin Chen
- grid.414252.40000 0004 1761 8894Graduate School, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Yue Pan
- grid.414252.40000 0004 1761 8894Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Graduate School, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Jingfeng Zhang
- grid.414252.40000 0004 1761 8894Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Graduate School, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Yun Han
- grid.414252.40000 0004 1761 8894Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Graduate School, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Xiaodan Xu
- grid.414252.40000 0004 1761 8894Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Guanyun Wang
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China. .,Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
| | - Baixuan Xu
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Ono R, Iwahana T, Daimon M, Kato H, Aoki K, Abe K, Kobayashi Y. Inflammation after catheterisation mimicking tumour with squamous cell lung carcinoma in positron emission tomography. BMJ Case Rep 2023; 16:e254072. [PMID: 36731950 PMCID: PMC9896172 DOI: 10.1136/bcr-2022-254072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Michiko Daimon
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Hirotoshi Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Kaoruko Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Kaori Abe
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
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26
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Lee H, Hwang KH. Significance of incidental focal fluorine-18 fluorodeoxyglucose uptake in colon/rectum, thyroid, and prostate: With a brief literature review. World J Clin Cases 2022; 10:12532-12542. [PMID: 36579086 PMCID: PMC9791515 DOI: 10.12998/wjcc.v10.i34.12532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/10/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT), a functional imaging method, is usually performed on the entire torso, and regions of unexpected suspicious focal hypermetabolism are not infrequently observed. Among the regions, colon, thyroid, and prostate were found to be the common organs in a recent umbrella review. Some studies reported that a high rate of malignancy was shown in incidentally identified focal hypermetabolic regions and suggested that further examinations should not be ignored.
AIM To investigate the malignancy rate of incidental focal FDG uptake, useful PET parameters and their cutoffs in discrimination between malignant and benign lesions.
METHODS Retrospectively, the final reports of 16510 F-18 FDG PET/CT scans performed at our hospital between January 2016 and March 2022 were reviewed to identify incidentally observed FDG uptake in the colon/rectum, thyroid, and prostate. The scans of patients with current or prior malignancies at each corresponding location, without the final reports of histopathology or colonoscopy (for colon and rectum) for the corresponding hypermetabolic regions, or with diffuse (not focal) hypermetabolism were excluded. Finally, 88 regions of focal colorectal hypermetabolism in 85 patients (48 men and 37 women with mean age 67.0 ± 13.4 years and 63.4 ± 15.8 years, respectively), 48 focal thyroid uptakes in 48 patients (12 men and 36 women with mean age 62.2 ± 13.1 years and 60.8 ± 12.4 years, respectively), and 39 focal prostate uptakes in 39 patients (mean age 71.8 ± 7.5 years) were eligible for this study. For those unexpected focal hypermetabolic regions, rates of malignancy were calculated, PET parameters, such as standardized uptake value (SUV), capable of distinguishing between malignant and benign lesions were investigated, and the cutoffs of those PET parameters were determined by plotting receiver operating characteristic curves.
RESULTS In the colon and rectum, 29.5% (26/88) were malignant and 33.0% (29/88) were premalignant lesions. Both SUVmax and SUVpeak differentiated malignant/premalignant from benign lesions, however, no parameters could distinguish malignant from premalignant lesions. Higher area under the curve was shown with SUVmax (0.752, 95%CI: 0.649-0.856, P < 0.001) and the cutoff was 7.6. In the thyroid, 60.4% (29/48) were malignant. The majority were well-differentiated thyroid cancers (89.7%, 26/29). The results of BRAF mutation tests were available for 20 of the 26 well-differentiated thyroid cancers and all 20 had the mutation. Solely SUVmax differentiated malignant from benign lesions and the cutoff was 6.9. In the prostate, 56.4% (22/39) were malignant. Only SUVmax differentiated malignant from benign lesions and the cutoff was 3.8. Overall, among the 175 focal hypermetabolic regions, 60.6% (106/175) were proven to be malignant and premalignant (in colon and rectum) lesions.
CONCLUSION Approximately 60% of the incidentally observed focal F-18 FDG uptake in the colon/rectum, thyroid, and prostate were found to be malignant. Of the several PET parameters, SUVmax was superior to others in distinguishing between malignant/premalignant and benign lesions. Based on these findings, incidental focal hypermetabolism should not be ignored and lead physicians to conduct further investigations with greater confidence.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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Lin M, Coll RP, Cohen AS, Georgiou DK, Manning HC. PET Oncological Radiopharmaceuticals: Current Status and Perspectives. Molecules 2022; 27:6790. [PMID: 36296381 PMCID: PMC9609795 DOI: 10.3390/molecules27206790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 02/01/2024] Open
Abstract
Molecular imaging is the visual representation of biological processes that take place at the cellular or molecular level in living organisms. To date, molecular imaging plays an important role in the transition from conventional medical practice to precision medicine. Among all imaging modalities, positron emission tomography (PET) has great advantages in sensitivity and the ability to obtain absolute imaging quantification after corrections for photon attenuation and scattering. Due to the ability to label a host of unique molecules of biological interest, including endogenous, naturally occurring substrates and drug-like compounds, the role of PET has been well established in the field of molecular imaging. In this article, we provide an overview of the recent advances in the development of PET radiopharmaceuticals and their clinical applications in oncology.
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Affiliation(s)
- Mai Lin
- Cyclotron Radiochemistry Facility, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Ryan P. Coll
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Allison S. Cohen
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dimitra K. Georgiou
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Henry Charles Manning
- Cyclotron Radiochemistry Facility, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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28
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Diagnostic Accuracy of 18F-FDG-PET/CT and 18F-FDG-PET/MRI in Detecting Locoregional Recurrence of HNSCC 12 Weeks after the End of Chemoradiotherapy: Single-Center Experience with PET/MRI. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8676787. [PMID: 36082064 PMCID: PMC9433207 DOI: 10.1155/2022/8676787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
Purpose In head and neck squamous cell carcinoma (HNSCC), the early diagnosis and efficient detection of recurrences and/or residual tumor after treatment play a very important role in patient's prognosis. Positron emission tomography (PET) using 2-deoxy-2-18F-fluoro-D-glucose (18F-FDG) has become an established method for the diagnosis of suspected recurrence in head and neck carcinomas. In particular, integrated PET/MRI imaging that provides optimal soft tissue contrast and less dental implant artifacts compared to PET/CT is an intriguing technique for the follow-up imaging of HNSCC patients. The aim of this study was to evaluate the benefit of PET/MRI compared to PET/CT in post-treatment follow-up imaging of HNSCC patients. Methods This retrospective observational cohort study consists of 104 patients from our center with histologically confirmed HNSCC. All patients received chemoradiotherapy (CRT) and underwent 18F-FDG-PET/CT (n = 52) or 18F-FDG-PET/MRI (n = 52) scan 12 weeks after the end of treatment. Image analysis was performed by two independent readers according to a five-point Likert scale analysis. Results PET/MRI was more sensitive (1.00 vs. 0.77) than PET/CT in the detection of locoregional recurrence. PET/MRI also had better negative (1.00 vs. 0.87) predictive values. AUCs for PET/MRI and PET/CT on patient-based analysis were 0.997 (95% CI 0.989–1.000) and 0.890 (95% CI 0.806–0.974), respectively. The comparison of sensitivity, AUCs, and negative predictive values revealed a statistically significant difference, p < 0.05. In PET/CT, false-negative and positive findings were observed in the more advanced disease stages, where PET/MRI performed better. Also, false-negative findings were located in the oropharyngeal, laryngeal, and nasopharyngeal regions, where PET/MRI made no false-negative interpretations. Conclusion Based on these results, PET/MRI might be considered the modality of choice in detecting locoregional recurrence in HNSCC patients, especially in the more advanced stages in the oral cavity, larynx, or nasopharynx.
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Zhi X, Sun X, Chen J, Wang L, Ye L, Li Y, Xie W, Sun J. Combination of 18F-FDG PET/CT and convex probe endobronchial ultrasound elastography for intrathoracic malignant and benign lymph nodes prediction. Front Oncol 2022; 12:908265. [PMID: 35992813 PMCID: PMC9389119 DOI: 10.3389/fonc.2022.908265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPositron emission tomography–computed tomography (PET/CT) and convex probe endobronchial ultrasound (CP-EBUS) elastography are important diagnostic methods in predicting intrathoracic lymph nodes (LNs) metastasis, but a joint analysis of the two examinations is still lacking. This study aimed to compare the diagnostic efficiency of the two methods and explore whether the combination can improve the diagnostic efficiency in differentiating intrathoracic benign LNs from malignant LNs.Materials and MethodsLNs examined by EBUS-guided transbronchial needle aspiration (EBUS-TBNA) and PET/CT from March 2018 to June 2019 in Shanghai Chest Hospital were retrospectively analyzed as the model group. Four PET/CT parameters, namely, maximal standardized uptake value mean standardized uptake value (SUVmean), SUVmean, metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG); four quantitative elastography indicators (stiff area ratio, mean hue value, RGB, and mean gray value); and the elastography grading score of targeted LNs were analyzed. A prediction model was constructed subsequently and the dataset from July to November 2019 was used to validate the diagnostic capability of the model.ResultsA total of 154 LNs from 135 patients and 53 LNs from 47 patients were enrolled in the model and validation groups, respectively. Mean hue value and grading score were independent malignancy predictors of elastography, as well as SUVmax and TLG of PET/CT. In model and validation groups, the combination of PET/CT and elastography demonstrated sensitivity, specificity, positive and negative predictive values, and accuracy for malignant LNs diagnosis of 85.87%, 88.71%, 91.86%, 80.88%, and 87.01%, and 94.44%, 76.47%, 89.47%, 86.67%, and 88.68%, respectively. Moreover, elastography had better diagnostic accuracies than PET/CT in both model and validation groups (85.71% vs. 79.22%, 86.79% vs. 75.47%).ConclusionEBUS elastography demonstrated better efficiency than PET/CT and the combination of the two methods had the best diagnostic efficacy in differentiating intrathoracic benign from malignant LNs, which may be helpful for clinical application.
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Affiliation(s)
- Xinxin Zhi
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xiaoyan Sun
- Department of Nuclear Medicine, The Fifth People’s Hospital of Shanghai Fu Dan University, Shanghai, China
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Lei Wang
- Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Ye
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Ying Li
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Jiayuan Sun, ; Wenhui Xie,
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
- *Correspondence: Jiayuan Sun, ; Wenhui Xie,
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Ahmadpour S, Habibi MA, Hosseinimehr SJ. Various Aspects of Fasting on the Biodistribution of Radiopharmaceuticals. Curr Drug Metab 2022; 23:827-841. [PMID: 36121082 DOI: 10.2174/1389200223666220919121354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/08/2022] [Accepted: 07/30/2022] [Indexed: 01/11/2023]
Abstract
It is demonstrated that fasting can alter the biodistribution of radiopharmaceuticals in nuclear medicine. Various studies have highlighted that fasting is interpreted to be easy for physicians during PET study, fasting is one of the most important factors determining the usefulness of this protocol. It is well documented that fasting can suppress normal 18F-FDG PET uptake during nuclear cardiology. However, there is no consensus about the usefulness of fasting on radiopharmaceuticals, especially on 18F-FDG in PET imaging, but special attention should be paid to the setting of the fasting duration. Nevertheless, it does seem we still need extensive clinical studies in the future. The present study aims to review the various aspects of fasting, especially metabolic alteration on radiopharmaceutical biodistribution. In this study, we focused more on the effect of fasting on 18F-FDG biodistribution, which alters its imaging contrast in cardiology and cancer imaging. Therefore, shifting substrate metabolism from glucose to free fatty acids during fasting can be an alternative approach to suppress physiological myocardial uptake.
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Affiliation(s)
- Sajjad Ahmadpour
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Mohammad Amin Habibi
- Iranian Tissue Bank and Research Center, Gene, Cell and Tissue Institute, Tehran University of Medical Sciences, Tehran, Iran.,Clinical Research of Development Center, Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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Huang Y, Zhang L, Wang M, Li C, Zheng W, Chen H, Liang Y, Wu Z. Optimization of Precursor Synthesis Conditions of (2S,4S)4–[18F]FPArg and Its Application in Glioma Imaging. Pharmaceuticals (Basel) 2022; 15:ph15080946. [PMID: 36015094 PMCID: PMC9416586 DOI: 10.3390/ph15080946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 01/27/2023] Open
Abstract
Although the tracer (2S,4S)4–[18F]FPArg is expected to provide a powerful imaging method for the diagnosis and treatment of clinical tumors, it has not been realized due to the low yield of chemical synthesis and radiolabeling. A simple synthetic method for the radiolabeled precursor of (2S,4S)4–[18F]FPArg in stable yield was obtained by adjusting the sequence of the synthetic steps. Furthermore, the biodistribution experiments confirmed that (2S,4S)4–[18F]FPArg could be cleared out quickly in wild type mouse. Cell uptake experiments and U87MG tumor mouse microPET–CT imaging experiments showed that the tumor had high uptake of (2S,4S)4–[18F]FPArg and the clearance was slow, but (2S,4S)4–[18F]FPArg was rapidly cleared in normal brain tissue. MicroPET–CT imaging of nude mice bearing orthotopic HS683–Luc showed that (2S,4S)4–[18F]FPArg can penetrate blood–brain barrier and image gliomas with a high contrast. Therefore, (2S,4S)4–[18F]FPArg is expected to be further applied in the diagnosis and efficacy evaluation of clinical glioma.
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Affiliation(s)
- Yong Huang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China; (Y.H.); (C.L.)
| | - Lu Zhang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100069, China; (L.Z.); (W.Z.); (H.C.)
| | - Meng Wang
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;
| | - Chengze Li
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China; (Y.H.); (C.L.)
| | - Wei Zheng
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100069, China; (L.Z.); (W.Z.); (H.C.)
| | - Hualong Chen
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100069, China; (L.Z.); (W.Z.); (H.C.)
| | - Ying Liang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China; (Y.H.); (C.L.)
- Correspondence: (Y.L.); (Z.W.)
| | - Zehui Wu
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100069, China; (L.Z.); (W.Z.); (H.C.)
- Correspondence: (Y.L.); (Z.W.)
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Spelta LEW, Real CC, Buchpiguel CA, de Paula Faria D, Marcourakis T. [ 18 F]FDG brain uptake of C57Bl/6 male mice is affected by locomotor activity after cocaine use: A small animal positron emission tomography study. J Neurosci Res 2022; 100:1876-1889. [PMID: 35779255 DOI: 10.1002/jnr.25102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/12/2022]
Abstract
We verified if cocaine-induced peripheral activation might disrupt [18 F]FDG brain uptake after a cocaine challenge and suggested an optimal protocol to measure cocaine-induced brain metabolic alterations in mice. C57Bl/6 male mice were injected with [18 F]FDG and randomly separated into three groups. Groups 1 and 2 were kept conscious after [18 F]FDG administration and after 5 min received saline or cocaine (20 mg/kg). The animals in group 1 (n = 5) were then evaluated in the open field for 30 min and those from group 2 (n = 6) were kept alone in a home cage for the same period. Forty-five minutes after [18 F]FDG administration, images were acquired for 30 min. Group 3 (n = 6) was kept anesthetized and image acquisition started immediately after tracer injection, for 75 min. Saline (Day 1) or cocaine (Day 2) was injected 5 min after starting acquisition. Another set of animals (n = 5) were treated with cocaine every other day for 10 days or saline (n = 6) and were scanned with the dynamic protocol to verify its efficacy. [18 F]FDG uptake increased after cocaine administration when compared to baseline only in animals kept under anesthesia. No brain effect of cocaine was observed in animals submitted to the open field or kept in the home cage. The use of anesthesia is essential to visualize cocaine-induced changes in brain metabolism by [18 F]FDG PET, providing an interesting preclinical approach to investigate naïve subjects and enabling a bidirectional translational science approach for better understanding of cocaine use disorder.
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Affiliation(s)
- Lidia Emmanuela Wiazowski Spelta
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Caroline Cristiano Real
- Laboratory of Nuclear Medicine, Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carlos Alberto Buchpiguel
- Laboratory of Nuclear Medicine, Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniele de Paula Faria
- Laboratory of Nuclear Medicine, Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Tania Marcourakis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
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Abstract
The authors define molecular imaging, according to the Society of Nuclear Medicine and Molecular Imaging, as the visualization, characterization, and measurement of biological processes at the molecular and cellular levels in humans and other living systems. Although practiced for many years clinically in nuclear medicine, expansion to other imaging modalities began roughly 25 years ago and has accelerated since. That acceleration derives from the continual appearance of new and highly relevant animal models of human disease, increasingly sensitive imaging devices, high-throughput methods to discover and optimize affinity agents to key cellular targets, new ways to manipulate genetic material, and expanded use of cloud computing. Greater interest by scientists in allied fields, such as chemistry, biomedical engineering, and immunology, as well as increased attention by the pharmaceutical industry, have likewise contributed to the boom in activity in recent years. Whereas researchers and clinicians have applied molecular imaging to a variety of physiologic processes and disease states, here, the authors focus on oncology, arguably where it has made its greatest impact. The main purpose of imaging in oncology is early detection to enable interception if not prevention of full-blown disease, such as the appearance of metastases. Because biochemical changes occur before changes in anatomy, molecular imaging-particularly when combined with liquid biopsy for screening purposes-promises especially early localization of disease for optimum management. Here, the authors introduce the ways and indications in which molecular imaging can be undertaken, the tools used and under development, and near-term challenges and opportunities in oncology.
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Affiliation(s)
- Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin G. Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Wang H, Miao Y, Yu W, Zhu G, Wu T, Zhao X, Yuan G, Li B, Xu H. Improved Clinical Workflow for Whole-Body Patlak Parametric Imaging Using Two Short Dynamic Acquisitions. Front Oncol 2022; 12:822708. [PMID: 35574350 PMCID: PMC9097952 DOI: 10.3389/fonc.2022.822708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We sought to explore the feasibility of shorter acquisition times using two short dynamic scans for a multiparametric PET study and the influence of quantitative performance in shortened dynamic PET. Methods Twenty-one patients underwent whole-body dynamic 18F-FDG PET/CT examinations on a PET/CT (Siemens Biograph Vision) with a total scan time of 75 min using continuous bed motion for Patlak multiparametric imaging. Two sets of Patlak multiparametric images were produced: the standard MRFDG and DVFDG images (MRFDG-std and DVFDG-std) and two short dynamic MRFDG and DVFDG images (MRFDG-tsd and DVFDG-tsd), which were generated by a 0–75 min post injection (p.i.) dynamic PET series and a 0–6 min + 60–75 min p.i. dynamic PET series, respectively. The maximum, mean, and peak values of the standard and two short dynamic multiparametric acquisitions were obtained and compared using Passing–Bablok regression and Bland–Altman analysis. Results High correlations were obtained between MRFDG-tsd and MRFDG-std, and between DVFDG-tsd and DVFDG-std for both normal organs and all lesions (0.962 ≦ Spearman’s rho ≦ 0.982, p < 0.0001). The maximum, mean, and peak values of the standard and two short dynamic multiparametric acquisitions were also in agreement. For normal organs, the Bland–Altman plot showed that the mean bias of MRFDG-max, MRFDG-mean, and MRFDG-peak was -0.002 (95% CI: -0.032–0.027), -0.002 (95% CI: -0.026–0.023), and -0.002 (95% CI: -0.026–0.022), respectively. The mean bias of DVFDG-max, DVFDG-mean, and DVFDG-peak was -3.3 (95% CI: -24.8–18.2), -1.4 (95% CI: -12.1–9.2), and -2.3 (95% CI: -15–10.4), respectively. For lesions, the Bland–Altman plot showed that the mean bias of MRFDG-max, MRFDG-mean, and MRFDG-peak was -0.009 (95% CI: -0.056–0.038), -0.004 (95% CI: -0.039–0.031), and -0.004 (95% CI: -0.036–0.028), respectively. The mean bias of DVFDG-max, DVFDG-mean, and DVFDG-peak was -8.4 (95% CI: -42.6–25.9), -4.8 (95% CI: -20.2–10.6), and -4.0 (95% CI: -23.7–15.6), respectively. Conclusions This study demonstrates the feasibility of using two short dynamic scans that include the first 0–6 min and 60–75 min scans p.i. for Patlak multiparametric images, which can increase patient throughout for parametric analysis.
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Affiliation(s)
- Hui Wang
- Department of Nuclear Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ying Miao
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Yu
- Department of Nuclear Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Gan Zhu
- Department of Nuclear Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tao Wu
- Department of Nuclear Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuefeng Zhao
- Department of Nuclear Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guangjie Yuan
- Department of Nuclear Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiqin Xu
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Clinical Imaging and Dosimetry of a Pan-Cancer Targeting Alkylphosphocholine Analog, [124I]I-NM404. RADIATION 2022. [DOI: 10.3390/radiation2020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to assess organ dosimetry and clinical use of [124I]I-NM404, a radiotheranostic alkylphosphocholine (APC) analog, for accurate detection and characterization of a wide variety of solid primary and metastatic malignancies anywhere in the body. Methods: Patterns of [124I]I-NM404 uptake were quantitatively analyzed and qualitatively compared with [18F]FDG PET/CT in 14 patients (median age, 61.5 years; 7 males, 7 females) with refractory metastatic cancer who were enrolled in one of two Phase I imaging studies. Primary cancer types included bronchogenic (n = 7), colorectal (n = 1), prostate (n = 1), triple-negative breast (n = 1), head and neck (n = 2), pancreatic (n = 1) carcinoma, and melanoma (n = 1). Patients were administered [124I]I-NM404 and imaged via PET/CT at 1–2, 4–6, 24, and 48 h and at 5–10 days post injection, from top of the skull to mid-thigh. Volumes of interest were drawn over lungs, heart, liver, kidneys, and whole body for dosimetry estimation using OLINDA 1.1 Representative metastatic index lesions were chosen when applicable for each case with active sites of disease to calculate maximum and mean tumor-to-background ratios (TBRmax, TBRmean), using the adjacent normal organ parenchyma as background when possible. Results: Administrations of [124I]-NM404 were safe and well-tolerated. The organs with the highest estimated absorbed dose (mean ± SD) were the lungs (1.74 ± 0.39 mSv/MBq), heart wall (1.52 ± 0.29 mSv/MBq), liver (1.28 ± 0.21 mSv/MBq) and kidneys (1.09 ± 0.20 mSv/MBq). The effective dose was 0.77 ± 0.05 mSv/MBq. Preferential uptake within metastatic foci was observed with all cancer subtypes, TBRmax ranged from 1.95 to 15.36 and TBRmean ranged from 1.63 to 6.63. Robust sensitive imaging of lesions was enhanced by delayed timing (2–6 days after single injection of [124I]I-NM404, respectively) due to persistent tumor retention coupled with progressive washout of background activity. NM404 uptake was evident in pulmonary, nodal, skeletal, CNS, and other metastatic sites of disease. Radiation related injury or necrosis were NM404 negative, whereas certain small number of metastatic brain lesions were false negative for NM404. Conclusions: In addition to being well tolerated, selective tumor uptake of NM404 with prolonged retention was demonstrated within a broad spectrum of highly treated metastatic cancers.
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Kanayama T, Nakase J, Mochizuki T, Asai K, Yoshimizu R, Kimura M, Kinuya S, Tsuchiya H. Evaluation of skeletal muscle activity during foot training exercises using positron emission tomography. Sci Rep 2022; 12:7076. [PMID: 35490192 PMCID: PMC9056519 DOI: 10.1038/s41598-022-11202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/30/2022] [Indexed: 11/12/2022] Open
Abstract
The foot exercises “rock-paper-scissors” and “towel gathering” are widely used in patients with lower limb disorders; however, there are no detailed reports on muscle activity during such training. We quantitatively evaluated the difference in skeletal muscle activity between the two exercises using positron emission tomography. Eight university student athletes were included. Four participants each were assigned to the foot rock-paper-scissors and towel gathering groups. Participants in each group underwent continuous training for 15 min, and received an intravenous injection of 18F-fluorodeoxyglucose. After retraining for 15 min, participants rested for 45 min. Regions of interest were defined in 25 muscles. The standardized uptake value (SUV) in the trained limb was compared with that in the non-trained control limb. SUVs increased in four skeletal muscles (tibialis anterior, peroneus brevis, extensor hallucis brevis, and abductor hallucis) in the rock-paper-scissors group, and in four muscles (flexor digitorum longus, extensor hallucis brevis, extensor digitorum brevis, and quadratus plantae) in the towel gathering group. Thus, foot rock-paper-scissors and towel gathering involved skeletal muscles related to the medial longitudinal arch and toe grip strength, respectively. Given that the two exercises target different skeletal muscles, they should be taught and implemented according to their respective purposes.
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Affiliation(s)
- Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan.
| | | | - Kazuki Asai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Mitsuhiro Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine/Biotracer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
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Purbhoo K, Vangu MDT. Normal Variants and Pitfalls of 18F-FDG PET/CT Imaging in Pediatric Oncology. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2022; 2:825891. [PMID: 39354970 PMCID: PMC11440973 DOI: 10.3389/fnume.2022.825891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/21/2022] [Indexed: 10/03/2024]
Abstract
Positron emission tomography (PET) with 2-[fluorine-18] fluoro-2- deoxy-D-glucose (FDG) is a well-established modality that is used in adult oncologic imaging. Its use in pediatric oncology has increased over time. It enables increased diagnostic accuracy due to the combination of functional and morphologic imaging, resulting in optimal patient management. However, the clinician should be aware that the normal distribution of FDG uptake in children differs from adults. Also, even though FDG is used widely in oncology, it is not tumor specific. Uptake of FDG may be seen in numerous benign conditions, including inflammation, infection, and trauma. Proper interpretation of pediatric FDG PET/CT studies requires knowledge of the normal distribution of FDG uptake in children, and an insight into the physiologic variants, benign lesions, and PET/CT related artifacts. Understanding the potential causes of misinterpretation increases the confidence of image interpretation, reduce the number of unnecessary follow-up studies, optimize treatment and more importantly, reduce the radiation exposure to the patient. We review and discuss the physiological distribution of FDG uptake in children, the variation in distribution, lesions that are benign that could be misinterpreted as malignancy, and the various artifacts associated with PET/CT performed in pediatric oncology patients. We add a pictorial illustration to prompt understanding and familiarity of the above-mentioned patterns. Therefore, we believe that this review will assist in reducing possible mistakes by reading physicians and prevent incorrect interpretation.
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Brody A, Crooks JC, French JM, Lang LG, Randall EK, Griffin LR. Staging canine patients with appendicular osteosarcoma utilizing fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography compared to whole body computed tomography. Vet Comp Oncol 2022; 20:541-550. [PMID: 35166445 DOI: 10.1111/vco.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/21/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
Few studies have investigated the diagnostic performance of fluorine-18-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) for staging veterinary patients with appendicular osteosarcoma. The purpose of this study was to evaluate the efficacy of 18 F-FDG-PET/CT compared to whole-body CT (WBCT) for staging canine patients with appendicular osteosarcoma. The 18 F-FDG-PET/CT imaging studies of 66 dogs with appendicular osteosarcoma were anonymized and separated into two detached studies (one with whole body pre- and post-contrast CT images and the other with the whole body pre- and post-contrast CT images with the associated 18 F-FDG-PET overlay). Image assessment was performed retrospectively by five board-certified veterinary radiologists. The radiologists were instructed to assign a predefined categorical score to each pre-designated anatomic region based on a devised lesional scoring system. A score of 1 was normal, 2 abnormal but not neoplastic, 3 abnormal and concerning for neoplasia, and 4 abnormal, most likely neoplastic. Overall, the likelihood of detection of '3 or 4' was found to be significantly higher with 18 F-FDG PET/CT when compared to WBCT after adjusting for the effect of evaluator and the subject. Most significantly, 13 osseous lesions concerning for metastasis (scored 3-4) were identified in 10/66 dogs by at least one reviewer on 18 F-FDG PET/CT, which were not identified by any reviewer on WBCT. Additionally, four comorbid neoplastic lesions were identified with 18 F-FDG PET/CT and not with WBCT. The results of this study suggest that 18 F-FDG PET/CT is more efficacious in detecting metastatic and comorbid neoplastic lesions compared to WBCT in dogs with appendicular osteosarcoma. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ariel Brody
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO, 80523 (Brody, Crooks, Lang, Randall, Griffin). Antech Imaging Services, 17620 Mt Herrmann St. Fountain Valley, California 92708, (French) United States
| | - J Clifton Crooks
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO, 80523 (Brody, Crooks, Lang, Randall, Griffin). Antech Imaging Services, 17620 Mt Herrmann St. Fountain Valley, California 92708, (French) United States
| | - John M French
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO, 80523 (Brody, Crooks, Lang, Randall, Griffin). Antech Imaging Services, 17620 Mt Herrmann St. Fountain Valley, California 92708, (French) United States
| | - Linda G Lang
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO, 80523 (Brody, Crooks, Lang, Randall, Griffin). Antech Imaging Services, 17620 Mt Herrmann St. Fountain Valley, California 92708, (French) United States
| | - Elissa K Randall
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO, 80523 (Brody, Crooks, Lang, Randall, Griffin). Antech Imaging Services, 17620 Mt Herrmann St. Fountain Valley, California 92708, (French) United States
| | - Lynn R Griffin
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO, 80523 (Brody, Crooks, Lang, Randall, Griffin). Antech Imaging Services, 17620 Mt Herrmann St. Fountain Valley, California 92708, (French) United States
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Vangu MDT, Momodu JI. Imaging Lymphoma With F-18 Fluorodeoxyglucose PET-CT: What Should Be Known About Normal Variants, Pitfalls, and Artifacts? FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2022; 1:826046. [PMID: 39355633 PMCID: PMC11440966 DOI: 10.3389/fnume.2021.826046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/15/2021] [Indexed: 10/03/2024]
Abstract
18F fluorodeoxyglucose ([F-18] FDG) PET-CT has gained popularity in the management of many types of malignancies. Today, imaging patients with lymphoma using of [F-18] FDG PET-CT not only is considered as a state-of-the-art tool but also has taken a central place for therapeutic decisions. In fact, accurate staging at diagnosis is imperative to prevent under treatment of individuals with advanced disease. In Hodgkin's lymphoma, in particular, the current role of interim [F-18] FDG PET imaging goes beyond speculations in the adaptation of different therapeutic strategies. Therefore, the use of such a critical imaging modality should go hand in hand with sound interpretation that provides accurate results. As the number patients referred for PET-CT continues to increase, imaging specialists should remain aware of the inherent limitations linked to the integrated imaging system that may introduce potential pitfalls related to the machine or the administered [F-18] FDG. Knowledge of the normal physiologic biodistribution of [F-18] FDG, its physiologic variants, and of all the potential pitfalls and artifacts is paramount to avoid misinterpretation. Recognition of the limitations of [F-18] FDG PET-CT will increase the confidence of practicing clinicians on the modality and impact positively on the management of patients. In this article, we will review the normal physiological variants, technical artifacts, and diagnostic pitfalls in lymphoma. Highlighting the limitations of [F-18] FDG PET-CT imaging should warn interpreting specialists to find measures that mitigate them and improve reporting results.
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Affiliation(s)
- Mboyo Di Tamba Vangu
- Department of Nuclear Medicine and Molecular Imaging, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jaleelat I Momodu
- Department of Nuclear Medicine and Molecular Imaging, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Minamimoto R. 2-[18F]FDG PET Imaging of Infection and Inflammation. NUCLEAR MEDICINE AND IMMUNOLOGY 2022:179-207. [DOI: 10.1007/978-3-030-81261-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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New PET radiopharmaceuticals for cancer imaging. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Engin G, Yirgin K, Kandemir H. Extrapulmonary Tuberculosis Mimics Diffuse Metastatic Disease: A Case Report. Indian J Radiol Imaging 2021; 31:1039-1042. [PMID: 35136525 PMCID: PMC8817791 DOI: 10.1055/s-0041-1739378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Extrapulmonary tuberculosis (TB) is associated with major diagnostic difficulties as it has many atypical symptoms and its imaging findings are similar to those of many other diseases.
Case Report
We present the case of a 50-year-old woman with a complex cystic mass in her pelvis and a 2-month history of pain. Thoracoabdominal computed tomography (CT) revealed the following: (1) multiple supraclavicular, axillary, mediastinal, and abdominal pathologic lymph nodes with central hypoattenuation; (2) sternal and dorsal vertebral bone destruction with a soft tissue mass; and (3) multiple hypoattenuating masses in the liver.
18
F-fludeoxyglucose positron emission tomography/computed tomography (
18
F-FDG PET/CT) revealed pathologic uptake in the defined areas, which were similar to metastases. Chest X-ray was normal. Diffuse metastatic disease was suspected clinically, but careful analysis of the imaging findings and the final pathologic results revealed multisystemic extrapulmonary TB. Clinical and radiological recovery was significant after anti-TB treatment at the 6-month follow-up.
Conclusion
Extrapulmonary TB without pulmonary involvement is associated with major diagnostic difficulties, especially with PET-CT. However, recognition and understanding of the CT or MR imaging spectrum can aid in the correct diagnosis and management of the disease.
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Affiliation(s)
- Gulgun Engin
- Department of Radiology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Kızıldag Yirgin
- Department of Radiology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Hulya Kandemir
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Capa, Turkey
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Nawwar AA, Searle J, Hopkins R, Lyburn ID. False-Positive Axillary Lymph Nodes on FDG PET/CT Resulting From COVID-19 Immunization. Clin Nucl Med 2021; 46:1004-1005. [PMID: 33883486 PMCID: PMC8575105 DOI: 10.1097/rlu.0000000000003657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT World-wide mass COVID-19 vaccination has been deployed starting with those most vulnerable, including the elderly and cancer patients. A 70-year-old man with right lung cancer underwent staging FDG PET/CT, which demonstrated an avid right lung mass with avid hilar and mediastinal nodes. Avid left axillary nodes of benign configuration were also noted. The patient had the Oxford-AstraZeneca COVID-19 vaccination in the left arm a week earlier. On reflection, the axillary nodes were concluded to be reactive related to this. This is a potential COVID-19 vaccination associated pitfall on PET/CT that should be considered when interpreting FDG PET/CT images.
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Affiliation(s)
- Ayah Adel Nawwar
- From the Cobalt Medical Charity, Cheltenham, United Kingdom
- Clinical Oncology and Nuclear Medicine Department, Cairo University, Cairo, Egypt
| | - Julie Searle
- From the Cobalt Medical Charity, Cheltenham, United Kingdom
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham
| | - Richard Hopkins
- From the Cobalt Medical Charity, Cheltenham, United Kingdom
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham
| | - Iain Douglas Lyburn
- From the Cobalt Medical Charity, Cheltenham, United Kingdom
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham
- Cranfield Forensic Institute, Cranfield University at Shrivenham, Swindon, United Kingdom
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Nakaya M, Kurokawa R, Kanemaru N, Sakamoto N, Nyunoya K, Joohyung Y, Kamiya K, Cho S, Fujita N, Kamio S, Koyama H, Suzuki S, Gonoi W, Abe O. Physiological 2-deoxy-2-[fluorine-18] fluoro-D-glucose accumulation in the thenar eminence in adults: a single-center retrospective study. Ann Nucl Med 2021; 35:1167-1173. [PMID: 34269978 DOI: 10.1007/s12149-021-01654-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study evaluated the frequency, and effect of physiological 2-deoxy-2-[fluorine-18] fluoro-D-glucose (FDG) tracer injection and its association with the penetration rates of mobile devices. METHODS This retrospective analysis included 213 patients (mean age ± standard deviation, 66.2 ± 14.1 years; range 23-93 years; 125 men) who underwent FDG-positron emission tomography examination. Elevated FDG activity in the thenar eminence with maximum standardized uptake value (SUVmax) ≥ 2.5 was considered positive. Differences according to age, sex, laterality, and tracer injection side were evaluated using Fisher's exact test. Associations were assessed using Pearson's correlation coefficient. RESULTS Twenty-three percent (49/213) of the patients had elevated FDG activity in the thenar eminence (mean SUVmax, 3.50 ± 1.04; range 2.5-6.3), including 18 with bilateral findings. No significant difference existed according to age (< 50 years vs. 50-69 years vs. ≥ 70 years), sex, laterality, or tracer injection side. No significant correlation existed between penetration rates of mobile devices and the findings (p = 0.08). CONCLUSION Elevated FDG activity in the thenar eminence occurs in adults, regardless of age, sex, laterality, or tracer injection side. This should be considered a common physiological change that does not warrant any further investigation.
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Affiliation(s)
- Moto Nakaya
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Noriko Kanemaru
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Naoya Sakamoto
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keisuke Nyunoya
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Youh Joohyung
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kouhei Kamiya
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Radiology, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Shinichi Cho
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nana Fujita
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoru Kamio
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Koyama
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoshi Suzuki
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Wu Y, Feng T, Zhao Y, Xu T, Fu F, Huang Z, Meng N, Li H, Shao F, Wang M. Whole-body Parametric Imaging of FDG PET using uEXPLORER with Reduced Scan Time. J Nucl Med 2021; 63:622-628. [PMID: 34385335 PMCID: PMC8973287 DOI: 10.2967/jnumed.120.261651] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
Parametric imaging of the net influx rate (Ki) in 18F-FDG PET has been shown to provide improved quantification and specificity for cancer detection compared with SUV imaging. Current methods of generating parametric images usually require a long dynamic scanning time. With the recently developed uEXPLORER scanner, a dramatic increase in sensitivity has reduced the noise in dynamic imaging, making it more robust to use a nonlinear estimation method and flexible protocols. In this work, we explored 2 new possible protocols besides the standard 60-min one for the possibility of reducing scanning time for Ki imaging. Methods: The gold standard protocol (protocol 1) was conventional dynamic scanning with a 60-min scanning time. The first proposed protocol (protocol 2) included 2 scanning periods: 0–4 min and 54–60 min after injection. The second proposed protocol (protocol 3) consisted of a single scanning period from 50 to 60 min after injection, with a second injection applied at 56 min. The 2 new protocols were simulated from the 60-min standard scans. A hybrid input function combining the population-based input function and the image-derived input function (IDIF) was used. The results were also compared with the IDIF acquired from protocol 1. A previously developed maximum-likelihood approach was used to estimate the Ki images. In total, 7 cancer patients imaged using the uEXPLORER scanner were enrolled in this study. Lesions were identified from the patient data, and the lesion Ki values were compared among the different protocols. Results: The acquired hybrid input function was comparable in shape to the IDIF for each patient. The average difference in area under the curve was about 3%, suggesting good quantitative accuracy. The visual difference between the Ki images generated using IDIF and those generated using the hybrid input function was also minimal. The acquired Ki images using different protocols were visually comparable. The average Ki difference in the lesions was 2.8% ± 2.1% for protocol 2 and 1% ± 2.2% for protocol 3. Conclusion: The results suggest that it is possible to acquire Ki images using the nonlinear estimation approach with a much-reduced scanning time. Between the 2 new protocols, the protocol with dual injection shows the greatest promise in terms of practicality.
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Affiliation(s)
- Yaping Wu
- Department of Medical Imaging, Henan Provincial People's Hospital, China
| | | | | | | | - Fangfang Fu
- Department of Medical Imaging, Henan Provincial People's Hospital, China
| | - Zhun Huang
- Department of Medical Imaging, Henan Provincial People's Hospital, China
| | - Nan Meng
- Department of Medical Imaging, Henan Provincial People's Hospital, China
| | | | - Fengmin Shao
- Department of Medical Imaging, Henan Provincial People's Hospital, China, China
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital, China
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Dual-Energy CT-Derived Electron Density for Diagnosing Metastatic Mediastinal Lymph Nodes in Non-Small Cell Lung Cancer: Comparison With Conventional CT and FDG PET/CT Findings. AJR Am J Roentgenol 2021; 218:66-74. [PMID: 34319164 DOI: 10.2214/ajr.21.26208] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Accurate nodal staging is essential to guide treatment selection in patients with non-small cell lung cancer (NSCLC). To our knowledge, measurement of electron density (ED) using dual-energy CT (DECT) is unexplored for this purpose. Objective: To assess the utility of ED from DECT in diagnosing metastatic mediastinal lymph nodes in patients with NSCLC, in comparison with conventional CT and FDG PET/CT. Methods: This retrospective study included 57 patients (36 men, 21 women; mean age 68.4±8.9 years) with NSCLC and surgically resected mediastinal lymph nodes who underwent preoperative DECT and FDG PET/CT. The patients had a total of 117 resected mediastinal lymph nodes (33 metastatic, 84 nonmetastatic). Two radiologists independently reviewed nodes' morphologic features on the 120 kVp images and also measured nodes' iodine concentration (IC) and ED using maps generated from DECT data; consensus was reached for discrepancies. Two separate radiologists assessed FDG PET/CT examinations in consensus for positive node uptake. Diagnostic performance was evaluated for individual and pairwise combinations of features. Results: The sensitivity, specificity, and accuracy for nodal metastasis were 15.2%, 98.8%, and 75.2% for presence of necrosis; 54.5%, 85.7%, and 76.9% for short-axis diameter >8.5 mm; 63.6%, 73.8%, and 70.9% for long-axis diameter >13.0 mm; 51.5%, 79.8%, and 71.8% for attenuation on 120 kVp images ≤95.8 HU; 87.9%, 58.3%, and 66.7% for ED ≤3.48×1023/cm3; and 66.7%, 75.0%, and 72.6% for positive FDG uptake, respectively. Among pairwise combinations of features, accuracy was highest for the combination of ED and short-axis diameter (accuracy 82.9%, sensitivity 54.5%, specificity 94.0%) and the combination of ED and positive FDG uptake (accuracy 82.1%, sensitivity 60.6%, specificity 90.5%); these accuracies were greater than for the individual features (p<.05). Remaining combinations exhibited accuracies ranging from 74.4% to 77.8%. Interobserver agreement analysis demonstrated intraclass correlation coefficient of 0.90 for ED. IC was not significantly different between metastatic and nonmetastatic nodes (p=.18) and was excluded from the diagnostic performance analysis. Conclusion: ED derived from DECT may help diagnose metastatic lymph nodes in NSCLC given decreased ED in metastatic nodes. Clinical Impact: ED may complement conventional CT findings and FDG uptake on PET/CT in diagnosing metastatic nodes.
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Liapis V, Tieu W, Wittwer NL, Gargett T, Evdokiou A, Takhar P, Rudd SE, Donnelly PS, Brown MP, Staudacher AH. Positron Emission Tomographic Imaging of Tumor Cell Death Using Zirconium-89-Labeled APOMAB® Following Cisplatin Chemotherapy in Lung and Ovarian Cancer Xenograft Models. Mol Imaging Biol 2021; 23:914-928. [PMID: 34231102 PMCID: PMC8578059 DOI: 10.1007/s11307-021-01620-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/28/2021] [Accepted: 05/26/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Early detection of tumor treatment responses represents an unmet clinical need with no approved noninvasive methods. DAB4, or its chimeric derivative, chDAB4 (APOMAB®) is an antibody that targets the Lupus associated antigen (La/SSB). La/SSB is over-expressed in malignancy and selectively targeted by chDAB4 in cancer cells dying from DNA-damaging treatment. Therefore, chDAB4 is a unique diagnostic tool that detects dead cancer cells and thus could distinguish between treatment responsive and nonresponsive patients. PROCEDURES In clinically relevant tumor models, mice bearing subcutaneous xenografts of human ovarian or lung cancer cell lines or intraperitoneal ovarian cancer xenografts were untreated or given chemotherapy followed 24h later by chDAB4 radiolabeled with [89Zr]ZrIV. Tumor responses were monitored using bioluminescence imaging and caliper measurements. [89Zr]Zr-chDAB4 uptake in tumor and normal tissues was measured using an Albira SI Positron-Emission Tomography (PET) imager and its biodistribution was measured using a Hidex gamma-counter. RESULTS Tumor uptake of [89Zr]Zr-chDAB4 was detected in untreated mice, and uptake significantly increased in both human lung and ovarian tumors after chemotherapy, but not in normal tissues. CONCLUSION Given that tumors, rather than normal tissues, were targeted after chemotherapy, these results support the clinical development of chDAB4 as a radiodiagnostic imaging agent and as a potential predictive marker of treatment response.
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Affiliation(s)
- Vasilios Liapis
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Level 9 University of South Australia Health Innovation Building, North Terrace, Adelaide, 5000, Australia.
| | - William Tieu
- School of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
- Molecular Imaging and Therapy Research Unit (MITRU), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Nicole L Wittwer
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Level 9 University of South Australia Health Innovation Building, North Terrace, Adelaide, 5000, Australia
| | - Tessa Gargett
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Level 9 University of South Australia Health Innovation Building, North Terrace, Adelaide, 5000, Australia
| | - Andreas Evdokiou
- Discipline of Surgery, Breast Cancer Research Unit, Basil Hetzel Institute and Centre for Personalised Cancer Medicine, University of Adelaide, Woodville, SA, 5011, Australia
| | - Prab Takhar
- Molecular Imaging and Therapy Research Unit (MITRU), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Stacey E Rudd
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Paul S Donnelly
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Michael P Brown
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Level 9 University of South Australia Health Innovation Building, North Terrace, Adelaide, 5000, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Alexander H Staudacher
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Level 9 University of South Australia Health Innovation Building, North Terrace, Adelaide, 5000, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
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Capozzi A, Kilund J, Karlsson M, Patel S, Pinon AC, Vibert F, Ouari O, Lerche MH, Ardenkjær-Larsen JH. Metabolic contrast agents produced from transported solid 13C-glucose hyperpolarized via dynamic nuclear polarization. Commun Chem 2021; 4:95. [PMID: 36697707 PMCID: PMC9814755 DOI: 10.1038/s42004-021-00536-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/08/2021] [Indexed: 01/28/2023] Open
Abstract
Magnetic Resonance Imaging combined with hyperpolarized 13C-labelled metabolic contrast agents produced via dissolution Dynamic Nuclear Polarization can, non-invasively and in real-time, report on tissue specific aberrant metabolism. However, hyperpolarization equipment is expensive, technically demanding and needs to be installed on-site for the end-user. In this work, we provide a robust methodology that allows remote production of the hyperpolarized 13C-labelled metabolic contrast agents. The methodology, built on photo-induced thermally labile radicals, allows solid sample extraction from the hyperpolarization equipment and several hours' lifetime of the 13C-labelled metabolic contrast agents at appropriate storage/transport conditions. Exemplified with [U-13C, d7]-D-glucose, we remotely produce hyperpolarized 13C-labelled metabolic contrast agents and generate above 10,000-fold liquid-state Magnetic Resonance signal enhancement at 9.4 T, keeping on-site only a simple dissolution device.
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Affiliation(s)
- Andrea Capozzi
- LIFMET, Department of Physics, EPFL, Station 6 (Batiment CH), Lausanne, Switzerland.
- HYPERMAG, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark.
| | - Jan Kilund
- HYPERMAG, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Magnus Karlsson
- HYPERMAG, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Saket Patel
- HYPERMAG, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Arthur Cesar Pinon
- HYPERMAG, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - François Vibert
- Institut de Chimie Radicalire Aix-Marseille Université, CNRS, ICR UMR 7273, Marseille, Cedex 20, France
| | - Olivier Ouari
- Institut de Chimie Radicalire Aix-Marseille Université, CNRS, ICR UMR 7273, Marseille, Cedex 20, France
| | - Mathilde H Lerche
- HYPERMAG, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
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Mahar R, Zeng H, Giacalone A, Ragavan M, Mareci TH, Merritt ME. Deuterated water imaging of the rat brain following metabolism of [ 2 H 7 ]glucose. Magn Reson Med 2021; 85:3049-3059. [PMID: 33576535 PMCID: PMC7953892 DOI: 10.1002/mrm.28700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE To determine whether deuterated water (HDO) generated from the metabolism of [2 H7 ]glucose is a sensitive biomarker of cerebral glycolysis and oxidative flux. METHODS A bolus of [2 H7 ]glucose was injected through the tail vein at 1.95 g/kg into Sprague-Dawley rats. A 2 H surface coil was placed on top of the head to record 2 H spectra of the brain every 1.3 minutes to measure glucose uptake and metabolism to HDO, lactate, and glutamate/glutamine. A two-point Dixon method based on a gradient-echo sequence was used to reconstruct deuterated glucose and water (HDO) images selectively. RESULTS The background HDO signal could be detected and imaged before glucose injection. The 2 H NMR spectra showed arrival of [2 H7 ]glucose and its metabolism in a time-dependent manner. A ratio of the HDO to glutamate/glutamine resonances demonstrates a pseudo-steady state following injection, in which cerebral metabolism dominates wash-in of HDO generated by peripheral metabolism. Brain spectroscopy reveals that HDO generation is linear with lactate and glutamate/glutamine appearance in the appropriate pseudo-steady state window. Selective imaging of HDO and glucose is easily accomplished using a gradient-echo method. CONCLUSION Metabolic imaging of HDO, as a marker of glucose, lactate, and glutamate/glutamine metabolism, has been shown here for the first time. Cerebral glucose metabolism can be assessed efficiently using a standard gradient-echo sequence that provides superior in-plane resolution compared with CSI-based techniques.
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Affiliation(s)
- Rohit Mahar
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Huadong Zeng
- Advanced Magnetic Resonance Imaging and Spectroscopy Facility, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Anthony Giacalone
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mukundan Ragavan
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas H Mareci
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Matthew E Merritt
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, Florida, USA
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Mihailovic J, Killeen RP, Duignan JA. PET/CT Variants and Pitfalls in Head and Neck Cancers Including Thyroid Cancer. Semin Nucl Med 2021; 51:419-440. [PMID: 33947603 DOI: 10.1053/j.semnuclmed.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PET/CT imaging is a dual-modality diagnostic technology that merges metabolic and structural imaging. There are several currently available radiotracers, but 18F-FDG is the most commonly utilized due to its widespread availability. 18F-FDG PET/CT is a cornerstone of head and neck squamous cell carcinoma imaging. 68Ga-DOTA-TOC is another widely used radiotracer. It allows for whole-body imaging of cellular somatostatin receptors, commonly expressed by neuroendocrine tumors and is the standard of reference for the characterization and staging of neuroendocrine tumors. The normal biodistribution of these PET radiotracers as well as the technical aspects of image acquisition and inadequate patient preparation affect the quality of PET/CT imaging. In addition, normal variants, artifacts and incidental findings may impede accurate image interpretation and can potentially lead to misdiagnosis. In order to correctly interpret PET/CT imaging, it is necessary to have a comprehensive knowledge of the normal anatomy of the head and neck and to be cognizant of potential imaging pitfalls. The interpreter must be familiar with benign conditions which may accumulate radiotracer potentially mimicking neoplastic processes and also be aware of malignancies which can demonstrate low radiotracer uptake. Appropriate use of structural imaging with either CT, MR or ultrasound can serve a complimentary role in several head and neck pathologies including local tumor staging, detection of bone marrow involvement or perineural spread, and classification of thyroid nodules. It is important to be aware of the role of these complementary modalities to maximize diagnostic accuracy and patient outcomes. The purpose of this article is to outline the basic principles of PET/CT imaging, with a focus on 18F-FDG PET/CT and 68Ga-DOTA PET/CT. Basic physiology, variant imaging appearances and potential pitfalls of image interpretation are presented within the context of common use cases of PET technology in patients with head and neck cancers and other pathologies, benign and malignant.
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Affiliation(s)
- Jasna Mihailovic
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Centre of Nuclear Medicine, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.
| | - Ronan P Killeen
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; UCD - SVUH PET CT Research Centre, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John A Duignan
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; UCD - SVUH PET CT Research Centre, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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