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Geiger KR, Pasvolsky O, Berger T, Raanani P, Shochat T, Gurion R, Anati T, Groshar D, Gafter-Gvili A, Bernstine H. Effect of steroid treatment on the diagnostic yield of baseline 18f-fluorodeoxyglucose positron emission tomography in aggressive B cell lymphoma. EJNMMI Res 2022; 12:59. [PMID: 36104603 PMCID: PMC9474759 DOI: 10.1186/s13550-022-00924-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/17/2022] [Indexed: 01/18/2023] Open
Abstract
Aggressive B cell lymphoma often requires prompt steroid treatment, even before baseline 18f-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and definitive treatment, to alleviate symptoms or prevent organ damage. Since lymphoma is a steroid-sensitive malignancy, there are concerns that steroids might affect the results of FDG PET/CT and decrease its diagnostic yield. The aim of the current study was to evaluate the effect of steroids administered before baseline PET/CT on the maximum standardized uptake value (SUVmax) and additional PET/CT parameters. Retrospective review of the database in a tertiary medical center yielded 178 patients newly diagnosed with aggressive B cell lymphoma between January 2017 and May 2020 who had an available baseline FDG PET/CT scan. The cohort was divided into patients who received steroids before PET/CT (n = 47) and those who did not (n = 131), and the groups were compared for SUVmax and additional PET/CT parameters. The steroid-treated group had a higher disease stage and lactate dehydrogenase level compared to the steroid-naïve group, with a trend toward a higher international prognostic index. There was no significant between-group difference in SUVmax (P = 0.61). This finding remained consistent across steroid treatment durations and dosage regimens. Further evaluation revealed a significantly larger mean tumor volume and a trend toward a higher tumor metabolic burden in the steroid-treated group, yet no between-group difference in SUV mean or other PET/CT parameters. In this retrospective analysis of patients with aggressive B cell lymphoma, steroid prophase prior to baseline PET/CT did not decrease the diagnostic yield of the scan. However, further studies are required to fully appreciate the impact of steroids on PET CT parameters.
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Allioux FM, Ghasemian MB, Xie W, O'Mullane AP, Daeneke T, Dickey MD, Kalantar-Zadeh K. Applications of liquid metals in nanotechnology. NANOSCALE HORIZONS 2022; 7:141-167. [PMID: 34982812 DOI: 10.1039/d1nh00594d] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Post-transition liquid metals (LMs) offer new opportunities for accessing exciting dynamics for nanomaterials. As entities with free electrons and ions as well as fluidity, LM-based nanomaterials are fundamentally different from their solid counterparts. The low melting points of most post-transition metals (less than 330 °C) allow for the formation of nanodroplets from bulk metal melts under mild mechanical and chemical conditions. At the nanoscale, these liquid state nanodroplets simultaneously offer high electrical and thermal conductivities, tunable reactivities and useful physicochemical properties. They also offer specific alloying and dealloying conditions for the formation of multi-elemental liquid based nanoalloys or the synthesis of engineered solid nanomaterials. To date, while only a few nanosized LM materials have been investigated, extraordinary properties have been observed for such systems. Multi-elemental nanoalloys have shown controllable homogeneous or heterogeneous core and surface compositions with interfacial ordering at the nanoscale. The interactions and synergies of nanosized LMs with polymeric, inorganic and bio-materials have also resulted in new compounds. This review highlights recent progress and future directions for the synthesis and applications of post-transition LMs and their alloys. The review presents the unique properties of these LM nanodroplets for developing functional materials for electronics, sensors, catalysts, energy systems, and nanomedicine and biomedical applications, as well as other functional systems engineered at the nanoscale.
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Affiliation(s)
- Francois-Marie Allioux
- School of Chemical Engineering, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
| | - Mohammad B Ghasemian
- School of Chemical Engineering, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
| | - Wanjie Xie
- School of Chemical Engineering, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
| | - Anthony P O'Mullane
- School of Chemistry and Physics, Queensland University of Technology (QUT), Brisbane, QLD 4001, Australia
| | - Torben Daeneke
- School of Engineering, RMIT University, Melbourne, Victoria, 3001, Australia
| | - Michael D Dickey
- Department of Chemical and Biomolecular Engineering, North Carolina State University, 911 Partners Way, Raleigh, NC, 27695, USA
| | - Kourosh Kalantar-Zadeh
- School of Chemical Engineering, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
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Wijetunga NA, Imber BS, Caravelli JF, Mikhaeel NG, Yahalom J. A picture is worth a thousand words: a history of diagnostic imaging for lymphoma. Br J Radiol 2021; 94:20210285. [PMID: 34111961 DOI: 10.1259/bjr.20210285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The journey from early drawings of Thomas Hodgkin's patients to deep learning with radiomics in lymphoma has taken nearly 200 years, and in many ways, it parallels the journey of medicine. By tracing the history of imaging in clinical lymphoma practice, we can better understand the motivations for current imaging practices. The earliest imaging modalities of the 2D era each had varied, site-dependent sensitivity, and the improved accuracy of imaging studies allowed new diagnostic and therapeutic techniques. First, we review the initial imaging technologies that were applied to understand lymphoma spread and achieve practical guidance for the earliest lymphoma treatments. Next, in the 3D era, we describe how anatomical imaging advances replaced and complemented conventional modalities. Afterward, we discuss how the PET era scans were used to understand response of tumors to treatment and risk stratification. Finally, we discuss the emergence of radiomics as a promising area of research in personalized medicine. We are now able to identify involved lymph nodes and body sites both before and after treatment to offer patients improved treatment outcomes. As imaging methods continue to improve sensitivity, we will be able to use personalized medicine approaches to give targeted and highly focused therapies at even earlier time points, and ideally, we can obtain long-term disease control and cures for lymphomas.
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Affiliation(s)
- N Ari Wijetunga
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon Stuart Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James F Caravelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N George Mikhaeel
- Department of Clinical Oncology, Guy's and St. Thomas' Hospital, London, UK
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Nguyen MP, Goorden MC, Ramakers RM, Beekman FJ. Efficient Monte-Carlo based system modelling for image reconstruction in preclinical pinhole SPECT. Phys Med Biol 2021; 66. [PMID: 34049291 DOI: 10.1088/1361-6560/ac0682] [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: 02/06/2021] [Accepted: 05/28/2021] [Indexed: 11/11/2022]
Abstract
The use of multi-pinhole collimation has enabled ultra-high-resolution imaging of SPECT and PET tracers in small animals. Key for obtaining high-quality images is the use of statistical iterative image reconstruction with accurate energy-dependent photon transport modelling through collimator and detector. This can be incorporated in a system matrix that contains the probabilities that a photon emitted from a certain voxel is detected at a specific detector pixel. Here we introduce a fast Monte-Carlo based (FMC-based) matrix generation method for pinhole imaging that is easy to apply to various radionuclides. The method is based on accelerated point source simulations combined with model-based interpolation to straightforwardly change or combine photon energies of the radionuclide of interest. The proposed method was evaluated for a VECTor PET-SPECT system with (i) a HE-UHR-M collimator and (ii) an EXIRAD-3D 3D autoradiography collimator. Both experimental scans with99mTc,111In, and123I, and simulated scans with67Ga and90Y were performed for evaluation. FMC was compared with two currently used approaches, one based on a set of point source measurements with99mTc (dubbed traditional method), and the other based on an energy-dependent ray-tracing simulation (ray-tracing method). The reconstruction results show better image quality when using FMC-based matrices than when applying the traditional or ray-tracing matrices in various cases. FMC-based matrices generalise better than the traditional matrices when imaging radionuclides with energies deviating too much from the energy used in the calibration and are computationally more efficient for very-high-resolution imaging than the ray-tracing matrices. In addition, FMC has the advantage of easily combining energies in a single matrix which is relevant when imaging radionuclides with multiple photopeak energies (e.g.67Ga and111In) or with a continuous energy spectrum (e.g.90Y). To conclude, FMC is an efficient, accurate, and versatile tool for creating system matrices for ultra-high-resolution pinhole SPECT.
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Affiliation(s)
- Minh Phuong Nguyen
- Section Biomedical Imaging, Delft University of Technology, Delft, The Netherlands
| | - Marlies C Goorden
- Section Biomedical Imaging, Delft University of Technology, Delft, The Netherlands
| | - Ruud M Ramakers
- Section Biomedical Imaging, Delft University of Technology, Delft, The Netherlands.,MILabs B.V., Utrecht, The Netherlands.,Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Freek J Beekman
- Section Biomedical Imaging, Delft University of Technology, Delft, The Netherlands.,MILabs B.V., Utrecht, The Netherlands.,Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
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Sun X, Yuan B, Wang H, Fan L, Duan M, Wang X, Guo R, Liu J. Nano‐Biomedicine based on Liquid Metal Particles and Allied Materials. ADVANCED NANOBIOMED RESEARCH 2021. [DOI: 10.1002/anbr.202000086] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Xuyang Sun
- Beijing Key Lab of Cryo-Biomedical Engineering and Key Lab of Cryogenics Technical Institute of Physics and Chemistry Chinese Academy of Sciences Beijing 100190 P.R. China
- School of Medical Science and Engineering Beihang University Beijing 100191 P.R. China
- Interdisciplinary Institute for Cancer Diagnosis and Treatment Beijing Advanced Innovation Center for Biomedical Engineering Beihang University Beijing 100191 P.R. China
| | - Bo Yuan
- Department of Biomedical Engineering School of Medicine Tsinghua University Beijing 100084 P.R. China
| | - Hongzhang Wang
- Department of Biomedical Engineering School of Medicine Tsinghua University Beijing 100084 P.R. China
| | - Linlin Fan
- Department of Biomedical Engineering School of Medicine Tsinghua University Beijing 100084 P.R. China
| | - Minghui Duan
- Department of Biomedical Engineering School of Medicine Tsinghua University Beijing 100084 P.R. China
| | - Xuelin Wang
- School of Medical Science and Engineering Beihang University Beijing 100191 P.R. China
- Interdisciplinary Institute for Cancer Diagnosis and Treatment Beijing Advanced Innovation Center for Biomedical Engineering Beihang University Beijing 100191 P.R. China
| | - Rui Guo
- Department of Biomedical Engineering School of Medicine Tsinghua University Beijing 100084 P.R. China
| | - Jing Liu
- Beijing Key Lab of Cryo-Biomedical Engineering and Key Lab of Cryogenics Technical Institute of Physics and Chemistry Chinese Academy of Sciences Beijing 100190 P.R. China
- Department of Biomedical Engineering School of Medicine Tsinghua University Beijing 100084 P.R. China
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Kahle XU, Montes de Jesus FM, Glaudemans AWJM, Lub-de Hooge MN, Jorritsma-Smit A, Plattel WJ, van Meerten T, Diepstra A, van den Berg A, Kwee TC, Noordzij W, de Vries EGE, Nijland M. Molecular imaging in lymphoma beyond 18F-FDG-PET: understanding the biology and its implications for diagnostics and therapy. LANCET HAEMATOLOGY 2020; 7:e479-e489. [PMID: 32470439 DOI: 10.1016/s2352-3026(20)30065-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/31/2020] [Accepted: 02/13/2020] [Indexed: 02/08/2023]
Abstract
Mature lymphoproliferative diseases are a heterogeneous group of neoplasms arising from different stages of B-cell and T-cell development. With improved understanding of the molecular processes in lymphoma and novel treatment options, arises a growing need for the molecular characterisation of tumours. Molecular imaging with single-photon-emission CT and PET using specific radionuclide tracers can provide whole-body information to investigate cancer biology, to evaluate phenotypic heterogeneity, to identify resistance to targeted therapy, and to assess the biodistribution of drugs in patients. In this Review, we evaluate the existing literature on molecular imaging in lymphoma, other than 18F-fluordeoxyglucose molecular imaging. The aim is to examine the contribution of molecular imaging to the understanding of the biology of lymphoma and to discuss potential implications for the diagnostics and therapy of this disease. Finally, we discuss possible applications for molecular imaging of patients with lymphoma in the clinical context.
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Affiliation(s)
- Xaver U Kahle
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Filipe M Montes de Jesus
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Annelies Jorritsma-Smit
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wouter J Plattel
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Tom van Meerten
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Anke van den Berg
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Thomas C Kwee
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Marcel Nijland
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
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Fouda A, Kandil S, Hamid G, Boujettif K, Mahfouz M, Abdelaziz M. Rebound (reactive) thymic hyperplasia after chemotherapy in children with lymphoma. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Fouda A, Kandil S, Hamid G, Boujettif K, Mahfouz M, Abdelaziz M. [Rebound (reactive) thymic hyperplasia after chemotherapy in children with lymphoma]. An Pediatr (Barc) 2019; 91:189-198. [PMID: 30713069 DOI: 10.1016/j.anpedi.2018.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/06/2018] [Accepted: 10/10/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Thymic regrowth after chemotherapy treatment has been reported in children with lymphoma, and in order to avoid misdiagnosing these cases as relapses, physicians should become familiar with rebound (reactive) thymic hyperplasia (RTH) and remain aware of its possible occurrence. We aimed to estimate the prevalence of RTH in children with lymphoma after completion of chemotherapy and to evaluate the clinical characteristics, outcomes, and the findings of computed tomography (CT) and gallium-67 (GA-67) scans in these patients. PATIENTS AND METHODS We conducted a retrospective cross-sectional study by reviewing the health records of children with a lymphoma diagnosis managed at an outpatient paediatric oncology clinic in Jeddah, Saudi Arabia. RESULTS Rebound thymic hyperplasia was detected in 51.9% of the lymphoma patients (14/27). It developed a median of 2.5 months after completion of chemotherapy (range, 2.0-4.25 months). Patients with RTH had significantly shorter treatment durations, and we found no significant differences between patients with and without RTH in sex, age at diagnosis, type of lymphoma or type of treatment received. All patients with RTH were asymptomatic, and routine laboratory tests did not detect any abnormalities in them. The findings of CT and GA-67 scans were highly suggestive of RTH. None of the patients with RTH had a recurrence, and RTH resolved spontaneously within a median of 6 months (range, 4.0-11.0). CONCLUSION RTH was detected in ∼50% of children with lymphoma after completion of chemotherapy. A clinical evaluation and laboratory tests combined with imaging by CT and GA-67 can help identify RTH and rule out other lesions elsewhere.
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Affiliation(s)
- Ashraf Fouda
- Departamento de Pediatría, Facultad de Medicina, Hospital Infantil de la Universidad de El Mansura, Universidad de El Mansura, El Mansura, Egipto.
| | - Shaimaa Kandil
- Departamento de Pediatría, Facultad de Medicina, Hospital Infantil de la Universidad de El Mansura, Universidad de El Mansura, El Mansura, Egipto
| | - Gihad Hamid
- División de Medicina Nuclear, Centro de Oncología de Yeda, Ciudad Médica Rey Abdullah, La Meca, Arabia Saudita
| | | | - Mohamed Mahfouz
- Departamento de Oncología Clínica, Facultad de Medicina, Universidad de Valle del Sur, Quena, Egipto
| | - Mohamed Abdelaziz
- Departamento de Oncología Clínica, Facultad de Medicina, Universidad de El Mansura, El Mansura, Egipto
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Interim Functional Imaging Is an Independent Predictor of Progression-free Survival in Advanced Classical Hodgkin Lymphoma - A Real-world Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:e71-e79. [PMID: 30292737 DOI: 10.1016/j.clml.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/15/2018] [Accepted: 08/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Response-adapted therapy in advanced classical Hodgkin lymphoma (cHL) using interim functional imaging (IFI) is under active investigation. PATIENTS AND METHODS We retrospectively examined patients with advanced cHL receiving 2 front-line regimens stratified by IFI results at our institution. Time to endpoint analysis was estimated using the method of Kaplan-Meier with log ranks. Cox regression modeling was computed for multivariable analysis. RESULTS A total of 124 patients with advanced cHL with a median follow up of 40.9 months were included. A total of 84 (67.7%) received ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), whereas the remaining 40 (32.3%) received ABVD/eBEACOPP (escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). A positive IFI was seen in 36 (29%) patients. The corresponding 3-year progression free survival (PFS) stratified by IFI was 81.7% (95% confidence interval [CI], 70.1%-88.8%) versus 48.3% (95% CI, 30.4%-64.1%) (P < .0001) for patients with negative or positive scan, respectively. Escalation to eBEACOPP from ABVD following a positive IFI resulted in a significantly higher 3-year PFS at 58.7% (95% CI, 0.3-0.79) versus 39.7% (95% CI, 0.18-0.61) respectively (P = .00015). Overall survival (OS) was similar across the groups (P = .44) irrespective of therapy received. At multivariable analysis, IFI was the only predictor of PFS with a hazard ratio of 4.6 (95% CI, 1.9-10.8; P = .0008) whereas therapy escalation had a hazard ratio of 0.66 (95% CI, 0.14-3.4; P = .62). CONCLUSION IFI is an independent predictor of PFS in advanced cHL and can guide therapeutic decisions in the real world. Given the inferior outcome seen in patients with a positive IFI, novel approaches of therapy are warranted.
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Sakurai M, Toyama T, Kikuchi T, Kato J, Shimizu T, Koda Y, Karigane D, Yamane Y, Abe R, Yamazaki R, Nakazato T, Nakahara T, Jinzaki M, Okamoto S, Mori T. Comparison of fluorine-18 fluorodeoxyglucose positron emission tomography with gallium-67 scintigraphy in the initial clinical staging of diffuse large B-cell lymphoma. Int J Hematol 2017; 107:194-200. [PMID: 28994017 DOI: 10.1007/s12185-017-2337-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has been recommended as a complementary tool for the staging of various malignancies, including malignant lymphoma. PET findings often shift patients to higher stages and may affect treatment outcomes. In this study, we retrospectively compared staging and treatment outcomes of newly diagnosed diffuse large B-cell lymphoma (DLBCL) assessed by PET (n = 153) or gallium-67 scintigraphy (Ga) (n = 95). In total, Ga upstaged two (2.1%) of 95 patients, whereas PET upstaged 13 (8.5%) of 153 patients. Bone/bone marrow (15 vs. 4%, P = 0.01) and muscle lesion (5 vs. 0%, P = 0.03) were identified more frequently in the PET group than in the Ga group. The estimated 3-year overall and progression-free survival rates did not differ significantly in the two groups at any stage. However, patients with stage III disease tended to have better progression-free survival in the PET group than in the Ga group [92.3 (95% CI 56.6-98.9%) vs. 58.3% (95% CI 27.0-80.1%), P = 0.086]. These results suggest that PET has a greater potential in detecting musculoskeletal lesions of DLBCL as extranodal lesions than Ga, and may contribute to the optimal staging.
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Affiliation(s)
- Masatoshi Sakurai
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takaaki Toyama
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taku Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jun Kato
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takayuki Shimizu
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuya Koda
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Daiki Karigane
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yusuke Yamane
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryohei Abe
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Rie Yamazaki
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomonori Nakazato
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Vishnu P, Wingerson A, Lee M, Mandelson MT, Aboulafia DM. Utility of Bone Marrow Biopsy and Aspirate for Staging of Diffuse Large B Cell Lymphoma in the Era of Positron Emission Tomography With 2-Deoxy-2-[Fluorine-18]fluoro-deoxyglucose Integrated With Computed Tomography. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:631-636. [PMID: 28684378 DOI: 10.1016/j.clml.2017.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/11/2017] [Accepted: 06/08/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND About one-third of patients with diffuse large B cell lymphoma (DLBCL) have lymphomatous bone marrow involvement (BMI) at the time of diagnosis, and bone marrow aspirate/biopsy (BMAB) is considered the gold standard to detect such involvement. [18F] fluorodeoxyglucose positron emission tomography combined with computed tomography (PET-CT), has become standard pretreatment imaging in DLBCL and may be a noninvasive alternative to BMAB to ascertain BMI. Prior studies have suggested that PET-CT scan may obviate the need for BMAB as a component for staging patients with newly diagnosed DLBCL, but this is not yet a standard of practice. The aim of this retrospective study was to determine the accuracy of PET-CT in detecting BMI in DLBCL and to define 2-year and 5-year overall survival based on BMI by BMAB versus PET-CT. METHODS We reviewed institutional records of all patients with newly diagnosed DLBCL between January 2004 and December 2013 who underwent pretreatment PET-CT and BMAB. PET-CT images were visually assessed for BMI, including the posterior iliac crest. Patients with primary mediastinal DLBCL, previous history or coexistence of another lymphoma subtype, and those with a nondiagnostic BMAB, and in whom the PET-CT did not show marrow signal abnormality, were excluded from the analysis. Ann Arbor stage was determined using PET-CT with and without the contribution of BMAB, and the proportion of stage IV cases by each method was measured. RESULTS Among 99 eligible patients, the median age was 62 years (range, 24-88 years), 62 (63%) were male, 53 (53%) had elevated serum lactate dehydrogenase, and 17 (16%) had an Eastern Community Oncology Group performance status of > 2. Thirteen (12%) patients had more than 1 extra-nodal site of lymphoma involvement. Revised International Prognostic Index score was 1 in 39 (37%) patients, 2 in 42 (40%) patients, 3 in 20 (19%) patients, and 4 in 4 (4%) patients. A total of 38 (36%) patients had BMI established by either PET-CT (n = 24; 24%), BMAB (n = 14; 14%), or by both modalities (n = 12; 12%). Twelve (50%) of the 24 patients with positive PET-CT had BMI by DLBCL, whereas only 2 (3%) of the 75 patients with negative PET-CT showed BMI. BMAB upstaged 1 (2%) of the 53 stage I/II patients to stage IV. The sensitivity and specificity of PET-CT scan to detect BMI by DLBCL was 86% (95% confidence interval, 51.9%-95.7%) and 87% (95% confidence interval, 76%-92%), respectively. Eighty-five (86%) patients had concordant results between lymphomatous BMAB and PET-CT (12 patients were positive for both; 73 patients were negative for both), and 14 (14%) patients had a discordant interpretation (2 patients were positive by BMAB and negative by PET-CT, and 12 patients were negative by BMAB and positive by PET-CT). The positive predictive value of PET-CT was only 50%, whereas the negative predictive value was 98%. The accuracy of PET-CT was 86%. Although patients with positive BMAB had inferior 5-year overall survival estimates compared with those with negative BMAB (66% vs. 85%; P = .08), no such difference was demonstrated between PET-CT-positive and PET-CT-negative patients (79% vs. 83%; P = .30). CONCLUSIONS In patients with newly diagnosed DLBCL, PET-CT is accurate in detecting BMI by DLBCL. Although PET-CT has a very high negative predictive value for BMI, it overestimates the number of cases with marrow involvement by DLBCL. In clinical practice, routine BMAB may no longer be necessary for all patients with DLBCL who are staged by PET-CT, unless the results would change both staging and therapy. The prognostic implication of BMI identified by PET-CT compared with BMAB remains unknown. Whether a PET-CT precludes the need for a BMAB in patients with DLBCL remains to be evaluated in a prospective study.
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Affiliation(s)
- Prakash Vishnu
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Centre, Seattle, WA
| | - Andrew Wingerson
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Centre, Seattle, WA
| | - Marie Lee
- Department of Radiology, Virginia Mason Medical Center, Seattle, WA
| | - Margaret T Mandelson
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Centre, Seattle, WA
| | - David M Aboulafia
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Centre, Seattle, WA; Division of Hematology, University of Washington, Seattle, WA.
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England CG, Rui L, Cai W. Lymphoma: current status of clinical and preclinical imaging with radiolabeled antibodies. Eur J Nucl Med Mol Imaging 2016; 44:517-532. [PMID: 27844106 DOI: 10.1007/s00259-016-3560-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/25/2016] [Indexed: 12/22/2022]
Abstract
Lymphoma is a complex disease that arises from cells of the immune system with an intricate pathology. While lymphoma may be classified as Hodgkin or non-Hodgkin, each type of tumor is genetically and phenotypically different and highly invasive tissue biopsies are the only method to investigate these differences. Noninvasive imaging strategies, such as immunoPET, can provide a vital insight into disease staging, monitoring treatment response in patients, and dose planning in radioimmunotherapy. ImmunoPET imaging with radiolabeled antibody-based tracers may also assist physicians in optimizing treatment strategies and enhancing patient stratification. Currently, there are two common biomarkers for molecular imaging of lymphoma, CD20 and CD30, both of which have been considered for investigation in preclinical imaging studies. In this review, we examine the current status of both preclinical and clinical imaging of lymphoma using radiolabeled antibodies. Additionally, we briefly investigate the role of radiolabeled antibodies in lymphoma therapy. As radiolabeled antibodies play critical roles in both imaging and therapy of lymphoma, the development of novel antibodies and the discovery of new biomarkers may greatly affect lymphoma imaging and therapy in the future.
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Affiliation(s)
- Christopher G England
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI, 53705-2275, USA.
| | - Lixin Rui
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Weibo Cai
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI, 53705-2275, USA.
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Room 7137, 1111 Highland Ave, Madison, WI, 53705-2275, USA.
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Valls L, Badve C, Avril S, Herrmann K, Faulhaber P, O'Donnell J, Avril N. FDG-PET imaging in hematological malignancies. Blood Rev 2016; 30:317-31. [PMID: 27090170 PMCID: PMC5298348 DOI: 10.1016/j.blre.2016.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/12/2016] [Accepted: 02/19/2016] [Indexed: 12/12/2022]
Abstract
The majority of aggressive lymphomas is characterized by an up regulated glycolytic activity, which enables the visualization by F-18 FDG-PET/CT. One-stop hybrid FDG-PET/CT combines the functional and morphologic information, outperforming both, CT and FDG-PET as separate imaging modalities. This has resulted in several recommendations using FDG-PET/CT for staging, restaging, monitoring during therapy, and assessment of treatment response as well as identification of malignant transformation. FDG-PET/CT may obviate the need for a bone marrow biopsy in patients with Hodgkin's lymphoma and diffuse large B cell lymphoma. FDG-PET/CT response assessment is recommended for FDG-avid lymphomas, whereas CT-based response evaluation remains important in lymphomas with low or variable FDG avidity. The treatment induced change in metabolic activity allows for assessment of response after completion of therapy as well as prediction of outcome early during therapy. The five-point scale Deauville Criteria allows the assessment of treatment response based on visual FDG-PET analysis. Although the use of FDG-PET/CT for prediction of therapeutic response is promising it should only be conducted in the context of clinical trials. Surveillance FDG-PET/CT after complete remission is discouraged due to the relative high number of false-positive findings, which in turn may result in further unnecessary investigations. Future directions include the use of new PET tracers such as F-18 fluorothymidine (FLT), a surrogate biomarker of cellular proliferation and Ga-68 CXCR4, a chemokine receptor imaging biomarker as well as innovative digital PET/CT and PET/MRI techniques.
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Affiliation(s)
- L Valls
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - C Badve
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - S Avril
- Department of Pathology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - K Herrmann
- Department of Nuclear Medicine, University Hospital Würzburg, 97080 Würzburg, Germany; Ahmanson Translational Imaging Division, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7370, USA
| | - P Faulhaber
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - J O'Donnell
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - N Avril
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA.
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Park SH, Lee JJ, Kim HO, Lee DY, Suh C, Jung HY, Choi KD, Kim DH, Huh J, Ryu JS. 18F-Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography in mucosa-associated lymphoid tissue lymphoma: variation in 18F-FDG avidity according to site involvement. Leuk Lymphoma 2015; 56:3288-94. [PMID: 25804932 DOI: 10.3109/10428194.2015.1030640] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to determine the 18F-FDG avidity of MALT lymphoma and the additional utility of 18F-FDG PET/CT in MALT lymphoma staging. Pretreatment 18F-FDG PET/CT scans of 222 patients with 227 MALT lymphoma lesions were retrospectively analyzed. 18F-FDG avidity of lesions was noted in 28%. The proportion was lower for gastric MALT lymphomas than for non-gastric lesions (9% vs. 60%, p<0.0001) and higher for mass-forming lesions than for superficial lesions (82% vs. 2%, p<0.0001). 18F-FDG PET/CT showed the presence of additional lesions in 23 patients: four of six true-positive lesions had 18F-FDG avid primary lesions, and 15 of 17 false-positive lesions had 18F-FDG-non avid lesions. 18F-FDG avidity differed according to the location and gross morphologic characteristics of the MALT lymphoma. Most gastric MALT lymphomas were superficial and had low 18F-FDG avidity. For staging, 18F-FDG PET/CT can be helpful mainly for 18F-FDG avid primary MALT lymphomas.
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Affiliation(s)
- Seol Hoon Park
- a Department of Nuclear Medicine , Ulsan University Hospital , Seoul , Republic of Korea
| | - Jong Jin Lee
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Hye Ok Kim
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Dong Yun Lee
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Cheolwon Suh
- c Department of Internal Medicine and Oncology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Hwoon-Yong Jung
- d Department of Internal Medicine and Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Kee Don Choi
- d Department of Internal Medicine and Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Do Hoon Kim
- d Department of Internal Medicine and Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jooryung Huh
- e Department of Pathology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jin-Sook Ryu
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
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Dorius TH, Bennion NR, Armitage JO. PET-directed therapy in Hodgkin lymphoma: Ready for prime time? Expert Rev Anticancer Ther 2015; 15:1431-41. [PMID: 26472333 DOI: 10.1586/14737140.2015.1096202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advances in chemotherapy and radiation therapy have allowed the vast majority of patients with Hodgkin lymphoma to be cured, but some of these patients develop treatment-related complications, including second malignancies, cardiovascular disease, and thyroid disease. Efforts to decrease exposure of patients to more chemotherapy or radiation therapy than is necessary to cure their disease have led to a trend toward shortened treatment regimens in patients with low-risk disease. Predicting which patients will relapse, and therefore might benefit from a more intense treatment regimen, has been a clinical challenge. PET has emerged as a useful modality in the diagnosis and management of Hodgkin lymphoma, and has been studied as a potential tool to help the oncologist to utilize the optimal chemotherapy and radiation therapy regimen for each patient.
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Affiliation(s)
- Timothy H Dorius
- a 1 Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, USA
| | - Nathan R Bennion
- b 2 Radiation Oncology Department, University of Nebraska Medical Center, Omaha, USA
| | - James O Armitage
- a 1 Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, USA
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17
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Swinnen LJ, Li H, Quon A, Gascoyne R, Hong F, Ranheim EA, Habermann TM, Kahl BS, Horning SJ, Advani RH. Response-adapted therapy for aggressive non-Hodgkin's lymphomas based on early [18F] FDG-PET scanning: ECOG-ACRIN Cancer Research Group study (E3404). Br J Haematol 2015; 170:56-65. [PMID: 25823885 DOI: 10.1111/bjh.13389] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/04/2015] [Indexed: 01/23/2023]
Abstract
A persistently positive positron emission tomography (PET) scan during therapy for diffuse large B-cell lymphoma (DLBCL) is predictive of treatment failure. A response-adapted strategy consisting of an early treatment change to four cycles of R-ICE (rituximab, ifosfamide, carboplatin, etoposide) was studied in the Eastern Cooperative Oncology Group E3404 trial. Previously untreated patients with DLBCL stage III, IV, or bulky II, were eligible. PET scan was performed after three cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and scored as positive or negative by central review during the fourth cycle. PET-positive patients received four cycles of R-ICE, PET-negative patients received two more cycles of R-CHOP. A ≥ 45% 2-year progression-free survival (PFS) for mid-treatment PET-positive patients was viewed as promising. Of 74 patients, 16% were PET positive, 79% negative. The PET positivity rate was much lower than the 33% expected. Two-year PFS was 70%; 42% [90% confidence interval (CI), 19-63%] for PET-positives and 76% (90% CI 65-84%) for PET-negatives. Three-year overall survival (OS) was 69% (90% CI 43-85%) and 93% (90% CI 86-97%) for PET-positive and -negative cases, respectively. The 2-year PFS for mid-treatment PET-positive patients intensified to R-ICE was 42%, with a wide confidence interval due to the low proportion of positive mid-treatment PET scans. Treatment modification based on early PET scanning should remain confined to clinical trials.
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Affiliation(s)
- Lode J Swinnen
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Hailun Li
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Andrew Quon
- Stanford University Medical Center, Stanford, CA, USA
| | - Randy Gascoyne
- British Columbia Cancer Agency, Centre for Lymphoid Cancer, Vancouver, BC, Canada
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Yamakawa H, Yoshida M, Yabe M, Baba E, Ishikawa T, Takagi M, Katagi H, Kuwano K. Useful Strategy of Pulmonary Microvascular Cytology in the Early Diagnosis of Intravascular Large B-cell Lymphoma in a Patient with Hypoxemia: A Case Report and Literature Review. Intern Med 2015; 54:1403-6. [PMID: 26027996 DOI: 10.2169/internalmedicine.54.4379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare extranodal lymphoma characterized by the presence of tumor cells within blood vessels, and it is considered to be a subtype of diffuse large B-cell lymphoma. We report a case of IVLBCL presenting as progressive hypoxemia. In this case, a definitive diagnosis could not be achieved by repeated transbronchial lung biopsy, a bone marrow biopsy, and a random skin biopsy, and the ultimate diagnosis was made on the basis of a pulmonary microvascular cytology (PMC) examination. Therefore, PMC is considered to be a useful strategy for the diagnosis of IVLBCL, particularly in this critically ill patient suffering from hypoxemia.
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Affiliation(s)
- Hideaki Yamakawa
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Kashiwa Hospital, Japan
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20
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Ito K, Minamimoto R, Yamashita H, Yoshida S, Morooka M, Okasaki M, Mimori A, Kubota K. Evaluation of Wegener's granulomatosis using 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Ann Nucl Med 2012; 27:209-16. [PMID: 23242952 PMCID: PMC3618408 DOI: 10.1007/s12149-012-0675-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 12/04/2012] [Indexed: 12/21/2022]
Abstract
Objective Wegener’s granulomatosis (WG) is a relatively rare disease characterized by granulomatous necrotizing vasculitis that primarily involves small- and medium-sized vessels. Systemic findings observed on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) have not been well reported. The purpose of this study was to evaluate the FDG PET/CT imaging in the diagnosis and follow-up of patients with WG. Materials and methods Thirteen FDG PET/CT images obtained for 8 patients (2 men and 6 women) with WG were retrospectively analyzed. Of these, 6 were performed for diagnosis, 2 for restaging and follow-up, and 5 for assessment of treatment efficacy. Maximum standardized uptake values (max SUVs) and visual analyses were used to interpret the FDG PET/CT images. In addition, nonenhanced CT findings obtained during FDG PET/CT were described. Results WG lesions of the upper respiratory tract and lung were more clearly detected by FDG PET/CT fusion imaging than by nonenhanced CT alone, and all of the active lesions showed decreased FDG uptake after treatment. In addition, FDG PET/CT can provide complementary information to indicate biopsy site based on FDG uptakes. Conclusions FDG PET/CT is a feasible modality for evaluating lesion activities, therapeutic monitoring, and follow-up of WG. Furthermore, biopsy sites of WG lesions may be determined by FDG PET/CT.
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Affiliation(s)
- Kimiteru Ito
- Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
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Lin TL, Kuo MC, Shih LY, Dunn P, Wang PN, Wu JH, Tang TC, Chang H, Hung YS, Lu SC. Value of surveillance computed tomography in the follow-up of diffuse large B-cell and follicular lymphomas. Ann Hematol 2012; 91:1741-5. [DOI: 10.1007/s00277-012-1508-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
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Shelly MJ, McDermott S, O'Connor OJ, Blake MA. 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Management of Aggressive Non-Hodgkin's B-Cell Lymphoma. ISRN HEMATOLOGY 2012; 2012:456706. [PMID: 22474590 PMCID: PMC3313577 DOI: 10.5402/2012/456706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/29/2011] [Indexed: 12/13/2022]
Abstract
18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma. The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone. The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.
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Affiliation(s)
- M J Shelly
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Underperformance of gallium-67 scan is greater in relapse than in initial staging, compared with FDG PET. Clin Nucl Med 2011; 36:867-71. [PMID: 21892035 DOI: 10.1097/rlu.0b013e318219b337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the performance of gallium-67 scan (GS) and F-18 fluorodeoxyglucose (FDG) PET scan in lymphoma staging and recurrence detection by comparing the 2 imaging studies in the same patient. MATERIALS AND METHODS A total of 42 patients from the period between July 2002 and May 2006 were included in this study. Of the 42 patients, 6 had Hodgkin disease and 36 had non-Hodgkin lymphomas. All of them underwent one or more FDG PET scans and also underwent corresponding GS performed within 7 days of FDG PET, for staging or detection of lymphoma recurrence. Among the non-Hodgkin lymphoma cases, 18 were diffuse large B-cell lymphoma, 10 were follicular center cell lymphoma, and 8 were of other types. Of the total 46 pairs of imaging performed in these 42 patients, 27 were for staging, and 19 for restaging after recurrence. RESULTS In all these studies, FDG PET detected 230 lesion sites, whereas GS detected 85 lesion sites. All of the lesions detected by GS were noted on FDG PET, whereas GS detected only 37.0% of the lesions detected by FDG PET. Among the 27 studies for staging, FDG PET detected 120 lesions, whereas GS detected 68 lesions (56.7%). In the 19 images taken for relapse, FDG PET detected 110 lesions, whereas GS detected only 17 (15.5%). CONCLUSIONS FDG PET is superior to GS in staging and detecting all types of lymphoma. The difference is notably more significant in recurrence detection.
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David Ladrón de Guevara H. PET/CT en oncología pediátrica. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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[Non-Hodgkin's lymphoma staging with PET-CT scan]. Med Clin (Barc) 2011; 137:402-4. [PMID: 21696781 DOI: 10.1016/j.medcli.2011.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/06/2011] [Accepted: 04/07/2011] [Indexed: 01/05/2023]
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Abstract
18-F-fluorodeoxyglucose (FDG) –positron emission tomography (PET), and more recently PET/computed tomography (CT), is the most sensitive and specific imaging technique currently available for patients with lymphoma. Nevertheless, despite being increasingly used in pretreatment assessment, midtreatment evaluation of response, post-treatment restaging, and surveillance during follow-up of patients with lymphoma, its impact on clinical outcome in most clinical situations remains to be confirmed. PET/CT provides its greatest clinical benefit in the post-treatment evaluation of Hodgkin's lymphoma and diffuse large B-cell lymphoma; however, the role of metabolic imaging in other indications and in other histologies remains to be demonstrated. Ongoing risk-adapted studies will hopefully provide evidence for clinical improvement on the basis of altering treatment as a result of interim PET results. Efforts are ongoing to better standardize the conduct and interpretation of FDG-PET scans. FDG-PET has the potential to improve lymphoma patient management; however, its usefulness will likely vary by histology, stage, therapy, and clinical setting.
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Kostakoglu L. PET-CT Imaging of Lymphoma. CLINICAL PET-CT IN RADIOLOGY 2011. [PMCID: PMC7120336 DOI: 10.1007/978-0-387-48902-5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PET-CT is now the mainstay for imaging lymphoma patients. The complimentary nature of the metabolic and anatomic information provided by a PET-CT examination has become an essential component of patient management, complimenting clinical and laboratory criteria used in staging, restaging, and therapy monitoring. The nature of a particular lymphoma subtype and the patient’s clinical presentation will determine the extent PET-CT imaging is best employed in a particular patient’s management.
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Revisiting gallium-67 imaging: investigation of the energy photopeaks. Nucl Med Commun 2010; 31:1068-74. [PMID: 20881893 DOI: 10.1097/mnm.0b013e3283400255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ga-67 has multiple energy emissions of different abundances and the quality of images is affected by these inhomogeneous energy distributions. Thus the purpose of this study was to investigate whether two or three energy peaks of Ga-67 would be the most appropriate setting in terms of γ-camera performance and image quality measurements. MATERIALS AND METHODS The physical performance of the γ-camera using Ga-67 has been tested; in particular, the effect of different gallium energy settings (two vs. three energy photopeaks) on the extrinsic and intrinsic uniformity and resolution of the γ-camera. The multicontrast/resolution phantom (OPRAXMEDICAL model 74-345) has been used to compare the two energy settings. The average contrast of the lesions and the contrast-to-noise ratio were measured and the significance of the result was determined using the paired Student's t-test. To test the effects of size and contrast on the detectability of defects, contrast detail curves have been generated for both the acquisition energy settings. For the optimization of the energy window, multiple static liver phantom images were acquired using the dual-energy photopeak acquisition method. However, each image was taken at different symmetric energy window combinations and the window settings were (5, 10, 15, and 20%) for 92 and 184 keV, respectively. RESULTS For the two energy window acquisitions, the intrinsic uniformity calculated by the integral and differential equations for the useful field of view was 2.26 and 1.39%, respectively. However, for the three energy windows, the values were 3.04 and 1.81%, respectively. The integral and differential values for the dual-energy flood images were 10.97 and 3.75%, respectively, whereas the integral and differential values for the triple-energy flood images were 13.3 and 4.13%, respectively. A slight improvement in the system's intrinsic spatial resolution was observed in the dual-window setting with a full width at half maximum of 9.24 mm compared with 10.42 mm for the triple-energy acquisition. The full width at half maximum was not drastically increased in the three window acquisitions, but the full width at tenth maximum was found to be larger. The two energy acquisitions yielded a significant improvement by 20.5 and 22% in the mean contrast of the planar images of the phantom filled with 2 and 5 mCi of Ga-67, respectively (P value <0.01). Single-photon emission computed tomography images acquired for the liver phantom showed an improvement in the mean contrast by 29 and 27.6% using two windows (P<0.001) for 2 and 5 mCi activity concentration, respectively. Unlike planar imaging, single-photon emission computed tomography images yielded a 45% increase in the contrast-to-noise ratio using the two window acquisitions with a mean CNR of 5.24±3.47 and 2.9±2.23 for two and three windows respectively; P value less than 0.05. The contrast detail curves showed better detectibality for small-sized lesions and lower contrast when using dual-energy settings. The best contrast, on average, was achieved using 10% for 92 keV and 5, 10, 15, and 20% for 184 keV, respectively, and it was improved by 16, 24, and 35% compared with other settings. CONCLUSION A significant improvement in image quality can be achieved by simply applying different window widths over the different photopeaks. Our results indicated that two photopeaks with optimized window widths can significantly outperform three windows in terms of spatial and contrast resolution and lesion detectability with a relatively negligible reduction of count sensitivity.
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Ito K, Shida Y, Kubota K, Morooka M, Aruga T, Itami J, Matsuda H. The management of pyothorax-associated lymphoma using 18F-FDG PET/CT. Ann Nucl Med 2010; 24:649-54. [DOI: 10.1007/s12149-010-0408-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 07/02/2010] [Indexed: 01/31/2023]
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Okada M, Sato N, Ishii K, Matsumura K, Hosono M, Murakami T. FDG PET/CT versus CT, MR Imaging, and67Ga Scintigraphy in the Posttherapy Evaluation of Malignant Lymphoma. Radiographics 2010; 30:939-57. [DOI: 10.1148/rg.304095150] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Shulkin BL, Goodin GS, McCarville MB, Kaste SC, Krasin MJ, Hudson MM, Metzger M. Bone and [18F]fluorodeoxyglucose positron-emission tomography/computed tomography scanning for the assessment of osseous involvement in Hodgkin lymphoma in children and young adults. Leuk Lymphoma 2010; 50:1794-802. [PMID: 19883309 DOI: 10.3109/10428190903189027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To compare FDG PET/CT and bone scans for the management of young patients with Hodgkin lymphoma (HL). Eighteen patients, aged 7-24 years, with HL received bone and PET scans within 2 weeks--11 at diagnosis and 7 at known or suspected relapse (37 scan pairs). In six patients (nine scan pairs) both studies were positive. In four patients (five scan pairs), PET showed involvement not evident on bone scan. In four patients (four scan pairs), one of the studies was equivocal and the other negative. In one patient, bone scan showed abnormal uptake in a benign lesion. In nine patients (19 scan pairs), both studies were negative. All osseous metastases identified on bone scan were present on PET. Many additional sites of bony involvement were identified on PET. The bone scan may be safely eliminated.
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Affiliation(s)
- Barry L Shulkin
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Riad R, Omar W, Kotb M, Hafez M, Sidhom I, Zamzam M, Zaky I, Abdel-Dayem H. Role of PET/CT in malignant pediatric lymphoma. Eur J Nucl Med Mol Imaging 2009; 37:319-29. [PMID: 19756591 DOI: 10.1007/s00259-009-1276-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 08/24/2009] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Malignant pediatric lymphoma accounts for 10-15% of all pediatric cancers, (representing 2-3% of all malignancies), with a peak incidence between 5-9 years. Chemotherapy is usually the first and most common mode of treatment. The choice of treatment and prediction of prognosis depend on the histological type of tumor, initial staging, evaluating treatment response, and detection of early recurrence. Conventional imaging modalities have many limitations. PET/CT is more accurate, however so far the literature lacks the results of a large group of patients. AIM OF STUDY To report the role of PET/CT in the above-mentioned objectives at the newly established Children's Cancer Hospital in Cairo, Egypt, which is one of the busiest dedicated pediatric oncology centers of such purposes in the world. All findings were proven by histopathology, clinically, and by clinical follow-up. PATIENT POPULATION A total of 152 patients (35 girls and 117 boys) with histologically proven malignant lymphoma (117 HD, 35 NHL) were included in this study. They were divided into four groups. Group I: 41 patients for initial staging. Group II: 51 patients for evaluating early treatment response after two to three cycles of chemotherapy. Group III: 42 patients for evaluating treatment response 4-8 weeks after the end of their treatment. Group IV: 18 patients evaluated for long-term follow-up. Results of PET/CT were compared with the other conventional imaging modalities (CIM). RESULTS The sensitivity, specificity, accuracy, and positive and negative predictive values of PET/CT and CIM were as follows: In Group I: PET/CT modified staging and treatment in 11 out of 41 cases (26.8%), upstaged 5(12.2%) patients and down-staged six (14.6%) patients. Group II: 100%, 97.7%, 98%, 85.7%, 100%, respectively, for PET/CT and 83%, 66.6%, 68.6%, 25%, 96.7% for CIM respectively Group III: At the end of chemotherapy 100%, 90.9%, 92.8%, 75%, 100%, respectively, for PET/CT and 55.5%, 57.5%, 57.1%, 26.3%, 82.6% for CIM, respectively. Group IV: For long-term follow-up, all the parameters scored 100% for PET/CT, 100%, 38.4%, 72.2%, 50%, 100% for CIM, respectively. CONCLUSION PET/CT in pediatric lymphoma is more accurate than CIM. We recommend that it should be the first modality for all purposes in initial staging, evaluating treatment response and follow-up.
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Affiliation(s)
- Raef Riad
- Department of Nuclear Medicine, Children's Cancer Hospital, Cairo University, Cairo, Egypt
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Alinari L, Ambrosini V, Castellucci P, Tani M, Stefoni V, Nanni C, Farsad M, Rubello D, Franchi R, Zinzani PL, Fanti S. Discordant response to chemotherapy: An unusual patternof fluoro-deoxy-d-glucose uptake in heavily pre-treated lymphoma patients. Leuk Lymphoma 2009; 47:1048-52. [PMID: 16840196 DOI: 10.1080/10428190600555785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In recent years a number of studies have been published showing strong value of positron emission tomography using 18-Fluorine 2-fluoro-deoxy-D-glucose (FDG-PET) in term of diagnosis, response to treatment, disease recurrence and prognostic indicator in early restaging. This study observed 17 patients who presented contemporary disease progression in some localizations as well as regression in others (PROG + REG pattern); this investigation assessed that this unusual pattern of FDG uptake lead to an unfavorable prognosis. Among 1280 FDG-PET scans performed between August 2003 and December 2004 on patients affected by lymphoma with suspected recurrence, attention was focused on 17 patients presenting a PROG + REG pattern. At follow-up (4 months) only 1/17 (6%) patient was in complete remission after salvage therapy, while 6/17 (35%) had stable disease and 10/17 (59%) had rapid progression of the disease. This study further strengthens the role of FDG-PET in lymphoma patients follow-up, as it can provide useful information to better differentiate those cases who may benefit from conventional treatments from others in whom additional treatment would provide avoidable toxicity.
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Affiliation(s)
- Lapo Alinari
- Istituto di Ematologia ed Oncologia Medica Seràgnoli, Italy
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Bishu S, Quigley JM, Schmitz J, Bishu SR, Stemm RA, Olsasky SM, Paknikar S, Holdeman KH, Armitage JO, Hankins JH. F-18-fluoro-deoxy-glucose positron emission tomography in the assessment of peripheral T-cell lymphomas. Leuk Lymphoma 2009; 48:1531-8. [PMID: 17701584 DOI: 10.1080/10428190701344915] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
F-18-fluoro-deoxy-glucose positron emission tomography (PET) is highly sensitive and specific in the imaging of B-cell lymphomas. In contrast, its utility in the diagnostic evaluation of T-cell lymphomas is less defined. In this article, we present our finding utilizing PET in peripheral T-cell lymphomas (PTCL). A retrospective review of patients who underwent PET examinations at our institution produced 24 PET examinations among patients with PTCL. A lesion-based analysis was undertaken to evaluate the diagnostic accuracy of PET in PTCL. PET findings were compared with a standard of reference and sensitivity, specificity, positive and negative predictive values were calculated. PET had an overall sensitivity of 86% and specificity of 100%. PET had high sensitivity (95%) at nodal and non-cutaneous extra-nodal sites and poor sensitivity (13%) at cutaneous sites. The mean SUV of abnormal foci in anaplastic large cell lymphoma was 11 mg/ml (range: 3 - 40), and PTCL-unclassified was 8 mg/ml (range: 1 - 23).
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Disease-Free Survival
- Female
- Fluorodeoxyglucose F18
- Humans
- Lymphoma, T-Cell, Cutaneous/diagnostic imaging
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Peripheral/diagnostic imaging
- Lymphoma, T-Cell, Peripheral/drug therapy
- Male
- Middle Aged
- Neoplasm Staging
- Positron-Emission Tomography
- Radiopharmaceuticals
- Retrospective Studies
- Sensitivity and Specificity
- Survival Rate
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- S Bishu
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Bishu S, Quigley JM, Bishu SR, Olsasky SM, Stem RA, Shostrom VK, Holdeman KP, Paknikar S, Armitage JO, Hankins JH. Predictive value and diagnostic accuracy of F-18-fluoro-deoxy-glucose positron emission tomography treated grade 1 and 2 follicular lymphoma. Leuk Lymphoma 2009; 48:1548-55. [PMID: 17701586 DOI: 10.1080/10428190701422059] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
F-18-fluoro-deoxy-glucose positron emission tomography (PET) is a powerful tool for the imaging of aggressive B-cell lymphomas. In contrast, there is relatively little data on PET in follicular lymphoma grade 1 (FL-1) and grade 2 (FL-2). In this manuscript, we present our findings utilizing PET in treated FL-1 and FL-2. A retrospective review of patients who underwent PET examinations at our institution produced 95 PET examinations among 31 patients with FL-1 and FL-2. PET was obtained at initial staging, mid-induction and post-treatment. Results were compared with clinical follow-up. PET had high sensitivity (95%) and specificity (88%) for lesion detection in treated FL-1 and FL-2. Abnormal foci in FL-1 and FL-2 had similar intensities. Post-induction PET positive patients had shorter mean progression free survivals compared with PET negative patients (p-value < or =0.001), post-salvage PET positive trended toward shorter mean response duration compared with negative patients (p-value: 0.09). Our results indicate that PET is accurate in the diagnostic assessment of treated FL-1 and FL-2 and, post-treatment PET positive patients are likely to relapse prior to PET negative patients.
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Affiliation(s)
- Shrinivas Bishu
- National Institute of Mental Health, National Institutes of Health, MD, USA.
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Hicks RJ. Ga-67 SPECT: ave atque vale! Or have we bid a premature farewell to a trusted friend? Leuk Lymphoma 2009; 47:2440-2. [PMID: 17169787 DOI: 10.1080/10428190600989380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rodney J Hicks
- The Peter MacCallum Cancer Centre, and The University of Melbourne, Australia.
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Abstract
PET has become a cornerstone procedure in modern lymphoma management. This paper reviews, from a clinical point of view, the evidence for using PET in the different subtypes of lymphoma and the different steps of their management. The reader is given an overview of the current PET-based interventional lymphoma trials and an insight into possible future developments in the field, including new PET tracers.
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Affiliation(s)
- Martin Hutchings
- Departments of Oncology and Haematology, Rigshospitalet, The Finsen Centre-Copenhagen University Hospital, 9 Blegdamsvej, Copenhagen Ø, Denmark.
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Abstract
Hodgkin's lymphoma is one of the most curable malignancies today. But treatment is associated with significant toxicity. The objective of high-quality management is to minimize treatment exposure while maximizing cure of disease. Principles of cancer staging and patient's assessment taxonomy are important to improve communication. An orderly patient evaluation and systematic recording of disease extent using the Ann Arbor classification forms the basis for treatment decision, response assessment, and clinical trials. The practice of staging in Hodgkin's lymphoma evolved over the past 40 years from clinical examination and plain imaging to modern anatomic and functional imaging. Although useful in the past, staging laparotomy, lymphangiograms, and Gallium scintigraphy have now been abandoned. Computerized tomography combined with 2-[18F]fluoro-2-deoxyglucose-positron emission tomography form the basis for anatomic disease extent assessment. Although patients' evaluation and staging at diagnosis are important, the management of Hodgkin's lymphoma involves a complex series of algorithms requiring interim and overall response assessment, careful follow-up, repeat assessment, and salvage management of recurrent disease.
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Trost O, Charon-Barra C, Soichot P, Moreau G, Trouilloud P, Malka G. Lymphome B mandibulaire isolé révélé par une anesthésie du nerf alvéolaire inférieur. ACTA ACUST UNITED AC 2009; 110:101-4. [DOI: 10.1016/j.stomax.2008.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 10/12/2008] [Accepted: 11/13/2008] [Indexed: 10/21/2022]
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PET-CT in radiation oncology: the impact on diagnosis, treatment planning, and assessment of treatment response. Am J Clin Oncol 2008; 31:352-62. [PMID: 18845994 DOI: 10.1097/coc.0b013e318162f150] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To review the role of hybrid positron emission tomography (PET)-computed tomography (CT) systems in the design and management of cancer patients in the modern radiation oncology practice. PET is co-registered with CT and incorporated into a systematic approach to the staging, management, and assessment of response and surveillance of a variety of oncologic diagnoses. METHODS A review of the literature of functional imaging such as PET-CT in staging, treatment plan design, assessment of response and detection of recurrence for tumors involving the head and neck, lung, esophagus, rectum amongst others. RESULTS PET and PET-CT offer significant advantages which include more accurate staging which often results in management changes in roughly one-third of patients across a number of disease site. More accurate target definition may augment highly conformal radiation treatment plans using intensity-modulated radiation therapy and stereotactic radiosurgery and radiotherapy. CONCLUSION The emerging data appears to suggest the functional imaging may be a more useful tool to evaluate the therapeutic effect of treatment, detect early failures and prognosticate long-term outcome.
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Gallardo F, Pujol RM. Subcutaneous Panniculitic-Like T-Cell Lymphoma and Other Primary Cutaneous Lymphomas with Prominent Subcutaneous Tissue Involvement. Dermatol Clin 2008; 26:529-40, viii. [DOI: 10.1016/j.det.2008.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Cheson BD. Staging and Evaluation of the Patient with Lymphoma. Hematol Oncol Clin North Am 2008; 22:825-37, vii-viii. [DOI: 10.1016/j.hoc.2008.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Successful treatment of Hodgkin lymphomas and non-Hodgkin lymphomas depends on accurate staging and prognostic estimations, as well as evaluation of response to therapy as early after initiation as possible. We focus on several aspects of molecular imaging and therapy that affect the management of patients who have lymphoma. First, we review prior use of gallium-67 citrate for evaluation of lymphoma patients, mainly from a historical perspective, since it was the mainstream lymphoma functional imaging tracer for decades. Next, we review current clinical uses of 18F Fluoro-2-Deoxyglucose (18F FDG) PET and PET/CT for evaluation of lymphoma patients and use of radioimmunotherapy in lymphoma. Finally, we discuss advances in molecular imaging that may herald the next generation of PET radiotracers after 18F FDG.
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Allen-Auerbach M, de Vos S, Czernin J. The impact of fluorodeoxyglucose-positron emission tomography in primary staging and patient management in lymphoma patients. Radiol Clin North Am 2008; 46:199-211, vii. [PMID: 18619376 DOI: 10.1016/j.rcl.2008.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fully diagnostic positron emission tomography (PET)/CT scans acquired during oral and intravenous contrast can be provided to patients and referring physicians in a single imaging session. Although FDG uptake varies, most low-grade lymphomas exhibit sufficient FDG avidity to also be staged reliably with FDG PET/CT. PET/CT imaging is more accurate for lymphoma staging than PET or CT alone and has substantial impact on patient management. This accurate whole-body glucose metabolic survey should serve as the baseline for subsequent treatment response evaluations. PET/CT has evolved to become the modality of choice for staging of nodal and extranodal lymphoma, for assessing therapeutic response, and for establishing patient prognosis.
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Affiliation(s)
- Martin Allen-Auerbach
- Department of Molecular and Medical Pharmacology, Ahmanson Biological Imaging Center/Nuclear Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095-6948, USA
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Roh JL, Kim JS, Lee JH, Cho KJ, Choi SH, Nam SY, Kim SY. Utility of combined (18)F-fluorodeoxyglucose-positron emission tomography and computed tomography in patients with cervical metastases from unknown primary tumors. Oral Oncol 2008; 45:218-24. [PMID: 18804404 DOI: 10.1016/j.oraloncology.2008.05.010] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 05/21/2008] [Accepted: 05/22/2008] [Indexed: 12/01/2022]
Abstract
(18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) has been reported to identify primary tumors in patients with cervical metastases from cancer of unknown primary (CUP). However, few reports have assessed the use of combined FDG-PET/computed tomography (CT) in this setting. We therefore examined the utility of combined FDG-PET/CT in the detection of primary tumors and unrecognized metastases in these patients. Patients with previously untreated CUPs underwent head and neck CT and whole-body FDG-PET/CT before panendoscopy and guided biopsy. The diagnostic accuracy of CT and FDG-PET/CT in detecting primary tumors and cervical metastases was compared with that of histopathology. The ability of FDG-PET/CT to detect distant metastases was also tested. Of the 44 eligible patients, 16 had occult primary tumors in the head and neck. FDG-PET/CT was significantly more sensitive than CT for detecting primary tumors (87.5% vs. 43.7%, P=.016), but their specificity did not differ (82.1% vs. 89.3%, P=.500). Thirty-four of 44 patients underwent neck dissection; 67 of 182 dissected cervical levels had metastatic nodal diseases. On a level-by-level basis, FDG-PET/CT was significantly more sensitive than CT (94.0% vs. 71.6%, P<.001), but the two methods were equally specific (94.8% vs. 96.5%). FDG-PET/CT correctly detected distant metastases in 6 of 6 patients. Combined FDG-PET/CT is a useful screening method for primary tumor detection, accurate nodal staging, and distant metastases in patients with CUPs.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Antonelli A, Fazzi P, Fallahi P, Ferrari SM, Grosso M, Boni G, Ferrannini E, Mariani G. Thyroid uptake of 67Ga-citrate is associated with thyroid autoimmunity and hypothyroidism in patients with sarcoidosis. Eur J Nucl Med Mol Imaging 2008; 36:137-43. [PMID: 18828014 DOI: 10.1007/s00259-008-0932-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 08/09/2008] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the association of gallium-67 ((67)Ga)-citrate thyroid uptake with the presence of thyroid disorders in patients with sarcoidosis (S patients). METHODS Eighty-four S patients were evaluated by a complete thyroid work-up (neck ultrasound, circulating thyroid hormones and anti-thyroid antibodies, fine-needle aspiration). RESULTS In S patients with (67)Ga thyroid uptake (respect those without): serum thyroid-stimulating hormone, the titre of anti-thyroid peroxidase (AbTPO) and/or anti-thyroglobulin antibodies (AbTg), and the prevalence of S patients with hypothyroidism or with positive AbTg or AbTPO was significantly higher; a thyroid hypoechoic pattern was more frequent. The prevalence of thyroid nodules was not significantly different between the two groups. Two cases of papillary thyroid cancer were observed in S patients without (67)Ga thyroid uptake, whilst no case in those with (67)Ga thyroid uptake. CONCLUSIONS (67)Ga thyroid uptake is associated with the presence of aggressive autoimmune thyroiditis and hypothyroidism in S patients; thyroid function and ultrasonography should be performed in the presence of (67)Ga thyroid uptake.
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Affiliation(s)
- Alessandro Antonelli
- Metabolism Unit, Department of Internal Medicine, University of Pisa and CNR Institute of Clinical Physiology, Via Roma, 67, 56126, Pisa, Italy.
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Hines-Thomas M, Kaste SC, Hudson MM, Howard SC, Liu WA, Wu J, Kun LE, Shulkin BL, Krasin MJ, Metzger ML. Comparison of gallium and PET scans at diagnosis and follow-up of pediatric patients with Hodgkin lymphoma. Pediatr Blood Cancer 2008; 51:198-203. [PMID: 18428430 DOI: 10.1002/pbc.21574] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Positron emission tomography (PET) and gallium scans facilitate diagnosis and staging, evaluation of response to therapy, and monitoring for relapse in Hodgkin lymphoma (HL), but have not been compared in pediatric HL. PROCEDURE We performed concurrent PET and gallium scans on 44 pediatric HL patients at diagnosis, early response, off chemotherapy, and off-therapy evaluations. PET and gallium scans were compared to each other and to computed tomography (CT) alone to determine whether either modality led to a change in stage or modified the results of the early response evaluation, which was used to determine the radiation dose. RESULTS PET upstaged four patients at diagnosis (2 from stage I to II, one II to III, and one III to IV), but did not lead to a change in therapy in any of them. It changed response category in two patients at early response evaluation, leading to a change in radiation dose for 1 patient (25.5 Gy instead of 15 Gy to the spleen). Gallium did not change the stage of treatment for any patient. The negative predictive values for eventual lymphoma relapse of PET and gallium scans at off therapy were 89% and 83%, respectively; the positive predictive value of PET at off therapy is 29%. CONCLUSION PET appears to be superior to gallium in pediatric HL; future studies will determine the optimal timing of PET to assess early response and the utility of quantitative interpretation of the avidity of specific nodal sites.
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Use of 18F-fluorodeoxyglucose positron emission tomography in patients with rare head and neck cancers. Clin Exp Otorhinolaryngol 2008; 1:103-9. [PMID: 19434281 PMCID: PMC2671791 DOI: 10.3342/ceo.2008.1.2.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 06/08/2008] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The clinical utility of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been demonstrated in major head and neck cancers (HNCs) but is unclear in rare HNCs. We therefore evaluated FDG PET in the management of patients with rare HNCs. METHODS FDG PET and CT/MRI scanning were performed at the initial staging and/or the follow-up in 24 patients with rare HNCs, 10 with melanoma, 9 with sarcoma, 3 with olfactory neuroblastomas, and 2 with basal cell carcinoma. The diagnostic accuracy of CT and FDG PET for detecting primary tumors and metastases were compared with a histopathologic reference. The association between the PET results and the clinicopathologic parameters predicting tumor invasion, histologic grade and disease-free survival (DFS), was assessed. RESULTS The overall accuracies of FDG PET and CT/MRI were 92% and 79%, respectively, for detecting primary tumors and 91% and 74%, respectively, for nodal metastases, but the differences were not significant due to the small number of patients. The sensitivity and specificity of FDG PET for detecting distant metastases and second primary tumors were 100% and 87%, respectively. Follow-up FDG PET correctly diagnosed locoregional recurrence in all 12 patients, as shown by biopsy, and distant metastases in 6 patients. However, thickness of melanoma, histologic grade of sarcoma, and DFS were not associated with tumor FDG uptake. CONCLUSION FDG PET may be useful for staging, posttreatment monitoring, and detection of distant metastases and second primary tumors in patients with rare HNCs.
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Gill S, Wolf M, Prince HM, Januszewicz H, Ritchie D, Hicks RJ, Seymour JF. [18F]Fluorodeoxyglucose Positron Emission Tomography Scanning for Staging, Response Assessment, and Disease Surveillance in Patients with Mantle Cell Lymphoma. ACTA ACUST UNITED AC 2008; 8:159-65. [DOI: 10.3816/clm.2008.n.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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