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Zirakchian Zadeh M. Clinical Application of 18F-FDG-PET Quantification in Hematological Malignancies: Emphasizing Multiple Myeloma, Lymphoma and Chronic Lymphocytic Leukemia. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:800-814. [PMID: 37558532 DOI: 10.1016/j.clml.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/15/2023] [Accepted: 07/20/2023] [Indexed: 08/11/2023]
Abstract
Most hematological malignancies display heightened glycolytic activity, leading to their detectability through 18F-FDG-PET imaging. PET quantification enables the extraction of metabolic information from tumors. Among various PET measurements, maximum standardized uptake value (SUVmax), which indicates the highest value of 18F-FDG uptake within the tumor, has emerged as the commonly used parameter in clinical oncology. This is because of SUVmax ease of calculation using most available commercial workstations, as well as its simplicity and independence from observer interpretation. Nonetheless, SUVmax represents the increase in activity within a specific small area, which may not fully capture the overall tumor uptake. Volumetric PET parameters have been identified as a potential solution to overcome certain limitations associated with SUVmax. However, these parameters are influenced by the low spatial resolution of PET when assessing small lesions. Another challenge is the high number of lesions observed in some patients, leading to a time-consuming process for evaluating all focal lesions. Some institutions recently have started advocating for CT-based segmentation as a method for measuring radiotracer uptake in the bone marrow and overall bone of the patients. This review article aims to provide insights into clinical application of PET quantification specifically focusing on 3 major hematologic malignancies: multiple myeloma, lymphoma, and chronic lymphocytic leukemia.
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Affiliation(s)
- Mahdi Zirakchian Zadeh
- Molecular Imaging and Therapy and Interventional Radiology Services, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Ha NT, Kamarova S, Youens D, Ho C, Bulsara MK, Doust J, Mcrobbie D, O'Leary P, Wright C, Trevithick R, Moorin R. Use of CT, ED presentation and hospitalisations 12 months before and after a diagnosis of cancer in Western Australia: a population-based retrospective cohort study. BMJ Open 2023; 13:e071052. [PMID: 37899144 PMCID: PMC10619095 DOI: 10.1136/bmjopen-2022-071052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 10/12/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To examine the use of CT, emergency department (ED)-presentation and hospitalisation and in 12 months before and after a diagnosis of cancer. DESIGN Population-based retrospective cohort study. SETTING West Australian linked administrative records at individual level. PARTICIPANTS 104 009 adults newly diagnosed with cancer in 2004-2014. MAIN OUTCOME MEASURES CT use, ED presentations, hospitalisations. RESULTS As compared with the rates in the 12th month before diagnosis, the rate of CT scans started to increase from 2 months before diagnosis with an increase in both ED presentations and hospitalisation from 1 month before the diagnosis. These rates peaked in the month of diagnosis for CT scans (477 (95% CI 471 to 482) per 1000 patients), and for hospitalisations (910 (95% CI 902 to 919) per 1000 patients), and the month prior to diagnosis for ED (181 (95% CI 178 to 184) per 1000 patients) then rapidly reduced after diagnosis but remained high for the next 12 months. While the patterns of the health services used were similar between 2004 and 2014, the rate of the health services used during after diagnosis was higher in 2014 versus 2004 except for CT use in patients with lymphohaematopoietic cancer with a significant reduction. CONCLUSION Our results showed an increase in demand for health services from 2 months before diagnosis of cancer. Increasing use of health services during and post cancer diagnosis may warrant further investigation to identify factors driving this change.
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Affiliation(s)
- Ninh Thi Ha
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Sviatlana Kamarova
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Nepean Blue Mountains Local Health District, New South Wales Health, Sydney, New South Wales, Australia
| | - David Youens
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Chau Ho
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Max K Bulsara
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- Biostatistics, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research (AWaGHR) Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Donald Mcrobbie
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter O'Leary
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia, Australia
| | - Cameron Wright
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Richard Trevithick
- Western Australian Cancer Registry, Clinical Excellence Division, Department of Health, East Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Correlation of texture feature analysis with bone marrow infiltration in initial staging of patients with lymphoma using 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography. Pol J Radiol 2020; 85:e586-e594. [PMID: 33204373 PMCID: PMC7654316 DOI: 10.5114/pjr.2020.99833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose To explore whether radiomic features of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomo-graphy-computed tomography (PET/CT) has association with bone marrow infiltration (BMI) in comparison to other conventional PET metrics. Material and methods Forty-four patients (with pathologically proven lymphoma disease) underwent staging 18F-FDG PET/CT scan. Primary tumour was semi-automatically or manually segmented with a threshold standardised uptake value (SUV) of 3. A total of 73 features were extracted from eight different textures. Spearman correlation was used to test the correlation of features with conventional quantitative metrics such as SUV, metabolic tumour volume, and total lesion glycolysis. Specificity and sensitivity (including 95% confidence intervals [CI]) for each of the studied parameters were derived using receiver operative characteristic (ROC) curves. Univariate and multivariate analyses were used to identify independent predictors associated with BMI. Results Correlation between conventional PET metrics and features ranged between 0.50 and 0.97 for positive correlation (33 significant association features) and ranged from -0.52 to -0.97 for inverse correlation (three significant association features) for both strong and moderate correlations. Analysis of ROC curves showed that high-intensity long-run emphasis 4 bin, high-intensity large zone emphasis 64 bin, long-run emphasis (LRE) 64 bin, large-zone emphasis 64 bin, max spectrum 8 bin, busyness 64 bin, and code similarity 32 and 64 bin were significant discriminators of BMI among other features (area under curve > 0.682, p < 0.05). Univariate analyses of texture features showed that code similarity and long-run emphasis (both 64 bin) were significant predictors of bone marrow involvement. Multivariate analyses revealed that LRE (64 bin, p = 0.031) with an odds ratio of 1.022 and 95% CI of (1.002-1.043) were independent variables for bone marrow involvement. Conclusions 18F-FDG PET/CT radiomic features are synergistic to visual assessment of BMI in patients diagnosed with lymphoma using 18F-FDG PET/CT. Further assessment of long-run emphasis is highly warranted.
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Li H, Xu C, Xin B, Zheng C, Zhao Y, Hao K, Wang Q, Wahl RL, Wang X, Zhou Y. 18F-FDG PET/CT Radiomic Analysis with Machine Learning for Identifying Bone Marrow Involvement in the Patients with Suspected Relapsed Acute Leukemia. Am J Cancer Res 2019; 9:4730-4739. [PMID: 31367253 PMCID: PMC6643435 DOI: 10.7150/thno.33841] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022] Open
Abstract
18F-FDG PET / CT is used clinically for the detection of extramedullary lesions in patients with relapsed acute leukemia (AL). However, the visual analysis of 18F-FDG diffuse bone marrow uptake in detecting bone marrow involvement (BMI) in routine clinical practice is still challenging. This study aims to improve the diagnostic performance of 18F-FDG PET/CT in detecting BMI for patients with suspected relapsed AL. Methods: Forty-one patients (35 in training group and 6 in independent validation group) with suspected relapsed AL were retrospectively included in this study. All patients underwent both bone marrow biopsy (BMB) and 18F-FDG PET/CT within one week. The BMB results were used as the gold standard or real “truth” for BMI. The bone marrow 18F-FDG uptake was visually diagnosed as positive and negative by three nuclear medicine physicians. The skeletal volumes of interest were manually drawn on PET/CT images. A total of 781 PET and 1045 CT radiomic features were automatically extracted to provide a more comprehensive understanding of the embedded pattern. To select the most important and predictive features, an unsupervised consensus clustering method was first performed to analyze the feature correlations and then used to guide a random forest supervised machine learning model for feature importance analysis. Cross-validation and independent validation were conducted to justify the performance of our model. Results: The training group involved 16 BMB positive and 19 BMB negative patients. Based on the visual analysis of 18F-FDG PET, 3 patients had focal uptake, 8 patients had normal uptake, and 24 patients had diffuse uptake. The sensitivity, specificity, and accuracy of visual analysis for BMI diagnosis were 62.5%, 73.7%, and 68.6%, respectively. With the cross-validation on the training group, the machine learning model correctly predicted 31 patients in BMI. The sensitivity, specificity, and accuracy of the machine learning model in BMI detection were 87.5%, 89.5%, and 88.6%, respectively, significantly higher than the ones in visual analysis (P < 0.05). The evaluation on the independent validation group showed that the machine learning model could achieve 83.3% accuracy. Conclusions:18F-FDG PET/CT radiomic analysis with machine learning model provided a quantitative, objective and efficient mechanism for identifying BMI in the patients with suspected relapsed AL. It is suggested in particular for the diagnosis of BMI in the patients with 18F-FDG diffuse uptake patterns.
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A Primary Retroperitoneal Diffuse Large B-Cell Lymphoma: A Challenging Diagnosis. CURRENT HEALTH SCIENCES JOURNAL 2018; 44:392-396. [PMID: 31123618 PMCID: PMC6421481 DOI: 10.12865/chsj.44.04.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/03/2018] [Indexed: 01/02/2023]
Abstract
Although quite rare, retroperitoneum can harbour malignant limphomas. On the grounds that the anatomical location is uncommon and the symptoms are scarce, the diagnosis is usually late and challenging. Imaging methods such as magnetic resonance imaging, computed tomography (CT) and positron emission tomography-computed tomography (PET-CT), can characterize and locate the tumor while endoscopic ultrasound fine needle aspiration (EUS-FNA) may provide pathological confirmation. We present the clinical case of a fifty-five-year-old female that is admitted to our hospital with epigastric discomfort, nausea and vomiting. CT showed a homogenously enhancing mass lesion that encased the pancreas, in contact with the portal vein, inferior vena cava, invading splenomesenteric confluence. To investigate further, EUS-FNA was decided and it revealed lymphocyte proliferation suggestive for the diagnosis of lymphoma. Hereinafter, surgical intervention was performed and immunohistochemical analysis and sub classification of lymphoma was obtained. The final diagnosis was non-Hodgkin lymphoma, Diffuse Large B-Cell Lymphoma (DLBCL). Poly-chemotherapy with R-CHOP was initiated. At the end of the treatment fluorodeoxyglucose positron emission tomography (FDG-PET) was performed and no pathological findings were found. A brief review of literature is also provided.
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Ayari Y, Taktak T, Boussaffa H, Ghorbel Z, Zehani A, Sellami A, Ben Rhouma S, Nouira Y. Retroperitoneal extra-adrenal non-Hodgkin lymphoma: An uncommon presentation. Urol Case Rep 2018; 23:34-36. [PMID: 30560056 PMCID: PMC6288313 DOI: 10.1016/j.eucr.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
Primary retroperitoneal non Hodgkin lymphoma is extremely rare, its diagnosis is often difficult and it may requires a time consuming and a costly diagnostic workup. We report the case of a 46-year-old patient complaining of abdominal fullness and dorsal pain, who was diagnosed with an extra-nodal non-Hodgkin lymphoma presenting as a unique and large retroperitoneal mass. The suggested diagnosis was a malignant retroperitoneal tumor and the patient underwent an excision of the tumor throw a lombotomy followed by an R-CHOP chemotherapy regimen with good outcome.
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Affiliation(s)
- Y Ayari
- Department of Urology, La Rabta University Hospital, Tunisia
| | - T Taktak
- Department of Urology, La Rabta University Hospital, Tunisia
| | - H Boussaffa
- Department of Urology, La Rabta University Hospital, Tunisia
| | - Z Ghorbel
- Department of Anatomopathology, La Rabta University Hospital, Tunisia
| | - A Zehani
- Department of Anatomopathology, La Rabta University Hospital, Tunisia
| | - A Sellami
- Department of Urology, La Rabta University Hospital, Tunisia
| | - S Ben Rhouma
- Department of Urology, La Rabta University Hospital, Tunisia
| | - Y Nouira
- Department of Urology, La Rabta University Hospital, Tunisia
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Coincidence of Malignant Melanoma and an Incidently Discovered Parotid Mass Presenting a Diagnostic Challenge. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1897. [PMID: 30324074 PMCID: PMC6181513 DOI: 10.1097/gox.0000000000001897] [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: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/15/2022]
Abstract
Parotid masses coincided with skin tumors in head and neck region may represent a serious diagnostic challenge. Conventional imaging modalities such as computed tomography, magnetic resonance imaging may help to determine nature of the masses. Positron emission tomography - computed tomography imaging is reported to be useful for the detection of malignancy in the parotid gland. But in some situations all of them become insufficient. We present a case of cheek malignant melanoma with an incidentally discovered parotid mass during the investigation. We describe the problems experienced in the course of differential diagnosis and decision making in terms of surgical management. As a result, the most reliable diagnosis of suspicious parotid lesions accompanying head and neck melanomas comes from frozen section analyses. The other diagnostic tools are not reliable enough to allow a safe surgical plan in terms of regional treatment; however, the significance of positron emission tomography - computed tomography in distant metastasis investigation should always be kept in mind.
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Can diffusion-weighted whole-body MRI replace contrast-enhanced CT for initial staging of Hodgkin lymphoma in children and adolescents? Pediatr Radiol 2018; 48:638-647. [PMID: 29362839 DOI: 10.1007/s00247-018-4071-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/30/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although positron emission tomography with 18F-fluoro-2-deoxyglucose (FDG-PET/CT) has been recommended as the method of choice for lymphoma staging, it has limited availability in several countries, therefore, studies comparing whole-body magnetic resonance imaging (MRI) to conventional staging methods or to FDG-PET/CT are an important tool to establish whole-body MRI as an alternative to these methods. OBJECTIVE To compare whole-body MRI versus conventional imaging methods for staging of Hodgkin lymphoma in children and adolescents. MATERIALS AND METHODS The study included 22 patients ages 5 to 21 years. Staging was performed using conventional imaging methods and whole-body MRI. Conventional imaging methods were defined as computed tomography (CT) of the neck, chest, abdomen and pelvis and ultrasonography of the neck and/or abdomen. We calculated the sensitivity of these methods for Hodgkin lymphoma staging and their sensitivity and specificity for detecting sites of nodal and extranodal involvement. RESULTS The sensitivity of whole-body MRI for Hodgkin lymphoma staging was superior to that of conventional imaging methods (95.5% vs. 86.4%, respectively), but both methods had similar sensitivity and specificity for detecting involvement of nodal sites (99.1% and 100% vs. 97.3% and 100%, respectively) and extranodal sites (90.5% and 98.7% vs. 90.5% and 99.4%, respectively). CONCLUSION Whole-body MRI has excellent sensitivity for staging of Hodgkin lymphoma in children and adolescents. It can thus be considered an alternative for this purpose, particularly because it does not expose patients to ionizing radiation.
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Park HS, McIntosh L, Braschi-Amirfarzan M, Shinagare AB, Krajewski KM. T-Cell Non-Hodgkin Lymphomas: Spectrum of Disease and the Role of Imaging in the Management of Common Subtypes. Korean J Radiol 2017; 18:71-83. [PMID: 28096719 PMCID: PMC5240486 DOI: 10.3348/kjr.2017.18.1.71] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/24/2016] [Indexed: 11/15/2022] Open
Abstract
T-cell non-Hodgkin lymphomas (NHLs) are biologically diverse, uncommon malignancies characterized by a spectrum of imaging findings according to subtype. The purpose of this review is to describe the common subtypes of T-cell NHL, highlight important differences between cutaneous, various peripheral and precursor subtypes, and summarize imaging features and the role of imaging in the management of this diverse set of diseases.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Lacey McIntosh
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Marta Braschi-Amirfarzan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Atul B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Katherine M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Sabaté-Llobera A, Cortés-Romera M, Mercadal S, Hernández-Gañán J, Pomares H, González-Barca E, Gámez-Cenzano C. Low-Dose PET/CT and Full-Dose Contrast-Enhanced CT at the Initial Staging of Localized Diffuse Large B-Cell Lymphomas. Clin Med Insights Blood Disord 2016; 9:29-32. [PMID: 27559300 PMCID: PMC4990149 DOI: 10.4137/cmbd.s38468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 12/01/2022]
Abstract
Computed tomography (CT) has been used as the reference imaging technique for the initial staging of diffuse large B-cell lymphoma until recent days, when the introduction of positron emission tomography (PET)/CT imaging as a hybrid technique has become of routine use. However, the performance of both examinations is still common. The aim of this work was to compare the findings between low-dose 2-deoxy-2-(18F)fluoro-d-glucose (18F-FDG) PET/CT and full-dose contrast-enhanced CT (ceCT) in 28 patients with localized diffuse large B-cell lymphoma according to PET/CT findings, in order to avoid the performance of ceCT. For each technique, a comparison in the number of nodal and extranodal involved regions was performed. PET/CT showed more lesions than ceCT in both nodal (41 vs. 36) and extranodal localizations (16 vs. 15). Disease staging according to both techniques was concordant in 22 patients (79%) and discordant in 6 patients (21%), changing treatment management in 3 patients (11%). PET/CT determined a better staging and therapeutic approach, making the performance of an additional ceCT unnecessary.
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Affiliation(s)
- Aida Sabaté-Llobera
- PET Unit, IDI, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Santiago Mercadal
- Department of Hematology, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Hernández-Gañán
- Department of Radiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Helena Pomares
- Department of Hematology, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eva González-Barca
- Department of Hematology, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Gámez-Cenzano
- PET Unit, IDI, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Albano D, Patti C, La Grutta L, Agnello F, Grassedonio E, Mulè A, Cannizzaro G, Ficola U, Lagalla R, Midiri M, Galia M. Comparison between whole-body MRI with diffusion-weighted imaging and PET/CT in staging newly diagnosed FDG-avid lymphomas. Eur J Radiol 2015; 85:313-8. [PMID: 26781135 DOI: 10.1016/j.ejrad.2015.12.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/12/2015] [Accepted: 12/10/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To compare whole body-MRI (WB-MRI) with diffusion-weighted imaging and FDG-PET/CT in staging newly diagnosed FDG-avid lymphomas. METHODS 68 patients (37 males, 31 females; median age 42 years; range 15-86 years) with histologically confirmed lymphoma (37 Classical Hodgkin, 16 Diffuse large B-cell, 10 Follicular, 5 Mantle cell) underwent both MRI and FDG-PET/CT before treatment. Ann Arbor stages obtained with WB-MRI and FDG-PET/CT were compared using Cohen's k statistics. Moreover WB-MRI and FDG-PET/CT stages were compared with the pathological stages obtained after the diagnostic iter using also bone marrow and available biopsies if clinically indicated. RESULTS The agreement between WB-MRI and FDG-PET/CT was excellent. WB-MRI stage was equal to those of FDG-PET/CT in 62/68 patients (91.2%). There was an excellent agreement between WB-MRI stage and pathological stage (63/68 patients; 92.6%), and between FDG-PET/CT and pathological stage (64/68 patients; 94.1%). The differences between the stages were more frequent in the patients with Mantle cell lymphoma. CONCLUSIONS WB-MRI can be considered as a promising technique for FDG-avid lymphoma staging.
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Affiliation(s)
- Domenico Albano
- Department of Radiology, University of Palermo, Via del Vespro 127, Palermo 90127, Italy.
| | - Caterina Patti
- Department of Hematology I, Azienda Ospedali Riuniti Villa Sofia-Cervello, Viale Strasburgo 233, Palermo 90146, Italy
| | - Ludovico La Grutta
- Department of Radiology, University of Palermo, Via del Vespro 127, Palermo 90127, Italy
| | - Francesco Agnello
- Department of Radiology, University of Palermo, Via del Vespro 127, Palermo 90127, Italy
| | - Emanuele Grassedonio
- Department of Radiology, University of Palermo, Via del Vespro 127, Palermo 90127, Italy
| | - Antonino Mulè
- Department of Hematology I, Azienda Ospedali Riuniti Villa Sofia-Cervello, Viale Strasburgo 233, Palermo 90146, Italy
| | - Giorgio Cannizzaro
- Department of Nuclear Medicine, Azienda Ospedali Riuniti Villa Sofia-Cervello, Viale Strasburgo 233, Palermo 90146, Italy
| | - Umberto Ficola
- Department of Nuclear Medicine, La Maddalena Hospital, Via San Lorenzo Colli 312/d, Palermo 90146, Italy
| | - Roberto Lagalla
- Department of Radiology, University of Palermo, Via del Vespro 127, Palermo 90127, Italy
| | - Massimo Midiri
- Department of Radiology, University of Palermo, Via del Vespro 127, Palermo 90127, Italy
| | - Massimo Galia
- Department of Radiology, University of Palermo, Via del Vespro 127, Palermo 90127, Italy
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Abstract
OBJECTIVE To determine pretreatment computed tomography observer agreement in patients with newly diagnosed lymphoma. METHODS Forty-nine computed tomography scans were reviewed by 3 experienced radiologists, with each scan assessed twice by 1 observer. Predefined nodal and extranodal regions were assessed, and Ann Arbor stages were assigned. K-statistics were defined as poor (κ < 0.2), fair (κ > 0.2 to κ ≤ 0.4), moderate (κ > 0.4 to κ ≤ 0.6), substantial (κ > 0.6 to κ ≤ 0.8), and almost perfect (κ > 0.8 to κ ≤ 1). RESULTS Nodal interobserver agreement varied from 0.09 for infraclavicular involvement to 0.95 for para-iliac involvement; intraobserver agreement was substantial to almost perfect, except for infraclavicular nodes. Extranodal interobserver agreement varied from 0.56 to 0.88; intraobserver agreement was substantial to almost perfect. Ann Arbor stage interobserver agreement varied from 0.57 to 0.69; intraobserver agreement was substantial. CONCLUSION Computed tomography observer agreement in staging malignant lymphoma appears to be suboptimal.
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Dan S, Qiang G, Shu-Xia W, Chang-Hong L. Preliminary discussion on the value of 18F-FDG PET/CT in the diagnosis and early staging of non-mycosis fungoides/Sézary's syndrome cutaneous malignant lymphomas. Eur J Radiol 2015; 84:1293-8. [DOI: 10.1016/j.ejrad.2015.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 03/20/2015] [Accepted: 03/24/2015] [Indexed: 11/30/2022]
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Rigacci L, Puccini B, Zinzani PL, Biggi A, Castagnoli A, Merli F, Balzarotti M, Stelitano C, Spina M, Vitolo U, Stefoni V, Levis A, Gotti M, Rosaria S, Maria SP, Bosi A, Gallamini A. The prognostic value of positron emission tomography performed after two courses (INTERIM-PET) of standard therapy on treatment outcome in early stage Hodgkin lymphoma: A multicentric study by the fondazione italiana linfomi (FIL). Am J Hematol 2015; 90:499-503. [PMID: 25720750 DOI: 10.1002/ajh.23994] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/03/2015] [Accepted: 02/25/2015] [Indexed: 11/05/2022]
Abstract
This retrospective study included 246 patients with a new diagnosis of Hodgkin Lymphoma (HL) with a localized-stage (IA-IIA), consecutively admitted from January 2002 to December 2008, by twelve Italian hematological centers on behalf of Fondazione Italiana Linfomi (FIL). Patients were staged at baseline and after two cycles of chemotherapy with PET. All patients were treated with four cycles of ABVD followed by involved-field radiotherapy. No treatment change, based on PET-2 results was allowed. Endpoint of the study was the predictive role of PET-2 on 2-y failure-free survival (FFS). PET-2 was positive in 36 patients (15%) and negative in 210. After a mean follow-up of 46 (3-105) months 19/36 PET-2 positive patients progressed or relapsed and 17 achieved and maintained a CCR. The positive and negative predictive value of a PET2 was 53% and 95%, respectively. The sensibility, specificity and accuracy of PET2 were 65.5%, 92% and 89%, respectively. PET-2 positive scans were centrally reviewed according to the recently defined Deauville Criteria. Upon review the PPV and NPV was 73% and 96% overall. Factors with prognostic significance for progression in univariate analysis were a positive PET-2 (P = 0.000) and the presence of bulky disease (P < 0.01). In a multivariate analysis the only factor that affected negatively FFS was a positive PET-2 (P = 0.000). This study confirms that interim-PET could be considered a prognostic test also in early stage HL, but is unlikely to be a factor that will justify the change of therapeutical approach.
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Affiliation(s)
- Luigi Rigacci
- Hematology Department; Azienda Ospedaliero Universitaria Careggi, University of Florence; Florence Italy
| | - Benedetta Puccini
- Hematology Department; Azienda Ospedaliero Universitaria Careggi, University of Florence; Florence Italy
| | - Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology L. E A. Seràgnoli; Policlinico Sant'Orsola-Malpighi, University of Bologna; Bologna Italy
| | - Alberto Biggi
- Nuclear Medicine; Azienda Ospedaliera S. Croce E Carle; Cuneo Italy
| | | | - Francesco Merli
- Hematology Unit; Arcispedale Santa Maria Nuova, Istituto Di Ricovero E Cura a Carattere Scientifico; Reggio Emilia Italy
| | | | - Caterina Stelitano
- Dipartimento Di Emato-Oncologia; Azienda Ospedaliera Bianchi-Melacrino-Morelli; Reggio Calabria Italy
| | - Michele Spina
- Division of Medical Oncology a; National Cancer Institute; Aviano Italy
| | - Umberto Vitolo
- Città Della Salute E Della Scienza Hospital and University; Turin Italy
| | - Vittorio Stefoni
- Institute of Hematology and Medical Oncology L. E A. Seràgnoli; Policlinico Sant'Orsola-Malpighi, University of Bologna; Bologna Italy
| | - Alessandro Levis
- Hematology Division; Ospedale SS Antonio E Biagio; Alessandria Italy
| | - Manuel Gotti
- Department of Hematology Oncology; University of Pavia, Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | | | | | - Alberto Bosi
- Hematology Department; Azienda Ospedaliero Universitaria Careggi, University of Florence; Florence Italy
| | - Andrea Gallamini
- Department of Hematology; Azienda Ospedaliera S. Croce E Carle; Cuneo Italy
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Adams HJA, de Klerk JMH, Fijnheer R, Heggelman BGF, Dubois SV, Nievelstein RAJ, Kwee TC. Does the presence of tumor-induced cortical bone destruction at CT have any prognostic value in newly diagnosed diffuse large B-cell lymphoma? Skeletal Radiol 2015; 44:687-94. [PMID: 25662178 PMCID: PMC4363520 DOI: 10.1007/s00256-015-2102-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/30/2014] [Accepted: 01/09/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the prognostic value of tumor-induced cortical bone destruction at computed tomography (CT) in newly diagnosed diffuse large B-cell lymphoma (DLBCL). MATERIALS AND METHODS This retrospective study included 105 patients with newly diagnosed DLBCL who had undergone CT and bone marrow biopsy (BMB) before R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisolone) chemo-immunotherapy. Cox regression analyses were used to determine the associations of cortical bone status at CT (absence vs. presence of tumor-induced cortical bone destruction), BMB findings (negative vs. positive for lymphomatous involvement), and dichotomized National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) strata (low risk vs. high risk) with progression-free survival (PFS) and overall survival (OS). RESULTS Univariate Cox regression analysis indicated that cortical bone status at CT was no significant predictor of either PFS or OS (p = 0.358 and p = 0.560, respectively), whereas BMB findings (p = 0.002 and p = 0.013, respectively) and dichotomized NCCN-IPI risk strata (p = 0.002 and p = 0.003, respectively) were significant predictors of both PFS and OS. In the multivariate Cox proportional hazards model, only the dichotomized NCCN-IPI score was an independent predictive factor of PFS and OS (p = 0.004 and p = 0.003, respectively). CONCLUSIONS The presence of tumor-induced cortical bone destruction at CT was not found to have any prognostic implications in newly diagnosed DLBCL.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands,
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16
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Gentile M, Cutrona G, Molica S, Ilariucci F, Mauro FR, Di Renzo N, Di Raimondo F, Vincelli I, Todoerti K, Matis S, Musolino C, Fabris S, Lionetti M, Levato L, Zupo S, Angrilli F, Consoli U, Festini G, Longo G, Cortelezzi A, Musto P, Federico M, Neri A, Ferrarini M, Morabito F. Prospective validation of predictive value of abdominal computed tomography scan on time to first treatment in Rai 0 chronic lymphocytic leukemia patients: results of the multicenter O-CLL1-GISL study. Eur J Haematol 2015; 96:36-45. [PMID: 25753656 DOI: 10.1111/ejh.12545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We performed an external and multicentric validation of the predictive value of abdominal computed tomography (aCT) on time to first treatment (TTFT) in early stage chronic lymphocytic leukemia (CLL) patients. METHODS aCT was performed at diagnosis in 181 Rai 0 patients enrolled in the O-CLL1-GISL trial (clinicaltrial.gov ID:NCT00917549). RESULTS Fifty-five patients showed an abnormal aCT. Patients with an abnormal aCT showed a significantly shorter TTFT than those with normal aCT (P < 0.0001). At multivariate analysis, aCT (P = 0.011), β-2 microglobulin (P = 0.019), and CD38 expression (P = 0.047) correlated with TTFT. Following IWCLL 2008 criteria, 112 (61.9%) cases remained at Rai 0, while 69 (38.1%) satisfied the criteria of clinical monoclonal B-cell lymphocytosis (cMBL). Reclassified Rai 0 patients with an abnormal aCT showed a significantly shorter TTFT than those with a normal aCT (P < 0.0001). At multivariate analysis, only aCT (P = 0.011) correlated with TTFT. Eleven cMBL cases (15.9%) showed an abnormal aCT and were reclassified as small lymphocytic lymphomas (SLL); nonetheless, TTFT was similar for cMBLs and SLLs. CONCLUSION Our results confirm the ability of the abnormal aCT to predict progression in early stage cases.
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Affiliation(s)
- Massimo Gentile
- Hematology Unit, Department of Onco-Hematology, A.O. of Cosenza, Cosenza, Italy
| | | | - Stefano Molica
- Department of Oncology and Haematology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | | | | | | | - Francesco Di Raimondo
- Division of Haematology, Department of Biomedical Sciences, University of Catania and Ferrarotto Hospital, Catania, Italy
| | | | - Katia Todoerti
- Laboratory of Preclinical and Translational Research, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - Serena Matis
- Direzione Scientifica IRCCS, San Martino IST, Genova, Italy
| | | | - Sonia Fabris
- Department of Clinical Sciences and Community Health, University of Milano and Hematology CTMO, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Lionetti
- Department of Clinical Sciences and Community Health, University of Milano and Hematology CTMO, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luciano Levato
- Department of Oncology and Haematology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Simona Zupo
- SS Molecular Diagnostics IRCCS S. Martino-IST, Genova, Italy
| | | | - Ugo Consoli
- U.O.S. di Emato-Oncologia, Ospedale Garibaldi-Nesima, Catania, Italy
| | - Gianluca Festini
- Centro di Riferimento Ematologico-Seconda Medicina, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Trieste, Italy
| | - Giuseppe Longo
- Unità di Ematologia, Ospedale San Vincenzo, Taormina, Italy
| | - Agostino Cortelezzi
- Laboratory of Preclinical and Translational Research, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - Massimo Federico
- Department of Onco-hematology, Università di Modena Centro Oncologico Modenese, Policlinico Modena, Italy
| | - Antonino Neri
- Department of Clinical Sciences and Community Health, University of Milano and Hematology CTMO, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Fortunato Morabito
- Hematology Unit, Department of Onco-Hematology, A.O. of Cosenza, Cosenza, Italy
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Teixeira SR, Martinez-Rios C, Hu L, Bangert BA. Clinical applications of pediatric positron emission tomography-magnetic resonance imaging. Semin Roentgenol 2014; 49:353-66. [PMID: 25498232 DOI: 10.1053/j.ro.2014.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sara R Teixeira
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH; Division of Radiology, Ribeirao Preto Medical School, University of Sao Paulo, São Paulo, Brazil
| | - Claudia Martinez-Rios
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH; Case Western Reserve University, Cleveland, OH
| | | | - Barbara A Bangert
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH; Case Western Reserve University, Cleveland, OH.
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D'souza MM, Jaimini A, Bansal A, Tripathi M, Sharma R, Mondal A, Tripathi RP. FDG-PET/CT in lymphoma. Indian J Radiol Imaging 2014; 23:354-65. [PMID: 24604942 PMCID: PMC3932580 DOI: 10.4103/0971-3026.125626] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Lymphomas are a heterogeneous group of diseases that arise from the constituent cells of the immune system or from their precursors. 18F-fludeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is now the cornerstone of staging procedures in the state-of-the-art management of Hodgkin's disease and aggressive non-Hodgkin's lymphoma. It plays an important role in staging, restaging, prognostication, planning appropriate treatment strategies, monitoring therapy, and detecting recurrence. However, its role in indolent lymphomas is still unclear and calls for further investigational trials. The protean PET/CT manifestations of lymphoma necessitate a familiarity with the spectrum of imaging findings to enable accurate diagnosis. A meticulous evaluation of PET/CT findings, an understanding of its role in the management of lymphomas, and knowledge of its limitations are mandatory for the optimal utilization of this technique.
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Affiliation(s)
- Maria M D'souza
- Department of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Majumdar Marg, New Delhi, India
| | - Abhinav Jaimini
- Department of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Majumdar Marg, New Delhi, India
| | - Abhishek Bansal
- Department of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Majumdar Marg, New Delhi, India
| | | | - Rajnish Sharma
- Department of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Majumdar Marg, New Delhi, India
| | - Anupam Mondal
- Department of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Majumdar Marg, New Delhi, India
| | - Rajendra Prashad Tripathi
- Department of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Majumdar Marg, New Delhi, India
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Kajáry K, Molnár Z, Szakáll S, Molnár P, Lengyel Z. [Is ceCT necessary beyond FDG-PET/CT for primary staging in Hodgkin lymphoma?]. Orv Hetil 2014; 155:226-30. [PMID: 24486846 DOI: 10.1556/oh.2014.29815] [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: 11/19/2022]
Abstract
INTRODUCTION Several study supported that 18F-Fluoro-deoxy-glucose (FDG) positron emission tomography/computer tomography with low dose CT (standard PET/CT) is more accurate than contrast-enhanced CT (ceCT) in the primary staging of Hodgkin disease. AIM The authors compared the accuracy of these examinations with this indication in their practice, and analysed the added value of ceCT which was performed as a supplement to standard PET/CT. METHOD Twenty-eight patients were categorized based on ceCT, single standard PET/CT and standard PET/CT with ceCT. RESULTS Twenty-four patients were in the same disease-stage based on all methods. Disease was upstaged by standard PET/CT compared to ceCT in 4 patients. There was no change in stage when comparing standard PET/CT and standard PET/CT with ceCT. CONCLUSIONS Standard PET/CT is more accurate than ceCT in the primary staging of Hodgkin disease. The authors established that it is not reasonable to supplement standard PET/CT with ceCT in this indication.
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20
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Vermoolen MA, Kersten MJ, Fijnheer R, van Leeuwen MS, Kwee TC, Nievelstein RAJ. Magnetic resonance imaging of malignant lymphoma. Expert Rev Hematol 2014; 4:161-71. [DOI: 10.1586/ehm.11.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Can Full-Dose Contrast-Enhanced CT Be Omitted From an FDG-PET/CT Staging Examination in Newly Diagnosed FDG-Avid Lymphoma? J Comput Assist Tomogr 2014; 38:620-5. [DOI: 10.1097/rct.0000000000000067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Kwee TC, Vermoolen MA, Akkerman EA, Kersten MJ, Fijnheer R, Ludwig I, Beek FJ, van Leeuwen MS, Bierings MB, Bruin MC, Zsíros J, Quarles van Ufford HM, de Klerk JM, Adam J, Stoker J, Uiterwaal CS, Nievelstein RA. Whole-body MRI, including diffusion-weighted imaging, for staging lymphoma: Comparison with CT in a prospective multicenter study. J Magn Reson Imaging 2013; 40:26-36. [DOI: 10.1002/jmri.24356] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/22/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Thomas C. Kwee
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Malou A. Vermoolen
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Erik A. Akkerman
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Marie José Kersten
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - Rob Fijnheer
- Department of Hematology; Meander Medical Center; Amersfoort The Netherlands
| | - Inge Ludwig
- Department of Hematology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Frederik J.A. Beek
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Marc B. Bierings
- Department of Pediatric Hematology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Marrie C.A. Bruin
- Department of Pediatric Hematology; University Medical Center Utrecht; Utrecht The Netherlands
| | - József Zsíros
- Department of Pediatric Oncology; Academic Medical Center; Amsterdam The Netherlands
| | | | - John M.H. de Klerk
- Department of Nuclear Medicine; Meander Medical Center; Amersfoort The Netherlands
| | - Judit Adam
- Department of Nuclear Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - Jaap Stoker
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Cuno S. Uiterwaal
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
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Gentile M, Cutrona G, Fabris S, Pesce EA, Baldini L, Di Raimondo F, Musolino C, Di Tonno P, Di Renzo N, Molica S, Brugiatelli M, Ilariucci F, Zupo S, Matis S, Maura F, Vigna E, Angrilli F, Recchia AG, Quarta G, Iannitto E, Fragasso A, Musto P, Spriano M, Vincelli I, Vallisa D, Cortelezzi A, Mauro FR, Foà R, Federico M, Neri A, Ferrarini M, Morabito F. Total body computed tomography scan in the initial work-up of Binet stage A chronic lymphocytic leukemia patients: Results of the prospective, multicenter O-CLL1-GISL study. Am J Hematol 2013; 88:539-44. [PMID: 23553682 DOI: 10.1002/ajh.23448] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 03/24/2013] [Accepted: 03/26/2013] [Indexed: 11/08/2022]
Abstract
Total body computed tomography (TB-CT) scan is not mandatory in the diagnostic/staging algorithm of chronic lymphocytic leukemia (CLL). The aim of this study was to determine the value and prognostic significance of TB-CT scan in early stage CLL patients. Baseline TB-CT scan was performed in 240 Binet stage A CLL patients (179 Rai low- and 61 Rai intermediate-risk) included in a prospective multicenter observational study (clinicaltrial.gov ID:NCT00917549). The cohort included 69 clinical monoclonal B lymphocytosis (cMBLs). Patients were restaged considering only radiological data. Following TB-CT scans, 20% of cases reclassified as radiologic Binet (r-Binet) stage B. r-Binet B patients showed a higher incidence of unfavorable cytogenetic abnormalities (P = 0.027), as well as a shorter PFS (P = 0.001). At multivariate analysis, r-Binet stage [HR = 2.48; P = 0.004] and IGHV mutational status [HR = 3.01; P = 0.002] retained an independent predictive value for PFS. Among 179 Rai low-risk cases, 100 were redefined as r-Rai intermediate-risk based upon TB-CT scan data, showing a higher rate of cases with higher ZAP-70 (P = 0.033) and CD38 expression (P = 0.029) and β2-microglobulin levels (P < 0.0001), as well as a shorter PFS than those with r-Rai low-risk (P = 0.008). r-Rai stage [HR = 2.78; P = 0.046] and IGHV mutational status [HR = 4.25; P = 0.009] retained a significant predictive value for PFS at multivariate analysis. Forty-two percent of cMBL patients were reclassified as r-small lymphocytic lymphomas (r-SLLs) by TB-CT scan. TB-CT scan appears to provide relevant information in early stage CLL related to the potential and the timing of patients to progress towards the more advanced disease stages.
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Affiliation(s)
| | | | - Sonia Fabris
- Dipartimento Scienze Mediche; Centro di Ricerca per lo Studio delle Leucemie, Università di Milano; Fondazione IRCCS Policlinico Milano Italy
| | | | - Luca Baldini
- UO di Ematologia; Fondazione IRCCS Cà Granda OM Policlinico; Dipartimento Scienze Cliniche e di Comunità dell'Università degli Studi; Milano Italy
| | - Francesco Di Raimondo
- Divisione di Ematologia; Dipartimento di Scienze Biomediche; Università di Catania & Ospedale Ferrarotto Catania Italy
| | | | | | | | - Stefano Molica
- U.O.C. di Ematologia; Azienda Ospedaliera “Pugliese-Ciaccio”; Catanzaro Italy
| | | | | | - Simona Zupo
- SS di Diagnostica Molecolare IRCCS S. Martino-IST; Genova Italy
| | - Serena Matis
- Direzione Scientifica; IRCCS S. Martino-IST; Genova Italy
| | - Francesco Maura
- UO di Ematologia; Fondazione IRCCS Cà Granda OM Policlinico; Dipartimento Scienze Cliniche e di Comunità dell'Università degli Studi; Milano Italy
| | - Ernesto Vigna
- U.O.C. di Ematologia; Azienda Ospedaliera di Cosenza; Italy
| | | | | | - Giovanni Quarta
- Divisione di Ematologia; Presidio Ospedaliero “A. Perrino”; Brindisi Italy
| | - Emilio Iannitto
- Divisione di Ematologia e Trapianto di Midollo Osseo; Policlinico P. Giaccone; Palermo Italy
| | - Alberto Fragasso
- Unità Operativa di Medicina Interna; Presidio Ospedaliero di Matera; Italy
| | - Pellegrino Musto
- Unità di Ematologia e Trapianto di Cellule Staminali; IRCCS-CROB; Rionero in Vulture Italy
| | | | - Iolanda Vincelli
- Divisione di Ematologia; Azienda Ospedaliera; Reggio Calabria Italy
| | | | - Agostino Cortelezzi
- Dipartimento Scienze Mediche; Centro di Ricerca per lo Studio delle Leucemie, Università di Milano; Fondazione IRCCS Policlinico Milano Italy
- UO di Ematologia; Fondazione IRCCS Cà Granda OM Policlinico; Dipartimento Scienze Cliniche e di Comunità dell'Università degli Studi; Milano Italy
| | | | - Robin Foà
- Divisione di Ematologia; Università La Sapienza; Roma Italy
| | - Massimo Federico
- Dipartimento di Oncologia ed Ematologia Università di Modena Centro Oncologico Modenese; Policlinico Modena; Italy
| | - Antonino Neri
- Dipartimento Scienze Mediche; Centro di Ricerca per lo Studio delle Leucemie, Università di Milano; Fondazione IRCCS Policlinico Milano Italy
- UO di Ematologia; Fondazione IRCCS Cà Granda OM Policlinico; Dipartimento Scienze Cliniche e di Comunità dell'Università degli Studi; Milano Italy
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Abstract
The lymphomas, Hodgkin lymphoma and non-Hodgkin lymphoma, are among the most common types of cancer in the United States. Imaging plays an important role in the evaluation of patients with lymphoma, because it aids in treatment planning and in the determination of prognosis. Structural imaging entails the assessment of morphologic features of normal tissues and organs of the body and of malignant lesions within these structures, and plays a major role in the noninvasive assessment of lymphoma. This article reviews cross-sectional structural imaging modalities with an emphasis on computed tomography and magnetic resonance imaging, with some mention of ultrasonography.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger A J Nievelstein
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Drew A Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19102, USA
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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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Picardi M, Soricelli A, Grimaldi F, Nicolai E, Gallamini A, Pane F. Fused FDG–PET/contrast-enhanced CT detects occult subdiaphragmatic involvement of Hodgkin's lymphoma thereby identifying patients requiring six cycles of anthracycline-containing chemotherapy and consolidation radiation of spleen. Ann Oncol 2011; 22:671-680. [DOI: 10.1093/annonc/mdq403] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Technetium-99m depreotide imaging by single photon emission tomography/low resolution computed tomography in malignant lymphomas: comparison with gallium-67 citrate. Ann Nucl Med 2010; 24:639-47. [PMID: 20799079 DOI: 10.1007/s12149-010-0405-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 07/02/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Previous studies have demonstrated the feasibility of targeting lymphoma lesions with somatostatin receptor binding agents, mainly with In-111-pentetreotide. In the present work another somatostatin analog, Tc-99m depreotide, is investigated. METHODS One-hundred and six patients, 47 with Hodgkin's (HL) and 59 with various types of non-Hodgkin's lymphoma (NHL), were imaged with both Tc-99m depreotide and Ga-67 citrate. Planar whole-body and single photon emission tomography/low resolution computerized tomography (SPECT/CT) images were obtained. A total of 142 examinations were undertaken at different phases of the disease. Depreotide and gallium findings were compared visually and semi-quantitatively, with reference to the results of conventional work-up and the patients' follow-up data. RESULTS In most HL, intermediate- and low-grade B-cell, as well as in T-cell NHL, depreotide depicted more lesions than Ga-67 and/or exhibited higher tumor uptake. The opposite was true in aggressive B-cell NHL. However, there were notable exceptions in all lymphoma subtypes. During initial staging, 93.3% of affected lymph nodes above the diaphragm, 100% of inguinal nodes and all cases with splenic infiltration were detected by depreotide. On the basis of depreotide findings, 32% of patients with early-stage HL were upstaged. However, advanced HL and NHL cases were frequently downstaged, due to low sensitivity for abdominal lymph node (22.7%), liver (45.5%) and bone marrow involvement (36.4%). Post-therapy, depreotide detected 94.7% of cases with refractory disease or recurrence. Its overall specificity was moderate (57.1%). Rebound thymic hyperplasia, various inflammatory processes and sites of unspecific uptake were the commonest causes of false positive findings. The combination of depreotide and gallium enhanced sensitivity (100%), while various false positive results of either agent could be avoided. CONCLUSION Except perhaps for early-stage HL, Tc-99m depreotide as a stand-alone imaging modality has limited value for the initial staging of lymphomas. Post-therapy, however, depreotide scintigraphy seems useful in the evaluation of certain anatomic areas, particularly in non-aggressive lymphoma types. The combination with Ga-67 potentially enhances sensitivity and specificity. If fluorodeoxyglucose positron emission tomography is not available or in case of certain indolent lymphoma types, Tc-99m depreotide may have a role as an adjunct to conventional imaging procedures.
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Kröger N, Bacher U, Bader P, Böttcher S, Borowitz MJ, Dreger P, Khouri I, Macapinlac HA, Macapintac H, Olavarria E, Radich J, Stock W, Vose JM, Weisdorf D, Willasch A, Giralt S, Bishop MR, Wayne AS. NCI First International Workshop on the Biology, Prevention, and Treatment of Relapse after Allogeneic Hematopoietic Stem Cell Transplantation: report from the Committee on Disease-Specific Methods and Strategies for Monitoring Relapse following Allogeneic Stem Cell Transplantation. Part I: Methods, acute leukemias, and myelodysplastic syndromes. Biol Blood Marrow Transplant 2010; 16:1187-211. [PMID: 20558311 DOI: 10.1016/j.bbmt.2010.06.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 06/06/2010] [Indexed: 12/14/2022]
Abstract
Relapse has become the major cause of treatment failure after allogeneic stem cell transplantation. Outcome of patients with clinical relapse after transplantation generally remains poor, but intervention prior to florid relapse improves outcome for certain hematologic malignancies. To detect early relapse or minimal residual disease, sensitive methods such as molecular genetics, tumor-specific molecular primers, fluorescein in situ hybridization, and multiparameter flow cytometry (MFC) are commonly used after allogeneic stem cell transplantation to monitor patients, but not all of them are included in the commonly employed disease-specific response criteria. The highest sensitivity and specificity can be achieved by molecular monitoring of tumor- or patient-specific markers measured by polymerase chain reaction-based techniques, but not all diseases have such targets for monitoring. Similar high sensitivity can be achieved by determination of donor chimerism, but its specificity regarding detection of relapse is low and differs substantially among diseases. Here, we summarize the current knowledge about the utilization of such sensitive monitoring techniques based on tumor-specific markers and donor cell chimerism and how these methods might augment the standard definitions of posttransplant remission, persistence, progression, relapse, and the prediction of relapse. Critically important is the need for standardization of the different residual disease techniques and to assess the clinical relevance of minimal residual disease and chimerism surveillance in individual diseases, which in turn, must be followed by studies to assess the potential impact of specific interventional strategies.
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Affiliation(s)
- Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinstrasse 52, Hamburg, Germany.
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Punwani S, Taylor SA, Bainbridge A, Prakash V, Bandula S, De Vita E, Olsen OE, Hain SF, Stevens N, Daw S, Shankar A, Bomanji JB, Humphries PD. Pediatric and Adolescent Lymphoma:Comparison of Whole-Body STIR Half-Fourier RARE MR Imaging with an Enhanced PET/CT Reference for Initial Staging. Radiology 2010; 255:182-90. [DOI: 10.1148/radiol.09091105] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Whole-Body MRI, Including Diffusion-Weighted Imaging, for the Initial Staging of Malignant Lymphoma. Invest Radiol 2009; 44:683-90. [DOI: 10.1097/rli.0b013e3181afbb36] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Stojković MV, Artiko VM, Radoman IB, Knežević SJ, Lukić SM, Kerkez MD, Lekić NS, Antić AA, Žuvela MM, Ranković VI, Petrović MN, Šobić DP, Obradović VB. Color Doppler sonography and angioscintigraphy in hepatic Hodgkin’s lymphoma. World J Gastroenterol 2009; 15:3269-75. [PMID: 19598303 PMCID: PMC2710783 DOI: 10.3748/wjg.15.3269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To estimate the characteristics of Color Doppler findings and the results of hepatic radionuclide angiography (HRA) in secondary Hodgkin’s hepatic lymphoma.
METHODS: The research included patients with a diagnosis of Hodgkin’s lymphoma with metastatic focal lesions in the liver and controls. Morphologic characteristics of focal liver lesions and hemodynamic parameters were examined by pulsed and Color Doppler in the portal, hepatic and splenic veins were examined. Hepatic perfusion index (HPI) estimated by HRA was calculated.
RESULTS: In the majority of patients, hepatomegaly was observed. Lesions were mostly hypoechoic and mixed, solitary or multiple. Some of the patients presented with dilated splenic veins and hepatofugal blood flow. A pulse wave was registered in the centre and at the margins of lymphoma. The average velocity of the pulse wave was higher at the margins (P > 0.05). A continuous venous wave was found only at the margins of lymphoma. There was no linear correlation between lymphoma size and velocity of pulse and continuous wave (r = 390, P < 0.01). HPI was significantly lower in patients with lymphomas than in controls (P < 0.05), pointing out increased arterial perfusion in comparison to portal perfusion.
CONCLUSION: Color Doppler ultrasonography is a sensitive method for the detection of neovascularization in Hodgkin’s hepatic lymphoma and estimation of its intensity. Hepatic radionuclide angiography can additionally help in the assesment of vascularisation of liver lesions.
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Radiology of the Retroperitoneum: Self-Assessment Module. AJR Am J Roentgenol 2009. [DOI: 10.2214/ajr.09.7166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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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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99mTc-labelled rituximab, a new non-Hodgkin's lymphoma imaging agent: first clinical experience. Nucl Med Commun 2009; 29:1059-65. [PMID: 18987526 DOI: 10.1097/mnm.0b013e3283134d6e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was performed to explore the possibility of using Tc-rituximab as an imaging agent to assess expression of CD20 antigen in patients with B-cell non-Hodgkin's lymphoma (NHL) before (radio) immunotherapy, for staging and subsequent evaluation of remission of NHL. METHODS Rituximab was purified from Mabthera and photoactivated by ultraviolet light. The irradiated solution was aliquoted and labelled with pertechnetate. The effectiveness of the labelling method was evaluated by determination of the number of free thiol groups per photoreduced antibody, radiochemical purity determination and in-vitro stability. Immunoreactivity of Tc-rituximab was assessed on Ramos cells using a direct binding assay. Ten patients (age 31-70 years, mean 50 years) were included, nine with CD20 B-cell NHL and one with CD20-NHL. Whole-body and single photon emission computed tomography images were taken 1, 3, 6 and 20 h postinjection of Tc-rituximab. Scintigraphic results were compared with computerized tomography (CT) findings. RESULTS In all cases radiochemical purity over 95% was observed with preserved affinity for CD20 antigen. In all patients expected activity was seen in the blood pool, liver, kidneys and spleen. Pathological, moderately to markedly increased Tc-rituximab activity was seen in all but one CT-confirmed NHL involved sites 6 and 20 h postinjection. In one patient, increased activity of Tc-rituximab was additionally seen in one region not seen on CT. In three patients increased accumulation was seen in bone marrow. CONCLUSION Tc-rituximab is a promising imaging agent suitable for assessing expression of CD20 in patients with NHL before (radio) immunotherapy.
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Cerci JJ, Pracchia LF, Soares Junior J, Linardi CDCG, Meneghetti JC, Buccheri V. Positron emission tomography with 2-[18F]-fluoro-2-deoxy-D-glucose for initial staging of hodgkin lymphoma: a single center experience in Brazil. Clinics (Sao Paulo) 2009; 64:491-8. [PMID: 19578651 PMCID: PMC2705152 DOI: 10.1590/s1807-59322009000600002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 03/02/2009] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND 2-[18F]-Fluoro-2-Deoxy-D-Glucose (FDG-PET) is a well established functional imaging modality for the initial staging of Hodgkin lymphoma (HL) in patients from Western Europe and North America. The reliability of FDG-PET in populations of different ethnic groups is unclear, as all investigations published to date have come from developed countries. PURPOSE The aim of the present study was to investigate the effectiveness of FDG-PET in the initial staging of HL patients in a Brazilian population. METHODS Eighty-two patients with newly diagnosed HL were prospectively included in the study. All patients were staged with both conventional clinical staging (CCS) methods, including computed tomography (CT) and whole-body FDG-PET methods. A standard of reference for the nodal regions and the extranodal organs was determined using all available information, including the CCS methods, FDG-PET, the diagnostic histology and the follow-up examinations. The results of the CCS were then compared to the FDG-PET results. RESULTS The sensitivity of FDG-PET was higher for nodal staging than that of CT (87.8% vs. 61.6%, respectively). FDG-PET was also more sensitive than CT in regard to evaluating the extranodal organs for lymphomatous involvement (96.2% vs. 40.0%, respectively). FDG-PET detected all 16 patients who were characterized by a positive bone marrow biopsy and identified an additional 4 patients with bone marrow disease. The incorporation of FDG-PET coupled with CCS in the staging procedure upstaged 20% (17/82) of the patients and downstaged 11% (9/82) of the patients. As a result of these changes in staging, 15% (13/82) of the patients would have received a different therapeutic regimen. CONCLUSIONS The FDG-PET method is superior to CT for the detection of nodal and extra-nodal HL. The observation that the FDG-PET method upstaged the disease was the most common result (20% of patients) brought about by the addition of PET to the staging algorithm, even in a population of patients with a high incidence of advanced disease. However, changes in stages based on FDG-PET results should be confirmed by biopsy.
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Affiliation(s)
- Juliano Julio Cerci
- Faculdade de Medicina, Instituto do Coração, Universidade de São Paulo, São Paulo, Brasil.
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Role of whole-body [18F] fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and conventional techniques in the staging of patients with Hodgkin and aggressive non Hodgkin lymphoma. Radiol Med 2008; 113:578-90. [DOI: 10.1007/s11547-008-0264-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 05/29/2007] [Indexed: 12/16/2022]
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Abstract
Computed tomography (CT) is currently the most commonly used means for staging malignant lymphoma. 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), FDG-PET/CT fusion, and whole-body magnetic resonance imaging (WB-MRI) are potential alternatives. The purpose of this study was to systematically review published data on the diagnostic performance of CT, FDG-PET, FDG-PET/CT fusion, and WB-MRI in staging of malignant lymphoma. In addition, technical aspects, procedures, advantages, and drawbacks of each imaging modality are outlined. Three CT studies, 17 FDG-PET studies, and 4 FDG-PET/CT fusion studies were included in this systematic review. The studies were of moderate methodological quality and used different scoring systems to stage malignant lymphoma. CT remains the standard imaging modality for initial staging of malignant lymphoma, while FDG-PET has an essential role in restaging after treatment. Early results suggest that FDG-PET/CT fusion outperforms both CT alone and FDG-PET alone. Data on the diagnostic performance of WB-MRI are lacking. Future well-designed studies, expressing their results according to the Ann Arbor staging system, are needed to determine which imaging modality is most accurate and cost-effective in staging malignant lymphoma.
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Rigacci L, Vitolo U, Nassi L, Merli F, Gallamini A, Pregno P, Alvarez I, Salvi F, Sancetta R, Castagnoli A, Versari A, Biggi A, Gregianin M, Pelosi E, Chisesi T, Bosi A, Levis A. Positron emission tomography in the staging of patients with Hodgkin’s lymphoma. A prospective multicentric study by the Intergruppo Italiano Linfomi. Ann Hematol 2007; 86:897-903. [PMID: 17701410 DOI: 10.1007/s00277-007-0356-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 07/19/2007] [Indexed: 10/23/2022]
Abstract
In this prospective multicentric study, we investigated the contribution of positron emission tomography (PET) scanning to the staging of Hodgkin's lymphoma (HL) by computed tomography (CT) and attempted to determine whether it has any impact on therapeutic approach. One hundred eighty six consecutive patients with HL from six Italian centers were enrolled in this study. They were staged with conventional methods; 2-[fluorine-18]fluoro-2-deoxy-D: -glucose PET scanning were prospectively compared to CT. CT and FDG-PET stages were concordant in 156 patients (84%) and discordant in 30 patients (16%). PET stage in comparison to CT stage was higher in 27 patients (14%) and lower in 3 patients (1%). The programmed treatment strategy was modified in 11 out of 30 patients (37%) after the definition of final stage. If we considered the 123 CT staged patients with localized stage, ten patients (8%) with a change of stage from localized to advanced after PET evaluation were treated with different strategy. FDG-PET was shown to be a relevant, non-invasive method that supplements conventional procedures and should therefore be used routinely to stage HL, particularly in early stage patients, where a change in stage may modify disease management.
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Affiliation(s)
- Luigi Rigacci
- Hematology and Nuclear Medicine, Careggi Hospital and University of Florence, Florence, Italy.
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Hodgson DC, Hudson MM, Constine LS. Pediatric Hodgkin Lymphoma: Maximizing Efficacy and Minimizing Toxicity. Semin Radiat Oncol 2007; 17:230-42. [PMID: 17591570 DOI: 10.1016/j.semradonc.2007.02.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Historically, both adult and childhood Hodgkin lymphoma (HL) were treated with full-dose (35-45 Gy) extended-field radiation therapy (RT). Although this treatment was the first to produce reliable disease control, the resulting late toxicity led pediatric oncologists to pioneer the use of combined chemotherapy and low-dose (15-25 Gy) involved-field RT for all stages of HL. Currently, standard treatment of childhood HL is risk adapted; those with favorable risk disease typically receive 2 to 4 cycles of multi-agent chemotherapy with low-dose IFRT, whereas those with higher-risk disease receive more intensive chemotherapy before IFRT. This approach produces long-term survival rates >90% while limiting exposure to anthracyclines, alkylators, and radiation to normal tissues. In contrast to adult HL, IFRT remains an important component of the treatment of advanced-stage HL in pediatric patients. Current clinical trials for children with HL aim to further segregate patients into risk strata such that those who are highly curable can receive less toxic therapy, whereas high-risk patients can receive augmented therapy. Response-adapted therapy, in which overall treatment intensity is modified according to the initial response to chemotherapy, is emerging as a potential means of further reducing therapy for some while maintaining high cure rates. The challenge is to refine therapy in a rare disease in which long-time intervals are necessary to observe an adequate number of events (treatment failure or late effects) to answer judicious questions.
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Affiliation(s)
- David C Hodgson
- Radiation Medicine Program, Princess Margaret Hospital, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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Bar-Shalom R. Normal and Abnormal Patterns of 18F-Fluorodeoxyglucose PET/CT in Lymphoma. Radiol Clin North Am 2007; 45:677-88, vi-vii. [PMID: 17706532 DOI: 10.1016/j.rcl.2007.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In spite of the high performance of 18F-fluorodeoxyglucose (FDG) PET for the evaluation of lymphoma, inherent limitations of this modality underscore the additional value of PET/CT as an important tool in the assessment of this disease. Accumulating data on the use of PET/CT in lymphoma indicate the contribution of hybrid imaging to improved interpretation accuracy of PET using FDG and CT. Knowledge of the normal and abnormal patterns of FDG-PET/CT imaging and their variability in patients with lymphoma is important to provide a comprehensive clinically significant interpretation that has an impact on patient management and potentially on outcome.
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Affiliation(s)
- Rachel Bar-Shalom
- Division of Positron Emission Tomography, Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, 35254 Israel.
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Muntañola A, Bosch F, Arguis P, Arellano-Rodrigo E, Ayuso C, Giné E, Crespo M, Abrisqueta P, Moreno C, Cobo F, López-Guillermo A, Montserrat E. Abdominal Computed Tomography Predicts Progression in Patients With Rai Stage 0 Chronic Lymphocytic Leukemia. J Clin Oncol 2007; 25:1576-80. [PMID: 17353549 DOI: 10.1200/jco.2006.08.4194] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Whether computed tomography (CT) should be routinely included in the diagnostic work-up in patients with chronic lymphocytic leukemia (CLL) has not yet been determined. The aim of this study was to analyze the prognostic significance of abdominal CT in patients with CLL in Rai clinical stage 0. Patients and Methods Abdominal CT was performed at diagnosis in 140 patients consecutively diagnosed with CLL in Rai stage 0 disease. Results An abnormal abdominal CT was found in 38 patients (27%). Abnormal CT correlated with increased bone marrow infiltration (P = .024), high lymphocyte count (P = .001), increased ZAP-70 expression (P = .003), and short lymphocyte doubling time (LDT; P = .007). Patients with abnormal CT progressed more frequently and had a shorter time to progression than those with normal CT (median, 3.5 years v not reached, respectively; P < .001) and required earlier treatment intervention. In a multivariate analysis, only high ZAP-70 expression (relative risk = 3.60) and an abnormal abdominal CT (RR = 2.71) correlated with disease progression. Conclusion In this series, an abnormal abdominal CT was a strong predictor of progression in patients with early-stage CLL. The inclusion of CT scans in the initial work-up of patients with early clinical stage on clinical grounds can, therefore, provide relevant clinical information.
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MESH Headings
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Cohort Studies
- Disease Progression
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Multivariate Analysis
- Neoplasm Staging
- Probability
- Prognosis
- Proportional Hazards Models
- Radiography, Abdominal/methods
- Retrospective Studies
- Sensitivity and Specificity
- Sex Factors
- Statistics, Nonparametric
- Survival Analysis
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Ana Muntañola
- Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Bar-Shalom R. Normal and Abnormal Patterns of 18F-Fluorodeoxyglucose PET/CT in Lymphoma. PET Clin 2006; 1:231-42. [DOI: 10.1016/j.cpet.2006.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kumar R, Xiu Y, Zhuang HM, Alavi A. 18
F-fluorodeoxyglucose-positron emission tomography in evaluation of primary cutaneous lymphoma. Br J Dermatol 2006; 155:357-63. [PMID: 16882175 DOI: 10.1111/j.1365-2133.2006.07367.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis of primary cutaneous lymphoma (PCL) is currently based on clinical and histological findings and/or relatively invasive procedures such as bone marrow and fine-needle lymph node biopsies. Although computed tomography (CT) is a noninvasive imaging modality that is widely used for staging in patients with lymphoma, it cannot provide information about malignant cutaneous lesions. OBJECTIVES To investigate the usefulness of (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in the management of PCL. METHODS We retrospectively analysed 31 FDG-PET studies in 19 patients with PCL [15 T-cell non-Hodgkin lymphoma (NHL) and four B-cell NHL]. There were 10 men and nine women (age range 23-84 years, mean +/- SD 54 +/- 16). Eleven FDG-PET studies were performed for initial staging and 20 FDG-PET studies were performed for restaging following therapy. Results of FDG-PET were compared with those of CT. Clinical parameters and/or biopsy results of lesions served as reference for the accuracy of PET and CT in evaluating local and metastatic lesions. RESULTS For the initial staging, FDG-PET had a sensitivity of 82% for the evaluation of local disease and 80% for the detection of distant metastasis. The corresponding values for CT were 55% and 100%, respectively. For restaging of cutaneous lymphoma, FDG-PET had a sensitivity of 86% and specificity of 92% for local recurrence/residual disease and a sensitivity of 100% and specificity of 100% for distant metastasis. The corresponding values for CT were 50% and 83% for local recurrence/residual disease and 100% and 67% for distant metastasis. CONCLUSIONS FDG-PET has a potential value for initial staging and restaging following therapy in patients with PCL. FDG-PET has higher diagnostic value than CT in the detection both of local disease and distant metastasis.
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Affiliation(s)
- R Kumar
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, U.S.A
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Affiliation(s)
- Lale Kostakoglu
- Department of Radiology, Division of Nuclear Medicine, The New York Presbyterian Hospital Weill Medical College of Cornell University, New York, NY, USA
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Affiliation(s)
- Richard W Tsang
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada
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Schwartz A, Gospodarowicz MK, Khalili K, Pintilie M, Goddard S, Keller A, Tsang RW. An audit of imaging test utilization for the management of lymphoma in an oncology hospital: implications for resource planning? Br J Radiol 2006; 79:116-22. [PMID: 16489192 DOI: 10.1259/bjr/27372198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to assist with resource planning by examining the pattern of physician utilization of imaging procedures for lymphoma patients in a dedicated oncology hospital. The proportion of imaging tests ordered for routine follow up with no specific clinical indication was quantified, with specific attention to CT scans. A 3-month audit was performed. The reasons for ordering all imaging procedures (X-rays, CT scans, ultrasound, nuclear scan and MRI) were determined through a retrospective chart review. 411 lymphoma patients had 686 assessments (sets of imaging tests) and 981 procedures (individual imaging tests). Most procedures were CT scans (52%) and chest radiographs (30%). The most common reasons for ordering imaging were assessing response (23%), and investigating new symptoms (19%). Routine follow up constituted 21% of the assessments (142/686), and of these, 82% were chest radiographs (116/142), while 24% (34/142) were CT scans. With analysis restricted to CT scans (296 assessments in 248 patients), the most common reason for ordering CT scans were response evaluation (40%), and suspicion of recurrence and/or new symptom (23%). Follow-up CT scans done with no clinical indication comprised 8% (25/296) of all CT assessments. Staging CT scans were under-represented at 6% of all assessments. Imaging with CT scans for follow up of asymptomatic patients is infrequent. However, scans done for staging new lymphoma patients were unexpectedly low in frequency, due to scans done elsewhere prior to referral. This analysis uncovered utilization patterns, helped resource planning and provided data to reduce unnecessary imaging procedures.
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Affiliation(s)
- A Schwartz
- University of Toronto, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9 Canada
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Raanani P, Shasha Y, Perry C, Metser U, Naparstek E, Apter S, Nagler A, Polliack A, Ben-Bassat I, Even-Sapir E. Is CT scan still necessary for staging in Hodgkin and non-Hodgkin lymphoma patients in the PET/CT era? Ann Oncol 2005; 17:117-22. [PMID: 16192294 DOI: 10.1093/annonc/mdj024] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The clinical impact of fused PET/CT data on staging and patient management of Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) was assessed. PATIENTS AND METHODS A total of 103 consecutive patients with newly diagnosed NHL (n = 68) and HD (n = 35) were assessed retrospectively. Three comparisons were carried out in an attempt to assess the added value of each modality. RESULTS For NHL patients, there were significant differences between staging by CT versus PET/CT (P = 0.0001). Disease was upstaged by PET/CT in 31% (mostly in stages I and II) and downstaged in only 1% of patients. In 25% of the patients, the treatment approach was changed according to CT versus PET/CT findings. For HD patients, disease was upstaged by PET/CT in 32% and downstaged by PET/CT in 15% (P = NS). As for NHL, upstaging by PET/CT versus CT was evident mostly for stages I and II. The treatment strategy was altered as determined by CT versus PET/CT in 45% of the patients. CONCLUSIONS The addition of PET/CT to CT changed the management decisions in approximately a quarter of NHL and a third of HD patients, mostly in early disease stages. Thus, PET/CT performed as the initial staging procedure may well obviate the need for additional diagnostic CT in the majority of patients.
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Affiliation(s)
- P Raanani
- Rabin Medical Center, Department of Hematology, Isreal.
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Stopar TG, Mlinaric-Rascan I, Fettich J, Hojker S, Mather SJ. 99mTc-rituximab radiolabelled by photo-activation: a new non-Hodgkin’s lymphoma imaging agent. Eur J Nucl Med Mol Imaging 2005; 33:53-9. [PMID: 16172899 DOI: 10.1007/s00259-005-1838-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Accepted: 04/06/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE Rituximab was the first chimeric monoclonal antibody to be approved for treatment of indolent B-cell non-Hodgkin's lymphoma (NHL). It is directed against the CD20 antigen, which is expressed by 95% of B-cell NHLs. The aim of this study was to explore the possibility of radiolabelling rituximab with (99m)Tc for use as an imaging agent in NHL for early detection, staging, remission assessment, monitoring for metastatic spread and tumour recurrence, and assessment of CD20 expression prior to (radio)immunotherapy. METHODS Rituximab was purified from Mabthera solution (Roche), photo-activated at 302 nm by UV irradiation and radiolabelled with (99m)Tc. The effectiveness of the labelling method was evaluated by determination of the number of free thiol groups per photoreduced antibody, radiochemical purity and in vitro stability of (99m)Tc-rituximab. RESULTS On average, 4.4 free thiol groups per photoreduced antibody were determined. Radiolabelling yields greater than 95% were routinely observed after storage of the photo-activated antibody at -80 degrees C for 195 days. The direct binding assay showed preserved ability of (99m)Tc-rituximab to bind to CD20, with an average immunoreactive fraction of 93.3%. The internalisation rate was proven to be low, with only 5.3% of bound (99m)Tc-rituximab being internalised over 4 h at 37 degrees C. CONCLUSION Our results demonstrate that (99m)Tc-rituximab of high radiochemical purity and with preserved binding affinity for the antigen can be prepared by photoreduction and that the method shows good reproducibility. (99m)Tc-rituximab will be further explored as an imaging agent applicable in NHL for the purposes mentioned above.
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Affiliation(s)
- T Gmeiner Stopar
- Department for Nuclear Medicine, University Medical Centre Ljubljana, Zaloska 7, 1525 Ljubljana. Slovenia.
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