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Mirshahvalad SA, Farag A, Thiessen J, Wong R, Veit-Haibach P. Current Applications of PET/MR: Part I: Technical Basics and Preclinical/Clinical Applications. Can Assoc Radiol J 2024:8465371241255903. [PMID: 38813998 DOI: 10.1177/08465371241255903] [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: 05/31/2024] Open
Abstract
Positron emission tomography/magnetic resonance (PET/MR) imaging has gone through major hardware improvements in recent years, making it a reliable state-of-the-art hybrid modality in clinical practice. At the same time, image reconstruction, attenuation correction, and motion correction algorithms have significantly evolved to provide high-quality images. Part I of the current review discusses technical basics, pre-clinical applications, and clinical applications of PET/MR in radiation oncology and head and neck imaging. PET/MR offers a broad range of advantages in preclinical and clinical imaging. In the preclinic, small and large animal-dedicated devices were developed, making PET/MR capable of delivering new insight into animal models in diseases and facilitating the development of methods that inform clinical PET/MR. Regarding PET/MR's clinical applications in radiation medicine, PET and MR already play crucial roles in the radiotherapy process. Their combination is particularly significant as it can provide molecular and morphological characteristics that are not achievable with other modalities. In addition, the integration of PET/MR information for therapy planning with linear accelerators is expected to provide potentially unique biomarkers for treatment guidance. Furthermore, in clinical applications in the head and neck region, it has been shown that PET/MR can be an accurate modality in head and neck malignancies for staging and resectability assessment. Also, it can play a crucial role in diagnosing residual or recurrent diseases, reliably distinguishing from oedema and fibrosis. PET/MR can furthermore help with tumour characterization and patient prognostication. Lastly, in head and neck carcinoma of unknown origin, PET/MR, with its diagnostic potential, may obviate multiple imaging sessions in the near future.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Adam Farag
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Jonathan Thiessen
- Imaging Program, Lawson Health Research Institute, London, ON, Canada
- Medical Biophysics, Medical Imaging, Western University, London, ON, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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2
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Caldarella C, De Risi M, Massaccesi M, Miccichè F, Bussu F, Galli J, Rufini V, Leccisotti L. Role of 18F-FDG PET/CT in Head and Neck Squamous Cell Carcinoma: Current Evidence and Innovative Applications. Cancers (Basel) 2024; 16:1905. [PMID: 38791983 PMCID: PMC11119768 DOI: 10.3390/cancers16101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
This article provides an overview of the use of 18F-FDG PET/CT in various clinical scenarios of head-neck squamous cell carcinoma, ranging from initial staging to treatment-response assessment, and post-therapy follow-up, with a focus on the current evidence, debated issues, and innovative applications. Methodological aspects and the most frequent pitfalls in head-neck imaging interpretation are described. In the initial work-up, 18F-FDG PET/CT is recommended in patients with metastatic cervical lymphadenectomy and occult primary tumor; moreover, it is a well-established imaging tool for detecting cervical nodal involvement, distant metastases, and synchronous primary tumors. Various 18F-FDG pre-treatment parameters show prognostic value in terms of disease progression and overall survival. In this scenario, an emerging role is played by radiomics and machine learning. For radiation-treatment planning, 18F-FDG PET/CT provides an accurate delineation of target volumes and treatment adaptation. Due to its high negative predictive value, 18F-FDG PET/CT, performed at least 12 weeks after the completion of chemoradiotherapy, can prevent unnecessary neck dissections. In addition to radiomics and machine learning, emerging applications include PET/MRI, which combines the high soft-tissue contrast of MRI with the metabolic information of PET, and the use of PET radiopharmaceuticals other than 18F-FDG, which can answer specific clinical needs.
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Affiliation(s)
- Carmelo Caldarella
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
| | - Marina De Risi
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
| | - Mariangela Massaccesi
- Radiation Oncology Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Miccichè
- Radiation Oncology Unit, Ospedale Isola Tiberina—Gemelli Isola, 00186 Rome, Italy;
| | - Francesco Bussu
- Otorhinolaryngology Operative Unit, Azienda Ospedaliero Universitaria Sassari, 07100 Sassari, Italy;
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Jacopo Galli
- Otorhinolaryngology Unit, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Section of Otolaryngology, Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lucia Leccisotti
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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3
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Gu B, Yang Z, Du X, Xu X, Ou X, Xia Z, Guan Q, Hu S, Yang Z, Song S. Imaging of Tumor Stroma Using 68Ga-FAPI PET/CT to Improve Diagnostic Accuracy of Primary Tumors in Head and Neck Cancer of Unknown Primary: A Comparative Imaging Trial. J Nucl Med 2024; 65:365-371. [PMID: 38272706 PMCID: PMC10924163 DOI: 10.2967/jnumed.123.266556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
The low detection rate of primary tumors by current diagnostic techniques remains a major concern for patients with head and neck cancer of unknown primary (HNCUP). Therefore, in this study, we aimed to investigate the potential role of 68Ga-labeled fibroblast activation protein inhibitor (68Ga-FAPI) PET/CT compared with 18F-FDG PET/CT for the detection of primary tumors of HNCUP. Methods: In this prospective comparative imaging trial conducted at Fudan University Shanghai Cancer Center, 91 patients with negative or equivocal findings of a primary tumor by comprehensive clinical examination and conventional imaging were enrolled from June 2020 to September 2022. The presence of a primary tumor was recorded by 3 experienced nuclear medicine physicians. Primary lesions were validated by histopathologic analysis and a composite reference standard. Results: Of the 91 patients (18 women, 73 men; median age, 60 y; age range, 24-76 y), primary tumors were detected in 46 (51%) patients after a thorough diagnostic work-up. 68Ga-FAPI PET/CT detected more primary lesions than 18F-FDG PET/CT (46 vs. 17, P < 0.001) and showed better sensitivity, positive predictive value, and accuracy in locating primary tumors (51% vs. 25%, 98% vs. 43%, and 51% vs. 19%, respectively). Furthermore, 68Ga-FAPI PET/CT led to treatment changes in 22 of 91 (24%) patients compared with 18F-FDG PET/CT. The Kaplan-Meier curve illustrated that patients with unidentified primary tumors had a significantly worse prognosis than patients with identified primary tumors (hazard ratio, 5.77; 95% CI, 1.86-17.94; P = 0.0097). Conclusion: 68Ga-FAPI PET/CT outperforms 18F-FDG PET/CT in detecting primary lesions and could serve as a sensitive, reliable, and reproducible imaging modality for HNCUP patients.
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Affiliation(s)
- Bingxin Gu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Center for Biomedical Imaging, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Ziyi Yang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Center for Biomedical Imaging, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Xinyue Du
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Center for Biomedical Imaging, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Xiaoping Xu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Center for Biomedical Imaging, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Xiaomin Ou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zuguang Xia
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; and
| | - Qing Guan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Silong Hu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Center for Biomedical Imaging, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Zhongyi Yang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China;
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Center for Biomedical Imaging, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China;
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Center for Biomedical Imaging, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
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4
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Zwittag P, Asel C, Gabriel M, Rubicz N, Bauer B, Poier-Fabian N. MRI and PET/CT in the assessment of lymph node metastases in head and neck cancer. Sci Rep 2023; 13:19347. [PMID: 37935875 PMCID: PMC10630387 DOI: 10.1038/s41598-023-46845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/06/2023] [Indexed: 11/09/2023] Open
Abstract
The aim of this study is to present the diagnostic accuracy of MRI and PET/CT in the evaluation of cervical lymph nodes in patients with head and neck cancer (HNC). Data of 114 patients who underwent MRI and PET/CT prior to surgery in the time period between January 2010 and September 2021 in our center is analyzed retrospectively. Histopathological results of surgical preparations serve as the gold standard. The mean time from MRI to surgery is 22.9 (± 18.7) days, and from PET/CT to surgery 21.7 (± 19.9) days. Sensitivities of 80.4% and 80.4%, specificities of 85.7% and 87.3%, PPVs of 82.0% and 83.7% and NPVs of 84.4% and 84.6% are registered for MRI and PET/CT, respectively. 37 false results are further analyzed with respect to side and level of the affected lymph node, as well as intersections of the two imaging modalities. In 29 patients (25.4%), additional findings are described in PET/CT, 7 (6.1%) of which were histologically confirmed to be further malignancies. A combination of both MRI and PET/CT imaging modalities could improve diagnostic accuracy, especially with regard to sensitivity. A notable number of additional findings in whole body acquisition leads to the potential diagnosis of further malignancies.
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Affiliation(s)
- Paul Zwittag
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Christian Asel
- Department of Radiology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Michael Gabriel
- Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Nina Rubicz
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Belinda Bauer
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Nikolaus Poier-Fabian
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria.
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
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5
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Gule-Monroe MK, Calle S, Policeni B, Juliano AF, Agarwal M, Chow LQM, Dubey P, Friedman ER, Hagiwara M, Hanrahan KD, Jain V, Rath TJ, Smith RB, Subramaniam RM, Taheri MR, Yom SS, Zander D, Burns J. ACR Appropriateness Criteria® Staging and Post-Therapy Assessment of Head and Neck Cancer. J Am Coll Radiol 2023; 20:S521-S564. [PMID: 38040469 DOI: 10.1016/j.jacr.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Susana Calle
- Research Author, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Q M Chow
- University of Texas at Austin, Dell Medical School, Austin, Texas; American Society of Clinical Oncology
| | | | | | - Mari Hagiwara
- New York University Langone Health, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio
| | | | - Russell B Smith
- Baptist Medical Center, Jacksonville, Florida; American Academy of Otolaryngology-Head and Neck Surgery
| | - Rathan M Subramaniam
- University of Otago, Dunedin, Otepoti, New Zealand; Commission on Nuclear Medicine and Molecular Imaging
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | - Sue S Yom
- University of California, San Francisco, San Francisco, California
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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6
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Becker M, de Vito C, Dulguerov N, Zaidi H. PET/MR Imaging in Head and Neck Cancer. Magn Reson Imaging Clin N Am 2023; 31:539-564. [PMID: 37741640 DOI: 10.1016/j.mric.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) can either be examined with hybrid PET/MR imaging systems or sequentially, using PET/CT and MR imaging. Regardless of the acquisition technique, the superiority of MR imaging compared to CT lies in its potential to interrogate tumor and surrounding tissues with different sequences, including perfusion and diffusion. For this reason, PET/MR imaging is preferable for the detection and assessment of locoregional residual/recurrent HNSCC after therapy. In addition, MR imaging interpretation is facilitated when combined with PET. Nevertheless, distant metastases and distant second primary tumors are detected equally well with PET/MR imaging and PET/CT.
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Affiliation(s)
- Minerva Becker
- Diagnostic Department, Division of Radiology, Unit of Head and Neck and Maxillofacial Radiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland.
| | - Claudio de Vito
- Diagnostic Department, Division of Clinical Pathology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland
| | - Nicolas Dulguerov
- Department of Clinical Neurosciences, Clinic of Otorhinolaryngology, Head and Neck Surgery, Unit of Cervicofacial Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland
| | - Habib Zaidi
- Diagnostic Department, Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland; Geneva University Neurocenter, University of Geneva, Geneva, Switzerland; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
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7
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Wangaryattawanich P, Agarwal M, Rath TJ. PET/CT and PET/MRI Evaluation of Post-treatment Head and Neck. Semin Roentgenol 2023; 58:331-346. [PMID: 37507173 DOI: 10.1053/j.ro.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 02/09/2023]
Affiliation(s)
| | - Mohit Agarwal
- Medical Collegeof Wisconsin, Milwaukee, Wisconsin USA
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8
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Ucisik FE, Huell D, Choi J, Gidley PW, DeMonte F, Hanna EY, Learned KO. Post-Treatment Imaging Evaluation of the Skull Base. Semin Roentgenol 2023; 58:217-236. [PMID: 37507165 DOI: 10.1053/j.ro.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/09/2023] [Accepted: 03/22/2023] [Indexed: 07/30/2023]
Affiliation(s)
- F Eymen Ucisik
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Derek Huell
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeanie Choi
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Kim O Learned
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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9
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Milosevic A, Styczen H, Grueneisen J, Li Y, Weber M, Fendler WP, Kirchner J, Damman P, Wrede K, Lazaridis L, Glas M, Guberina M, Eckstein A, Blau T, Herrmann K, Umutlu L, Forsting M, Deuschl C, Schaarschmidt B. Evaluation of [ 68Ga]-DOTATOC PET/MRI in Patients with Meningioma of the Subcranial and Intraorbital Space. J Nucl Med 2023:jnumed.123.265424. [PMID: 37385668 DOI: 10.2967/jnumed.123.265424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/20/2023] [Indexed: 07/01/2023] Open
Abstract
Meningiomas are known to express somatostatin receptor (SSTR) type 2 to a high degree. Therefore, radiolabeled somatostatin analogs, such as DOTATOC, have been introduced for PET imaging of meningiomas. However, the benefit of hybrid SSTR PET/MRI is still debated. Here, we report our experience with [68Ga]-DOTATOC PET/MRI. Methods: PET/MRI was performed in 60 patients with suspected or diagnosed meningiomas of the skull plane and eye socket. Acquired datasets were reported by 2 independent readers regarding local tumor extent and signal characteristics. Histopathologic results and follow-up imaging served as the reference standard. SUVs of target lesions were analyzed according to the corresponding maximal tracer uptake. The diagnostic accuracy of PET/MRI and conventional MRI was determined independently and compared with the reference standard. Results: In total, 60 target lesions were identified, with 54 considered to be meningiomas according to the reference standard. Sensitivity and specificity of PET/MRI versus MRI alone were 95% versus 96% and 75% versus 66%, respectively. The McNemar test was not able to distinguish any differences between PET/MRI and the reference standard or MRI and the reference standard. No differences were found between the 2 modalities with respect to local infiltration. Conclusion: SSTR PET/MRI and MRI yielded similar accuracy for the detection of meningiomas of the skull base and intraorbital space. Here, sequential low-dose SSTR PET/CT might be helpful for the planning of radioligand therapy or radiotherapy.
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Affiliation(s)
- Aleksandar Milosevic
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany;
| | - Hanna Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Johannes Grueneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, Düsseldorf, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Düsseldorf, Germany
| | - Julian Kirchner
- Institute of Radiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Philipp Damman
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Düsseldorf, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Düsseldorf, Germany
| | - Lazaros Lazaridis
- Department of Neurology and Neurooncology, University Hospital Essen, Düsseldorf, Germany
| | - Martin Glas
- Department of Neurology and Neurooncology, University Hospital Essen, Düsseldorf, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen, Düsseldorf, Germany
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, Düsseldorf, Germany; and
| | - Tobias Blau
- Department of Neuropathology, University Hospital Essen, Düsseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Düsseldorf, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Benedikt Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
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10
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Jiang Y, Wen B, Li C, Tian Y, Xiao Z, Xu K, Xing D, Yu Z, Huang J, Jia J, He Y. The performance of 68Ga-FAPI-04 PET/CT in head and neck squamous cell carcinoma: a prospective comparison with 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 2023; 50:2114-2126. [PMID: 36808001 DOI: 10.1007/s00259-023-06138-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE This study was designed to compare the performance of 68Ga-FAPI-04 and 18F-FDG PET/CT for initial staging and recurrence detection of head and neck squamous cell carcinoma (HNSCC). METHODS Prospectively, 77 patients with histologically proven or highly suspected HNSCC underwent paired 18F-FDG and 68Ga-FAPI-04 PET/CT in a week for either initial staging (n = 67) or restaging (n = 10). The diagnostic performance was compared for the two imaging approaches, especially for N staging. SUVmax, SUVmean, and target-to-background ratio (TBR) were assessed for paired positive lesions. Furthermore, change in management by 68Ga-FAPI-04 PET/CT and histopathologic FAP expression of some lesions were explored. RESULTS 18F-FDG and 68Ga-FAPI-04 PET/CT exhibited a comparable detection efficiency for primary tumor (100%) and recurrence (62.5%). In the twenty-nine patients receiving neck dissection, 68Ga-FAPI-04 PET/CT showed greater specificity and accuracy in evaluating preoperative N staging than 18F-FDG based on patient (p = 0.031 and p = 0.070), neck side (p = 0.002 and p = 0.006), and neck level (p < 0.001 and p < 0.001). As for distant metastasis, 68Ga-FAPI-04 PET/CT detected more positive lesions than 18F-FDG (25 vs 23) and with higher SUVmax (7.99 ± 9.04 vs 3.62 ± 2.68, p = 0.002) by lesion-based analysis. The type of neck dissection in 9 cases (9/33) was altered by 68Ga-FAPI-04. Overall, clinical management was significantly changed in 10 patients (10/61). Three patients had a follow-up 68Ga-FAPI-04 PET/CT post neoadjuvant therapy: One showed complete remission, and the others showed progression. The 68Ga-FAPI-04 uptake intensity was confirmed to be consistent with FAP expression. CONCLUSION 68Ga-FAPI-04 outperforms 18F-FDG PET/CT in evaluating preoperative N staging in patients with HNSCC. Furthermore, 68Ga-FAPI-04 PET/CT also shows the potential in clinical management and monitoring response to treatment.
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Affiliation(s)
- Yaqun Jiang
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Bing Wen
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Chongjiao Li
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Yueli Tian
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Zhiwei Xiao
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Kui Xu
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Diankui Xing
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Zili Yu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Jing Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Jun Jia
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
| | - Yong He
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China.
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11
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Contemporary Imaging and Reporting Strategies for Head and Neck Cancer: MRI, FDG PET/MRI, NI-RADS, and Carcinoma of Unknown Primary- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 220:160-172. [PMID: 36069482 DOI: 10.2214/ajr.22.28120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
CT, MRI, and FDG PET/CT play major roles in the diagnosis, staging, treatment planning, and surveillance of head and neck cancers. Nonetheless, an evolving understanding of head and neck cancer pathogenesis, advances in imaging techniques, changing treatment regimens, and a lack of standardized guidelines have led to areas of uncertainty in the imaging of head and neck cancer. This narrative review aims to address four issues in the contemporary imaging of head and neck cancer. The first issue relates to the standard and advanced sequences that should be included in MRI protocols for head and neck cancer imaging. The second issue relates to approaches to surveillance imaging after treatment of head and neck cancer, including the choice of imaging modality, the frequency of surveillance imaging, and the role of standardized reporting through the Neck Imaging Reporting and Data System. The third issue relates to the role of imaging in the setting of neck carcinoma of unknown primary. The fourth issue relates to the role of simultaneous PET/MRI in head and neck cancer evaluation. The authors of this review provide consensus opinions for each issue.
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12
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Flygare L, Erdogan ST, Söderkvist K. PET/MR versus PET/CT for locoregional staging of oropharyngeal squamous cell cancer. Acta Radiol 2022; 64:1865-1872. [PMID: 36464816 PMCID: PMC10160406 DOI: 10.1177/02841851221140668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
Background The value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for TN staging in head and neck cancer (HNC) has been proven in numerous studies. A few studies have investigated the value of FDG-PET/magnetic resonance imaging (MRI) in the staging of HNC; the combined results indicate potential for FDG-PET/MRI, but the scientific evidence remains weak. Purpose To compare performance of FDG-PET/CT and FDG-PET/MRI for locoregional staging in patients with oropharyngeal carcinomas. Material and Methods Two radiologists independently of each other retrospectively reviewed primary pre-therapeutic FDG-PET/CT and FDG-PET/MRI examinations from 40 individuals with oropharyngeal carcinomas. TN stage and primary tumor size were noted. The results were compared between observers and modalities and against TN stage set at a multidisciplinary conference. Results For nodal staging, PET/MRI had slightly higher specificity and accuracy than PET/CT for the most experienced observer. Both methods demonstrated excellent sensitivity (≥ 0.97 and 1.00, respectively), as well as high negative predictive values (≥ 0.95 and 1.00, respectively). No significant differences were found for tumor staging or measurement of maximum tumor diameter. There was a weak agreement (κ = 0.35–0.49) between PET/CT and PET/MRI for T and N stages for both observers. Inter-observer agreement was higher for PET/MRI than for PET/CT, both for tumor staging (κ = 0.57 vs. 0.35) and nodal staging (κ = 0.69 vs. 0.55). The agreement between observers was comparable to the agreement between methods. Conclusion PET/MRI may be a viable alternative to PET/CT for locoregional staging (TN staging) and assessment of maximal tumor diameter in oropharyngeal squamous cell cancer.
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Affiliation(s)
- Lennart Flygare
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Secil Telli Erdogan
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Karin Söderkvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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13
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Diagnostic Accuracy of 18F-FDG-PET/CT and 18F-FDG-PET/MRI in Detecting Locoregional Recurrence of HNSCC 12 Weeks after the End of Chemoradiotherapy: Single-Center Experience with PET/MRI. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8676787. [PMID: 36082064 PMCID: PMC9433207 DOI: 10.1155/2022/8676787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
Purpose In head and neck squamous cell carcinoma (HNSCC), the early diagnosis and efficient detection of recurrences and/or residual tumor after treatment play a very important role in patient's prognosis. Positron emission tomography (PET) using 2-deoxy-2-18F-fluoro-D-glucose (18F-FDG) has become an established method for the diagnosis of suspected recurrence in head and neck carcinomas. In particular, integrated PET/MRI imaging that provides optimal soft tissue contrast and less dental implant artifacts compared to PET/CT is an intriguing technique for the follow-up imaging of HNSCC patients. The aim of this study was to evaluate the benefit of PET/MRI compared to PET/CT in post-treatment follow-up imaging of HNSCC patients. Methods This retrospective observational cohort study consists of 104 patients from our center with histologically confirmed HNSCC. All patients received chemoradiotherapy (CRT) and underwent 18F-FDG-PET/CT (n = 52) or 18F-FDG-PET/MRI (n = 52) scan 12 weeks after the end of treatment. Image analysis was performed by two independent readers according to a five-point Likert scale analysis. Results PET/MRI was more sensitive (1.00 vs. 0.77) than PET/CT in the detection of locoregional recurrence. PET/MRI also had better negative (1.00 vs. 0.87) predictive values. AUCs for PET/MRI and PET/CT on patient-based analysis were 0.997 (95% CI 0.989–1.000) and 0.890 (95% CI 0.806–0.974), respectively. The comparison of sensitivity, AUCs, and negative predictive values revealed a statistically significant difference, p < 0.05. In PET/CT, false-negative and positive findings were observed in the more advanced disease stages, where PET/MRI performed better. Also, false-negative findings were located in the oropharyngeal, laryngeal, and nasopharyngeal regions, where PET/MRI made no false-negative interpretations. Conclusion Based on these results, PET/MRI might be considered the modality of choice in detecting locoregional recurrence in HNSCC patients, especially in the more advanced stages in the oral cavity, larynx, or nasopharynx.
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14
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Burian E, Palla B, Callahan N, Pyka T, Wolff C, von Schacky CE, Schmid A, Froelich MF, Rübenthaler J, Makowski MR, Gassert FG. Comparison of CT, MRI, and F-18 FDG PET/CT for initial N-staging of oral squamous cell carcinoma: a cost-effectiveness analysis. Eur J Nucl Med Mol Imaging 2022; 49:3870-3877. [PMID: 35606526 PMCID: PMC9399011 DOI: 10.1007/s00259-022-05843-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Treatment of oral squamous cell carcinoma (OSCC) is based on clinical exam, biopsy, and a precise imaging-based TNM-evaluation. A high sensitivity and specificity for magnetic resonance imaging (MRI) and F-18 FDG PET/CT are reported for N-staging. Nevertheless, staging of oral squamous cell carcinoma is most often based on computed tomography (CT) scans. This study aims to evaluate cost-effectiveness of MRI and PET/CT compared to standard of care imaging in initial staging of OSCC within the US Healthcare System. Methods A decision model was constructed using quality-adjusted life years (QALYs) and overall costs of different imaging strategies including a CT of the head, neck, and the thorax, MRI of the neck with CT of the thorax, and whole body F-18 FDG PET/CT using Markov transition simulations for different disease states. Input parameters were derived from literature and willingness to pay (WTP) was set to US $100,000/QALY. Deterministic sensitivity analysis of diagnostic parameters and costs was performed. Monte Carlo modeling was used for probabilistic sensitivity analysis. Results In the base-case scenario, total costs were at US $239,628 for CT, US $240,001 for MRI, and US $239,131 for F-18 FDG PET/CT whereas the model yielded an effectiveness of 5.29 QALYs for CT, 5.30 QALYs for MRI, and 5.32 QALYs for F-18 FDG PET/CT respectively. F-18 FDG PET/CT was the most cost-effective strategy over MRI as well as CT, and MRI was the cost-effective strategy over CT. Deterministic and probabilistic sensitivity analysis showed high robustness of the model with incremental cost effectiveness ratio remaining below US $100,000/QALY for a wide range of variability of input parameters. Conclusion F-18 FDG PET/CT is the most cost-effective strategy in the initial N-staging of OSCC when compared to MRI and CT. Despite less routine use, both whole body PET/CT and MRI are cost-effective modalities in the N-staging of OSCC. Based on these findings, the implementation of PET/CT for initial staging could be suggested to help reduce costs while increasing effectiveness in OSCC.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Benjamin Palla
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nicholas Callahan
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Thomas Pyka
- Department of Nuclear Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Constantin Wolff
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claudio E von Schacky
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Annabelle Schmid
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix G Gassert
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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15
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Kandathil A, Subramaniam RM. PET/Computed Tomography. PET Clin 2022; 17:235-248. [DOI: 10.1016/j.cpet.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Guzmán Pérez-Carrillo GJ, Ivanidze J. PET/CT and PET/MR Imaging of the Post-treatment Head and Neck: Traps and Tips. Neuroimaging Clin N Am 2021; 32:111-132. [PMID: 34809833 DOI: 10.1016/j.nic.2021.09.003] [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: 11/30/2022]
Abstract
PET/computed tomography and PET/MR imaging are used to evaluate the post-treatment neck. Although 18F-FDG is helpful in the staging and treatment response assessment of head and neck cancer, recently developed PET radiotracers targeting specific surface markers are promising for applications of diagnostic problem solving and improved extent delineation. Diffusion-weighted MR imaging is helpful in the differential diagnosis of head and neck neoplasms, and improves the sensitivity and specificity for the detection of certain pathologies. Following standardized imaging parameters for PET/computed tomography and diffusion-weighted imaging in PET/MR imaging improves diagnostic accuracy and allows for future research data mining.
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Affiliation(s)
- Gloria J Guzmán Pérez-Carrillo
- Neuroradiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway, Campus Box 8131, St Louis, MO 63110, USA.
| | - Jana Ivanidze
- Division of Molecular Imaging & Therapeutics, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Starr Building, 2nd Floor, New York, NY 10065, USA; Division of Neuroradiology, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Starr Building, 2nd Floor, New York, NY 10065, USA
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17
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Kure AJ, Savas H, Hijaz TA, Hussaini SF, Korutz AW. Advancements in Positron Emission Tomography/Magnetic Resonance Imaging and Applications to Diagnostic Challenges in Neuroradiology. Semin Ultrasound CT MR 2021; 42:434-451. [PMID: 34537113 DOI: 10.1053/j.sult.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since the clinical adoption of magnetic resonance (MR) in medical imaging, MR has proven to be a workhorse in diagnostic neuroradiology, with the ability to provide superb anatomic detail as well as additional functional and physiologic data, depending on the techniques utilized. Positron emission tomography/computed tomography has also shown irreplaceable diagnostic value in certain disease processes of the central nervous system by providing molecular and metabolic information through the development of numerous disease-specific PET tracers, many of which can be utilized as a diagnostic technique in and of themselves or can provide a valuable adjunct to information derived from MR. Despite these advances, many challenges still remain in neuroradiology, particularly in malignancy, neurodegenerative disease, epilepsy, and cerebrovascular disease. Through improvements in attenuation correction, motion correction, and PET detectors, combining the 2 modalities of PET and MR through simultaneous imaging has proven feasible and allows for improved spatial and temporal resolution without compromising either of the 2 individual modalities. The complementary information offered by both technologies has provided increased diagnostic accuracy in both research and many clinical applications in neuroradiology.
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Affiliation(s)
- Andrew J Kure
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Hatice Savas
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Tarek A Hijaz
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Syed F Hussaini
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Alexander W Korutz
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
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Abstract
PET/MR imaging is in routine clinical use and is at least as effective as PET/CT for oncologic and neurologic studies with advantages with certain PET radiopharmaceuticals and applications. In addition, whole body PET/MR imaging substantially reduces radiation dosages compared with PET/CT which is particularly relevant to pediatric and young adult population. For cancer imaging, assessment of hepatic, pelvic, and soft-tissue malignancies may benefit from PET/MR imaging. For neurologic imaging, volumetric brain MR imaging can detect regional volume loss relevant to cognitive impairment and epilepsy. In addition, the single-bed position acquisition enables dynamic brain PET imaging without extending the total study length which has the potential to enhance the diagnostic information from PET.
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Affiliation(s)
- Farshad Moradi
- Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA.
| | - Andrei Iagaru
- Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA
| | - Jonathan McConathy
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT 773, Birmingham, AL 35249, USA
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Marcus C, Sheikhbahaei S, Shivamurthy VKN, Avey G, Subramaniam RM. PET Imaging for Head and Neck Cancers. Radiol Clin North Am 2021; 59:773-788. [PMID: 34392918 DOI: 10.1016/j.rcl.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Head and neck cancers are commonly encountered cancers in clinical practice in the United States. Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT has been clinically applied in staging, occult primary tumor detection, treatment planning, response assessment, follow-up, recurrent disease detection, and prognosis prediction in these patients. Alternative PET tracers remain investigational and can provide additional valuable information such as radioresistant tumor hypoxia. The recent introduction of 18F-FDG PET/MR imaging has provided the advantage of combining the superior soft tissue resolution of MR imaging with the functional information provided by 18F-FDG PET. This article is a concise review of recent advances in PET imaging in head and neck cancer.
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Affiliation(s)
- Charles Marcus
- Department of Nuclear Medicine and Molecular Imaging, Emory University Hospital, Atlanta, GA, USA.
| | - Sara Sheikhbahaei
- Department of Radiology, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235, Baltimore, MD 21287, USA
| | - Veeresh Kumar N Shivamurthy
- Epilepsy Center, St. Francis Hospital and Medical Center, Trinity Health of New England, 114 Woodland Street, Hartford, CT 06105, USA
| | - Greg Avey
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave #3284, Madison, WI 53792, USA
| | - Rathan M Subramaniam
- Dean's Office, Otago Medical School, University of Otago, 201 Great King Street, Dunedin 9016, New Zealand
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Diagnostic Accuracy of Combined PET/CT with MRI, 18F-FDG PET/MRI, and 18F-FDG PET/CT in Patients with Oropharyngeal and Hypopharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:6653117. [PMID: 34007251 PMCID: PMC8099512 DOI: 10.1155/2021/6653117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/03/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
Introduction The aim of this paper is to compare the diagnostic accuracy of PET/CT, PET/MRI, and the combination of PET/CT and MRI for detecting synchronous cancer and distant metastasis in patients with oropharyngeal and hypopharyngeal squamous cell carcinomas (OHSCC). Method A large and growing body of literature has been conducted using the Preferred Reporting Items for Systematic Reviews (PRISMA). The researchers collected all accessible literature existing through Cochrane Library (John Wiley & Sons) electronic databases, Embase (Elsevier), PubMed (U.S. National Library of Medicine), Scopus, and Google Scholar up to June 2020. Analyses were conducted using Stata version 12.0 (StataCorp LP). Results A total of nine studies consisting of 1166 patients were included. The pooled sensitivity of combined PET/CT with MRI, 18F-FDG PET/MRI, and 18F-FDG PET/CT was 0.92, 0.80, and 0.79, respectively, and the corresponding specificities were 0.93, 0.91, and 0.88. The overall prevalence of distant metastases and synchronous cancer in patients with oropharyngeal and hypopharyngeal squamous cell carcinomas was 9.2% and 11.8%, respectively, with the esophagus (4.6%) being the most common site of synchronous cancer. The most common sites of distant metastases were lung (3%), bone (1.2%), and distant lymph nodes (1.2%), respectively. Conclusion Our study showed an approximately similar diagnostic performance for PET/CT, PET/MRI, and the combination of PET/CT and MRI for metastasis assessment in advanced oropharyngeal and hypopharyngeal squamous cell carcinomas.
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Jiang H, Tan Q, He F, Yang W, Liu J, Zhou F, Zhang M. Ultrasound in patients with treated head and neck carcinomas: A retrospective analysis for effectiveness of follow-up care. Medicine (Baltimore) 2021; 100:e25496. [PMID: 33879682 PMCID: PMC8078385 DOI: 10.1097/md.0000000000025496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 03/15/2021] [Indexed: 02/05/2023] Open
Abstract
Correct follow-up is necessary to avoid under- or overtreatment in the care of patients with treated carcinomas of head and neck. Ultrasound is a cost-effective, harmless, easy, and feasible method. It can be applied in the outpatient clinic in follow-up but the United Kingdom National Multidisciplinary guidelines are recommended computed tomography or magnetic resonance imaging for the detection of metastasis for head and neck carcinomas in the follow-up period. The purpose of the study was to state that neck ultrasound would be the method of choice on follow-up care of Chinese patients who received primary treatment for carcinoma of head and neck.Patients who received primary treatment for carcinoma of the head and neck were examined for 5-years in follow-up through physical, clinical, and neck ultrasound (n = 198). If patients had no evidence of disease after 60 months of definitive therapy considered as a cure. If patients had no evidence of disease after 36 months of salvage therapy considered as a cure of recurrence.Irrespective of definitive treatment used, the study was monitored through neck ultrasound during 5 years of a follow-up visit and was reported cure in 126 (64%) patients and recurrence in 72 (36%; distant metastasis: 33 [17%], local recurrence: 24 [12%], and regional recurrence: 15 [7%]) patients. Primary tumor stage IV, III, II, and I had 63% (15/24), 51% (21/41), 32% (18/56), and 23% (18/77) recurrence, respectively. The time to detect regional recurrence was shorter than that for local recurrence (P < .0001, q = 15.059) and distant recurrence (P < .0001, q = 7.958). Local recurrence and stage I primary tumor had the highest percentage cure for recurrence.Neck ultrasound in the follow-up period is reported to be effective for the detection of recurrence of patients who received primary treatment for carcinoma of head and neck especially regional recurrence and primary tumor stage I.Level of Evidence: III.
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Affiliation(s)
- Hongying Jiang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University
- Key Laboratory of Rehabilitation Medicine in Sichuan Province
- West China School of Nursing, West China Hospital, Sichuan University
| | - Qiling Tan
- West China School of Nursing, West China Hospital, Sichuan University
| | - Fawei He
- Department of Ultrasound, Sichuan Cancer Hospital
| | - Wei Yang
- Department of Ultrasound, Sichuan Cancer Hospital
| | - Jifeng Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu
| | - Fang Zhou
- Department of Oncology, Gong’an County People's Hospital, Gong’an, Hubei, China
| | - Mingxia Zhang
- Department of Oncology, Gong’an County People's Hospital, Gong’an, Hubei, China
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22
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Pace L, Nicolai E, Cavaliere C, Basso L, Garbino N, Spinato G, Salvatore M. Prognostic value of 18F-FDG PET/MRI in patients with advanced oropharyngeal and hypopharyngeal squamous cell carcinoma. Ann Nucl Med 2021; 35:479-484. [PMID: 33575927 PMCID: PMC7981313 DOI: 10.1007/s12149-021-01590-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/12/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prognostic value of combined positron emission tomography (PET)/magnetic resonance imaging (MRI) parameters provided by simultaneous 18F-fluorodeoxyglucose (FDG) PET/MRI in patients with locally advanced oropharyngeal and hypopharyngeal squamous cell carcinomas (OHSCC). METHODS Forty-five patients with locally advanced OHSCC who underwent simultaneous FDG PET/MRI before (chemo)radiotherapy were retrospectively enrolled. Peak standardized uptake value (SULpeak), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary lesion were obtained on PET data. On MRI scans, primary tumor size, diffusion and perfusion parameters were assessed using pre-contrast and high-resolution post-contrast images. Ratios between metabolic/metabolo-volumetric parameters and ADC were calculated. Comparisons between groups were performed by Student's t test. Survival analysis was performed by univariate Cox proportional hazard regression analysis. Overall survival curves were obtained by the Kaplan-Meier method and compared with the log-rank test. Survivors were censored at the time of the last clinical control. p < 0.05 was considered statistically significant RESULTS: During follow-up (mean 31.4 ± 21 months), there were 15 deaths. Univariate analysis shows that SULpeak and SULpeak/ADCmean were significant predictors of overall survival (OS). At multivariate analysis, only SULpeak remained a significant predictor of OS. Kaplan-Meier survival analyses showed that patients with higher SULpeak had poorer outcome compared to those with lower values (HR: 3.7, p = 0.007). CONCLUSION Pre-therapy SULpeak of the primary site was predictive of overall survival in patients with oropharyngeal or hypopharyngeal cancer treated with (chemo)radiotherapy.
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Affiliation(s)
- Leonardo Pace
- Dipartimento di Medicina Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, via M. de Vito Piscicelli 44, 80128, Naples, Italy.
| | | | | | | | | | - Giacomo Spinato
- Dipartimento di Neuroscienze Sezione di Otorinolaringoiatria e Centro Regionale Tumori Testa Collo, Università degli Studi di Padova, Treviso, Italy
- Dipartimento di ChirurgiaOncologia e GastroenterologiaSezione di Oncologia ed Immunologia, Università degli Studi di Padova, Padua, Italy
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Crimì F, Borsetto D, Stramare R, Di Carlo R, Emauelli E, Nicolai P, Lacognata C, Zucchetta P, Oliveri G, Merola A, Bodanza V, Albertoni L, Campi C, Cecchin D. [ 18F]FDG PET/MRI versus contrast-enhanced MRI in detecting regional HNSCC metastases. Ann Nucl Med 2021; 35:260-269. [PMID: 33454923 DOI: 10.1007/s12149-020-01565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological criteria versus integrated [18F]FDG PET/MRI in identifying regional lymph node metastases in patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC). For this purpose, we compare MRI and PET/MRI using the histopathological findings in dissected lymph nodes as the gold standard. METHODS We retrospectively reviewed 26 patients with histologically proven HNSCC who underwent gadolinium-enhanced [18F]FDG PET/MRI as part of their staging. All neck lymph nodes were classified on MRI using dimensional and/or morphological criteria. Then, they were jointly assessed by a nuclear medicine physician and a radiologist using integrated [18F]PET/MR images. ROC curves were obtained to compare the techniques. Lymph node histopathology was considered as the reference standard. RESULTS Out of 865 lymph nodes, 35 were malignant at histopathology (3 with micro-metastases). Sensitivity and specificity were 48.6% and 99.5% for MRI using dimensional criteria; 60.0% and 99.6% for MRI using morphological criteria; 60.0% and 99.4% for MRI using both; and 74.3% and 97.6% for PET using MR as anatomic localization. The area under the ROC curve was higher for PET and MRI localization (0.859) than for MRI using dimensional (0.740; p < 0.05), or morphological (0.798; p < 0.05), or both criteria (0.797; p < 0.05). PET/MR using a PET SUVmax cutoff of 5.7 combined with MRI using dimensional and/or morphological criteria reached high values for accuracy (98.2%), NPV (98.2%), and PPV (95.2%). CONCLUSIONS Compared with traditional contrast-enhanced MRI or PET alone, integrated PET/MRI could improve diagnostic accuracy in detecting metastatic lymph nodes in patients with HNSCC.
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Affiliation(s)
- Filippo Crimì
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy
| | - Daniele Borsetto
- Guy's and St Thomas NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
| | - Roberto Stramare
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy
| | - Roberto Di Carlo
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | - Enzo Emauelli
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | - Piero Nicolai
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | | | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
| | - Giulia Oliveri
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | - Arcangelo Merola
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy
| | - Valentina Bodanza
- Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
| | - Laura Albertoni
- Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
| | - Cristina Campi
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
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Mu W, Liang Y, Hall LO, Tan Y, Balagurunathan Y, Wenham R, Wu N, Tian J, Gillies RJ. 18F-FDG PET/CT Habitat Radiomics Predicts Outcome of Patients with Cervical Cancer Treated with Chemoradiotherapy. Radiol Artif Intell 2020; 2:e190218. [PMID: 33937845 PMCID: PMC8082355 DOI: 10.1148/ryai.2020190218] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine if quantitative features extracted from pretherapy fluorine 18 fluorodeoxyglucose (18F-FDG) PET/CT estimate prognosis in patients with locally advanced cervical cancer treated with chemoradiotherapy. MATERIALS AND METHODS In this retrospective study, PET/CT images and outcomes were curated from 154 patients with locally advanced cervical cancer, who underwent chemoradiotherapy from two institutions between March 2008 and June 2016, separated into independent training (n = 78; mean age, 51 years ± 13 [standard deviation]) and testing (n = 76; mean age, 50 years ± 10) cohorts. Radiomic features were extracted from PET, CT, and habitat (subregions with different metabolic characteristics) images that were derived by fusing PET and CT images. Parsimonious sets of these features were identified by the least absolute shrinkage and selection operator analysis and used to generate predictive radiomics signatures for progression-free survival (PFS) and overall survival (OS) estimation. Prognostic validation of the radiomic signatures as independent prognostic markers was performed using multivariable Cox regression, which was expressed as nomograms, together with other clinical risk factors. RESULTS The radiomics nomograms constructed with T stage, lymph node status, and radiomics signatures resulted in significantly better performance for the estimation of PFS (Harrell concordance index [C-index], 0.85 for training and 0.82 for test) and OS (C-index, 0.86 for training and 0.82 for test) compared with International Federation of Gynecology and Obstetrics staging system (C-index for PFS, 0.70 for training [P = .001] and 0.70 for test [P = .002]; C-index for OS, 0.73 for training [P < .001] and 0.70 for test [P < .001]), respectively. CONCLUSION Prognostic models were generated and validated from quantitative analysis of 18F-FDG PET/CT habitat images and clinical data, and may have the potential to identify the patients who need more aggressive treatment in clinical practice, pending further validation with larger prospective cohorts.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
| | | | - Lawrence O. Hall
- From the Department of Cancer Physiology (W.M., Y.T., Y.B., R.J.G.) and Gynecologic Oncology (R.W.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612; Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China (Y.L., N.W.); Department of Computer Science and Engineering, University of South Florida, Tampa, Fla (L.O.H.); Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China (J.T.); and CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.)
| | - Yan Tan
- From the Department of Cancer Physiology (W.M., Y.T., Y.B., R.J.G.) and Gynecologic Oncology (R.W.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612; Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China (Y.L., N.W.); Department of Computer Science and Engineering, University of South Florida, Tampa, Fla (L.O.H.); Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China (J.T.); and CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.)
| | - Yoganand Balagurunathan
- From the Department of Cancer Physiology (W.M., Y.T., Y.B., R.J.G.) and Gynecologic Oncology (R.W.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612; Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China (Y.L., N.W.); Department of Computer Science and Engineering, University of South Florida, Tampa, Fla (L.O.H.); Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China (J.T.); and CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.)
| | - Robert Wenham
- From the Department of Cancer Physiology (W.M., Y.T., Y.B., R.J.G.) and Gynecologic Oncology (R.W.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612; Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China (Y.L., N.W.); Department of Computer Science and Engineering, University of South Florida, Tampa, Fla (L.O.H.); Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China (J.T.); and CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.)
| | - Ning Wu
- From the Department of Cancer Physiology (W.M., Y.T., Y.B., R.J.G.) and Gynecologic Oncology (R.W.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612; Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China (Y.L., N.W.); Department of Computer Science and Engineering, University of South Florida, Tampa, Fla (L.O.H.); Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China (J.T.); and CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.)
| | - Jie Tian
- From the Department of Cancer Physiology (W.M., Y.T., Y.B., R.J.G.) and Gynecologic Oncology (R.W.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612; Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China (Y.L., N.W.); Department of Computer Science and Engineering, University of South Florida, Tampa, Fla (L.O.H.); Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China (J.T.); and CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.)
| | - Robert J. Gillies
- From the Department of Cancer Physiology (W.M., Y.T., Y.B., R.J.G.) and Gynecologic Oncology (R.W.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612; Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China (Y.L., N.W.); Department of Computer Science and Engineering, University of South Florida, Tampa, Fla (L.O.H.); Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China (J.T.); and CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.)
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Comparison of diagnostic accuracy between [ 18F]FDG PET/MRI and contrast-enhanced MRI in T staging for oral tongue cancer. Ann Nucl Med 2020; 34:952-959. [PMID: 33040312 DOI: 10.1007/s12149-020-01526-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Integrated PET/MRI with [18F]FDG is advantageous in that it enables simultaneous PET and MR imaging with higher soft-tissue contrast, multiplanar image acquisition, and functional imaging capability without using fat suppression and gadolinium-based contrast agents (GBCAs). The aims of this study were to demonstrate the feasibility of [18F]FDG PET/MRI for assessing the extent of the primary tumor (T) in oral tongue cancer (OTC) based on the 8th edition of American Joint Committee on Cancer (AJCC) cancer staging system, and to compare the diagnostic accuracy between [18F]FDG PET/MRI and contrast-enhanced MRI (ceMRI). METHODS 18 patients with biopsy-proven operable OTC underwent preoperative regional [18F]FDG PET/MRI and ceMRI within 2 weeks. For [18F]FDG PET/MRI, rainbow-colored PET images were overlaid on the corresponding MR images. Tumor size and the depth of invasion (DOI) were visually measured on [18F]FDG PET/MRI and ceMRI. The size, DOI, and clinical T stage were evaluated using the final surgical pathology as the reference. RESULTS Of the 18 OTCs, one was not detected by ceMRI due to metal artifacts from an artificial denture, and another due to superficial type (pathological DOI = 0 mm). Tumor sizes measured by ceMRI and [18F]FDG PET/MRI had significant positive correlations with the pathological size (r = 0.80 and r = 0.90, respectively), and DOIs measured by ceMRI and [18F]FDG PET/MRI had significant positive correlations with the pathological DOI (r = 0.74 and r = 0.64, respectively). The means ± SD of size (mm) were 20.4 ± 9.1, 22.9 ± 10.9, and 26.2 ± 10.0, and those of DOI (mm) were 7.1 ± 2.5, 6.9 ± 2.2, and 5.8 ± 3.2 for ceMRI, [18F]FDG PET/MRI, and pathology, respectively. A significant difference was observed in tumor size between ceMRI and pathology (p < 0.05), whereas no significant differences were observed between any other sizes, DOIs, or T stages. The accuracy for T status was 72% (13/18 including 2 undetectable cases) for ceMRI and 89% (16/18) for [18F]FDG PET/MRI. CONCLUSIONS Although shallow DOIs are often overestimated, regional [18F]FDG PET/MRI without fat suppression and gadolinium enhancement is comparable to and may be substituted for ceMRI in preoperative T staging for OTC patients, reducing metal artifacts and avoiding the adverse effects of GBCAs.
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Applications of Hybrid PET/Magnetic Resonance Imaging in Central Nervous System Disorders. PET Clin 2020; 15:497-508. [DOI: 10.1016/j.cpet.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Pyatigorskaya N, De Laroche R, Bera G, Giron A, Bertolus C, Herve G, Chambenois E, Bergeret S, Dormont D, Amor-Sahli M, Kas A. Are Gadolinium-Enhanced MR Sequences Needed in Simultaneous 18F-FDG-PET/MRI for Tumor Delineation in Head and Neck Cancer? AJNR Am J Neuroradiol 2020; 41:1888-1896. [PMID: 32972956 DOI: 10.3174/ajnr.a6764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 06/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE PET/MRI with 18F-FDG has demonstrated the advantages of simultaneous PET and MR imaging in head and neck cancer imaging, MRI allowing excellent soft-tissue contrast, while PET provides metabolic information. The aim of this study was to evaluate the added value of gadolinium contrast-enhanced sequences in the tumor delineation of head and neck cancers on 18F-FDG-PET/MR imaging. MATERIALS AND METHODS Consecutive patients who underwent simultaneous head and neck 18F-FDG-PET/MR imaging staging or restaging followed by surgery were retrospectively included. Local tumor invasion and lymph node extension were assessed in 45 head and neck anatomic regions using 18F-FDG-PET/MR imaging by 2 rater groups (each one including a radiologist and a nuclear medicine physician). Two reading sessions were performed, one without contrast-enhanced sequences (using only T1WI, T2WI, and PET images) and a second with additional T1WI postcontrast sequences. The results were compared with the detailed histopathologic analysis, used as reference standard. The κ concordance coefficient between the reading sessions and sensitivity and specificity for each region were calculated. RESULTS Thirty patients were included. There was excellent agreement between the contrast-free and postgadolinium reading sessions in delineating precise tumor extension in the 45 anatomic regions studied (Cohen κ = 0.96, 95% CI = [0.94-0.97], P < .001). The diagnostic accuracy did not differ between contrast-free and postgadolinium reading sessions, being 0.97 for both groups and both reading sessions. For the 2 rater groups, there was good sensitivity for both contrast-free (0.83 and 0.85) and postgadolinium reading sessions (0.88 and 0.90, respectively). Moreover, there was excellent specificity (0.98) for both groups and reading sessions. CONCLUSIONS Gadolinium chelate contrast administration showed no added value for accurate characterization of head and neck primary tumor extension and could possibly be avoided in the PET/MR imaging head and neck workflow.
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Affiliation(s)
- N Pyatigorskaya
- From Assistance Publique Hôpitaux de Paris Neuroradiology Department (N.P., E.C., D.D., M.A.-S.)
- Sorbonne University (N.P., D.D.), Pierre and Marie Faculty of Medicine, Paris, France
| | - R De Laroche
- Nuclear Medicine Department (R.D.L.), Morvan Hospital, Brest, France
| | - G Bera
- Nuclear Medicine Department (G.B., S.B., A.K.), Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
| | - A Giron
- Sorbonne University (A.G., A.K.), Laboratoire d'Imagerie Biomédicale, Paris, France
| | - C Bertolus
- Sorbonne University, Maxillo-Facial Surgery Department (C.B.)
- CIMI Sorbonne University UPMC (C.B.), Paris, France
| | - G Herve
- Pathology Department (G.H.), Pitié Salpêtrière-Charles Foix Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - E Chambenois
- From Assistance Publique Hôpitaux de Paris Neuroradiology Department (N.P., E.C., D.D., M.A.-S.)
| | - S Bergeret
- Nuclear Medicine Department (G.B., S.B., A.K.), Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
| | - D Dormont
- From Assistance Publique Hôpitaux de Paris Neuroradiology Department (N.P., E.C., D.D., M.A.-S.)
- Sorbonne University (N.P., D.D.), Pierre and Marie Faculty of Medicine, Paris, France
| | - M Amor-Sahli
- From Assistance Publique Hôpitaux de Paris Neuroradiology Department (N.P., E.C., D.D., M.A.-S.)
| | - A Kas
- Nuclear Medicine Department (G.B., S.B., A.K.), Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
- Sorbonne University (A.G., A.K.), Laboratoire d'Imagerie Biomédicale, Paris, France
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Abstract
Oncologic imaging has been a major focus of clinical research on PET/MR over the last 10 years. Studies so far have shown that PET/MR with 18F-Fluorodeoxyglucose (FDG) overall provides a similar accuracy for tumor staging as FDG PET/CT. The effective radiation dose of whole-body FDG PET/MR is more than 50% lower than for FDG PET/CT, making PET/MR particularly attractive for imaging of children. However, the longer acquisition times and higher costs have so far limited broader clinical use of PET/MR technology for whole-body staging. With the currently available technology, PET/MR appears more promising for locoregional staging of diseases for which MR is the anatomical imaging modality of choice. These include brain tumors, head and neck cancers, gynecologic malignancies, and prostate cancer. For instance, PET imaging with ligands of prostate-specific membrane antigen, combined with multi-parametric MR, appears promising for detection of prostate cancer and differentiation from benign prostate pathologies as well as for detection of local recurrences. The combination of functional parameters from MR, such as apparent diffusion coefficients, and molecular parameters from PET, such as receptor densities or metabolic rates, is feasible in clinical studies, but clinical applications for this multimodal and multi-parametric imaging approach still need to be defined.
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Abstract
In academic centers, PET/MR has taken the road to clinical nuclear medicine in the past 6 years since the last review on its applications in head and neck cancer patients in this journal. Meanwhile, older sequential PET + MR machines have largely vanished from clinical sites, being replaced by integrated simultaneous PET/MR scanners. Evidence from several studies suggests that PET/MR overall performs equally well as PET/CT in the staging and restaging of head and neck cancer and in radiation therapy planning. PET/MR appears to offer advantages in the characterization and prognostication of head and neck malignancies through multiparametric imaging, which demands an exact preparation and validation of imaging modalities, however. The majority of available clinical PET/MR studies today covers FDG imaging of squamous cell carcinoma arising from a broad spectrum of locations in the upper aerodigestive tract. In the future, specific PET/MR studies are desired that address specific histopathological tumor entities, nonepithelial malignancies, such as major salivary gland tumors, squamous cell carcinomas arising in specific locations, and malignancies imaged with non-FDG radiotracers. With the advent of digital PET/CT scanners, PET/MR is expected to partake in future technical developments, such as novel iterative reconstruction techniques and deviceless motion correction for respiration and gross movement in the head and neck region. Owing to the still comparably high costs of PET/MR scanners and facility requirements on the one hand, and the concentration of multidisciplinary head and neck cancer treatment mainly at academic centers on the other hand, a more widespread use of this imaging modality outside major hospitals is currently limited.
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Comparative Study Between Integrated Positron Emission Tomography/Magnetic Resonance and Positron Emission Tomography/Computed Tomography in the T and N Staging of Hypopharyngeal Cancer: An Initial Result. J Comput Assist Tomogr 2020; 44:540-545. [PMID: 32558774 DOI: 10.1097/rct.0000000000001036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of positron emission tomography/magnetic resonance (PET/MR) versus PET/computed tomography (PET/CT) for T and N staging of hypopharyngeal cancer. METHODS Integrated PET/MR and PET/CT examinations were performed in 20 patients with hypopharyngeal cancer after same-day single injection. Eleven of 20 patients underwent surgery with histologic findings directly compared with imaging findings. Statistical analysis included Spearman correlation and McNemar test. RESULTS Accuracy of PET/MR, PET/CT, and MRI for T staging was 81.8%, 63.6%, and 72.7%, respectively. Sensitivity and specificity for detecting metastatic lymph nodes was 88.2% and 98.2% on PET/MR, 76.5% and 98.3% on PET/CT, and 64.7% and 94.7% on MRI. CONCLUSIONS The PET/MR and PET/CT provide comparable results for assessing hypopharyngeal carcinoma and detecting metastatic lymph nodes.
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Zheng D, Liu Y, Liu J, Li K, Lin M, Schmidt H, Xu B, Tian J. Improving MR sequence of 18F-FDG PET/MR for diagnosing and staging gastric Cancer: a comparison study to 18F-FDG PET/CT. Cancer Imaging 2020; 20:39. [PMID: 32546207 PMCID: PMC7298805 DOI: 10.1186/s40644-020-00317-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/28/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Evaluate the feasibility of fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) and magnetic resonance (MR) imaging in patients with gastric cancer by optimizing the scan protocol and to compare the image quality to 18F FDG PET and computed tomography (CT). Methods The PET/CT and PET/MR imaging were sequentially performed in 30 patients with gastric cancer diagnosed by gastroscope using a single-injection-with-dual-imaging protocol. After intravenous injection of 18F-FDG (mean, 249 MBq), PET/CT imaging including low-dose CT was performed (mean uptake time, 47 ± 6 min), and PET/MR imaging including a T1-weighted Dixon sequence for attenuation correction and two different T2-weighted sequences was subsequently acquired (88 ± 15 min after 18F-FDG injection). Four series of images (CT from PET/CT, T1W, T2W Half-Fourier acquisition single-shot turbo spin-echo [T2W-HASTE] and T2W-BLADE from PET/MR) were visually evaluated using a 3–4 points scale for: (1) image artifacts, (2) lesion conspicuity and (3) image fusion quality. The characteristics of the primary lesions were assessed and compared between the PET/CT and PET/MR acquisitions. Results The image quality and lesion conspicuity of the T2W-HASTE images were significantly improved compared to that of the T2W-BLADE images. A significantly higher number of artifacts were seen in the T2W-HASTE images compared with the T1W and CT images (p < 0. 05). No differences in the accuracy of image fusion between PET/MR and PET/CT (p > 0. 05); however, significant difference was seen in the lesion conspicuity measurements (p < 0.05) with T2W-HASTE being superior. For information about the primary lesion characteristics, the T2W-HASTE images provided the most successful identifications compared with those of the T1W and PET/CT (13vs7vs5) images. Conclusions PET/MR with the T2W-HASTE was better at revealing the details of local stomach lesions compared with PET/CT imaging. Combining the PET/MR with the T2W-HASTE technique is a promising imaging method for diagnosing and staging gastric cancer.
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Affiliation(s)
- Dong Zheng
- Department of Nuclear Medicine, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian Street, Beijing, 100853, China.,Department of Radiology, Chinese People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Yi Liu
- Department of General Surgery, The Seventh Medical Center of Chinese People's Liberation Army, General Hospital, Beijing, 100010, China
| | - Jiajin Liu
- Department of Nuclear Medicine, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian Street, Beijing, 100853, China
| | - Ke Li
- Department of Radiology, Chinese People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Mu Lin
- MR Collaboration, Diagnostic Imaging, Siemens Healthineers Ltd, Shanghai, 201318, China
| | - Holger Schmidt
- MR Education, Customer Services, Siemens Healthcare GmbH, 91052, Erlangen, Germany
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian Street, Beijing, 100853, China.
| | - Jiahe Tian
- Department of Nuclear Medicine, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian Street, Beijing, 100853, China.
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Mu W, Tunali I, Gray JE, Qi J, Schabath MB, Gillies RJ. Radiomics of 18F-FDG PET/CT images predicts clinical benefit of advanced NSCLC patients to checkpoint blockade immunotherapy. Eur J Nucl Med Mol Imaging 2020; 47:1168-1182. [PMID: 31807885 PMCID: PMC8663718 DOI: 10.1007/s00259-019-04625-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/18/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Immunotherapy has improved outcomes for patients with non-small cell lung cancer (NSCLC), yet durable clinical benefit (DCB) is experienced in only a fraction of patients. Here, we test the hypothesis that radiomics features from baseline pretreatment 18F-FDG PET/CT scans can predict clinical outcomes of NSCLC patients treated with checkpoint blockade immunotherapy. METHODS This study included 194 patients with histologically confirmed stage IIIB-IV NSCLC with pretreatment PET/CT images. Radiomics features were extracted from PET, CT, and PET+CT fusion images based on minimum Kullback-Leibler divergence (KLD) criteria. The radiomics features from 99 retrospective patients were used to train a multiparametric radiomics signature (mpRS) to predict DCB using an improved least absolute shrinkage and selection operator (LASSO) method, which was subsequently validated in both retrospective (N = 47) and prospective test cohorts (N = 48). Using these cohorts, the mpRS was also used to predict progression-free survival (PFS) and overall survival (OS) by training nomogram models using multivariable Cox regression analyses with additional clinical characteristics incorporated. RESULTS The mpRS could predict patients who will receive DCB, with areas under receiver operating characteristic curves (AUCs) of 0.86 (95%CI 0.79-0.94), 0.83 (95%CI 0.71-0.94), and 0.81 (95%CI 0.68-0.92) in the training, retrospective test, and prospective test cohorts, respectively. In the same three cohorts, respectively, nomogram models achieved C-indices of 0.74 (95%CI 0.68-0.80), 0.74 (95%CI 0.66-0.82), and 0.77 (95%CI 0.69-0.84) to predict PFS and C-indices of 0.83 (95%CI 0.77-0.88), 0.83 (95%CI 0.71-0.94), and 0.80 (95%CI 0.69-0.91) to predict OS. CONCLUSION PET/CT-based signature can be used prior to initiation of immunotherapy to identify NSCLC patients most likely to benefit from immunotherapy. As such, these data may be leveraged to improve more precise and individualized decision support in the treatment of patients with advanced NSCLC.
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Affiliation(s)
- Wei Mu
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Ilke Tunali
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Jhanelle E Gray
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jin Qi
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Matthew B Schabath
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Robert J Gillies
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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Samolyk-Kogaczewska N, Sierko E, Dziemianczyk-Pakiela D, Nowaszewska KB, Lukasik M, Reszec J. Usefulness of Hybrid PET/MRI in Clinical Evaluation of Head and Neck Cancer Patients. Cancers (Basel) 2020; 12:cancers12020511. [PMID: 32098356 PMCID: PMC7072319 DOI: 10.3390/cancers12020511] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 12/22/2022] Open
Abstract
(1) Background: The novel hybrid of positron emission tomography/magnetic resonance (PET/MR) examination has been introduced to clinical practice. The aim of our study was to evaluate PET/MR usefulness in preoperative staging of head and neck cancer (HNC) patients (pts); (2) Methods: Thirty eight pts underwent both computed tomography (CT) and PET/MR examination, of whom 21 pts underwent surgical treatment as first-line therapy and were further included in the present study. Postsurgical tissue material was subjected to routine histopathological (HP) examination with additional evaluation of p16, human papillomavirus (HPV), Epstein-Barr virus (EBV) and Ki67 status. Agreement of clinical and pathological T staging, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of CT and PET/MR in metastatic lymph nodes detection were defined. The verification of dependences between standardized uptake value (SUV value), tumor geometrical parameters, number of metastatic lymph nodes in PET/MR and CT, biochemical parameters, Ki67 index, p16, HPV and EBV status was made with statistical analysis of obtained results; (3) Results: PET/MR is characterized by better agreement in T staging, higher specificity, sensitivity, PPV and NPV of lymph nodes evaluation than CT imaging. Significant correlations were observed between SUVmax and maximal tumor diameter from PET/MR, between SUVmean and CT tumor volume, PET/MR tumor volume, maximal tumor diameter assessed in PET/MR. Other correlations were weak and insignificant; (4) Conclusions: Hybrid PET/MR imaging is useful in preoperative staging of HNC. Further studies are needed.
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Affiliation(s)
| | - Ewa Sierko
- Department of Radiotherapy, Comprehensive Cancer Center, 15-027 Bialystok, Poland;
- Department of Oncology, Medical University of Bialystok, 15-027 Bialystok, Poland
- Correspondence: ; Tel.: +48-85-6646827
| | - Dorota Dziemianczyk-Pakiela
- Department of Otolaryngology and Maxillofacial Surgery, Jedrzej Sniadecki Memorial Regional Hospital, 15-950 Bialystok, Poland;
| | - Klaudia Beata Nowaszewska
- Department of Maxillofacial and Plastic Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Malgorzata Lukasik
- Department of Medical Pathology, Medical University of Bialystok, 15-089 Bialystok, Poland; (M.L.); (J.R.)
| | - Joanna Reszec
- Department of Medical Pathology, Medical University of Bialystok, 15-089 Bialystok, Poland; (M.L.); (J.R.)
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Nieberler M, Stimmer H, Rasthofer D, Nentwig K, Weirich G, Wolff KD. Defining secure surgical bone margins in head and neck squamous cell carcinomas: The diagnostic impact of intraoperative cytological assessment of bone resection margins compared with preoperative imaging. Oral Oncol 2020; 102:104579. [PMID: 32062159 DOI: 10.1016/j.oraloncology.2020.104579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/09/2020] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Imaging provides crucial staging information for treatment planning of head and neck squamous cell carcinomas (HNSCCs). Despite technical progress in imaging techniques, defining the extent of bone involvement preoperatively remains challenging and requires intraoperative information to control for adequate resection. The intraoperative cytological assessment of the bone resection margins (ICAB) provides information whether bone is infiltrated by carcinoma. The aim of this study was to assess the diagnostic value of preoperative imaging compared with ICAB in order to achieve carcinoma-free bone margins. MATERIALS AND METHODS 108 HNSCC patients underwent preoperative computed tomography (CT), magnetic resonance imaging (MRI) and orthopantomogram (OPG) for staging and surgical planning. Curative resection was planned based on imaging. Intraoperatively, the resection margins were controlled by ICAB. The diagnostic value of preoperative imaging and ICAB was assessed with reference to the histological findings. RESULTS CT showed a sensitivity of 89.7%, specificity of 63.0%, positive predictive value (PPV) of 85.9%, and negative predictive value (NPV) of 70.8%. MRI revealed a sensitivity of 45.5%, specificity of 66.7%, PPV of 71.4% and NPV of 40.0%. OPG-imaging had a sensitivity of 64.7%, specificity of 76.2%, PPV of 81.5%, NPV 57.1%. In comparison, ICAB provided a sensitivity of 78.6%, specificity of 95.7%, PPV 73.3%, and NPV 96.7%. The accuracy was 82.1%, 52.9%, 69.0%, and 93.5% for CT, MRI, OPG, and ICAB, respectively. CONCLUSION Preoperative imaging lacks accuracy in defining adequate bone resection margins, compared with ICAB. ICAB supports preoperative imaging and intraoperative frozen sections to improve bone margin control.
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Affiliation(s)
- Markus Nieberler
- Department of Oral and Maxillofacial Surgery, Hospital rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679 Munich, Germany.
| | - Herbert Stimmer
- Department of Radiology, Hospital rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679 Munich, Germany
| | - Daniela Rasthofer
- Department of Oral and Maxillofacial Surgery, Hospital rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679 Munich, Germany
| | - Katharina Nentwig
- Department of Oral and Maxillofacial Surgery, Hospital rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679 Munich, Germany
| | - Gregor Weirich
- Institute of Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Hospital rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679 Munich, Germany
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Ruhlmann M, Ruhlmann V. PET in Head and Neck Cancer. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martin O, Schaarschmidt BM, Kirchner J, Suntharalingam S, Grueneisen J, Demircioglu A, Heusch P, Quick HH, Forsting M, Antoch G, Herrmann K, Umutlu L. PET/MRI Versus PET/CT for Whole-Body Staging: Results from a Single-Center Observational Study on 1,003 Sequential Examinations. J Nucl Med 2019; 61:1131-1136. [DOI: 10.2967/jnumed.119.233940] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/02/2019] [Indexed: 12/31/2022] Open
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Cheng Y, Bai L, Shang J, Tang Y, Ling X, Guo B, Gong J, Wang L, Xu H. Preliminary clinical results for PET/MR compared with PET/CT in patients with nasopharyngeal carcinoma. Oncol Rep 2019; 43:177-187. [PMID: 31746412 PMCID: PMC6908933 DOI: 10.3892/or.2019.7392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/09/2019] [Indexed: 12/23/2022] Open
Abstract
The present study aimed to assess the performance of positron emission tomography-magnetic resonance imaging (PET/MR) for the visualization and characterization of lesions. In addition, the present study investigated whether the apparent diffusion coefficient (ADC) and intravoxel incoherent motion parameters exhibited any significant correlation with standardized uptake values (SUV) in patients with nasopharyngeal carcinoma (NPC). A total of 35 patients with NPC underwent whole body PET-computed tomography (CT) and head and neck MR imaging (MRI) scans using the PET/CT-MRI system. Image quality, lesion conspicuity and the diagnostic confidence of PET/CT, T1 weighted (T1w) PET/MR and T2w PET/MR imaging were assessed. The true diffusion coefficient (D), the pseudo-diffusion coefficient or diffusion within the microcirculation (D*), and the perfusion fraction or the contribution of water moving in the capillaries (f), and ADC, were calculated. The correlation between the ADC, D*, D and f values and the SUV were analyzed using Pearson's correlation analysis. Similar image quality was obtained using PET/CT, T1w PET/MR and T2w PET/MR imaging. However, the T1w PET/MR and T2w PET/MR imaging were more effective than PET/CT in analyzing the lesion conspicuity of the primary tumors and lymph nodes. In addition, T2w PET/MR imaging was more efficient than T1w PET/MR imaging in analyzing primary tumors and lymph nodes. Pearson's correlation analysis showed no significant correlation between the SUV and ADC, and D*, D and f values in NPC. The present results suggested that the application of PET/MR is feasible and could serve as a reliable alternative to PET/CT, while SUV and ADC, D*, D and f values were identified as independent biomarkers in NPC.
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Affiliation(s)
- Yong Cheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Le Bai
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Jingjie Shang
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Yongjin Tang
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Xueying Ling
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Bin Guo
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Jian Gong
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Lu Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Hao Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
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Comparison of 18F-FDG PET/MRI, MRI, and 18F-FDG PET/CT for the detection of synchronous cancers and distant metastases in patients with oropharyngeal and hypopharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2019; 47:94-104. [PMID: 31606831 DOI: 10.1007/s00259-019-04510-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE In this prospective study, we sought to compare the clinical utility of fluorodeoxyglucose PET/MRI, MRI, and PET/CT in the detection of synchronous cancers and distant metastases in patients with oropharyngeal and hypopharyngeal squamous cell carcinoma (OHSCC). METHODS We examined 198 consecutive patients with biopsy-proven OHSCC who agreed to receive chemoradiation. All patients underwent pretreatment PET/MRI and PET/CT on the same day. Patients were followed-up for a minimum of 12 months or until death. The McNemar's test and receiver-operating characteristic (ROC) curves were used to compare sensitivity/specificity and the diagnostic capabilities of PET/MRI, MRI, and PET/CT, respectively. RESULTS We identified 55 patients (27.7%) who had synchronous cancers and/or distant metastases (number of involved sites: 83). The results of site-based analysis revealed that the sensitivity of PET/MRI was 15.7% higher than that of MRI (73.5% versus 57.8%, p < 0.001) and 3.6% higher compared with PET/CT (73.5% versus 69.9%, p = 0.083), whereas the sensitivity of PET/CT was 12.1% higher than that of MRI (69.9% versus 57.8%, p = 0.012). On a patient-basis, ROC curve analysis demonstrated that PET/MRI yielded a greater area under curve than MRI (0.930 versus 0.905, p = 0.023). There were no significant differences in terms of diagnostic capability between MRI and PET/CT (0.905 versus 0.917, p = 0.469) and between PET/MRI and PET/CT (0.930 versus 0.917, p = 0.062). CONCLUSIONS In our cohort, PET/MRI showed a significantly higher diagnostic capability than MRI and no significant difference compared with PET/CT for the detection of synchronous cancers or distant metastases in patients with OHSCC.
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Morsing A, Hildebrandt MG, Vilstrup MH, Wallenius SE, Gerke O, Petersen H, Johansen A, Andersen TL, Høilund-Carlsen PF. Hybrid PET/MRI in major cancers: a scoping review. Eur J Nucl Med Mol Imaging 2019; 46:2138-2151. [PMID: 31267161 DOI: 10.1007/s00259-019-04402-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/13/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE PET/MRI was introduced for clinical use in 2011 and is now an established modality for the imaging of brain and certain pelvic cancers, whereas clinical use for the imaging of other forms of cancer is not yet widespread. We therefore systematically investigated what has been published on the use of PET/MRI compared to PET/CT in the imaging of cancers outside the brain, focusing on clinical areas of application related to diagnosis, staging and restaging. METHODS A systematic search of PubMed/MEDLINE, Embase and the Cochrane Library was performed. Studies evaluating the diagnostic performance of simultaneous PET/MRI in cancer patients were chosen. RESULTS A total of 3,138 publications were identified and 116 published during the period 2012-2018 were included and were grouped according to the major cancer forms: 13 head and neck (HNC), 9 breast (BC), 21 prostate (PC), 14 gynaecological, 13 gastrointestinal (GIC), and 46 various cancers. Data from studies comparing PET/MRI and PET/CT for staging/restaging suggested the superiority of 18F-FDG PET/MRI for the detection of tumour extension and retropharyngeal lymph node metastases in nasopharyngeal cancer, and for the detection of liver metastases and possibly bone marrow metastases in high-risk BC. FDG PET/MRI tended to be inferior for the detection of lung metastases in HNC and BC. 68Ga-PSMA-11 PET/MRI was superior to PET/CT for the detection of local PC recurrence. FDG PET/MRI was superior to FDG PET/CT for the detection of local tumour invasion in cervical cancer and had higher accuracy for the detection of liver metastases in colorectal cancer. CONCLUSION The scoping review methodology resulted in the identification of a huge number of records, of which less than 5% were suitable for inclusion and only a limited number allowed conclusions on the advantages/disadvantages of PET/MRI compared to PET/CT in the oncological setting. There was evidence to support the use of FDG PET/MRI in staging of nasopharyngeal cancer and high-risk BC. Preliminary data indicate the superiority of PET/MRI for the detection of local recurrence in PC, local tumour invasion in cervical cancer, and liver metastases in colorectal cancer. These conclusions are based on small datasets and need to be further explored.
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Affiliation(s)
- Anni Morsing
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
- MAgNetic Resonance Technology for Response Adapted Radiotherapy (MANTRA), Odense University Hospital, Odense, Denmark.
| | - Malene Grubbe Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology (CIMT), Odense University Hospital, Odense, Denmark
| | - Mie Holm Vilstrup
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Henrik Petersen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Allan Johansen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Thomas Lund Andersen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- MAgNetic Resonance Technology for Response Adapted Radiotherapy (MANTRA), Odense University Hospital, Odense, Denmark
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Witoszynskyj S, Andrzejewski P, Georg D, Hacker M, Nyholm T, Rausch I, Knäusl B. Attenuation correction of a flat table top for radiation therapy in hybrid PET/MR using CT- and 68Ge/ 68Ga transmission scan-based μ-maps. Phys Med 2019; 65:76-83. [PMID: 31437602 DOI: 10.1016/j.ejmp.2019.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 12/28/2022] Open
Abstract
Hybrid PET/MR offers new opportunities in radiation oncology for tissue/tumour characterisation and response assessment. Attenuation correction (AC) is an important issue especially in the presence of immobilization devices and flat table tops (FTT). The goal of this study was to compare two methods of AC using CT- and 68Ge/68Ga transmission scan-based attenuation maps (μ-maps) for a custom-designed FTT. Measurements were performed in the mMR PET/MR and TrueV PET/CT Biograph Siemens scanners with three different phantoms, namely the Siemens MR-QA, a cubic canister and the NEMA IEC body phantom. The study revealed that the MR image quality is not hampered by the presence of the FTT. For cubic canister applying the scanner's inherent AC alone resulted in inaccuracies in PET images, with up to -4.0% underestimation of the activity. The mean NEMA sphere activity measurements without FTT, agreed within 3.5% with the respective inserted activity. Placing the FTT in the PET/MR scanner resulted in a difference to the injected activity of 4.5% when the table was not corrected for. By introducing the μ-maps the discrepancy between the used activity and the measurements decreased down to 2.6%. To improve the AC of the FTT the creation of a dedicated μ-map was necessary while the CT-based μ-map performed equally good as the source transmission scan-based one.
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Affiliation(s)
- Stephan Witoszynskyj
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
| | - Piotr Andrzejewski
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
| | - Dietmar Georg
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
| | - Tufve Nyholm
- Department of Radiation Sciences, Umeå University, SE-90187 Umeå, Sweden
| | - Ivo Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
| | - Barbara Knäusl
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
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Ryan JL, Aaron VD, Sims JB. PET/MRI vs PET/CT in Head and Neck Imaging: When, Why, and How? Semin Ultrasound CT MR 2019; 40:376-390. [PMID: 31635765 DOI: 10.1053/j.sult.2019.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The increasing availability of hybrid PET/MRI systems has led to a breadth of new publications and opportunities for use of PET/MRI. While PET/CT has been a valuable tool for oncologic staging, including head and neck malignancy, there are several theoretical and practical advantages a PET/MRI system would have over PET/CT in head and neck imaging. This review article discusses the established role of PET/CT, early evidence for the role of PET/MRI, and protocol considerations for both PET/CT and PET/MRI as they apply to head and neck imaging.
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Affiliation(s)
- Joshua L Ryan
- Indiana University School of Medicine, Indianapolis, IN.
| | | | - Justin B Sims
- Indiana University School of Medicine, Indianapolis, IN
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van de Goor RMGE, Hardy JCA, van Hooren MRA, Kremer B, Kross KW. Detecting recurrent head and neck cancer using electronic nose technology: A feasibility study. Head Neck 2019; 41:2983-2990. [PMID: 31012533 PMCID: PMC6767436 DOI: 10.1002/hed.25787] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 02/19/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this feasibility study was to assess the diagnostic performance of an electronic nose (e-nose) as a noninvasive diagnostic tool in detecting locoregional recurrent and/or second (or third) primary head and neck squamous cell carcinoma (HNSCC) after curative treatment. METHODS Using an e-nose (Aeonose, The eNose Company, Zutphen, The Netherlands), breath samples were collected from patients after curative treatment of an HNSCC with a locoregional recurrence or second (or third) primary tumor (N = 20) and from patients without evidence of recurrent disease (N = 20). Analyses were performed utilizing artificial neural networking based on patterns of volatile organic compounds. RESULTS A diagnostic accuracy of 83% was observed in differentiating follow-up patients with locoregional recurrent or second (or third) primary HNSCC from those without evidence of disease. CONCLUSION This study has demonstrated the feasibility of using an e-nose to detect locoregional recurrent and/or second (or third) primary HNSCC.
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Affiliation(s)
- Rens M G E van de Goor
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Joey C A Hardy
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michel R A van Hooren
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kenneth W Kross
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Kim ES, Yoon DY, Moon JY, Baek S, Han YM, Seo YL, Yun EJ. Detection of loco-regional recurrence in malignant head and neck tumors: a comparison of CT, MRI, and FDG PET-CT. Acta Radiol 2019; 60:186-195. [PMID: 29754496 DOI: 10.1177/0284185118776504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The early and accurate detection of local or regional recurrence of head and neck tumor is critically important. PURPOSE To compare the diagnostic accuracy of contrast-enhanced computed tomography (CT), contrast-enhanced magnetic resonance imaging (MRI), and fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT, alone and in combination, in detecting the locoregional recurrence of malignant head and neck tumor. MATERIAL AND METHODS A total of 93 patients with loco-regional recurrence of malignant head and neck tumors underwent CT, MRI, and PET-CT within 30 days before surgery. CT, MRI, and PET-CT for each patient were retrospectively reviewed to determine the presence of recurrent tumors in the primary site on a patient-by-patient basis and that of regional lymph nodes on a level-by-level basis. The diagnostic accuracy of CT, MRI, and PET-CT, alone and combined, were accessed with the postoperative histopathological findings or with 12-month follow-up results as the standard of reference. RESULTS The sensitivity/specificity/and accuracy of CT, MRI, and PET-CT for the detection of primary site recurrence was 89.9/85.7/89.3%, 94.9/85.7/93.6%, and 97.5/92.9/96.8%, respectively. The sensitivity/specificity/accuracy of CT, MRI, and PET-CT for the detection of nodal recurrence was 66.3/99.4/92.4%, 74.7/99.4/94.2%, and 85.5/94.9/93.0%, respectively. MRI + PET-CT achieved the best performance in the receiver operating characteristics curve analysis (Az value = 0.958 for primary site recurrence and 0.929 for nodal recurrence). CONCLUSION MRI + PET-CT offered the highest diagnostic performance in the detection of loco-regional recurrence of malignant head and neck tumor, compared with CT, MRI, PET-CT, and other combinations including CT.
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Affiliation(s)
- Eun Soo Kim
- Department of Radiology Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ji Yoon Moon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sora Baek
- Department of Nuclear Medicine, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - You Mie Han
- Department of Nuclear Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Young Lan Seo
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Eun Joo Yun
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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Helali M, Moreau M, Le Fèvre C, Heimburger C, Bund C, Goichot B, Veillon F, Hubelé F, Charpiot A, Noel G, Imperiale A. 18F-FDOPA PET/CT Combined with MRI for Gross Tumor Volume Delineation in Patients with Skull Base Paraganglioma. Cancers (Basel) 2019; 11:cancers11010054. [PMID: 30626096 PMCID: PMC6360018 DOI: 10.3390/cancers11010054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 11/16/2022] Open
Abstract
In this simulation study, we assessed differences in gross tumor volume (GTV) in a series of skull base paragangliomas (SBPGLs) using magnetic resonance imaging (MRI), 18F-dihydroxyphenylalanine (18F-FDOPA) combined positron emission tomography/computed tomography (PET/CT), and 18F-FDOPA PET/MRI images obtained by rigid alignment of PET and MRI. GTV was delineated in 16 patients with SBPGLs on MRI (GTVMRI), 18F-FDOPA PET/CT (GTVPET), and combined PET/MRI (GTVPET/MRI). GTVPET/MRI was the union of GTVMRI and GTVPET after visual adjustment. Three observers delineated GTVMRI and GTVPET/MRI independently. Excellent interobserver reproducibility was found for both GTVMRI and GTVPET/MRI. GTVPET and GTVMRI were not significantly different. However, there was some spatial difference between the locations of GTVMRI, GTVPET, and GTVPET/MRI. The Dice similarity coefficient median value was 0.4 between PET/CT and MRI, and 0.8 between MRI and PET/MRI. The combined use of PET/MRI produced a larger GTV than MRI alone. Nevertheless, both the target-delivered dose and organs-at-risk conservancy were respected when treatment was planned on the PET/MRI-matched data set. Future integration of 18F-FDOPA PET/CT into clinical practice will be necessary to evaluate the influence of this diagnostic modality on SBPGL therapeutic management. If the clinical utility of 18F-FDOPA PET/CT and/or PET/MRI is confirmed, GTVPET/MRI should be considered for tailored radiotherapy planning in patients with SBPGL.
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Affiliation(s)
- Mehdi Helali
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
| | - Matthieu Moreau
- Radiophysics, Centre Paul-Strauss, UNICANCER, 67065 Strasbourg, France.
| | - Clara Le Fèvre
- Radiotherapy, Centre Paul-Strauss, 67065 Strasbourg, France.
| | - Céline Heimburger
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, 67000 Strasbourg, France.
| | - Caroline Bund
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, 67000 Strasbourg, France.
| | - Bernard Goichot
- Internal Medicine, University Hospitals of Strasbourg, Strasbourg University, 67098 Strasbourg, France.
| | - Francis Veillon
- Radiology, University Hospitals of Strasbourg, Strasbourg University, 67098 Strasbourg, France.
| | - Fabrice Hubelé
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, 67000 Strasbourg, France.
| | - Anne Charpiot
- Otolaryngology and Maxillofacial Surgery, University Hospitals of Strasbourg, 67098 Strasbourg, France.
| | - Georges Noel
- Radiotherapy, Centre Paul-Strauss, 67065 Strasbourg, France.
- Université de Strasbourg, CNRS, IPHC UMR 7178, Centre Paul Strauss, UNICANCER, 67065 Strasbourg, France.
| | - Alessio Imperiale
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, 67000 Strasbourg, France.
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Abstract
There are recent advances, namely, a standardized method for reporting therapy response (Hopkins criteria), a multicenter prospective cohort study with excellent negative predictive value of F-FDG PET/CT for N0 clinical neck, a phase III multicenter randomized controlled study establishing the value of a negative posttherapy F-FDG PET/CT for patient management, a phase II randomized controlled study demonstrating radiation dose reduction strategies for human papilloma virus-related disease, and Food and Drug Administration approval of nivolumab for treatment of recurrent head and neck squamous cell carcinoma.
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Kirchner J, Schaarschmidt BM, Sauerwein W, Deuschl C, Arweiler-Harbeck D, Holtmann L, Stebner V, Umutlu L, Antoch G, Ruhlmann V. 18 F-FDG PET/MRI vs MRI in patients with recurrent adenoid cystic carcinoma. Head Neck 2018; 41:170-176. [PMID: 30548894 DOI: 10.1002/hed.25485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/27/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate and compare the diagnostic potential of 18 F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18 FDG-PET/MRI) and MRI for recurrence diagnostics after primary therapy in patients with adenoid cystic carcinoma (ACC). METHODS A total of 32 dedicated head and neck 18 F-FDG PET/MRI datasets were included in this analysis. MRI and 18 F-FDG PET/MRI datasets were analyzed in separate sessions by two readers for tumor recurrence or metastases. RESULTS Lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 96%, 84%, 90%, 93%, and 91% for 18 F-FDG PET/MRI and 77%, 94%, 95%, 73%, and 84% for MRI, resulting in a significantly higher diagnostic accuracy of 18 F-FDG PET/MRI compared to MRI (P < .005). CONCLUSION 18 F-FDG PET/MRI is superior to MRI in detecting local recurrence and metastases in patients with ACC of the head and neck. Especially concerning its negative predictive value, 18 F-FDG PET/MRI outperforms MRI.
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Affiliation(s)
- Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Wolfgang Sauerwein
- Department of Radiation Oncology, University of Duisburg-Essen, Essen, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Laura Holtmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vanessa Stebner
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Verena Ruhlmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Zaccagna F, Grist JT, Deen SS, Woitek R, Lechermann LMT, McLean MA, Basu B, Gallagher FA. Hyperpolarized carbon-13 magnetic resonance spectroscopic imaging: a clinical tool for studying tumour metabolism. Br J Radiol 2018; 91:20170688. [PMID: 29293376 PMCID: PMC6190784 DOI: 10.1259/bjr.20170688] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 01/09/2023] Open
Abstract
Glucose metabolism in tumours is reprogrammed away from oxidative metabolism, even in the presence of oxygen. Non-invasive imaging techniques can probe these alterations in cancer metabolism providing tools to detect tumours and their response to therapy. Although Positron Emission Tomography with (18F)2-fluoro-2-deoxy-D-glucose (18F-FDG PET) is an established clinical tool to probe cancer metabolism, it has poor spatial resolution and soft tissue contrast, utilizes ionizing radiation and only probes glucose uptake and phosphorylation and not further downstream metabolism. Magnetic Resonance Spectroscopy (MRS) has the capability to non-invasively detect and distinguish molecules within tissue but has low sensitivity and can only detect selected nuclei. Dynamic Nuclear Polarization (DNP) is a technique which greatly increases the signal-to-noise ratio (SNR) achieved with MR by significantly increasing nuclear spin polarization and this method has now been translated into human imaging. This review provides a brief overview of this process, also termed Hyperpolarized Carbon-13 Magnetic Resonance Spectroscopic Imaging (HP 13C-MRSI), its applications in preclinical imaging, an outline of the current human trials that are ongoing, as well as future potential applications in oncology.
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Affiliation(s)
- Fulvio Zaccagna
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - James T Grist
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Surrin S Deen
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Ramona Woitek
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Bristi Basu
- Department of Oncology, University of Cambridge, Cambridge, UK
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Chan SC, Yeh CH, Yen TC, Ng SH, Chang JTC, Lin CY, Yen-Ming T, Fan KH, Huang BS, Hsu CL, Chang KP, Wang HM, Liao CT. Clinical utility of simultaneous whole-body 18F-FDG PET/MRI as a single-step imaging modality in the staging of primary nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging 2018; 45:1297-1308. [PMID: 29502310 DOI: 10.1007/s00259-018-3986-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/19/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Both head and neck magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) play a crucial role in the staging of primary nasopharyngeal carcinoma (NPC). In this study, we sought to prospectively investigate the clinical utility of simultaneous whole-body 18F-FDG PET/MRI for primary staging of NPC patients. METHODS We examined 113 patients with histologically confirmed NPC who underwent pretreatment, simultaneous whole-body PET/MRI and PET/CT for primary tumor staging. The images obtained with the different imaging modalities were interpreted independently and compared with each other. RESULTS PET/MRI increased the accuracy of head and neck MRI for assessment of primary tumor extent in four patients via addition of FDG uptake information to increase the conspicuity of morphologically subtle lesions. PET/MR images were more discernible than PET/CT images for mapping tumor extension, especially intracranial invasion. Regarding the N staging assessment, the sensitivity of PET/MRI (99.5%) was higher than that of head and neck MRI (94.2%) and PET/CT (90.9%). PET/MRI was particularly useful for distinguishing retropharyngeal nodal metastasis from adjacent nasopharyngeal tumors. For distant metastasis evaluation, PET/MRI exhibited a similar sensitivity (90% vs. 86.7% vs. 83.3%), but higher positive predictive value (93.1% vs. 78.8% vs. 83.3%) than whole-body MRI and PET/CT, respectively. CONCLUSIONS For tumor staging of NPC, simultaneous whole-body PET/MRI was more accurate than head and neck MRI and PET/CT, and may serve as a single-step staging modality.
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Affiliation(s)
- Sheng-Chieh Chan
- Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tsang Yen-Ming
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Lung Hsu
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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50
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PET/MR Imaging in Head and Neck Cancer: Current Applications and Future Directions. Magn Reson Imaging Clin N Am 2018; 26:167-178. [PMID: 29128003 DOI: 10.1016/j.mric.2017.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Clinical PET/MR imaging is being implemented at institutions worldwide as part of the standard-of-care imaging for select oncology patients. This article focuses on oncologic applications of PET/MR imaging in cancers of the head and neck. Although current published literature is relatively sparse, the potential benefits of a hybrid modality of PET/MR imaging are discussed along with several possible areas of research. With the increasing number of PET/MR imaging scanners in clinical use and ongoing research, the role of PET/MR imaging in the management of head and neck cancer is likely to become more evident in the near future.
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