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Gammel MCM, Solari EL, Eiber M, Rauscher I, Nekolla SG. A Clinical Role of PET-MRI in Prostate Cancer? Semin Nucl Med 2024; 54:132-140. [PMID: 37652782 DOI: 10.1053/j.semnuclmed.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
PET/MRI is a relevant application field for prostate cancer management, offering advantages in early diagnosis, staging, and therapy planning. Despite drawbacks such as higher costs, longer acquisition time, and the need for skilled personnel, the technical integration of PET and MRI provides valuable information for detecting primary tumors, identifying metastases, and characterizing the disease, leading to more accurate staging and personalized treatment strategies. However, PET/MRI adoption has been slow, but ongoing technological advancements and AI integration might overcome challenges and improve clinical utility. As precision medicine gains importance in oncology, PET/MRI's multiparametric data can tailor treatment plans to individual patients, providing a comprehensive assessment of tumor biology and aggressiveness for more effective therapeutic strategies.
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Affiliation(s)
- Michael C M Gammel
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Esteban L Solari
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan G Nekolla
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Deantonio L, Castronovo F, Paone G, Treglia G, Zilli T. Metabolic Imaging for Radiation Therapy Treatment Planning: The Role of Hybrid PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:637-654. [PMID: 37741647 DOI: 10.1016/j.mric.2023.06.005] [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
The use of hybrid PET/MR imaging for radiotherapy treatment planning has the potential to reduce tumor and organ displacements caused by different scan times and setup changes. Although with mixed results mainly due to single-center studies with small sample size, PET/MR imaging could provide better target delineation, especially by reducing coregistration discrepancies on computed tomography simulation scan and offering better soft tissue contrast. The main limitation to drive stronger conclusions is due to the relatively low availability of hybrid PET/MR imaging systems, mainly limited to large academic centers.
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Affiliation(s)
- Letizia Deantonio
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona 6500, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano 6900, Switzerland
| | - Francesco Castronovo
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona 6500, Switzerland
| | - Gaetano Paone
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano 6900, Switzerland; Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona 6500, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano 6900, Switzerland; Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona 6500, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne 1015, Switzerland
| | - Thomas Zilli
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona 6500, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano 6900, Switzerland; Faculty of Medicine, University of Geneva, Geneva 1211, Switzerland.
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Variability of radiotherapy volume delineation: PSMA PET/MRI and MRI based clinical target volume and lymph node target volume for high-risk prostate cancer. Cancer Imaging 2023; 23:1. [PMID: 36600283 DOI: 10.1186/s40644-022-00518-7] [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: 08/01/2022] [Accepted: 12/25/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE A comparative retrospective study to assess the impact of PSMA Ligand PET/MRI ([68 Ga]-Ga-PSMA-11 and [18F]-F-PSMA-1007 PET/MRI) as a new method of target delineation compared to conventional imaging on whole-pelvis radiotherapy for high-risk prostate cancer (PCa). PATIENTS AND METHODS Forty-nine patients with primary high-risk PCa completed the whole-pelvis radiotherapy plan based on PSMA PET/MRI and MRI. The primary endpoint compared the size and overlap of clinical target volume (CTV) and nodal gross tumour volume (GTVn) based on PSMA PET/MRI and MRI. The diagnostic performance of two methods for pelvic lymph node metastasis (PLNM) was evaluated. RESULTS In the radiotherapy planning for high-risk PCa patients, there was a significant correlation between MRI-CTV and PET/MRI-CTV (P = 0.005), as well as between MRI-GTVn and PET/MRI-GTVn (P < 0.001). There are non-significant differences in the CTV and GTVn based on MRI and PET/MRI images (P = 0.660, P = 0.650, respectively). The conformity index (CI), lesion coverage factor (LCF) and Dice similarity coefficient (DSC) of CTVs were 0.999, 0.953 and 0.954. The CI, LCF and DSC of GTVns were 0.927, 0.284, and 0.32. Based on pathological lymph node analysis of 463 lymph nodes from 37 patients, the sensitivity, specificity of PET/MRI in the diagnosis of PLNM were 77.78% and 99.76%, respectively, which were higher than those of MRI (P = 0.011). Eight high-risk PCa patients who finished PSMA PET/MRI changed their N or M stage. CONCLUSION The CTV delineated based on PET/MRI and MRI differ little. The GTVn delineated based on PET/MRI encompasses metastatic pelvic lymph nodes more accurately than MRI and avoids covering pelvic lymph nodes without metastasis. We emphasize the utility of PET/MRI fusion images in GTVn delineation in whole pelvic radiotherapy for PCa. The use of PSMA PET/MRI aids in the realization of more individual and precise radiotherapy for PCa.
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Zhang A, Meng X, Yao Y, Zhou X, Yan S, Fei W, Zhou N, Zhang Y, Kong H, Li N. Predictive Value of 18 F-FDG PET/MRI for Pleural Invasion in Solid and Subsolid Lung Adenocarcinomas Smaller Than 3 cm. J Magn Reson Imaging 2022; 57:1367-1375. [PMID: 36066210 DOI: 10.1002/jmri.28422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET)/MRI combines the characteristics of metabolism imaging and high soft tissue resolution, and could provide high diagnostic efficacy for assessment of pleural invasion (PI) of lung cancer. PURPOSE To investigate the application of 18 F-fluorodeoxyglucose (FDG) PET/MRI for predicting PI of lung cancer with the maximum diameter ≤3 cm. STUDY TYPE Prospective. POPULATION A total of 44 patients with non-small cell lung cancer (NSCLC), age from 39 to 79 years old, including 19 (56.82%) females. FIELD STRENGTH/SEQUENCE A 3-T, hybrid PET/MRI including axial fast spin echo respiratory-triggered T2 fat-suppressed imaging (T2FS) and echo planar imaging diffusion-weighted imaging (DWI). ASSESSMENT The maximum standardized uptake value (SUVmax) of all lesions was measured on PET images. Localized effusion outside the contact between the nodules and the pleura on T2FS and signal at the contact between the nodules and the pleura on DWI were evaluated by experienced physicians through visual assessment of the MRI sequences. STATISTICAL TESTS Three models (models 1-3) were developed, incorporating CT, CT and PET, PET and MRI features, and Lasso regression was used in feature selection. The receiver operating characteristic (ROC) curve for PI diagnosis was visualized for each model, and the area under the curve (AUC) was calculated. The DeLong test was used to compare the different AUCs. A P value < 0.05 was considered statistically significant. RESULTS The AUC of models 1-3 was 0.762, 0.829, and 0.915, respectively. The DeLong test showed a statistically significant difference between the AUCs of model 1 vs. model 3, while the differences between the AUCs of model 1 vs. model 2 (P = 0.253) and model 2 vs. model 3 (P = 0.075) were not statistically significant. DATA CONCLUSION 18 F-FDG PET/MRI might show high predictive value for lung adenocarcinoma smaller than 3 cm with PI. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Annan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Haidian, Beijing, China
| | - Xiangxi Meng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Haidian, Beijing, China
| | - Yuan Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Haidian, Beijing, China
| | - Xin Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Haidian, Beijing, China
| | - Shuo Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Haidian, Beijing, China
| | - Wang Fei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Haidian, Beijing, China
| | - Nina Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Haidian, Beijing, China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Haidian, Beijing, China
| | - Hanjing Kong
- Beijing United Imaging Research Institute of Intelligent Imaging, UIH Group, Beijing, China
| | - Nan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Haidian, Beijing, China
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Cegla P, Wojewódzka M, Gorczewska I, Chalewska W, Łapińska G, Ochman P, Sackiewicz A, Dedecjus M. Identification of the Optimal Cut-Off Value of PSA for Assessing Severity of Disease in [68Ga]Ga-PSMA-11 PET/CT Study in Prostate Cancer Patients after Radical Prostatectomy. Diagnostics (Basel) 2022; 12:diagnostics12020349. [PMID: 35204440 PMCID: PMC8871181 DOI: 10.3390/diagnostics12020349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/22/2022] [Accepted: 01/27/2022] [Indexed: 12/24/2022] Open
Abstract
Objective: The objective of this study was to identify the optimal cut-off value of prostate specific antigen (PSA) to assess the extent of the disease in [68Ga]Ga-PSMA-11 PET/CT study in patients after radical prostatectomy. Materials and Methods: Retrospective analysis was performed on a group of 215 patients who underwent a [68Ga]Ga-PSMA-11 PET/CT examination because of suspected recurrence after radical prostatectomy. Patients were divided into four groups: 1, no active lesions suggesting recurrence (n = 92); 2, suspected isolated local recurrence (n = 19); 3, oligometastatic disease (n = 82); and 4, polymetastatic disease (n = 22). Results: In group 1, the mean PSA level was 0.962 ng/mL (median: 0.376; min: 0.004; max: 25 ng/mL); in group 2, it was 4.970 ng/mL (median 1.320; min: 0.003; max: 40.350 ng/mL); in group 3, it was 2.802 ng/mL (median: 1.270; min: 0.020; max: 59.670 ng/mL); and in group 4, it was 4.997 ng/mL (median: 3.795; min: 0.007; max 21.110 ng/mL). Statistically significant differences were shown in PSA levels when comparing groups 1 and 2 (p = 0.0025) and groups 3 and 4 (p = 0.0474). The PSA cut-off point for discriminating groups 1 and 2 was 0.831 (sensitivity: 0.684; specificity: 0.772; area under the curve (AUC): 0.775), and for groups 3 and 4, it was 2.51 (sensitivity: 0.682; specificity: 0.780; AUC: 0.720). Conclusions: Our preliminary data suggested that the PSA level has an essential influence on determining the extent of disease in a [68Ga]Ga-PSMA-11 PET/CT study in patients after radical prostatectomy. Identification of the optimal cut-off values for the oligo- and polymetastatic diseases might be helpful in stratifying these patients.
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Affiliation(s)
- Paulina Cegla
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
- Correspondence:
| | - Marta Wojewódzka
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Izabela Gorczewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland;
| | - Wioletta Chalewska
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Grażyna Łapińska
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Paweł Ochman
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Agata Sackiewicz
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
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