La tomografía por emisión de positrones (pet) y pet-tac en riñón, vías urinarias y próstata: actualización

Usefulness of PET/CT 18-FDG for the diagnosis and follow-up of urological, urothelial and kidney tumours

INTRODUCTION

New imaging studies have appeared in recent years for the diagnosis and follow-up of metastatic urological tumours.

MATERIAL AND METHODS

A total of 41 patients were reviewed with suspected recurrence of a urothelial or kidney tumour, analysing the diagnostic performance of PET-CT scans undertaken between 2013 and 2016.

RESULTS

We collected 17 urothelial tumours and 24 renal tumours, with a median follow-up of 30 months. A total of 39.3% of the urothelial tumours were high grade and 29.3% of the kidney tumours were clear cell Fuhrman II. As a whole, the imaging studies detected recurrences in 34 patients. CT was positive in 83% of the patients, while the PET scan was positive in 75.6%, CT/PET coincidence was 50%. The PET scan detected further disease in 41% of the cases compared to 5% by CT. This resulted in a change of therapeutic strategy in 40% of the patients. Sensitivity, specificity, positive predictive value and negative predictive value for the CT and the PET scans were 92% and 92%, 57% and 100%, 92% and 100%, and 57% and 70% respectively.

CONCLUSION

The PET scan showed similar sensitivity for urological tumours to the standard imaging techniques but with higher specificity, positive predictive value and negative predictive value. This led to a change in treatment strategy for 40% of the patients in our series. The PET scan will probably become the standard test in the extension and follow-up studies of most urological tumours.

18F-FDG positron emission tomography in oncology: main indications

The development of molecular and functional imaging with new imaging techniques such as computed tomography, magnetic resonance imaging, and positron emission tomography (PET) among others, has greatly improved the detection of tumors, tumor staging, and the detection of possible recurrences. Furthermore, the combination of these different imaging modalities and the continual development of radiotracers for PET have advanced our understanding and knowledge of the different pathophysiological processes in cancer, thereby helping to make treatment more efficacious, improving patients' quality of life, and increasing survival. PET is one of the imaging techniques that has attracted the most interest in recent years for its diagnostic capabilities. Its ability to anatomically locate pathologic foci of metabolic activity has revolutionized the detection and staging of many tumors, exponentially broadening its potential indications not only in oncology but also in other fields such as cardiology, neurology, and inflammatory and infectious diseases.

The clinical role of multimodality imaging in the detection of prostate cancer recurrence after radical prostatectomy and radiation therapy: past, present, and future

Detection of the recurrence sites in prostate cancer (PCa) patients affected by biochemical recurrence after radical prostatectomy (RP) and radiation therapy (RT) is still a challenge for clinicians, nuclear medicine physicians, and radiologists. In the era of personalised and precision care, this task requires the integration, amalgamation, and combined analysis of clinical and imaging data from multiple sources. At present, multiparametric Magnetic Resonance Imaging (mpMRI) and choline–positron emission tomography (PET) are giving encouraging results; their combination allows the effective detection of local, lymph nodal, and skeletal recurrences at low PSA levels. Future diagnostic perspectives include the clinical implementation of PET/MRI scanners, multimodal fusion imaging platforms for retrospective co-registration of PET and MR images, real-time transrectal ultrasound/mpMRI fusion imaging, and novel organ-specific PET radiotracers.

The role of positron emission tomography/computed tomography imaging with radiolabeled choline analogues in prostate cancer

INTRODUCTION

prostate cancer is the most frequent solid malignant tumor in Western Countries. Positron emission tomography/x-ray computed tomography imaging with radiolabeled choline analogues is a useful tool for restaging prostate cancer in patients with rising prostate-specific antigen after radical treatment (in whom conventional imaging techniques have important limitations) as well as in the initial assessment of a selected group of prostate cancer patients. For this reason a literature review is necessary in order to evaluate the usefulness of this imaging test for the diagnosis and treatment of prostate cancer.

EVIDENCE ACQUISITION

a MEDLINE (PubMed way) literature search was performed using the search parameters: «Prostate cancer» and «Choline-PET/CT». Other search terms were «Biochemical failure» and/or «Staging» and/or «PSA kinetics». English and Spanish papers were selected; original articles, reviews, systematic reviews and clinical guidelines were included.

CONCLUSIONS

according to available data, radiolabeled choline analogues plays an important role in the management of prostate cancer, especially in biochemical relapse because technique accuracy is properly correlated with prostate-specific antigen values and kinetics. Although is an emerging diagnostic technique useful in treatment planning of prostate cancer, final recommendations have not been submitted.

A comparative study of radiolabeled bombesin analogs for the PET imaging of prostate cancer

Radiolabeled bombesin (BBN) analogs that bind to the gastrin-releasing peptide receptor (GRPR) represent a topic of active investigation for the development of molecular probes for PET or SPECT of prostate cancer (PCa). RM1 and AMBA have been identified as the 2 most promising BBN peptides for GRPR-targeted cancer imaging and therapy. In this study, to develop a clinically translatable BBN-based PET probe, we synthesized and evaluated (18)F-AlF- (aluminum-fluoride) and (64)Cu-radiolabeled RM1 and AMBA analogs for their potential application in PET imaging of PCa.

METHODS

1,4,7-triazacyclononane, 1-glutaric acid-4,7 acetic acid (NODAGA)-conjugated RM1 and AMBA were synthesized and tested for their GRPR-binding affinities. The NODAGA-RM1 and NODAGA-AMBA probes were further radiolabeled with (64)Cu or (18)F-AlF and then evaluated in a subcutaneous PCa xenograft model (PC3) by small-animal PET imaging and biodistribution studies.

RESULTS

NODAGA-RM1 and NODAGA-AMBA can be successfully synthesized and radiolabeled with (64)Cu and (18)F-AlF. (64)Cu- and (18)F-AlF-labeled NODAGA-RM1 demonstrated excellent serum stability and tumor-imaging properties in the in vitro stability assays and in vivo imaging studies. (64)Cu-NODAGA-RM1 exhibited tumor uptake values of 3.3 ± 0.38, 3.0 ± 0.76, and 3.5 ± 1.0 percentage injected dose per gram of tissue (%ID/g) at 0.5, 1.5, and 4 h after injection, respectively. (18)F-AlF-NODAGA-RM1 exhibited tumor uptake values of 4.6 ± 1.5, 4.0 ± 0.87, and 3.9 ± 0.48 %ID/g at 0.5, 1, and 2 h, respectively.

CONCLUSION

The high-stability, efficient tumor uptake and optimal pharmacokinetic properties highlight (18)F-AlF-NODAGA-RM1 as a probe with great potential and clinical application for the PET imaging of prostate cancer.