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McBriar JD, Shafiian N, Scharf S, Boockvar JA, Wernicke AG. Prostate-Specific Membrane Antigen Use in Glioma Management: Past, Present, and Future. Clin Nucl Med 2024; 49:806-816. [PMID: 38968568 DOI: 10.1097/rlu.0000000000005365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
BACKGROUND Prostate-specific membrane antigen (PSMA) is a membrane-bound metallopeptidase highly expressed in the neovasculature of many solid tumors including gliomas. It is a particularly enticing therapeutic target due to its ability to internalize, thereby delivering radioligands or pharmaceuticals to the intracellular compartment. Targeting the neovasculature of gliomas using PSMA for diagnosis and management has been a recent area of increased study and promise. The purpose of this review is to synthesize the current state and future directions of PSMA use in the histopathologic study, imaging, and treatment of gliomas. METHODS PubMed and Scopus databases were used to conduct a literature review on PSMA use in gliomas in June 2023. Terms searched included "PSMA," "Prostate-Specific Membrane Antigen" OR "PSMA" OR "PSMA PET" AND "glioma" OR "high grade glioma" OR "glioblastoma" OR "GBM." RESULTS Ninety-four publications were screened for relevance with 61 studies, case reports, and reviews being read to provide comprehensive context for the historical, contemporary, and prospective use of PSMA in glioma management. CONCLUSIONS PSMA PET imaging is currently a promising and accurate radiographic tool for the diagnosis and management of gliomas. PSMA histopathology likely represents a viable tool for helping predict glioma behavior. More studies are needed to investigate the role of PSMA-targeted therapeutics in glioma management, but preliminary reports have indicated its potential usefulness in treatment.
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Affiliation(s)
- Joshua D McBriar
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Neeva Shafiian
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | | | | | - A Gabriella Wernicke
- Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
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Miceli A, Liberini V, Pepe G, Dondi F, Vento A, Jonghi Lavarini L, Celesti G, Gazzilli M, Serani F, Guglielmo P, Buschiazzo A, Filice R, Alongi P, Laudicella R, Santo G. Prostate-Specific Membrane Antigen Positron Emission Tomography Oncological Applications beyond Prostate Cancer in Comparison to Other Radiopharmaceuticals. Diagnostics (Basel) 2024; 14:1002. [PMID: 38786300 PMCID: PMC11119694 DOI: 10.3390/diagnostics14101002] [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: 04/08/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Prostate-specific membrane antigen (PSMA) is a type II transmembrane glycoprotein overexpressed on the surface of tumor cells in most of the patients affected by prostate adenocarcinoma (PCa). However, PSMA expression has also been demonstrated in the endothelial cells of newly formed vessels of various solid tumors, suggesting a role for PSMA in neoangiogenesis. In this scenario, gallium-68 (68Ga) or fluoro-18 (18F)-labeled PSMA positron emission tomography (PET) may play a role in tumors other than PCa, generally evaluated employing other radiopharmaceuticals targeting different pathways. This review aims to investigate the detection rate of PSMA-PET compared to other radiopharmaceuticals (especially [18F]FDG) in non-prostate tumors to identify patients who may benefit from the use of such a theragnostic agent. METHODS We performed a bibliographic search on three different databases until February 2024 using the following terms: "positron emission tomography", "PET", "PET/CT", "Prostate-specific membrane antigen", "PSMA", "non-prostate", "not prostate cancer", "solid tumor", "FDG", "Fluorodeoxyglucose", "FAPi", "FET", "MET", "DOPA", "choline", "FCH", "FES", "DOTATOC", "DOTANOC", and "DOTATATE". Only original articles edited in English with at least 10 patients were included. RESULTS Out of a total of 120 articles, only 25 original articles comparing PSMA with other radiotracers were included in this study. The main evidence was demonstrated in renal cell carcinoma, where PSMA showed a higher detection rate compared to [18F]FDG PET/CT, with implications for patient management. PSMA PET may also improve the assessment of other entities, such as gliomas, in defining regions of early neoangiogenesis. Further data are needed to evaluate the potential role of PSMA-PET in triple-negative breast cancer as a novel therapeutic vascular target. Finally, unclear applications of PSMA-PET include thyroid and gastrointestinal tumors. CONCLUSIONS The present review shows the potential use of PSMA-labeled PET/CT in solid tumors beyond PCa, underlining its value over other radiopharmaceuticals (mainly [18F]FDG). Prospective clinical trials with larger sample sizes are crucial to further investigate these possible clinical applications.
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Affiliation(s)
- Alberto Miceli
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Virginia Liberini
- Nuclear Medicine Unit, ASO S.Croce e Carle Cuneo, 12100 Cuneo, Italy; (V.L.); (A.B.)
| | - Giovanna Pepe
- Nuclear Medicine Unit, Fondazione IRCCS Policlinico San Matteo—Pavia V.le Camillo Golgi, 27100 Pavia, Italy;
| | - Francesco Dondi
- Nuclear Medicine Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Antonio Vento
- Nuclear Medicine Unit, ASP 1—P.O. San Giovanni di Dio, 92100 Agrigento, Italy;
| | | | - Greta Celesti
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, 98122 Messina, Italy; (G.C.); (R.L.)
| | - Maria Gazzilli
- Nuclear Medicine Unit, ASL Bari—Di Venere Bari, 70131 Bari, Italy;
| | - Francesca Serani
- Nuclear Medicine Unit, Presidio Ospedaliero Santo Spirito, 65124 Pescara, Italy;
| | - Priscilla Guglielmo
- Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy;
| | - Ambra Buschiazzo
- Nuclear Medicine Unit, ASO S.Croce e Carle Cuneo, 12100 Cuneo, Italy; (V.L.); (A.B.)
| | - Rossella Filice
- Nuclear Medicine Unit, University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy;
| | - Pierpaolo Alongi
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy;
| | - Riccardo Laudicella
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, 98122 Messina, Italy; (G.C.); (R.L.)
| | - Giulia Santo
- Nuclear Medicine Unit, Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
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Verma P, Singh BK, Sudhan MD, Singh RK, Bagul SD, Chandak AR, Soni BK, Shelly D, Basu S. 68 Ga-PSMA-11 PET/CT Imaging in Brain Gliomas and Its Correlation With Clinicopathological Prognostic Parameters. Clin Nucl Med 2023; 48:e559-e563. [PMID: 37883060 DOI: 10.1097/rlu.0000000000004903] [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] [Indexed: 10/27/2023]
Abstract
BACKGROUND Gliomas are the most common primary central nervous system tumors, of which the malignant gliomas account for 60%-75%. The primary and secondary brain malignancies are highly treatment resistant, and their marked angiogenesis attracts interest as a potential therapeutic target. The grade of gliomas, Ki-67 index, and IDH mutation status are among the major prognostic markers in gliomas. Prostate-specific membrane antigen (PSMA) is a zinc-dependent peptidase that is not only expressed in prostate cancer cells but also in the tumor neovasculature. The initial PSMA PET studies in central nervous system tumors using 68 Ga-HBED-CC-PSMA ( 68 Ga-PSMA-11) PET tracer confirmed selective target expression in gliomas of different grades, with higher expression in high-grade glioma compared with low-grade glioma. AIMS AND OBJECTIVES The aim of the present study was to correlate and compare the 68 Ga-PSMA-11 and 18 F-FDG uptake in brain tumors with their clinicopathological prognostic parameters, so as to study their prognostic implications. In addition, the study also aimed to identify patients who are likely to benefit from potential PSMA-targeted therapies. PATIENTS AND METHODS This ongoing prospective study was approved by the institutional scientific and medical ethics committee. The patients with primary or recurrent glioma lesions on MRI underwent regional brain PET/CT scanning with 68 Ga-PSMA-11 and 18 F-FDG. The final histopathology of the brain lesions (glioma grade), Ki-67 index, and IDH mutation status were compared with SUV max values of the 68 Ga-PSMA-11 and 18 F-FDG PET/CT. RESULTS A total of 15 patients (13 males and 2 females; age range, 21-73 years; median age, 58 years) were included in this study analysis. Among the 15 patients, 10 were treatment naive and 2 were patients with recurrent glioma. Three patients turned out to be WHO grade I-II, 6 belonged to grade III, and 6 grade IV (glioblastoma multiforme) on final histopathology. The 68 Ga-PSMA-11 PET/CT showed tracer uptake in all high-grade gliomas with good tumor-to-background ratio. It was PSMA nonavid in 2/3 low-grade gliomas, and it showed low-grade uptake in 1/3 patients. PSMA expression (as evaluated by SUV max values) was significantly higher in higher-grade tumors, those with IDH mutation wildtype status, and higher Ki-67 indices. FDG PET SUV max also showed significant correlation with these prognostic parameters. CONCLUSIONS In these preliminary results, PSMA PET appears to be an important tool in the evaluation and prognosis of gliomas. PSMA-directed theranostics can be explored as a personalized approach in gliomas with high PSMA uptake. However, with the limitation of small sample size, larger clinical trials are warranted to draw conclusive evidence regarding the same.
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Affiliation(s)
| | | | | | | | - Swati D Bagul
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Ashok R Chandak
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
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4
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Sadowski EA, Lees B, McMillian AB, Kusmirek JE, Cho SY, Barroilhet LM. Distribution of prostate specific membrane antigen (PSMA) on PET-MRI in patients with and without ovarian cancer. Abdom Radiol (NY) 2023; 48:3643-3652. [PMID: 37261441 DOI: 10.1007/s00261-023-03957-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Ovarian cancer is the most lethal cancer and future research needs to focus on the early detection and exploration of new therapeutic agents. The objectives of this proof-of-concept study are to assess the feasibility of PSMA 18F-DCFPyl PET/MR imaging for detecting ovarian cancer and to evaluate the PSMA distribution in patients with and without ovarian cancer. METHODS This prospective pilot proof-of-concept study in patients with and without ovarian cancers occurred between October 2017 and January 2020. Patients were recruited from gynecologic oncology or hereditary ovarian cancer clinics, and underwent surgical removal of the uterus and ovaries for gynecologic indications. PSMA 18F-DCFPyl PET/MRI was obtained prior to standard of care surgery. RESULTS Fourteen patients were scanned: four patients with normal ovaries, six patients with benign ovarian lesions, and four patients with malignant ovarian lesions. Tracer uptake in normal ovaries (SUVmax = 2.8 ± 0.4) was greater than blood pool (SUVmax = 1.8 ± 0.5, p < 0.0001). Tracer uptake in benign ovarian lesions (2.2 ± 1.0) did not differ significantly from blood pool (p = 0.331). Tracer uptake in ovarian cancer (SUVmax = 7.8 ± 3.8) was greater than blood pool (p < 0.0001), normal ovaries (p = 0.0014), and benign ovarian lesions (p = 0.005). CONCLUSION PET/MR imaging detected PSMA uptake in ovarian cancer, with little to no uptake in benign ovarian findings. These results are encouraging and further studies in a larger patient cohort would be useful to help determine the extent and heterogeneity of PSMA uptake in ovarian cancer patients.
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Affiliation(s)
- Elizabeth A Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI, 53792-3252, USA.
| | - Brittany Lees
- Atrium Health Levine Cancer Institute, 1021 Morehead Medical Drive, Suite 2100, Charlotte, NC, 28204, USA
| | - Alan B McMillian
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue, Rm 1139, Madison, WI, 53705, USA
| | - Joanna E Kusmirek
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., E3/372, Madison, WI, 53792-3252, USA
| | - Steve Y Cho
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., E3/372, Madison, WI, 53792-3252, USA
| | - Lisa M Barroilhet
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI, 53792-3252, USA
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5
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Chen S, Lin Z, Wang C, Miao W. 68 Ga-PSMA PET/CT in Hepatic Metastasis From Pancreatic Neuroendocrine Tumor. Clin Nucl Med 2023; 48:991-993. [PMID: 37796174 DOI: 10.1097/rlu.0000000000004834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
ABSTRACT A 53-year-old man underwent both 18 F-FDG and 68 Ga-PSMA PET/CT to evaluate a mass in the left upper abdomen. The scans demonstrated intense uptake of both 18 F-FDG and 68 Ga-PSMA in the mass. However, a nodule in the left lobe of the liver showed increased uptake of 68 Ga-PSMA, which was not FDG avid. Histopathological examination after surgical resection of the mass confirmed the diagnosis of pancreatic neuroendocrine tumor (G2). Subsequently, 68 Ga-DOTATATE PET/CT demonstrated intense radioactivity of the nodule in the left lobe of the liver consistent with hepatic metastasis from neuroendocrine tumor.
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Sharma S, Pandey MK. Radiometals in Imaging and Therapy: Highlighting Two Decades of Research. Pharmaceuticals (Basel) 2023; 16:1460. [PMID: 37895931 PMCID: PMC10610335 DOI: 10.3390/ph16101460] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
The present article highlights the important progress made in the last two decades in the fields of molecular imaging and radionuclide therapy. Advancements in radiometal-based positron emission tomography, single photon emission computerized tomography, and radionuclide therapy are illustrated in terms of their production routes and ease of radiolabeling. Applications in clinical diagnostic and radionuclide therapy are considered, including human studies under clinical trials; their current stages of clinical translations and findings are summarized. Because the metalloid astatine is used for imaging and radionuclide therapy, it is included in this review. In regard to radionuclide therapy, both beta-minus (β-) and alpha (α)-emitting radionuclides are discussed by highlighting their production routes, targeted radiopharmaceuticals, and current clinical translation stage.
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Affiliation(s)
| | - Mukesh K. Pandey
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA;
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7
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van Lith SAM, Pruis IJ, Tolboom N, Snijders TJ, Henssen D, Ter Laan M, Te Dorsthorst M, Leenders WPJ, Gotthardt M, Nagarajah J, Robe PA, De Witt Hamer P, Hendrikse H, Oprea-Lager DE, Yaqub M, Boellaard R, Wesseling P, Balvers RK, Verburg FA, Harteveld AA, Smits M, van den Bent M, van Zanten SEMV, van de Giessen E. PET Imaging and Protein Expression of Prostate-Specific Membrane Antigen in Glioblastoma: A Multicenter Inventory Study. J Nucl Med 2023; 64:1526-1531. [PMID: 37652540 DOI: 10.2967/jnumed.123.265738] [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: 03/16/2023] [Revised: 05/31/2023] [Indexed: 09/02/2023] Open
Abstract
Upregulation of prostate-specific membrane antigen (PSMA) in neovasculature has been described in glioblastoma multiforme (GBM), whereas vasculature in nonaffected brain shows hardly any expression of PSMA. It is unclear whether PSMA-targeting tracer uptake on PET is based on PSMA-specific binding to neovasculature or aspecific uptake in tumor. Here, we quantified uptake of various PSMA-targeting tracers in GBM and correlated this with PSMA expression in tumor biopsy samples from the same patients. Methods: Fourteen patients diagnosed with de novo (n = 8) or recurrent (n = 6) GBM underwent a preoperative PET scan after injection of 1.5 MBq/kg [68Ga]Ga-PSMA-11 (n = 7), 200 MBq of [18F]DCFpyl (n = 3), or 200 MBq of [18F]PSMA-1007 (n = 4). Uptake in tumor and tumor-to-background ratios, with contralateral nonaffected brain as background, were determined. In a subset of patients, PSMA expression levels from different regions in the tumor tissue samples (n = 40), determined using immunohistochemistry (n = 35) or RNA sequencing (n = 13), were correlated with tracer uptake on PET. Results: Moderate to high (SUVmax, 1.3-20.0) heterogeneous uptake was found in all tumors irrespective of the tracer type used. Uptake in nonaffected brain was low, resulting in high tumor-to-background ratios (6.1-359.0) calculated by dividing SUVmax of tumor by SUVmax of background. Immunohistochemistry showed variable PSMA expression on endothelial cells of tumor microvasculature, as well as on dispersed individual cells (of unknown origin), and granular staining of the neuropil. No correlation was found between in vivo uptake and PSMA expression levels (for immunohistochemistry, r = -0.173, P = 0.320; for RNA, r = -0.033, P = 0.915). Conclusion: Our results indicate the potential use of various PSMA-targeting tracers in GBM. However, we found no correlation between PSMA expression levels on immunohistochemistry and uptake intensity on PET. Whether this may be explained by methodologic reasons, such as the inability to measure functionally active PSMA with immunohistochemistry, tracer pharmacokinetics, or the contribution of a disturbed blood-brain barrier to tracer retention, should still be investigated.
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Affiliation(s)
- Sanne A M van Lith
- Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilanah J Pruis
- Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Nelleke Tolboom
- Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom J Snijders
- Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dylan Henssen
- Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Ter Laan
- Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - William P J Leenders
- Biochemistry, Radboud University Medical Center, Nijmegen, The Netherlands
- Predica Diagnostics, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - James Nagarajah
- Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pierre A Robe
- Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Harry Hendrikse
- Radiology and Nuclear Medicine, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | | | - Maqsood Yaqub
- Radiology and Nuclear Medicine, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Radiology and Nuclear Medicine, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Pieter Wesseling
- Pathology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
- Pathology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Anita A Harteveld
- Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Marion Smits
- Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands; and
| | - Martin van den Bent
- Brain Tumor Center at Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
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Moreau A, Khayi F, Maureille A, Bonneville-Levard A, Larrouquere L, Ducray F, Kryza D. Discriminating Inflammatory Radiation-Related Changes From Early Recurrence in Patients With Glioblastomas: A Preliminary Analysis of 68Ga-PSMA-11 PET/CT Compared With 18F-FDOPA PET/CT. Clin Nucl Med 2023; Publish Ahead of Print:00003072-990000000-00584. [PMID: 37276534 DOI: 10.1097/rlu.0000000000004716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE OF THE REPORT Using morphological and functional imaging to discriminate recurrence from postradiation-related modifications in patients with glioblastomas remains challenging. This pilot study aimed to assess the feasibility of using 68Ga-prostate-specific membrane antigen (PSMA) 11 PET/CT compared with 18F-FDOPA PET/CT to detect early recurrence. METHODS Nine patients followed up for glioblastomas who received MRI during 12 months of follow-up were referred for both 68Ga-PSMA-11 and 18F-FDOPA PET/CT. The SUVmax, lesion-to-striatum ratio, lesion-to-normal parenchyma ratio, and lesion-to-salivary gland ratio were calculated. RESULTS Good correlation between 18F-FDOPA and 68Ga-PSMA PET/CT findings was seen in 5 patients. In 4 patients, the findings of both examinations were consistent with recurrence but were better visualized with the PSMA PET/CT. Examinations of the fifth patient were suggestive of postradiation-related changes and were better analyzed with the PSMA PET/CT, which displayed relatively low uptake compared with DOPA PET/CT. Conversely, 4 patients showed conflicting results: recurrence was not detected on the PSMA PET/CT because of previously introduced bevacizumab treatment; in another patient, both examinations were consistent with recurrence, but there was an uptake mismatch at the suspected lesion sites, and 2 patients presented with inconsistent findings. CONCLUSIONS Despite a few discrepancies, this study highlights the potential role of 68Ga-PSMA-11 PET/CT for discriminating postradiation inflammation from recurrence. 68Ga-PSMA-11 PET/CT has an excellent lesion-to-background ratio, and false-positive and false-negative results could be minimized through implementing certain protocols before performing the examination. More powerful prospective studies are required to validate our results.
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Graef J, Bluemel S, Brenner W, Amthauer H, Truckenmueller P, Kaul D, Vajkoczy P, Onken JS, Furth C. [ 177Lu]Lu-PSMA Therapy as an Individual Treatment Approach for Patients with High-Grade Glioma: Dosimetry Results and Critical Statement. J Nucl Med 2023:jnumed.122.264850. [PMID: 37116918 DOI: 10.2967/jnumed.122.264850] [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: 09/02/2022] [Revised: 01/06/2023] [Indexed: 04/30/2023] Open
Abstract
The theranostic use of prostate-specific membrane antigen (PSMA) appears to be promising in patients with high-grade glioma. This study investigated [177Lu]Lu-PSMA therapy as an individual treatment approach with a focus on intratherapeutic dosimetry. Methods: Three patients were treated with a median of 6.03 GBq (interquartile range [IQR], 5.74-6.10) of [177Lu]Lu-PSMA. Intratherapeutic dosimetry was performed using a hybrid scenario with planar whole-body scintigraphy at 2, 24, and 48 h after treatment injection and SPECT/CT at 48 h after injection. Additive whole-body scintigraphy at 8 d after injection was performed on 1 patient. Results: The median doses were 0.56 Gy (IQR, 0.36-1.25 Gy) to tumor, 0.27 Gy (IQR, 0.16-0.57 Gy) to risk organs, 2.13 Gy (IQR, 1.55-2.89 Gy) to kidneys, and 0.76 Gy (IQR, 0.70-1.20 Gy) to salivary glands. Whole-body exposure was 0.11 Gy (IQR, 0.06-0.18 Gy). Conclusion: Because the intratherapeutic tumor dose is lower than that used in external radiation oncology, the effectiveness of treatment is questionable.
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Affiliation(s)
- Josefine Graef
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany;
| | - Stephanie Bluemel
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium, Partner Site Berlin, German Cancer Research Center, Heidelberg, Germany
| | - Holger Amthauer
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - David Kaul
- German Cancer Consortium, Partner Site Berlin, German Cancer Research Center, Heidelberg, Germany
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany; and
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Julia S Onken
- German Cancer Consortium, Partner Site Berlin, German Cancer Research Center, Heidelberg, Germany
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Furth
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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10
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Yuile A, Lee A, Moon EA, Hudson A, Kastelan M, Miller S, Chan D, Wei J, Back MF, Wheeler HR. PSMA Expression Correlates with Improved Overall Survival and VEGF Expression in Glioblastoma. Biomedicines 2023; 11:biomedicines11041148. [PMID: 37189766 DOI: 10.3390/biomedicines11041148] [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: 03/16/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Glioblastomas are the most common and fatal primary brain malignancy in adults. There is a growing interest in identifying the molecular mechanisms of these tumors to develop novel treatments. Glioblastoma neo-angiogenesis is driven by VEGF, and another potential molecule linked to angiogenesis is PSMA. Our study suggests the potential for an association between PSMA and VEGF expression in glioblastoma neo-vasculature. METHODS Archived IDH1/2 wild-type glioblastomas were accessed; demographic and clinical outcomes were recorded. PSMA and VEGF expression by IHC were examined. Patients were dichotomized into PSMA expression high (3+) and low (0-2+) groups. The association between PSMA and VEGF expression was evaluated using Chi2 analysis. OS in PSMA high and low expression groups were compared using multi-linear regression. RESULTS In total, 247 patients with IDH1/2 wild-type glioblastoma with archival tumor samples (between 2009-2014) were examined. PSMA expression correlated positively with VEGF expression (p = 0.01). We detected a significant difference in median OS between PSMA vascular endothelial expression high and low groups-16.1 and 10.8 months, respectively (p = 0.02). CONCLUSION We found a potential positive correlation between PSMA and VEGF expression. Secondly, we showed a potential positive correlation between PSMA expression and overall survival.
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Affiliation(s)
- Alexander Yuile
- Department of Medical Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2000, Australia
- The Brain Cancer Group, North Shore Private Hospital, Westbourne Street, St Leonards, NSW 2065, Australia
| | - Adrian Lee
- Department of Medical Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2000, Australia
- The Brain Cancer Group, North Shore Private Hospital, Westbourne Street, St Leonards, NSW 2065, Australia
| | - Elizabeth A Moon
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2000, Australia
| | - Amanda Hudson
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2000, Australia
| | - Marina Kastelan
- The Brain Cancer Group, North Shore Private Hospital, Westbourne Street, St Leonards, NSW 2065, Australia
| | - Samuel Miller
- Department of Medical Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
| | - David Chan
- Department of Medical Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2000, Australia
| | - Joe Wei
- Department of Medical Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2000, Australia
| | - Michael F Back
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2000, Australia
- The Brain Cancer Group, North Shore Private Hospital, Westbourne Street, St Leonards, NSW 2065, Australia
- Department of Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
| | - Helen R Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2000, Australia
- The Brain Cancer Group, North Shore Private Hospital, Westbourne Street, St Leonards, NSW 2065, Australia
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Şahin M, Akgun E, Sirolu S, Can G, Sayman HB, Oner Dincbas F. Is there any additional benefit of 68Ga-PSMA PET on radiotherapy target volume definition in patients with glioblastoma? Br J Radiol 2022; 95:20220049. [PMID: 35993417 PMCID: PMC9793479 DOI: 10.1259/bjr.20220049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To investigate the contribution of 68Gallium (68Ga)-PSMA (prostate-specific membrane antigen) positron emission tomography (PET) in defining radiotherapy (RT) target volume for glioblastoma and to compare the target volumes defined by Magnetic Resonance Imaging (MRI). METHODS RT planning Computed Tomography (CT) images were fused separately with pre-operative MRI and PET/MRI images of 10 glioblastoma patients, retrospectively. The contrast-enhanced area in T1 weighted MRI was contoured as gross tumor volume (GTV) and clinical target volume (CTV1) was obtained by including the cavity and T2/FLAIR hyperintense areas after giving a margin of 2 cm to the GTV. 68Ga-PSMA uptake area was contoured as biological tumor volume (BTV) and CTV2 was obtained with a margin of 2 cm to BTV. Planning target volumes (PTVs) were created with the 3 mm added to the CTVs. Conformity index (CI), dice similarity coefficient (DSC) and overlap volume (OV) were calculated by obtaining the intersection and union volumes. Volumetric comparison, similarity and overlap analyzes were performed statistically by Wilcoxon signed rank and One sample t-test. RESULTS The median GTV was 21,96 cc (1,04 - 82,04) and BTV was 25,58 cc (2,43 - 99,47). BTV was on average 47% larger than GTV which was statistically significant (p = 0.03). For GTV-BTV, CTV1-CTV2 and PTV1-PTV2; mean values of CI were 0,56, 0,76 and 0,76; DSC were 0,70, 0,86 and 0,86; OV were 0,88, 0,94 and 0,94, respectively. There was no significant difference on size and spatial similarity between CTV1 and CTV2, PTV1 and PTV2. CONCLUSION Altough BTV was larger than GTV, this significance was lost while we gave the same CTV margin including the peripheral edema. It seems that it may help to improve defining non-enhancing tumor part and also recurrent tumor volume. ADVANCES IN KNOWLEDGE Recent studies have focused on the role of 68Ga-PSMA PET in imaging of glial tumors. It has been observed that 68Ga-PSMA PET can clearly define the tumor borders and it can be beneficial in target volume delineation, especially in reirradiation of recurrent tumors.
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Affiliation(s)
- Merve Şahin
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Elife Akgun
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Sabri Sirolu
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Gunay Can
- Department of Public Health, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Haluk Burcak Sayman
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Fazilet Oner Dincbas
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Truckenmueller P, Graef J, Scheel M, Vajkoczy P, Capper D, Kaul D, Furth C, Amthauer H, Brenner W, Onken JS. [68Ga]Ga-PSMA PET/MRI, histological PSMA expression and preliminary experience with [177Lu]Lu-PSMA therapy in relapsing high-grade glioma. Front Oncol 2022; 12:980058. [PMID: 36119502 PMCID: PMC9478729 DOI: 10.3389/fonc.2022.980058] [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: 06/28/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose High-grade gliomas (HGG) are still associated with a dismal prognosis. Prostate specific membrane antigen (PSMA) is discussed as a theranostic target for PSMA-directed radioligand therapy ([177Lu]Lu-PSMA RLT). Here, we report on the correlation of [68Ga]Ga-PSMA uptake with histological PSMA expression and on our preliminary experience with [177Lu]Lu-PSMA RLT in relapsing HGG. Methods Patients with relapsing HGG underwent [68Ga]Ga-PSMA PET/MRI to evaluate eligibility for an individualized treatment approach with [177Lu]Lu-PSMA. Standard uptake values (SUV) for tumor and liver and respective tumor-to-background ratios (compared to the liver) (TBR) on [68Ga]Ga-PSMA PET/MRI were assessed. Eligibility criteria for [177Lu]Lu-PSMA therapy were exhaustion of all standard treatment options available and TBRmax>1.0. In 11 samples, immunohistochemical PSMA expression was determined, quantified using the H-score and correlated with uptake on [68Ga]Ga-PSMA PET/MRI. Results We included 20 patients with a median age of 53 years (IQR 42-57). The median SUV on [68Ga]Ga-PSMA PET/MRI was 4.5 (3.7-6.2) for SUVmax and 1.4 (1.1-1.7) for SUVmean. The respective TBR was maximum 0.6 (0.4-0.8) and mean 0.3 (0.2-0.4). High TBRmax correlated with increased endothelial PSMA expression [H-score of 65 (62.5-77.5)]. Three patients (15%) presented a TBRmax>1.0 and qualified for [177Lu]Lu-PSMA RLT. No treatment related toxicity was observed. Conclusion Only a minority of patients with relapsing HGG qualified for [177Lu]Lu-PSMA RLT. Our data demonstrates that PSMA expression in the neo-vasculature corresponds to PSMA uptake on [68Ga]Ga-PSMA PET/MRI and might be used as a screening tool for patient selection. Future prospective studies need to focus the debate on TBRmax thresholds as inclusion criteria for PSMA RLT.
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Affiliation(s)
- Peter Truckenmueller
- Department of Neurosurgery, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Josefine Graef
- Department of Nucelar Medicine, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Scheel
- Department of Neuroradiology, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - David Capper
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Kaul
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian Furth
- Department of Nucelar Medicine, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Holger Amthauer
- Department of Nucelar Medicine, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Winfried Brenner
- Department of Nucelar Medicine, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Sophie Onken
- Department of Neurosurgery, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Julia Sophie Onken,
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13
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Rizzo A, Dall’Armellina S, Pizzuto DA, Perotti G, Zagaria L, Lanni V, Treglia G, Racca M, Annunziata S. PSMA Radioligand Uptake as a Biomarker of Neoangiogenesis in Solid Tumours: Diagnostic or Theragnostic Factor? Cancers (Basel) 2022; 14:4039. [PMID: 36011032 PMCID: PMC9406909 DOI: 10.3390/cancers14164039] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 01/10/2023] Open
Abstract
Due to its overexpression on the surface of prostate cancer cells, prostate-specific membrane antigen (PSMA) is a relatively novel effective target for molecular imaging and radioligand therapy (RLT) in prostate cancer. Recent studies reported that PSMA is expressed in the neovasculature of various types of cancer and regulates tumour cell invasion as well as tumour angiogenesis. Several authors explored the role of diagnostic and therapeutic PSMA radioligands in various malignancies. In this narrative review, we describe the current status of the literature on PSMA radioligands' application in solid tumours other than prostate cancer to explore their potential role as diagnostic or therapeutic agents, with particular regard to the relevance of PSMA radioligand uptake as neoangiogenetic biomarker. Hence, a comprehensive review of the literature was performed to find relevant articles on the applications of PSMA radioligands in non-prostate solid tumours. Data on the general, methodological and clinical aspects of all included studies were collected. Forty full-text papers were selected for final review, 8 of which explored PSMA radioligand PET/CT performances in gliomas, 3 in salivary gland malignancies, 6 in thyroid cancer, 2 in breast cancer, 16 in renal cell carcinoma and 5 in hepatocellular carcinoma. In the included studies, PSMA radioligand PET showed promising performance in patients with non-prostate solid tumours. Further studies are needed to better define its potential role in oncological patients management, especially in those undergoing antineoangiogenic therapies, and to assess the efficacy of PSMA-RLT in this clinical context.
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Affiliation(s)
- Alessio Rizzo
- Department of Nuclear Medicine, Candiolo Cancer Institute, FPO—IRCCS, 10060 Turin, Italy
| | - Sara Dall’Armellina
- Nuclear Medicine Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, 10134 Turin, Italy
| | - Daniele Antonio Pizzuto
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Germano Perotti
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Luca Zagaria
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Valerio Lanni
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Giorgio Treglia
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Manuela Racca
- Department of Nuclear Medicine, Candiolo Cancer Institute, FPO—IRCCS, 10060 Turin, Italy
| | - Salvatore Annunziata
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
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14
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Diagnostic Accuracy of PET/CT or PET/MRI Using PSMA-Targeting Radiopharmaceuticals in High-Grade Gliomas: A Systematic Review and a Bivariate Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12071665. [PMID: 35885569 PMCID: PMC9323081 DOI: 10.3390/diagnostics12071665] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/30/2022] Open
Abstract
Background: Several studies proposed the use of positron emission tomography (PET) with Prostate Specific Membrane Antigen (PSMA)-targeting radiopharmaceuticals in brain tumors. Our aim is to calculate the diagnostic accuracy of these methods in high-grade gliomas (HGG) with a bivariate meta-analysis. Methods: A comprehensive literature search of studies on the diagnostic accuracy of PET/CT or PET/MRI with PSMA-targeting radiopharmaceuticals in HGG was performed. Original articles evaluating these imaging methods both in the differential diagnosis between HGG and low-grade gliomas (LGG) and in the assessment of suspicious HGG recurrence were included. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and diagnostic odds ratio (DOR) including 95% confidence intervals (95% CI) were calculated. Statistical heterogeneity was also assessed using the I2 test. Results: The meta-analysis of six selected studies (157 patients) provided the following results about PET/CT or PET/MRI with PSMA-targeting radiopharmaceuticals in the diagnosis of HGG: sensitivity 98.2% (95% CI: 75.3–99.9%), specificity 91.2% (95% CI: 68.4–98.1%), LR+ 4.5 (95% CI: 2.2–9.3), LR− 0.07 (95% CI: 0.04–0.15), and DOR 70.1 (95% CI: 19.6–250.9). No significant statistical heterogeneity among the included studies was found (I2 = 0%). Conclusions: the quantitative data provided demonstrate the high diagnostic accuracy of PET/CT or PET/MRI with PSMA-targeting radiopharmaceuticals for HGG detection. However, more studies are needed to confirm the promising role of PSMA-targeted PET in this clinical setting.
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15
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Withofs N, Kumar R, Alavi A, Hustinx R. Facts and Fictions About [ 18F]FDG versus Other Tracers in Managing Patients with Brain Tumors: It Is Time to Rectify the Ongoing Misconceptions. PET Clin 2022; 17:327-342. [PMID: 35717096 DOI: 10.1016/j.cpet.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
MRI is the first-choice imaging technique for brain tumors. Positron emission tomography can be combined together with multiparametric MRI to increase diagnostic confidence. Radiolabeled amino acids have gained wide clinical acceptance. The reported pooled specificity of [18F]FDG positron emission tomography is high and [18F]FDG might still be the first-choice positron emission tomography tracer in cases of World Health Organization grade 3 to 4 gliomas or [18F]FDG-avid tumors, avoiding the use of more expensive and less available radiolabeled amino acids. The present review discusses the additional value of positron emission tomography with a focus on [18F]FDG and radiolabeled amino acids.
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Affiliation(s)
- Nadia Withofs
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Quartier Hopital, Avenue de l'hopital, 1, Liege 1 4000, Belgium; GIGA-CRC in vivo imaging, University of Liege, GIGA CHU - B34 Quartier Hôpital Avenue de l'Hôpital,11, 4000 Liège, Belgium.
| | - Rakesh Kumar
- Diagnostic Nuclear Medicine Division, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Quartier Hopital, Avenue de l'hopital, 1, Liege 1 4000, Belgium; GIGA-CRC in vivo imaging, University of Liege, GIGA CHU - B34 Quartier Hôpital Avenue de l'Hôpital,11, 4000 Liège, Belgium
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16
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Prostate-Specific Membrane Antigen as Target for Neuroimaging of Central Nervous System Tumors. Mol Imaging 2022; 2022:5358545. [PMID: 35517711 PMCID: PMC9042374 DOI: 10.1155/2022/5358545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/24/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction. Positron emission tomography (PET) imaging with prostate-specific membrane antigen- (PSMA-) binding tracers has been found incidentally to demonstrate uptake in CNS tumors. Following the encouraging findings of several such case reports, there is a growing interest in the potential application of PSMA-targeted PET imaging for diagnostics, theranostics, and monitoring of CNS tumors. This is a systematic literature review on PSMA-binding tracers in CNS tumors. Methods. A PubMed search was conducted, including preclinical and clinical reports. One hundred and twelve records were identified, and after screening, 56 were included in the final report. Results. Tissue studies demonstrated PSMA expression in tumor vascular endothelial cells, without expression in normal brain tissue, though the extent and intensity of staining varied by anti-PSMA antibody and methodology. Most included studies reported on gliomas, which showed strong PSMA ligand uptake and more favorable tumor to background ratios than other PET tracers. There are also case reports demonstrating PSMA ligand uptake in prostate cancer brain metastases, nonprostate cancer brain metastases, and meningiomas. We also review the properties of the various PSMA-binding radiotracers available. Therapeutic and theranostic applications of PSMA-binding tracers have been studied, including labeled alpha- and beta-ray emitting isotopes, as well as PSMA targeting in directing MRI-guided focused ultrasound. Conclusions. There is a potential application for PSMA-targeted PET in neuro-oncology as a combination of diagnostic and therapeutic use, as a theranostic modality for managing CNS tumors. Further research is needed regarding the mechanism(s) of PSMA expression in CNS tumors and its differential performance by tumor type.
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Kunikowska J, Czepczyński R, Pawlak D, Koziara H, Pełka K, Królicki L. Expression of glutamate carboxypeptidase II in the glial tumor recurrence evaluated in vivo using radionuclide imaging. Sci Rep 2022; 12:652. [PMID: 35027580 PMCID: PMC8758702 DOI: 10.1038/s41598-021-04613-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022] Open
Abstract
Glutamate carboxypeptidase II (GCP), also known as prostate specific membrane antigen (PSMA) has been found to be expressed in glioma vasculature in in-vitro studies. GCP expression can be traced with the use of [68Ga]Ga-PSMA-11 PET/CT used routinely for prostate cancer imaging. The aim of this paper was to analyze GCP expression in the recurrent glial tumors in vivo. 34 patients (pts.) aged 44.5 ± 10.3 years with suspicion of recurrence of histologically confirmed glioma grade III (6 pts.) and grade IV (28 pts.) were included in the study. All patients underwent contrast-enhanced MR and [68Ga]Ga-PSMA-11 PET/CT. No radiopharmaceutical-related adverse events were noted. PET/CT was positive in all the areas suspected for recurrence at MR in all the patients. The recurrence was confirmed by histopathological examinations or follow-up imaging in all cases. The images showed a very low background activity of the normal brain. Median maximal standard uptake value (SUVmax) of the tumors was 6.5 (range 0.9–15.6) and mean standard uptake value (SUVmean) was 3.5 (range 0.9–7.5). Target-to-background (TBR) ratios varied between 15 and 1400 with a median of 152. Target-to-liver background ratios (TLR) ranged from 0.2 to 2.6, the median TLR was 1.3. No significant difference of the measured parameters was found between the subgroups according to the glioma grade. High GCP expression in the recurrent glioma was demonstrated in-vivo with the use of [68Ga]Ga-PSMA-11 PET/CT. As the treatment options in recurrent glioma are limited, this observation may open new therapeutic perspectives with the use of radiolabeled agents targeting the GCP.
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Affiliation(s)
- Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Czepczyński
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.
| | - Dariusz Pawlak
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, Otwock, Poland
| | - Henryk Koziara
- Department of Neurosurgery, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Kacper Pełka
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland.,Department of Methodology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Królicki
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
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Chiaravalloti A, Cimini A, Ricci M, Quartuccio N, Arnone G, Filippi L, Calabria F, Leporace M, Bagnato A, Schillaci O. Positron emission tomography imaging in primary brain tumors. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kirchner MA, Holzgreve A, Brendel M, Orth M, Ruf VC, Steiger K, Pötter D, Gold L, Unterrainer M, Mittlmeier LM, Barci E, Kälin RE, Glass R, Lindner S, Kaiser L, Maas J, von Baumgarten L, Ilhan H, Belka C, Notni J, Bartenstein P, Lauber K, Albert NL. PSMA PET Imaging in Glioblastoma: A Preclinical Evaluation and Theranostic Outlook. Front Oncol 2021; 11:774017. [PMID: 34869017 PMCID: PMC8635528 DOI: 10.3389/fonc.2021.774017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/20/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Prostate specific membrane antigen (PSMA) PET imaging has recently gained attention in glioblastoma (GBM) patients as a potential theranostic target for PSMA radioligand therapy. However, PSMA PET has not yet been established in a murine GBM model. Our goal was to investigate the potential of PSMA PET imaging in the syngeneic GL261 GBM model and to give an outlook regarding the potential of PMSA radioligand therapy in this model. METHODS We performed an 18F-PSMA-1007 PET study in the orthotopic GL261 model (n=14 GBM, n=7 sham-operated mice) with imaging at day 4, 8, 11, 15, 18 and 22 post implantation. Time-activity-curves (TAC) were extracted from dynamic PET scans (0-120 min p. i.) in a subset of mice (n=4 GBM, n=3 sham-operated mice) to identify the optimal time frame for image analysis, and standardized-uptake-values (SUV) as well as tumor-to-background ratios (TBR) using contralateral normal brain as background were calculated in all mice. Additionally, computed tomography (CT), ex vivo and in vitro 18F-PSMA-1007 autoradiographies (ARG) were performed. RESULTS TAC analysis of GBM mice revealed a plateau of TBR values after 40 min p. i. Therefore, a 30 min time frame between 40-70 min p. i. was chosen for PET quantification. At day 15 and later, GBM mice showed a discernible PSMA PET signal on the inoculation site, with highest TBRmean in GBM mice at day 18 (7.3 ± 1.3 vs. 1.6 ± 0.3 in shams; p=0.024). Ex vivo ARG confirmed high tracer signal in GBM compared to healthy background (TBRmean 26.9 ± 10.5 vs. 1.6 ± 0.7 in shams at day 18/22 post implantation; p=0.002). However, absolute uptake values in the GL261 tumor remained low (e.g., SUVmean 0.21 ± 0.04 g/ml at day 18) resulting in low ratios compared to dose-relevant organs (e.g., mean tumor-to-kidney ratio 1.5E-2 ± 0.5E-2). CONCLUSIONS Although 18F-PSMA-1007 PET imaging of GL261 tumor-bearing mice is feasible and resulted in high TBRs, absolute tumoral uptake values remained low and hint to limited applicability of the GL261 model for PSMA-directed therapy studies. Further investigations are warranted to identify suitable models for preclinical evaluation of PSMA-targeted theranostic approaches in GBM.
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Affiliation(s)
- Maximilian A. Kirchner
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Michael Orth
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Viktoria C. Ruf
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, Technische Universität München (TUM) School of Medicine, Technical University of Munich, Munich, Germany
| | - Dennis Pötter
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Lukas Gold
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Lena M. Mittlmeier
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Enio Barci
- Neurosurgical Research, Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Roland E. Kälin
- Neurosurgical Research, Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Rainer Glass
- Neurosurgical Research, Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simon Lindner
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Lena Kaiser
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Jessica Maas
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes Notni
- Institute of Pathology, Technische Universität München (TUM) School of Medicine, Technical University of Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kirsten Lauber
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nathalie L. Albert
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
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20
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Kumar A, ArunRaj ST, Bhullar K, Haresh KP, Gupta S, Ballal S, Yadav M, Singh M, Damle NA, Garg A, Tripathi M, Bal C. Ga-68 PSMA PET/CT in recurrent high-grade gliomas: evaluating PSMA expression in vivo. Neuroradiology 2021; 64:969-979. [PMID: 34648046 DOI: 10.1007/s00234-021-02828-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/09/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE We planned this prospective study to evaluate PSMA expression in recurrent high-grade gliomas (rHGG), including anaplastic astrocytoma and glioblastoma using Glu-NH-CO-NH-Lys-(Ahx)-[Ga-68 (HBED-CC)]- (Ga-68 PSMA) positron emission tomography (PET), with its theranostic potential in mind. METHODS This was a prospective study enrolling patients with clinical and MRI evidence of rHGG on follow-up. Three treated cases of HGG with RN on MRI were also included as negative controls. Abnormal tracer accumulation in the brain parenchyma, more than the contralateral hemisphere was interpreted as positive study. For semiquantitative analysis, a 3D spherical region of interest (ROI) was drawn around the site of the abnormal Ga-68 PSMA uptake, and the ratio of SUVmax of tumor (T) to SUVmax of the contralateral corresponding area (TBR) was calculated. Each patients' PSMA brain PET was fused to the corresponding MRI and reviewed for concordance. RESULTS Thirty patients were included in the study, a total of 49 lesions were detected on MRI, and fused PET/MR images showed increased Ga-68 PSMA uptake in all these lesions. Multifocal lesions were better appreciated on fused PET-MR images, and concordance between MRI and PET was 100 % for patient and lesion-wise detection. Recurrent glioma lesions showed SUVmax and SUVmean values (median and IQR) 6.0 (4.4-8.2) and 3.3 (2.8-3.7), respectively. Lesions labeled as radiation necrosis on MRI did not show tracer accumulation. CONCLUSION Ga-68 PSMA has potential utility for evaluating recurrence in HGG and its potential for theranostics would encourage its use in the evaluation of these patients.
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Affiliation(s)
- Arunav Kumar
- Department of Nuclear Medicine and PET/CT, All India Institute of Medical Sciences, New Delhi, India
| | | | - Khush Bhullar
- Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - K P Haresh
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjana Ballal
- Department of Nuclear Medicine and PET/CT, All India Institute of Medical Sciences, New Delhi, India
| | - Madhav Yadav
- Department of Nuclear Medicine and PET/CT, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nishikant Avinash Damle
- Department of Nuclear Medicine and PET/CT, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine and PET/CT, All India Institute of Medical Sciences, New Delhi, India.
| | - Chandrasekhar Bal
- Department of Nuclear Medicine and PET/CT, All India Institute of Medical Sciences, New Delhi, India
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21
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Zaccagna F, Grist JT, Quartuccio N, Riemer F, Fraioli F, Caracò C, Halsey R, Aldalilah Y, Cunningham CH, Massoud TF, Aloj L, Gallagher FA. Imaging and treatment of brain tumors through molecular targeting: Recent clinical advances. Eur J Radiol 2021; 142:109842. [PMID: 34274843 DOI: 10.1016/j.ejrad.2021.109842] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023]
Abstract
Molecular imaging techniques have rapidly progressed over recent decades providing unprecedented in vivo characterization of metabolic pathways and molecular biomarkers. Many of these new techniques have been successfully applied in the field of neuro-oncological imaging to probe tumor biology. Targeting specific signaling or metabolic pathways could help to address several unmet clinical needs that hamper the management of patients with brain tumors. This review aims to provide an overview of the recent advances in brain tumor imaging using molecular targeting with positron emission tomography and magnetic resonance imaging, as well as the role in patient management and possible therapeutic implications.
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Affiliation(s)
- Fulvio Zaccagna
- Division of Neuroimaging, Department of Medical Imaging, University of Toronto, Toronto, Canada.
| | - James T Grist
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom; Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, University of Bergen, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Corradina Caracò
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Richard Halsey
- Institute of Nuclear Medicine, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Yazeed Aldalilah
- Institute of Nuclear Medicine, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom; Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Charles H Cunningham
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tarik F Massoud
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, USA
| | - Luigi Aloj
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
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22
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Peptide Receptor Radionuclide Therapy and Primary Brain Tumors: An Overview. Pharmaceuticals (Basel) 2021; 14:ph14090872. [PMID: 34577572 PMCID: PMC8470698 DOI: 10.3390/ph14090872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
Primary brain tumors (PBTs) are some of the most difficult types of cancer to treat, and despite advancements in surgery, chemotherapy and radiotherapy, new strategies for the treatment of PBTs are needed, especially for those with poor prognosis such as inoperable/difficult-to-reach lesions or relapsing disease. In regard to the last point, malignant primary brain tumors remain some of the most lethal types of cancer. Nuclear medicine may provide exciting new weapons and significant contributions in the treatment of PBTs. In this review, we performed literature research in order to highlight the possible role of peptide receptor radionuclide therapy (PRRT) in the treatment of PBTs with radiolabeled molecules that bind with high-affinity transmembrane receptors such as somatostatin receptors (SSTRs), neurokinin type-1 receptor and prostate-specific membrane antigen (PSMA). These receptors are overexpressed in some cancer types such as gliomas, meningiomas, pituitary tumors and medulloblastomas. A comprehensive overview of possible applications in this field will be shown, providing knowledge about benefits, feasibility, developments and limitations of PRRT in this type of tumor, also revealing new advantages in the management of the disease.
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23
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Shooli H, Nemati R, Ahmadzadehfar H, Aboian M, Jafari E, Jokar N, Nabipour I, Dadgar H, Gholamrezanezhad A, Larvie M, Assadi M. Theranostics in Brain Tumors. PET Clin 2021; 16:397-418. [PMID: 34053584 DOI: 10.1016/j.cpet.2021.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Theranostic nuclear oncology, mainly in neuro-oncology (neurotheranostics), aims to combine cancer imaging and therapy using the same targeting molecule. This approach tries to identify patients who are most likely to benefit from tumor molecular radionuclide therapy. The ability of radioneurotheranostic agents to interact with cancer cells at the molecular level with high specificity can significantly improve the effectiveness of cancer therapy. A variety of biologic targets are under investigation for treating brain tumors. PET-based precision imaging can substantially improve the therapeutic efficacy of radiotheranostic approach in brain tumors.
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Affiliation(s)
- Hossein Shooli
- Department of Molecular Imaging and Radionuclide Therapy (MIRT), The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Moallem St, Bushehr, Iran
| | - Reza Nemati
- Department of Neurology, Bushehr Medical University Hospital, Bushehr University of Medical Sciences, School of Medicine, Bushehr, Iran
| | | | - Mariam Aboian
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Esmail Jafari
- Department of Molecular Imaging and Radionuclide Therapy (MIRT), The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Moallem St, Bushehr, Iran
| | - Narges Jokar
- Department of Molecular Imaging and Radionuclide Therapy (MIRT), The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Moallem St, Bushehr, Iran
| | - Iraj Nabipour
- Department of Internal Medicine (Division of Endocrinology), Bushehr Medical University Hospital, The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Habibollah Dadgar
- Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran
| | - Ali Gholamrezanezhad
- Department of Diagnostic Radiology, Keck School of Medicine, University of Southern California (USC), 1520 San Pablo Street, Suite L1600, Los Angeles, CA 90033, USA
| | - Mykol Larvie
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Majid Assadi
- Department of Molecular Imaging and Radionuclide Therapy (MIRT), The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Moallem St, Bushehr, Iran.
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24
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PSMA radioligand therapy for solid tumors other than prostate cancer: background, opportunities, challenges, and first clinical reports. Eur J Nucl Med Mol Imaging 2021; 48:4350-4368. [PMID: 34120192 PMCID: PMC8566635 DOI: 10.1007/s00259-021-05433-w] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/24/2021] [Indexed: 12/11/2022]
Abstract
In the past decade, a growing body of literature has reported promising results for prostate-specific membrane antigen (PSMA)-targeted radionuclide imaging and therapy in prostate cancer. First clinical studies evaluating the efficacy of [177Lu]Lu-PSMA radioligand therapy (PSMA-RLT) demonstrated favorable results in prostate cancer patients. [177Lu]Lu-PSMA is generally well tolerated due to its limited side effects. While PSMA is highly overexpressed in prostate cancer cells, varying degrees of PSMA expression have been reported in other malignancies as well, particularly in the tumor-associated neovasculature. Hence, it is anticipated that PSMA-RLT could be explored for other solid cancers. Here, we describe the current knowledge of PSMA expression in other solid cancers and define a perspective towards broader clinical implementation of PSMA-RLT. This review focuses specifically on salivary gland cancer, glioblastoma, thyroid cancer, renal cell carcinoma, hepatocellular carcinoma, lung cancer, and breast cancer. An overview of the (pre)clinical data on PSMA immunohistochemistry and PSMA PET/CT imaging is provided and summarized. Furthermore, the first clinical reports of non-prostate cancer patients treated with PSMA-RLT are described.
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25
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Bertagna F, Albano D, Cerudelli E, Gazzilli M, Giubbini R, Treglia G. Potential of Radiolabeled PSMA PET/CT or PET/MRI Diagnostic Procedures in Gliomas/Glioblastomas. Curr Radiopharm 2021; 13:94-98. [PMID: 31625482 PMCID: PMC7527542 DOI: 10.2174/1874471012666191017093721] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/29/2019] [Accepted: 09/16/2019] [Indexed: 01/26/2023]
Abstract
Background: Radiolabeled prostate-specific membrane antigen PSMA-based PET/CT or PET/MRI is a whole-body imaging technique currently performed for the detection of prostate cancer lesions. PSMA has been also demonstrated to be expressed by the neovasculature of many other solid tumors. Objective: The aim of this review is to evaluate the possible diagnostic role of radiolabeled PSMA PET/CT or PET/MRI in patients with gliomas and glioblastomas, by summarizing the available literature data. Methods: A comprehensive literature search of the PubMed/MEDLINE, Scopus, Embase and Cochrane library databases was conducted to find relevant published articles about the diagnostic performance of radiolabeled PSMA binding agents in PET/CT or PET/MRI imaging of patients with suspected gliomas or glioblastomas. Results: Seven case reports or case series and 3 studies enrolling more than 10 patients showed that gliomas and glioblastoma are PSMA-avid tumors. Conclusion: Radiolabeled PSMA imaging seems to be useful in analyzing glioma/glioblastoma. Further studies enrolling a wider population are needed to clarify the real clinical and diagnostic role of radiolabeled PSMA in this setting and its possible position in the diagnostic flow-chart.
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Affiliation(s)
- Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Elisabetta Cerudelli
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Maria Gazzilli
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Bellinzona and Lugano, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona,
Switzerland
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26
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Liu D, Cheng G, Ma X, Wang S, Zhao X, Zhang W, Yang W, Wang J. PET/CT using 68 Ga-PSMA-617 versus 18 F-fluorodeoxyglucose to differentiate low- and high-grade gliomas. J Neuroimaging 2021; 31:733-742. [PMID: 34021667 DOI: 10.1111/jon.12856] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND PURPOSE To compare and characterize metabolic features of high- and low-grade glioma tumors using 68 Ga-PSMA-617 and 18 F-FDG positron emission tomography/computed tomography (PET/CT). METHODS Thirty patients who underwent both 68 Ga-PSMA-617 and 18 F-FDG PET/CT over 2 consecutive days and then underwent surgical treatment were retrospectively identified. All tumors were diagnosed histologically. This report includes 16 high-grade glioma (HGG) and 14 low-grade glioma (LGG) tumors. Standard uptake value (SUV) and target to nontarget (T/NT) were quantitatively investigated through the entire tumor region. Statistical analyses were performed using area under the curve (AUC) and comparison of two means. RESULTS SUVmax and SUVmean were the most effective (AUC, 0.96 and 0.94 for PSMA PET; AUC, 0.79 and 0.74 for FDG PET, respectively) for differentiating HGGs from LGGs. These methods distinguished between HGG and LGG effectively (PSMA PET: SUVmax , 5.766 ± 3.945 vs. 0.7364 ± 0.5295, p < 0.0001; SUVmean , 1.666 ± 1.680 and 0.1514 ± 0.1534, p < 0.0001, respectively) (FDG PET: SUVmax , 11.67 ± 3.639 and 9.118 ± 6.612; SUVmean , 5.648 ± 2.114 and 4.435 ± 2.872; p = 0.0083, 0.0262, respectively). The Youden index for SUVmax and SUVmean of 68 Ga-PSMA-617 and 18 F-FDG were 0.82 and 0.79 and 0.54 and 0.61, separately. T/NTmax was helpful for visual inspection of 68 Ga-PSMA-617-PET images (T/NTmax : 1.291 ± 0.9553 in grade II, 5.25 ± 2.435 in grade III, and 13.61 ± 13.84 in grade IV). T/NTmax differed significantly between LGG and HGG and between subtypes of LGG. CONCLUSION PET/CT with 68 Ga-PSMA-617 and 18 F-FDG may help distinguish between HGG and LGG, and 68 Ga-PSMA-617 PET/CT is superior to18 F-FDG in differentiating HGG and LGG.
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Affiliation(s)
- Daliang Liu
- Department of Nuclear Medicine, The first affiliated Hospital of Fourth Military Medical University, Xi'an, Shannxi Province, China
| | - Guang Cheng
- Department of Neurosurgery, The first affiliated Hospital of Fourth Military Medical University, Xi'an, Shannxi Province, China
| | - Xiaowei Ma
- Department of Nuclear Medicine, The first affiliated Hospital of Fourth Military Medical University, Xi'an, Shannxi Province, China
| | - Shuailiang Wang
- Department of Nuclear Medicine, The first affiliated Hospital of Fourth Military Medical University, Xi'an, Shannxi Province, China
| | - Xiaohu Zhao
- Department of Nuclear Medicine, The first affiliated Hospital of Fourth Military Medical University, Xi'an, Shannxi Province, China
| | - Wei Zhang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shannxi Province, China
| | - Weidong Yang
- Department of Nuclear Medicine, The first affiliated Hospital of Fourth Military Medical University, Xi'an, Shannxi Province, China
| | - Jing Wang
- Department of Nuclear Medicine, The first affiliated Hospital of Fourth Military Medical University, Xi'an, Shannxi Province, China
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27
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Phipps MD, Sanders VA, Deri MA. Current State of Targeted Radiometal-Based Constructs for the Detection and Treatment of Disease in the Brain. Bioconjug Chem 2021; 32:1331-1347. [PMID: 34015928 DOI: 10.1021/acs.bioconjchem.1c00180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The continual development of radiopharmaceutical agents for the field of nuclear medicine is integral to promoting the necessity of personalized medicine. One way to greatly expand the selection of radiopharmaceuticals available is to broaden the range of radionuclides employed in such agents. Widening the scope of development to include radiometals with their variety of physical decay characteristics and chemical properties opens up a myriad of possibilities for new actively targeted molecules and bioconjugates. This is especially true to further advance the imaging and treatment of disease in the brain. Over the past few decades, imaging of disease in the brain has heavily relied on agents which exploit metabolic uptake. However, through utilizing the broad range of physical characteristics that radiometals offer, the ability to target other processes has become more available. The varied chemistries of radiometals also allows for them to incorporated into specifically designed diverse constructs. A major limitation to efficient treatment of disease in the brain is the ability for relevant agents to penetrate the blood-brain barrier. Thus, along with efficient disease targeting, there must be intentional thought put into overcoming this challenge. Here, we review the current field of radiometal-based agents aimed at either imaging or therapy of brain disease that have been evaluated through at least in vivo studies.
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Affiliation(s)
- Michael D Phipps
- Ph.D. Program in Chemistry, Graduate Center of the City University of New York, New York, New York 10016, United States.,Department of Chemistry, Lehman College of the City University of New York, New York, New York 10468, United States.,Department of Chemistry, Hunter College of the City University of New York, New York, New York 10065, United States.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Vanessa A Sanders
- Collider Accelerator Department, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - Melissa A Deri
- Ph.D. Program in Chemistry, Graduate Center of the City University of New York, New York, New York 10016, United States.,Department of Chemistry, Lehman College of the City University of New York, New York, New York 10468, United States
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28
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Vallejo-Armenta P, Soto-Andonaegui J, Villanueva-Pérez RM, González-Díaz JI, Contreras-Contreras K, Bautista-Wong CG, Sandoval-Bonilla B, Nettel-Rueda B, Santos-Cuevas C, Ferro-Flores G. [ 99mTc]Tc-iPSMA SPECT brain imaging as a potential specific diagnosis of metastatic brain tumors and high-grade gliomas. Nucl Med Biol 2021; 96-97:1-8. [PMID: 33640681 DOI: 10.1016/j.nucmedbio.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/22/2021] [Accepted: 02/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND PSMA (prostate-specific membrane antigen) protein is heavily expressed in the proliferating microvasculature of high-grade gliomas (HGG) and brain metastases (BM). This research aimed to assess [99mTc]Tc-iPSMA SPECT brain imaging as a potential specific diagnosis of HGG and BM by PSMA-targeting in their proliferating vasculature. METHODS Forty-one patients, with suspected brain tumors, as detected by enhanced MRI scanning, were enrolled to undergo preoperative [99mTc]Tc-iPSMA SPECT brain imaging. Semiquantitative image analyses, to evaluate the maximum target-to-background ratio (TBRmax), were performed. All diagnoses were histopathologically confirmed. PSMA expression was evaluated by immunohistochemistry (IHC) in 11 brain tumor tissues. TBRmax values were correlated with IHC results and tumor WHO grade (HGG vs LGG). RESULTS [99mTc]Tc-iPSMA images showed increased uptake in BM, HGG, and recurrent gliomas (TBRmax of 25.1 ± 7.1, 18.5 ± 9.0, 15.0 ± 9.9, respectively), and was negative in treatment-naive patients with LGG and reactive gliosis. PSMA was highly expressed in the vascular endothelium of grade IV gliomas and BM, while its expression was extremely low in LGG and completely absent in gliosis. By using 2.8 as a threshold value for TBRmax, the specificity, sensitivity, PPV, NPV and accuracy were 100%, 94%, 100%, 77% and 95%, respectively. CONCLUSIONS The results of this pilot study show that [99mTc]Tc-iPSMA SPECT brain imaging is a specific and potentially useful neuroimaging tool for assessing tumoral neovasculature formation in gliomas and brain metastases.
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Affiliation(s)
- Paola Vallejo-Armenta
- Departament of Nuclear Medicine, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City 06720, Mexico
| | - Juan Soto-Andonaegui
- Departament of Nuclear Medicine, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City 06720, Mexico
| | - Rosa M Villanueva-Pérez
- Departament of Nuclear Medicine, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City 06720, Mexico
| | - Jorge I González-Díaz
- Departament of Nuclear Medicine, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City 06720, Mexico
| | - Keren Contreras-Contreras
- Departament of Nuclear Medicine, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City 06720, Mexico
| | - Claudia G Bautista-Wong
- Department of Pathology, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City 06720, Mexico
| | - Bayron Sandoval-Bonilla
- Department of Neurosurgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City 06720, Mexico
| | - Bárbara Nettel-Rueda
- Department of Neurosurgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City 06720, Mexico
| | - Clara Santos-Cuevas
- Department of Radioactive Materials, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac, 52750, Mexico State, Mexico
| | - Guillermina Ferro-Flores
- Department of Radioactive Materials, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac, 52750, Mexico State, Mexico.
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29
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Pernthaler B, Nazerani Hooshmand T, Igrec J, Kvaternik H, Aigner RM. Oligodendroglioma in 68Ga-PSMA-11 and 18F-Fluciclovine PET/CT. Clin Nucl Med 2021; 46:e231-e232. [PMID: 33086280 DOI: 10.1097/rlu.0000000000003347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Prostate cancer (PC) is one of the most common cancers affecting men worldwide, with a high recurrence rate after therapy. 68Ga-PSMA-11 and 18F-fluciclovine are PET imaging tracers for the detection of recurrence sites in PC patients. 68Ga-PSMA-11 is a membrane antigen overexpressed by tumor cells, whereas 18F-fluciclovine targets increased amino acid transporter in the membrane of cancer cells. We report a case of an 83-year-old man with known oligodendroglioma and biochemically recurrent PC who shows a high focal 68Ga-PSMA-11 and 18F-fluciclovine uptake in the brain.
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Affiliation(s)
| | | | - Jasminka Igrec
- General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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30
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Pseudoprogression on 68Ga-Prostate-Specific Membrane Antigen-11 PET/CT in a Treated Glioblastoma. Clin Nucl Med 2020; 45:621-622. [PMID: 32520501 DOI: 10.1097/rlu.0000000000003121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
After standard treatment of glioblastoma, pseudoprogression versus true progression is a clinical challenge. Indeed, to differentiate these 2 on contrast MRI (cMRI) is problematic. In recent time, Ga-prostate-specific membrane antigen-11 (Ga-PSMA) PET/CT has been suggested to have high accuracy in glioblastoma recurrence. We present a case of a 40-year-old man with right frontotemporal glioblastoma underwent surgery and radiotherapy. One month posttreatment cMRI showed a new enhancing lesion in the right hippocampal region, which was also positive on Ga-PSMA-11 PET/CT. On follow-up with conservative management, both cMRI and Ga-PSMA-11 PET/CT showed regression in new lesion, hence suggest pseudoprogression.
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Brain PET/CT using prostate cancer radiopharmaceutical agents in the evaluation of gliomas. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00389-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Valtorta S, Salvatore D, Rainone P, Belloli S, Bertoli G, Moresco RM. Molecular and Cellular Complexity of Glioma. Focus on Tumour Microenvironment and the Use of Molecular and Imaging Biomarkers to Overcome Treatment Resistance. Int J Mol Sci 2020; 21:E5631. [PMID: 32781585 PMCID: PMC7460665 DOI: 10.3390/ijms21165631] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023] Open
Abstract
This review highlights the importance and the complexity of tumour biology and microenvironment in the progression and therapy resistance of glioma. Specific gene mutations, the possible functions of several non-coding microRNAs and the intra-tumour and inter-tumour heterogeneity of cell types contribute to limit the efficacy of the actual therapeutic options. In this scenario, identification of molecular biomarkers of response and the use of multimodal in vivo imaging and in particular the Positron Emission Tomography (PET) based molecular approach, can help identifying glioma features and the modifications occurring during therapy at a regional level. Indeed, a better understanding of tumor heterogeneity and the development of diagnostic procedures can favor the identification of a cluster of patients for personalized medicine in order to improve the survival and their quality of life.
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Affiliation(s)
- Silvia Valtorta
- Department of Medicine and Surgery and Tecnomed Foundation, University of Milano—Bicocca, 20900 Monza, Italy; (S.V.); (D.S.); (P.R.)
- Nuclear Medicine Department, San Raffaele Scientific Institute (IRCCS), 20132 Milan, Italy;
| | - Daniela Salvatore
- Department of Medicine and Surgery and Tecnomed Foundation, University of Milano—Bicocca, 20900 Monza, Italy; (S.V.); (D.S.); (P.R.)
- Nuclear Medicine Department, San Raffaele Scientific Institute (IRCCS), 20132 Milan, Italy;
| | - Paolo Rainone
- Department of Medicine and Surgery and Tecnomed Foundation, University of Milano—Bicocca, 20900 Monza, Italy; (S.V.); (D.S.); (P.R.)
- Nuclear Medicine Department, San Raffaele Scientific Institute (IRCCS), 20132 Milan, Italy;
| | - Sara Belloli
- Nuclear Medicine Department, San Raffaele Scientific Institute (IRCCS), 20132 Milan, Italy;
- Institute of Molecular Bioimaging and Physiology (IBFM), CNR, 20090 Segrate, Italy
| | - Gloria Bertoli
- Institute of Molecular Bioimaging and Physiology (IBFM), CNR, 20090 Segrate, Italy
| | - Rosa Maria Moresco
- Department of Medicine and Surgery and Tecnomed Foundation, University of Milano—Bicocca, 20900 Monza, Italy; (S.V.); (D.S.); (P.R.)
- Nuclear Medicine Department, San Raffaele Scientific Institute (IRCCS), 20132 Milan, Italy;
- Institute of Molecular Bioimaging and Physiology (IBFM), CNR, 20090 Segrate, Italy
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Akgun E, Akgun MY, Selçuk HH, Uzan M, Sayman HB. 68Ga PSMA PET/MR in the differentiation of low and high grade gliomas: Is 68Ga PSMA PET/MRI useful to detect brain gliomas? Eur J Radiol 2020; 130:109199. [PMID: 32763474 DOI: 10.1016/j.ejrad.2020.109199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/28/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the most important imaging modality in the diagnosis and follow-up of glial brain tumors. OBJECTIVE The aim of our study is to determine the correlation between tumor grade, determined with postoperative pathological examination, and standard uptake value (SUV), a semi-quantitative parameter, in patients who underwent imaging 68Ga-PSMA with using PET/MR. MATERIAL-METHOD Thirty-five out of 38 patients' images whose pathology was consistent with glial tumor, 42 lesions from separate anatomic localizations or with higher activity uptake than the rest of the tumor were evaluated. SUV values measured on PET images and grade relationship were evaluated based on each lesion while mitosis, Ki-67 were evaluated for each patient. RESULTS Grade, Ki-67, mitosis, necrosis and SUVmax/mean/peak were found statistically significant with moderate/high correlation. The parameter with the highest correlation coefficient was mitosis. (For SUVmax r = 0.64, p = 0). When Grade II and III were considered as the first group and IV as the second group, the cutoff values were found to be 2.3 for SUVmax, 0.21 for SUVmean and 0.63 for SUVpeak. In the diagnosis of HGG, PET's sensitivity is higher than MRI but no statistically difference was found between specificities. CONCLUSION 68Ga PSMA PET imaging is found to be particularly useful in differentiating Grade IV glial tumors from other grades. This finding is thought to be important in the differentiation the relapse with postoperative tissue changes, which is an important problem in the follow-up.
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Affiliation(s)
- Elife Akgun
- High Specialized Hospital, Department Of Nuclear Medicine, Kirikkale, Turkey
| | - Mehmet Yigit Akgun
- High Specialized Hospital, Department Of Neurosurgery, Kirikkale, Turkey.
| | - Hatem Hakan Selçuk
- Dr. Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Mustafa Uzan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department Of Neurosurgery, Istanbul, Turkey
| | - Haluk Burcak Sayman
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department Of Nuclear Medicine, Istanbul, Turkey
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Pilati E, Nicolotti DG, Ceci F, Finessi M, Cerio I, Dionisi B, Zotta M, Bellò M, Deandreis D. 68Ga-Prostate-Specific Membrane Antigen 11 PET/CT Detects Residual Glioblastoma After Radical Surgery in a Patient With Synchronous Recurrent Prostate Cancer: A Case Report. Clin Nucl Med 2020; 45:e151-e153. [PMID: 31876821 DOI: 10.1097/rlu.0000000000002884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prostate-specific membrane antigen (PSMA) is a transmembrane enzyme also known as folate hydrolase 1 highly expressed by prostate cancer (PCa) cells. However, PSMA overexpression by tumor-associated neovasculature of a variety of solid tumors, including glioblastoma (GBM), has also been proven. This clinical case reports about a 67-year-old man with a history of PCa who underwent radical surgery for GBM and performed a Ga-PSMA-11 PET/CT to restage PCa. PET imaging showed PSMA uptake in GBM residual disease after surgery. This finding suggests a possible role of PSMA inhibitors as diagnostic and therapeutic agents in patients affected by GBM.
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Affiliation(s)
- Emanuela Pilati
- From the Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
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Wang X, Jaraquemada-Peláez MDG, Cao Y, Ingham A, Rodríguez-Rodríguez C, Pan J, Wang Y, Saatchi K, Häfeli UO, Lin KS, Orvig C. H2CHXhox: Rigid Cyclohexane-Reinforced Nonmacrocyclic Chelating Ligand for [nat/67/68Ga]Ga3+. Inorg Chem 2020; 59:4895-4908. [DOI: 10.1021/acs.inorgchem.0c00168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Xiaozhu Wang
- Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, Vancouver BC V6T 1Z1, Canada
| | | | - Yang Cao
- Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, Vancouver BC V6T 1Z1, Canada
| | - Aidan Ingham
- Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, Vancouver BC V6T 1Z1, Canada
- Life Sciences Division, TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3,Canada
| | - Cristina Rodríguez-Rodríguez
- Center for Comparative Medicine, 4145 Wesbrook Mall, Vancouver, British Columbia V6T 1W5, Canada
- Department of Physics and Astronomy, University of British Columbia, 6224 Agronomy Road, Vancouver, British Columbia V6T 1Z1, Canada
| | - Jinhe Pan
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver BC V5Z 1L3, Canada
| | - Yongliang Wang
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver BC V5Z 1L3, Canada
| | - Katayoun Saatchi
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Urs O. Häfeli
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Kuo-Shyan Lin
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver BC V5Z 1L3, Canada
| | - Chris Orvig
- Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, Vancouver BC V6T 1Z1, Canada
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de Galiza Barbosa F, Queiroz MA, Nunes RF, Costa LB, Zaniboni EC, Marin JFG, Cerri GG, Buchpiguel CA. Nonprostatic diseases on PSMA PET imaging: a spectrum of benign and malignant findings. Cancer Imaging 2020; 20:23. [PMID: 32169115 PMCID: PMC7071711 DOI: 10.1186/s40644-020-00300-7] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
PSMA PET imaging was originally used to assess biochemical recurrence of prostate cancer (PCa), but its clinical use was promptly extended to detection, staging and therapy response assessment. The expanding use of PSMA PET worldwide has also revealed PSMA ligand uptake in diverse nonprostatic diseases, which raised questions about the specificity of this imaging modality. Although not very common initially, a growing number of pathologies presenting PSMA uptake on PET have been reported in the last few years, and a proper interpretation of PSMA PET imaging findings suddenly became challenging and, to some extent, confusing. Compared to cytoplasmic PSMA expression in nonprostatic cells, the molecular features of apical PSMA expression in PCa cells can help to distinguish these various conditions. Correlations of imaging findings to patient history, to the expected pattern of disease spread and mainly to computed tomography (CT) and/or magnetic resonance imaging (MRI) characteristics will reinforce the distinction of lesions that are more likely related to PCa from those that could lead to an incorrect diagnosis. The overall benefits of endothelial PSMA expression, which is associated with the neovasculature of malignant neoplasms, will be highlighted, stating the potential use of PSMA ligand uptake as a theranostic tool. This review aims to cover the collection of nonprostatic diseases, including benign and malignant tumors, in a didactic approach according to disease etiology, with discussion of bone-related conditions and inflammatory and infectious processes.
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Affiliation(s)
- Felipe de Galiza Barbosa
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Marcelo Araujo Queiroz
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil.
| | - Rafael Fernandes Nunes
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Larissa Bastos Costa
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Elaine Caroline Zaniboni
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - José Flavio Gomes Marin
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Giovanni Guido Cerri
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Carlos Alberto Buchpiguel
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
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Pruis IJ, van Dongen GAMS, Veldhuijzen van Zanten SEM. The Added Value of Diagnostic and Theranostic PET Imaging for the Treatment of CNS Tumors. Int J Mol Sci 2020; 21:E1029. [PMID: 32033160 PMCID: PMC7037158 DOI: 10.3390/ijms21031029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/27/2020] [Accepted: 02/01/2020] [Indexed: 12/11/2022] Open
Abstract
This review highlights the added value of PET imaging in Central Nervous System (CNS) tumors, which is a tool that has rapidly evolved from a merely diagnostic setting to multimodal molecular diagnostics and the guidance of targeted therapy. PET is the method of choice for studying target expression and target binding behind the assumedly intact blood-brain barrier. Today, a variety of diagnostic PET tracers can be used for the primary staging of CNS tumors and to determine the effect of therapy. Additionally, theranostic PET tracers are increasingly used in the context of pharmaceutical and radiopharmaceutical drug development and application. In this approach, a single targeted drug is used for PET diagnosis, upon the coupling of a PET radionuclide, as well as for targeted (nuclide) therapy. Theranostic PET tracers have the potential to serve as a non-invasive whole body navigator in the selection of the most effective drug candidates and their most optimal dose and administration route, together with the potential to serve as a predictive biomarker in the selection of patients who are most likely to benefit from treatment. PET imaging supports the transition from trial and error medicine to predictive, preventive, and personalized medicine, hopefully leading to improved quality of life for patients and more cost-effective care.
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Affiliation(s)
- Ilanah J. Pruis
- Department of Radiology & Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands;
| | - Guus A. M. S. van Dongen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Sophie E. M. Veldhuijzen van Zanten
- Department of Radiology & Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands;
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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Moreau A, Febvey O, Mognetti T, Frappaz D, Kryza D. Contribution of Different Positron Emission Tomography Tracers in Glioma Management: Focus on Glioblastoma. Front Oncol 2019; 9:1134. [PMID: 31737567 PMCID: PMC6839136 DOI: 10.3389/fonc.2019.01134] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022] Open
Abstract
Although rare, glioblastomas account for the majority of primary brain lesions, with a dreadful prognosis. Magnetic resonance imaging (MRI) is currently the imaging method providing the higher resolution. However, it does not always succeed in distinguishing recurrences from non-specific temozolomide, have been shown to improve -related changes caused by the combination of radiotherapy, chemotherapy, and targeted therapy, also called pseudoprogression. Strenuous attempts to overcome this issue is highly required for these patients with a short life expectancy for both ethical and economic reasons. Additional reliable information may be obtained from positron emission tomography (PET) imaging. The development of this technique, along with the emerging of new classes of tracers, can help in the diagnosis, prognosis, and assessment of therapies. We reviewed the current data about the commonly used tracers, such as 18F-fluorodeoxyglucose (18F-FDG) and radiolabeled amino acids, as well as different PET tracers recently investigated, to report their strengths, limitations, and relevance in glioblastoma management.
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Affiliation(s)
| | | | | | | | - David Kryza
- UNIV Lyon - Université Claude Bernard Lyon 1, LAGEPP UMR 5007 CNRS Villeurbanne, Villeurbanne, France
- Hospices Civils de Lyon, Lyon, France
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Van de Wiele C, Sathekge M, de Spiegeleer B, de Jonghe PJ, Beels L, Maes A. PSMA-Targeting Positron Emission Agents for Imaging Solid Tumors Other Than Non-Prostate Carcinoma: A Systematic Review. Int J Mol Sci 2019; 20:E4886. [PMID: 31581638 PMCID: PMC6801742 DOI: 10.3390/ijms20194886] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022] Open
Abstract
Despite its name, prostate-specific membrane antigen (PSMA) has been shown using immunohistochemistry (IHC) to also be over-expressed in the tumor neovasculature of a wide variety of solid tumors other than prostate carcinoma. Accordingly, positron-emitting radiolabeled small molecules targeting PSMA, initially developed for positron emission tomography in prostate carcinomas, are currently being explored for their staging and restaging potential as an alternative imaging modality in other solid tumor types where 18-F-fluorodeoxyglucose (FDG)-PET imaging has low diagnostic accuracy. In this paper, the currently available literature in this field is reviewed. Preliminary, mainly retrospective studies are encouraging, with evidence of improved diagnostic sensitivity and specificity in clear cell renal carcinoma, glioma, and hepatocellular carcinoma, leading to a change in patient management in several patients. However, the results published thus far warrant confirmation by larger prospective studies additionally assessing the longitudinal impact on patient outcomes.
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Affiliation(s)
- Christophe Van de Wiele
- Department of Nuclear Medicine, AZ Groeninge, 8500 Kortrijk, Belgium.
- Department of Nuclear Medicine and Radiology, University Ghent, 9000 GHent, Belgium.
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria, 0001 Pretoria, South-Africa.
| | - Bart de Spiegeleer
- Laboratory of Drug Quality and Registration, University Ghent, 9000 Ghent, Belgium.
| | | | - Laurence Beels
- Department of Nuclear Medicine, AZ Groeninge, 8500 Kortrijk, Belgium.
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, 8500 Kortrijk, Belgium.
- Department of Imaging and Pathology, KULAK, University of Leuven, 3000 Leuven, Belgium.
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